Psych Exam 2 (Ch. 10,13,16,17,18,19,20,21)

21. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

ANS: D The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance.

53. During the planning of care for a suicidal client, which correctly written outcome should be a nurses first priority? A. The client will not physically harm self. B. The client will express hope for the future by day 3. C. The client will establish a trusting relationship with the nurse. D. The client will remain safe during the hospital stay.

ANS: D The nurses priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurses priority. The A answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, and realistic and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated.

17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group.

6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yaloms curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others.

14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. There is little research to support AAs effectiveness. B. Self-help groups used to be the treatment of choice, but their popularity is waning. C. These groups have no external regulation, so clients need to be cautious. D. Members themselves run the group, with leadership usually rotating among the members.

ANS: D The student indicates an understanding of self-help groups when stating, Members themselves run the group, with leadership usually rotating among the members. Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences.

86. During a smoking cessation group, the community health nurse explains that in their effort to quit smoking, a reciprocal inhibition approach will be used. The nurse should give the group which example of this technique? A. Before you can smoke, you must first take a half-hour walk. B. When you have the urge to smoke, imagine being short of breath. C. You'll receive $1 for each cigarette not smoked and forfeit $2 for each cigarette smoked. D. When you have the urge to smoke, hold your breath and then rhythmically breathe.

ANS: D These breathing exercises cannot be done while the client smokes. Therefore, they decrease or eliminate the undesired behavior (smoking) that is incompatible with the desired behavior (smoking cessation). This is an example of the behavior therapy of reciprocal inhibition.

82. A child always chooses to ask mother over father when seeking special privileges. The father is more apt to disagree than agree with the child's requests, whereas the mother usually consents. The child's choice is the result of which component of operant conditioning? A. Conditioned stimuli B. Unconditioned stimuli C. Aversive stimuli D. Discriminative stimuli

ANS: D This child is able to discriminate between stimuli. This child can predict with assurance that asking mother (not father) will result in a desired response.

47. A client diagnosed with brief psychotic disorder is pacing the milieu and occasionally punches the wall. Which should be the initial nursing action? A. Assertively instruct the client to stop punching the wall. B. Encourage the client to write down feelings in a journal. C. With the help of staff, initiate seclusion protocol. D. Ensure adequate physical space between the nurse and the client.

ANS: D To maintain a safe environment, it is important to initially assure that there is adequate physical space between the nurse and the client. Violence can be related to increased contact and decreased defensible space.

111. A client states, I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store. Using a cognitive approach, which nursing reply would be most therapeutic? A. Are other issues from your past affecting your ability to move on? B. Describe your current feelings about your loss. C. Let's talk about something that will help you move on. D. Can anyone predict when a car accident will happen?

ANS: D When the nurse attempts to encourage the client to reframe thoughts, the nurse is using a cognitive approach.

132. When scheduling electroconvulsive therapy (ECT), which client should the nurse prioritize? A. A client in bed in a fetal position who is experiencing active suicidal ideations B. A client with an irritable mood and exhibiting angry outbursts C. A client experiencing command hallucinations and delusions of reference D. A client experiencing manic episodes of bipolar disorder

ANS: A A client who is experiencing suicidal ideations is in need of an immediate intervention to prevent self-harm and must be prioritized when the nurse schedules ECT.

126. A client scheduled for electroconvulsive therapy (ECT) at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. On the basis of this observation, which is the most appropriate nursing action? A. The nurse notifies the clients physician of the situation and cancels the ECT. B. The nurse removes the breakfast tray and assists the client to the ECT procedure room. C. The nurse allows the client to finish breakfast and reschedules ECT for 10:00 a.m. D. The nurse increases the clients fluid intake to facilitate the digestive process.

ANS: A A client who is scheduled for ECT procedures is given nothing by mouth (NPO) for a minimum of 6 to 8 hours before treatment.

93. A nurse should recognize which intervention as most appropriate within a behavioral therapy program? A. A child is given a Popsicle for staying dry and clean. B. A child is put in time-out after soiling his or her undergarments. C. A child is allowed to remain in soiled undergarments. D. A child is taught the advantages of staying dry and clean.

ANS: A A stimulus that follows a behavior or response is called a reinforcing stimulus or reinforcer. The reward of a Popsicle is a reinforcer for the child staying dry and clean. This is an example of operant conditioning, a form of behavioral therapy.

110. A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred? A. Dichotomous thinking is when an individual views situations as being good or bad or black or white. B. Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances. C. Dichotomous thinking is when an individual exaggerates the negative significance of an event. D. Dichotomous thinking is when an individual undervalues the positive significance of an event.

ANS: A An individual who is using dichotomous thinking views situations in terms of all or nothing, good or bad, or black or white.

146. A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to find when assessing this client? A. A client feeling confident about achieving goals in life. B. A client who is aware of the need to set goals in life. C. A client who has mobilized personal and external resources. D. A client who begins to actively take control of his or her life.

ANS: A Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1, Moratorium; Stage 2, Awareness; Stage 3, Preparation; Stage 4, Rebuilding; and Stage 5, Growth. In the growth stage, the individual feels a sense of optimism and hope of a rewarding future. Skills that have been nurtured in the previous stages are applied with confidence, and the individual strives for higher levels of well-being.

144. A client states, My illness is so devastating, I feel like my life is on hold. The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates? A. Moratorium B. Awareness C. Preparation D. Rebuilding

ANS: A Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1, Moratorium; Stage 2, Awareness; Stage 3, Preparation; Stage 4, Rebuilding; and Stage 5, Growth. The moratorium stage is identified by dark despair and confusion. It is called moratorium, because it seems that life is on hold.

114. Using a cognitive approach, a nurse would choose which intervention for assisting clients to manage their anger without the use of violence? A. Assist the client to identify thoughts that trigger anger and substitute reality-based thinking. B. Provide consequences, such as removal from group therapy, in response to angry outbursts. C. Administer antipsychotic medications and use limit-setting such as a room restriction. D. Administer anti-anxiety medication and encourage participation in a group on medication actions.

ANS: A By assisting the client to identify thoughts that trigger anger and encourage the substitution of more reality- based thinking, the nurse can help the client to alter dysfunctional beliefs that predispose the client to distort experiences.

63. A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, Im going to use a knotted shower curtain when no one is around. Which information would determine the nurses plan of care for this client? A. The more specific the plan is, the more likely the client will attempt suicide. B. Clients who talk about suicide never actually commit it. C. Clients who threaten suicide should be observed every 15 minutes. D. After a brief assessment, the nurse should avoid the topic of suicide.

ANS: A Clients who have specific plans are at greater risk for suicide.

121. A chronically depressed and suicidal client is admitted to a psychiatric unit. The client is scheduled for electroconvulsive therapy (ECT). During the course of ECT, a nurse should recognize the continued need for which critical intervention? A. Suicide assessment must continue throughout the ECT course. B. Antidepressant medications are contraindicated throughout the ECT course. C. Discourage expressions of hopelessness throughout the ECT course. D. Encourage a high-caloric diet throughout the ECT course.

ANS: A ECT is an intervention for major depression that often includes suicidal ideations as a symptom. Continued suicide assessment is needed because mood improvement due to ECT may cause the client to act on suicidal ideations.

123. Immediately after an initial electroconvulsive therapy (ECT) procedure, a client states, Im not hungry and just want to stay in bed and sleep. On the basis of this information, which is the most appropriate nursing intervention? A. Allow the client to remain in bed. B. Encourage the client to join the milieu to promote socialization. C. Obtain a physicians order for parenteral nutrition. D. Involve the client in physical activities to stimulate circulation.

ANS: A Immediately after electroconvulsive therapy a nurse should monitor pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the client should remain in bed.

78. A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this child's parent? A. Your child will receive green tokens for completing homework that can be cashed in for desired rewards. B. Your child will receive red tokens when homework is incomplete and this will result in school suspension. C. Your child will receive a time out for each homework assignment not completed. D. Your child, with your assistance, will envision receiving rewards for completed homework.

ANS: A In a token economy, tokens are a form of contingency contracting in that tokens immediately reinforce appropriate behavior (completed homework) and are exchanged later for a desired reward.

102. An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this clients concerns. What is the purpose of this nursing intervention? A. To identify important areas needing concentration during therapy B. To increase self-esteem and decrease feelings of helplessness C. To modify maladaptive behaviors by the use of role-play D. To divert away from intrusive thoughts and depressive ruminations

ANS: A In activity scheduling, the client is asked to keep a daily log of activities and rate them for mastery and pleasure in order to identify recurring daily patterns that may need to be addressed in therapy.

87. A mother states, You are old enough to clean your own bedroom. Later inspection finds the floor clear, but with everything stacked in a chair. The mother praises the child for clearing the floor. This is consistent with which technique of behavior modification? A. Shaping B. Extinction C. Stimulus generalization D. Reciprocal inhibition

ANS: A In shaping, behavior is molded in a desired direction by reinforcing each small step toward the desired behavior. The child is praised for clearing the floor, the first step toward cleaning the room.

45. A client begins to smash furniture, cannot be talked down, and refuses medications. Which is the most appropriate nursing intervention? A. Call a violence code. B. Ask the ward clerk to put in a call for the physician. C. Place the client in seclusion. D. Place the client in four-point restraints.

ANS: A In this situation the nurse must have adequate, trained help to prevent injury to the client or staff. Calling a violence code will access this help.

75. A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? A. Assessing the clients pulse oximetry and vital signs B. Developing a plan for safety for the client C. Assessing the client for suicidal ideations D. Establishing a trusting nurse-client relationship

ANS: A It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslows hierarchy of needs. This clients problems with oxygenation will take priority over assessing for current suicidal ideations.

18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

ANS: A The nurse should determine that the clients absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses.

25. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. Are you currently thinking about harming yourself? B. Why do you want to harm yourself? C. Have you thought about the consequences of your actions? D. Who is your emergency contact person?

ANS: A The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should prioritize safety by assessing the client for thoughts of self-harm.

119. Immediately after electroconvulsive therapy, in which position should a nurse place the client? A. On his or her side to prevent aspiration B. In semi-Fowlers position to promote oxygenation C. In Trendelenburgs position to promote blood flow to vital organs D. In prone position to prevent airway blockage

ANS: A The nurse should place a client who has received electroconvulsive therapy on his or her side to prevent aspiration. After the treatment, most clients will awaken within 10 to 15 minutes and will be confused and disoriented. Some clients will sleep for 1 to 2 hours. All clients require close observation following treatment.

4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed.

2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit-setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members.

70. Which nursing intervention strategy is most appropriate to implement initially with a suicidal client? A. Ask a direct question such as, Do you ever think about killing yourself? B. Ask client, Please rate your mood on a scale from 1 to 10. C. Establish a trusting nurse-client relationship. D. Apply the nursing process to the planning of client care.

ANS: A The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan.

106. A high school basketball player sustains a serious knee injury and states to the school nurse, I will never get to college if I don't receive a basketball scholarship. Which nursing reply would assist the student to see a broader range of possibilities? A. Let's look at the alternatives for funding your college education. B. I know you are feeling helpless now, but you are looking at this from only one perspective. C. Can your family afford knee surgery? D. You now need to prioritize your academics and not focus on basketball.

ANS: A When the nurse helps the student to see a broader range of possibilities, the nurse is using the cognitive technique of generating alternatives.

104. A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of examining the evidence. Which response exemplifies this technique? A. Let's look at the potential reasons why your partner has not participated. B. How would you define irresponsibility? C. Has it occurred to you that your partner may be working on the project at home? D. Are you telling me that you feel totally responsible for this project?

ANS: A When using the technique of examining the evidence, the student and nurse review automatic thoughts and study the evidence to support or counter the belief.

8. During a group discussion, members freely interact with each other. Which member statement is an example of Yaloms curative group factor of imparting information? A. I found a Web site explaining the different types of brain tumors and their treatment. B. My brother also had a brain tumor and now is completely cured. C. I understand your fear and will be by your side during this time. D. My mother was also diagnosed with cancer of the brain.

ANS: A Yaloms curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by advice and suggestions given by other group members.

33. Which client statement demonstrates improvement in anger/aggression management? A. I realize I have a problem expressing my anger appropriately. B. I know I cant use physical force anymore, but I can intimidate someone with my words. C. Its bad to feel as angry as I feel. Im working on eliminating this poisonous emotion entirely. D. Because my wife seems to be the one to set me off, Ive decided to remain separated from her

ANS: A The client is recognizing and taking responsibility for personal anger.

129. A nursing student is observing an electroconvulsive therapy (ECT) procedure. The student notices a blood pressure cuff on the clients lower leg. The student questions the instructor about the cuff placement. Which is the most accurate instructor reply? A. The cuff has to be placed on the leg because both arms are used for intravenous fluids. B. The cuff functions to prevent succinylcholine from reaching the foot. C. The cuff position gives a more accurate blood pressure reading during the treatment. D. The cuff is placed on the leg so that arms can easily be restrained during seizure.

ANS: B A blood pressure cuff is placed on the lower leg and inflated above systolic pressure before injection of succinylcholine. This is to ensure that seizure activity can be observed and timed in this one limb that is unaffected by the paralytic agent.

43. Which risk factor should a nurse recognize as the most reliable indicator of potential client violence? A. A diagnosis of schizotypal personality disorder B. History of assaultive behavior C. Family history of violence D. Recent eviction from a homeless shelter

ANS: B A prior history of assault is the most widely recognized risk factor for client violence.

67. Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self? A. The client will not physically harm self. B. The client will express three positive self-attributes by day 4. C. The client will reveal a suicide plan. D. The client will establish a trusting relationship.

ANS: B Although the client has a history of suicide attempts, the current problem is isolate behaviors based on low self-esteem. Outcomes should be client centered, specific, realistic, and measurable and contain a time frame.

145. A client states, I have come to the conclusion that this disease has not paralyzed me. The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates? A. Moratorium B. Awareness C. Preparation D. Rebuilding

ANS: B Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1, Moratorium; Stage 2, Awareness; Stage 3, Preparation; Stage 4, Rebuilding; and Stage 5, Growth. In the awareness stage, the individual comes to a realization that a possibility for recovery exists. Andresen and associates state, It involves an awareness of a possible self other than that of sick person: a self that is capable of recovery.

60. A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? A. Your grieving will subside within 1 year; until then I recommend antidepressants. B. Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area. C. The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them. D. Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone.

ANS: B Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work.

109. The director of nursing (DON) sets up a meeting with the newly appointed nurse manager, who, to this point, has done an excellent job. The nurse manager anticipates job termination. What is the best description of the cognitive error being employed by the nurse manager? A. Thinking from an all-or-nothing perspective B. Always thinking the worst will occur without considering positive outcomes C. Viewing only selected negative evidence while editing out positive aspects D. Undervaluing the positive significance of an event

ANS: B Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. The nurse manager has quickly jumped to the conclusion that the meeting will result in job termination.

96. A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content? A. The therapist provides information about the process of cognitive therapy. B. The therapist uses guided imagery in an effort to elicit automatic thoughts. C. The therapist provides information about how cognitive therapy works. D. The therapist uses reading assignments to reinforce learning.

ANS: B Cognitive therapy prepares the client to become his or her own cognitive therapist. The didactic portion of the therapy provides educational material to reinforce learning about the therapy and how it affects psychiatric disorders.

48. The nurse observes a clients escalating anger. The client begins to pace the hall and shouts, You all better watch out. Im going to hurt anyone who gets in my way. Which should be the priority nursing intervention? A. Calmly tell the client, Staff will help you to control your impulse to hurt others. B. Remove other clients from the area and maintain milieu safety. C. Gather a show of force by contacting security for assistance. D. Calmly tell the client, You will need to be medicated and secluded.

ANS: B During an emergent situation on an inpatient unit, the nurses priority action should be to keep all clients safe by removing them from the area of conflict.

28. A despondent client, who has recently lost her husband of 30 years, tearfully states, I'll feel a lot better if I sell my house and move away. Which nursing reply is most appropriate? A. Im confident you know whats best for you. B. This may not be the best time for you to make such an important decision. C. Your children will be terribly disappointed. D. Tell me why you want to make this change.

ANS: B During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. The nurse should also assist the client in determining whether any changes are realistic and if timing of change is appropriate. This response encourages the client to think through what may be an impulsive decision.

32. A nursing instructor is teaching about the concept of anger. Which student statement indicates the need for further instruction? A. Anger is physiological arousal. B. Anger and aggression are essentially the same. C. Anger expression is a learned response. D. Anger is not a primary emotion.

ANS: B Further teaching is necessary when the student states that anger and aggression are essentially the same. Anger and aggression are significantly different.

84. Parents of a 3-year-old have noticed an improvement in behavior because of using a time out behavioral approach. What aspect of time out therapy may be responsible for this child's improved behavior? A. Negative reinforcement discourages maladaptive behavior. B. Positive reinforcement is removed. C. Covert sensitization is being applied. D. Reciprocal inhibition is eliminated.

ANS: B In a time out, the positive reinforcement of attention is removed from the child during inappropriate behavior.

143. A nursing instructor is teaching about components present in the recovery process, as described by Andresen and associates, which led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed? A. A client has a better chance of recovery if he or she truly believes that recovery can occur. B. If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover. C. A client who has a positive sense of self and a positive identity is likely to recover. D. A client has a better chance of recovery if he or she has purpose and meaning in life.

ANS: B In examining a number of studies, Andresen and associates identified four components that were consistently evident in the recovery process. These components are hope, responsibility, self and identity, and meaning and purpose. Under responsibility, this model tasks the client, not the health-care team, with taking responsibility for his or her life and well-being.

94. An adolescent client was recently admitted to the psychiatric unit because of impulsivity and acting-out behavior at school. The nurse should initially implement which nursing action? A. Redirect the client to activities to decrease stress. B. Explain the unit rules and consequences of breaking the rules. C. Place the client on close observation to insure a trusting relationship. D. Administer an anti-anxiety medication.

ANS: B It is important for the nurse to initially explain the unit rules and consequences of breaking the rules. It is imperative that consequences of rule infractions are explained early in treatment to avoid misunderstanding and manipulation.

1. Which nursing approach is likely to be most therapeutic when dealing with a newly admitted, hostile, suspicious client? A. Place a hand on the clients shoulder and state, I will help you to your room. B. Slowly and matter-of-factly state, I am your nurse and I will show you to your room. C. Firmly set limits by stating, If your behavior does not improve you will be secluded. D. Smile and state, I am your nurse. When do you want to go to your room?

ANS: B It is important to maintain an unemotional tone of voice when dealing with a hostile client. The client might misinterpret touch and become violent.

39. Once the nurse initiates restraint for an out-of-control 45-year-old patient, what must occur within 1 hour, according to JCAHO standards? A. The patient must be let out of restraint. B. A physician or other licensed independent practitioner must conduct an in-person evaluation. C. The patient must be bathed and fed. D. The patient must be included in debriefing.

ANS: B Joint Commission (JCAHO) standards require that a physician or other licensed independent practitioner conduct an in-person evaluation of the client within 1 hour of the initiation of restraint.

77. An adolescent comes from a dysfunctional family where physical and verbal abuse prevails. At school this adolescent bullies and fights with classmates. According to principles of behavior therapy, what is the probable source of this behavior? A. Shaping B. Modeling C. Premack principle D. Reciprocal inhibition

ANS: B Modeling is the learning of new behaviors by imitating the behaviors of others. This adolescent, witnessing physical and verbal abuse in the home, models this behavior in school.

89. A nursing instructor is teaching about the behavior technique of modeling. When asked to give an example of this behavioral intervention, which student statement meets the learning objective? A. A child is first rewarded for using a spoon to eat and then rewarded for using a fork, and finally rewarded for cutting food with a knife. B. An adolescent imitates Dad by using and caring for tools appropriately. C. A client and therapist agree to conditions of therapy, stating explicitly in writing the behavior change that is desired. D. A mother tells her child that television can be watched only after homework is completed.

ANS: B Modeling refers to the learning of new behaviors by imitating the behavior of others.

130. A client states, My doctor has told me I am a candidate for electroconvulsive therapy (ECT). Where will the treatment take place, and how much time would this entail? Which is the most accurate nursing reply? A. Clients typically receive ECT in their hospital room, daily for 1 month. B. Clients typically undergo 6 to 12 ECT procedures, three times a week in an outpatient setting. C. Clients typically receive an unlimited number of treatments, in the hospital procedure room. D. Clients typically receive two to three treatments, in either an outpatient or inpatient setting.

ANS: B Most clients require an average of 6 to 12 ECT procedures, but some may require up to 20 procedures. Treatments are usually administered every other day, three times per week. Treatments are performed on either an inpatient or outpatient basis, depending on the need for client monitoring.

105. A nursing assistant has failed a prerequisite course toward admission to nursing school and states, I will always be only a nursing assistant and never an RN. Her nursing advisor understands this is an example of which automatic thought? A. Arbitrary inference B. Overgeneralization C. Dichotomous thinking D. Personalization

ANS: B Overgeneralization occurs when sweeping conclusions are made on the basis of one incident. Because the student failed a prerequisite nursing course, the student overgeneralizes that the goal of being an RN will never be attained.

79. A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, Whats that? Which is the most appropriate nursing reply? A. At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon. B. By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve. C. Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety. D. In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate.

ANS: B Reciprocal inhibition decreases or eliminates an undesired behavior by introducing a more adaptive behavior that is incompatible with the undesired behavior.

40. For select clients, physical restraint is considered to be a beneficial intervention. This is based on which premise? A. Clients with poor boundaries do not respond to verbal redirection, and they need firm and consistent limit setting. B. Clients with limited internal control over their behavior need external controls to prevent harm to themselves and others. C. Clients with antisocial tendencies need to submit to authority. D. Clients with behavioral dysfunction need behavioral interventions.

ANS: B Restraints are used for clients who are unable to control their behavior in order to prevent harming themselves or others

136. A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed? A. Recovery occurs via many pathways. B. Recovery emerges from strong religious affiliations. C. Recovery is supported by peers and allies. D. Recovery is culturally based and influenced.

ANS: B SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. Recovery emerges from hope, but affiliation with any particular religion would have little bearing on the recovery process.

95. According to behavioral theory, the treatment of phobic symptoms should involve which action? A. The manipulation of the environment B. The use of desensitization C. The use of family therapy D. The uncovering of past events

ANS: B Systematic desensitization is a technique for assisting individuals to overcome their fear of a phobic stimulus. It is systematic in that there is a hierarchy of anxiety-producing events through which the individual progresses during therapy.

46. On an inpatient psychiatric unit, a restrained 16-year-old client continues to verbally lash out and threatens to abuse staff and kill self when released. To meet Joint Commission standards, at what time should a nurse expect the physician to renew the clients restraint order? A. Within 1 hour of the original restraint order B. Within 2 hours of the original restraint order C. Within 3 hours of the original restraint order D. Within 4 hours of the original restraint order

ANS: B The Joint Commission (JCAHO) requires that a physician or a licensed independent practitioner reissue a new order for restraints every 4 hours for adults, every 2 hours for adolescents, and every 1 hour for children.

139. A nurse maintains a clients confidentiality, addresses the client appropriately, and does not discriminate on the basis of gender, age, race, or religion. Which guiding principle of recovery has this nurse employed? A. Recovery is culturally based and influenced. B. Recovery is based on respect. C. Recovery involves individual, family, and community strengths and responsibility. D. Recovery is person-driven.

ANS: B The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. This nurse accepts and appreciates clients who are affected by mental health and substance use problems. This nurse protects the rights of clients and does not discriminate against them.

134. A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed? A. The goal of recovery is improved health and wellness. B. The goal of recovery is expedient, comprehensive behavioral change. C. The goal of recovery is the ability to live a self-directed life. D. The goal of recovery is the ability to reach full potential.

ANS: B The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental health disorders and substance use disorders as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Change in recovery is not an expedient process. It occurs incrementally over time.

141. Which is the priority focus of recovery models? A. Empowerment of the health-care team to bring their expertise to decision-making B. Empowerment of the client to make decisions related to individual health care C. Empowerment of the family system to provide supportive care D. Empowerment of the physician to provide appropriate treatments

ANS: B The basic concept of a recovery model is empowerment of the client. The recovery model is designed to allow clients primary control over decisions about their own care.

56. A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this clients safety upon discharge? A. Provide a 6-month supply of Elavil to ensure long-term compliance. B. Provide a 1-week supply of Elavil with refills contingent on follow-up appointments. C. Provide a pill dispenser as a memory aid. D. Provide education regarding the avoidance of foods containing tyramine.

ANS: B The health-care provider should provide a 1-week supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the clients safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential.

73. Which statement indicates that the nurse is acting as an advocate for a client who was hospitalized after a suicide attempt and is now nearing discharge? A. I must observe you continually for 1 hour in order to keep you safe. B. Lets confer with the treatment team about the resources that you may need after discharge. C. You must have been very upset to do what you did today. D. Are you currently thinking about harming yourself?

ANS: B The nurse is functioning in an advocacy role when collaborating with the client and treatment team to discuss client problems and needs.

1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

ANS: B The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer.

5. Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses association advertises for candidates for president.

ANS: B The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity.

15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

ANS: B The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement.

31. A student nurse has just entered a psychiatric rotation. The student asks a nursing instructor, How will we know if someone may get violent? Which is the most appropriate reply by the nursing instructor? A. You cant really say for sure. There are limited indicators of potential violence. B. Certain behaviors indicate a potential for violence. They are labeled as a prodromal syndrome and include rigid posture, clenched fists, and raised voice. C. Any client can become violent, so it is best to be aware of your surroundings at all times. D. When a client suddenly becomes quiet, is withdrawn, and maintains a flat affect, this is an indicator of potential violence.

ANS: B These behaviors have been identified as predictors of violent behavior.

61. After years of dialysis, an 84-year-old states, Im exhausted, depressed, and done with these attempts to keep me alive. Which question should the nurse ask the spouse when preparing a discharge plan of care? A. Have there been any changes in appetite or sleep? B. How often is your spouse left alone? C. Has your spouse been following a diet and exercise program consistently? D. How would you characterize your relationship with your spouse?

ANS: B This client has many risk factors for suicide. The client should have increased supervision to decrease likelihood of self-harm.

62. . A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include? A. Elderly people use less lethal means to commit suicide. B. Although the elderly make up less than 13% of the population, they account for 16% of all suicides. C. Suicide is the second leading cause of death among the elderly. D. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

ANS: B This factual information should be included in the nursing instructors teaching plan. An expressed desire to die is not normal in any age group.

7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yaloms curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

ANS: B This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved.

37. An adult client assaults another client and is placed in restraints. Which statement from the client while in restraints should alert a nurse that further assessment is necessary? A. I hate all of you! B. My fingers are tingly. C. You wait until I tell my lawyer. D. I have a sinus headache

ANS: B This statement may mean that the restraints are excessively tight and impeding circulation.

42. At 3 a.m., when less restrictive methods fail, a physician orders restraints for an angry, aggressive client. To meet Joint Commission standards, at what time and by whom should a nurse expect an in-person client evaluation? A. No later than 8 a.m., by a licensed independent practitioner or a clinical nurse specialist B. No later than 4 a.m., by a physician or a licensed independent practitioner (LIP) C. No later than 3:30 a.m., by a physician or the clients case manager D. No later than 6 a.m., by the psychiatrist or a clinical nurse specialist

ANS: B To meet Joint Commission standards, an in-person evaluation by a physician or LIP should be conducted within 1 hour of the initiation of restraints.

44. A nursing instructor is teaching about violence-intervention protocols. Which student statement would indicate the need for further instruction? A. Administering psychotropic medications can be a part of violence-intervention protocols. B. Soothing the client by stroking an arm or shoulder can be a part of violence-intervention protocols. C. Applying leather restraints can be a part of violence-intervention protocols. D. Calling for assistance is a part of violence-intervention protocols.

ANS: B Touching the client could be seen by him or her as threatening and provoke further violence.

81. A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents? A. You are shaping your child's behavior. B. Your child has modeled your behavior. C. You are positively reinforcing your child's behavior. D. You are negatively reinforcing your child's behavior.

ANS: C

133. A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option? A. Because the client is extremely suicidal, ECT is an appropriate option. B. Because antidepressant medications have been ineffective, ECT is a good alternative. C. Because informed consent is required for ECT, cognitive deficits could preclude this option. D. Because of the clients cognitive deficits, a signed consent is waived.

ANS: C A client who is experiencing cognitive deficits cannot give informed consent, which is required prior to ECT. A court proceeding could determine the clients level of competency and, if necessary, the judge would appoint a guardian.

72. Which client data indicate that a suicidal client is participating in a plan for safety? A. Compliance with antidepressant therapy B. A mood rating of 9/10 C. Disclosing a plan for suicide to staff D. Expressing feelings of hopelessness to nurse

ANS: C A degree of the responsibility for the suicidal clients safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide.

74. A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide? A. Family history of depression B. The clients orientation to reality C. The clients history of suicide attempts D. Family support systems

ANS: C A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the clients risk.

19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

ANS: C A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine.

140. A nurse on an inpatient unit helps a client understand the significance of treatments and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the Tidal Model of Recovery? A. Know that Change Is Constant B. Reveal Personal Wisdom C. Be Transparent D. Give the Gift of Time

ANS: C Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. This nurse is employing the Be Transparent commitment.

127. A client who is learning about electroconvulsive therapy (ECT) asks a nurse, Isnt this treatment dangerous? Which is the most appropriate nursing reply? A. No, this treatment is side-effect free. B. There can be temporary paralysis, but full functioning returns within 3 hours of treatment. C. There are some risks, but a thorough examination will determine your candidacy for ECT. D. Transient ischemic attacks (TIAs) can occur but are rare.

ANS: C Clients are given medical clearance for ECT. This decreases the risk of injury from the treatment.

A mother tells her teenager that in order for college tuition to be paid, the teenager must quit smoking. They develop a written agreement stipulating time frames and consequences. This is an example of which technique of behavior modification? A. Shaping B. Modeling C. Contracting D. Premack principle

ANS: C Contracting occurs when the mother and teenager together develop a written agreement related to desired behavior (smoking cessation) and positive reinforcement (paid college tuition).

69. A nurse is caring for four clients diagnosed with major depressive disorder. When considering each clients belief system, the nurse should conclude which client would potentially be at highest risk for suicide? A. Roman Catholic B. Protestant C. Atheist D. Muslim

ANS: C Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts.

88. During hospitalization, an attention-seeking client has repeatedly cut herself. After threatening to cut herself again, the nurse states, Here are some Band-Aids so you wont bleed on the sheets. Which is the underlying reason for this nurses response? A. The nurse is using an aversive stimulus in response to the clients manipulative cutting behavior. B. The nurse is using negative reinforcement in response to the clients behavior. C. The nurse is minimizing reinforcement of the clients manipulative behavior with the goal of extinction. D. The nurse lacks empathy for the clients recurring self-injurious behavior.

ANS: C Extinction is the gradual decrease in frequency or disappearance of a response when a positive reinforcement is withheld. The nurse is withholding attention to the client who is exhibiting manipulative, attention-seeking behavior. The lack of positive response (attention) should cause extinction of the undesired behavior.

49. The client states, I get into trouble because I respond violently without thinking. That usually gets me into a mess. Which nursing reply would be most therapeutic to address this clients problem? A. Everybody loses their temper. It's good that you know that about yourself. B. I'll bet you have some interesting stories to share about overreacting. C. Let's explore methods to help you stop and think before taking action. D. Its good that you are showing readiness for behavioral change.

ANS: C Helping the client to find alternative ways to release tension by more appropriate problem-solving behaviors is a therapeutic nursing intervention.

99. A nursing student states, The instructor gave me a failing grade on my research paper. I know its because the instructor doesn't like me. Which cognitive error does a nurse recognize in this students statement? A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization

ANS: C In magnification, negative events are exaggerated. It is irrational to assume that there is a relationship between failing a paper and being personally disliked by the instructor.

125. A nursing instructor is teaching about the medications given prior to and during electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. Atropine (Atro-Pen) is administered to paralyze skeletal muscles during ECT. B. Succinylcholine chloride (Anectine) decreases secretions to prevent aspiration. C. Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious. D. Glycopyrrolate (Robinul) is given to prevent severe muscle contractions during seizure.

ANS: C In order to render a client unconscious during the ECT procedure, an anesthesiologist administers intravenously a short-acting anesthetic such as thiopental sodium (Pentothal).

107. A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? A. My baby is refusing to nurse, and I know it's because she hates me. B. My baby needs to be under the bilirubin lights, but I resent her time away from me. C. My baby is wonderful, but Im depressed because I wanted twins. D. My baby has an elevated bilirubin, and I know it will get worse and she will die.

ANS: C In selective abstraction the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred.

41. A client diagnosed with paranoid schizophrenia has a history of aggravated assault. A nurse assigns Risk for other-directed violence as the clients priority nursing diagnosis. Based on this diagnosis, which would be an appropriate, correctly written outcome for this client? A. The client will not verbalize anger or hit anyone. B. The client will verbalize anger rather than hit others. C. The client will not inflict harm on others during this shift. D. The client will be restrained if verbal or physical abuse is observed during this shift.

ANS: C Preventing injury to others is the appropriate outcome. Outcomes must be client centered, specific, realistic, and measureable and contain a time frame. Answer A does not contain a time frame.

50. Which initial nursing approach makes limit-setting better accepted by clients who are aggressively acting out? A. Confronting clients with their needs for secondary gains B. Teaching relaxation techniques C. Reflecting back to the client empathy about the clients distress D. Presenting appropriate values that need to be modified

ANS: C Reflecting back to the client empathy about the clients distress promotes a trusting relationship and may prevent the clients anxiety from escalating when limits are set.

65. A new nursing graduate asks the psychiatric nurse manager how to best classify suicide. Which is the nurse managers best reply? A. Suicide is a DSM-5 diagnosis. B. Suicide is a mental disorder. C. Suicide is a behavior. D. Suicide is an antisocial affliction.

ANS: C Suicide is not a diagnosis, disorder, or affliction. It is a behavior.

80. A client reports, My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious. Which technique was the friends therapist most likely using? A. Extinction B. Covert sensitization C. Systematic desensitization D. Reciprocal inhibition

ANS: C Systematic desensitization is a treatment for phobias in which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no anxiety.

122. After undergoing two of nine electroconvulsive therapy (ECT) procedures, a client states, I cant even remember eating breakfast, so I want to stop the ECT. Which is the most appropriate nursing reply? A. After you begin the course of treatments, you must complete all of them. B. Youll need to talk with your doctor about what youre thinking. C. It is within your right to discontinue the treatments, but lets talk about your concerns. D. Memory loss is a rare side effect of the treatment. I dont think it should be a concern.

ANS: C The client has the right to terminate treatment. This nursing reply acknowledges this right but focuses on the clients concerns so that the nurse can provide needed information.

118. A nurse administers pure oxygen to a client during and after electroconvulsive therapy. What is the nurses rationale for this procedure? A. To prevent increased intracranial pressure resulting from anoxia B. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation C. To prevent anoxia due to medication-induced paralysis of respiratory muscles D. To prevent blocked airway resulting from seizure activity

ANS: C The nurse administers 100% oxygen during and after electroconvulsive therapy to prevent anoxia due to medication-induced paralysis of respiratory muscles. Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain.

3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: C The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style.

11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

ANS: C The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group.

55. A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurses priority at this time? A. Give the client off-unit privileges as positive reinforcement. B. Encourage the client to share mood improvement in group. C. Increase frequency of client observation. D. Request that the psychiatrist reevaluate the current medication protocol.

ANS: C The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self- destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication.

30. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger

ANS: C The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst is to process feelings and concerns related to the witnessed intervention.

20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. Psychodrama provides a safe setting in which to discuss painful issues. B. In psychodrama, the client is the protagonist. C. In psychodrama, the client observes actor interactions from the audience. D. Psychodrama facilitates resolution of interpersonal conflicts.

ANS: C The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist.

16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: C The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members.

71. A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this clients risk for suicide? A. Encouraging participation in the milieu to promote hope B. Developing a strong personal relationship with the client C. Observing the client at intervals determined by assessed data D. Encouraging and redirecting the client to concentrate on happier times

ANS: C The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors.

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self- harm. The client refuses to commit to developing a plan for safety. What should be the nurses priority intervention at this time? A. Obtaining an order for locked seclusion until client is no longer suicidal B. Conducting 15-minute checks to ensure safety C. Placing the client on one-to-one observation while monitoring suicidal ideations D. Encouraging client to express feelings related to suicide

ANS: C The nurses priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation.

52. A nurse discovers a clients suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? A. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note B. Establishing room restrictions, because the clients threat is an attempt to manipulate the staff C. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide D. Calling an emergency treatment team meeting, because the clients threat must be addressed

ANS: C The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide.

24. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations

ANS: C The priority nursing diagnosis for this client is Risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes on the basis of potential safety risk to the client and/or others. Nursing diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is determined to be potential.

115. A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? A. I cant give up alcohol right now because I just gave up smoking. B. I just read that red wine has health benefits. C. I may have a minor problem, but I can handle it. D. I don't drink as much as my wife, and nobody thinks she has a problem.

ANS: C The statement I may have a minor problem, but I can handle it is an example of the use of the cognitive distortion of minimization. Minimization is the undervaluing of the positive significance of an event.

112. Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety? A. Right now I feel as sharp as a tack. B. Im having a tough time focusing. C. Sometimes I feel like Im having an out-of-body experience. D. All I seem to focus on is my anger.

ANS: A Cognitive ability will be enhanced with mild anxiety. Mild anxiety prepares the individual for heightened responses to environmental stimuli.

98. A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the clients thinking is reflective of which cognitive error? A. Minimization B. Dichotomous thinking C. Arbitrary inference D. Personalization

ANS: A Minimization is the cognitive error that undervalues positive events and experiences. The client cannot give credit for personal strengths.

10. During an inpatient educational group, a client shouts out, This information is worthless. Nothing you have said can help me. These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

ANS: A The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others.

138. A client diagnosed with obsessive-compulsive disorder states, I really think my future will improve because of my successful treatment choices. Im going to make my life better. Which guiding principle of recovery has assisted this client? A. Recovery emerges from hope. B. Recovery is person-driven. C. Recovery occurs via many pathways. D. Recovery is holistic.

ANS: A. The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. This client has internalized hope. This hope is the catalyst of the recovery process.

120. A nursing instructor is teaching about electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. During ECT a state of euphoria is induced. B. ECT induces a grand mal seizure. C. During ECT a state of catatonia is induced. D. ECT induces a petit mal seizure.

ANS: B Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain for the purpose of decreasing depression.

137. A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the SAMHSA, which dimension of recovery is supporting this client? A. Health B. Home C. Purpose D. Community

ANS: B SAMHSA describes the dimension of Home as a stable and safe place to live.

131. A client is scheduled for an initial electroconvulsive therapy (ECT) procedure. Which information should a nurse include when teaching about the potential side effects of this procedure? A. You may experience transient tangential thinking. B. You may experience some memory deficit surrounding the ECT. C. You may experience avolution for the remainder of the day. D. You may experience a higher risk for subsequent seizures.

ANS: B The most common side effect of ECT is temporary amnesia following the ECT procedure.

29. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers.

ANS: B The nurse should assess that tense facial expressions and body language may indicate that a clients anger is escalating. The nurse should conduct a thorough assessment of the clients past and current violent behaviors and develop interventions for de-escalation.

12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. Its hard for me to tell my story when Im not sure about the reactions of others. B. I think Joes Antabuse suggestion is a good one and might work for me. C. My situation is very complex, and I need professional, not peer, advice. D. I am really upset that you expect me to solve my own problems.

ANS: B The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change.

22. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis

ANS: B The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or inability to assume personal responsibility.

103. When a clients husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husbands tardiness. What technique is the nurse using? A. Examination of the evidence B. Decatastrophizing C. Generating alternatives D. Reattribution

ANS: C Using the technique of generating alternatives will assist the client to recognize a wider range of possible explanations for her husbands behavior.

85. A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of flooding. Which intervention best exemplifies this technique? A. Giving rewards for demonstrating a decrease in fear of spiders B. Encouraging the client to sit through the movie Spiderman C. Accompanying the client to a 1-hour visit to the local zoos spider room D. Offering a computer program that progressively presents anxiety-producing spider scenarios

ANS: C Visiting the spider room would flood the client with the phobic stimuli of real spiders. This would continue until the stimulus no longer creates anxiety.

128. A client experienced bradycardia during electroconvulsive therapy (ECT). A nurse assigns a nursing diagnosis of decreased cardiac output R/T vagal stimulation occurring during ECT. Which outcome would the nurse expect the client to achieve? A. The client will verbalize an understanding of the need for moving slowly after treatment. B. The client will maintain an oxygen saturation level of 88% 1 hour after treatment. C. The client will continue adequate tissue perfusion 1 hour after treatment. D. The client will verbalize an understanding of common side effects of ECT.

ANS: C Vagal stimulation induced by ECT may cause a client to experience bradycardia. Adequate tissue perfusion would be a realistic expectation when normal cardiac output is restored.

142. A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model should be employed, and what action reflects this step? A. Step 3: Triggers that cause distress or discomfort are listed.B. Step 4: Signs indicating relapse are identified and plans for responding are developed. C. Step 5: A specific plan to help with symptoms is formulated. D. Step 6: Following client-designed plan, caregivers now become decision-makers.

ANS: D The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include Step 1, Develop a Wellness Toolbox; Step 2, Daily Maintenance List; Step 3, Triggers; Step 4, Early Warning Signs; Step 5, Things Are Breaking Down or Getting Worse; and Step 6, Crisis Planning. In Step 6 (Crisis Planning), clients can no longer care for themselves, make independent decisions, or keep themselves safe. Caregivers take an active role in this step on behalf of the client and implement the plan that the client has previously developed. All other actions presented require the client to be functionally capable.

117. A client diagnosed with borderline personality disorder states, Get out of here. No one cares about me or my situation! Which nursing reply is an example of a cognitive intervention? A. You have an anti-anxiety medication ordered. It may make you feel better. B. It sounds like you are feeling really frustrated. C. Can you explain further your thinking about your situation? D. No one cares about you?

ANS: C When a nurse asks for an explanation about a clients thinking, the nurse is using a cognitive approach to assessment. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors.

113. When using a cognitive approach, a nurse would include which point in teaching a client about panic disorder? A. You might want to stay in the house when you notice the symptoms beginning. B. Medications such as lorazepam (Ativan) should be taken when symptoms start. C. Remind yourself that symptoms of a panic attack are time limited and will end. D. Keep a journal in order to note feelings surrounding the panic attacks.

ANS: C When a nurse reminds a client that symptoms of a panic attack are time limited and will end, the nurse is using the cognitive approach of presenting rational thinking.

A suicidal client says to a nurse, Theres nothing to live for anymore. Which is the most appropriate nursing reply? A. Why don't you consider doing volunteer work in a homeless shelter? B. Let's discuss the negative aspects of your life. C. Things will look better in the morning. D. It sounds like you are feeling pretty hopeless.

ANS: D This statement verbalizes the clients implied feelings and allows him or her to validate and explore them.

9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yaloms curative group factor of altruism? A. I'll give you the name of a friend that rents inexpensive rooms. B. The last time we helped a family, they got back on their feet and prospered. C. I can give you all of my baby clothes for your little one. D. I can appreciate your situation. I had to declare bankruptcy last year.

ANS: C Yaloms curative group factor of altruism occurs when group members provide assistance and support to each other, creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern.

83. Parents decide to try the nurse practitioners suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents? A. Correct your child's behavior by spanking for a specified time period. B. Ignore the child's negative behavior. C. Add positive reinforcement for acceptable behavior. D. Temporarily move your child to an area where behavior is not being reinforced.

ANS: D A time out is an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behavior is occurring. Usually during a time out, the person is temporarily isolated so there is no reinforcing attention. This discourages a reoccurrence of the undesired behavior.

97. A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client? A. Thought patterns are triggered by specific stressful stimuli. B. Thought patterns contain the clients fundamental beliefs and assumptions. C. Thought patterns are flexible and based on personal experience. D. Thought patterns include a predominance of automatic thoughts.

ANS: D According to Beck, automatic thoughts consist of rapid responses to a situation without rational analysis. These thoughts are often negative and based on erroneous logic.

35. A nurse is caring for four clients. Which client should the nurse identify as least prone to developing problems with anger and aggression? A. A child raised by a physically abusive parent B. An adult with a history of epilepsy C. A young adult living in the ghetto of an inner city D. An adolescent raised by Scandinavian immigrant parents

ANS: D An adolescent raised by Scandinavian immigrant parents would be least prone to developing problems with anger and aggression as compared with the other clients presented. A history of abuse, epilepsy, overcrowding, and poverty all contribute as predisposing factors to anger and aggression.

34. A client is served divorce papers while on the inpatient psychiatric unit. When a nurse tells the client the unit telephone cannot be used after hours, the client raises his fists, swears, and spits at the nurse. Which negative coping mechanism has the client exhibited? A. The defense mechanism of projection B. The defense mechanism of reaction formation C. The defense mechanism of sublimation D. The defense mechanism of displacement

ANS: D Anger can lead to aggression when the coping response is displacement. This client has discharged anger against a person (the nurse) unrelated to the true target of the anger (the spouse).

66. A nursing student is developing a plan of care for a suicidal client. Which documented intervention should the student implement first? A. Communicate therapeutically. B. Observe the client. C. Provide a hazard-free environment. D. Assess suicide risk.

ANS: D Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions.

91. When asked to identify principles that define the term maladaptive behavior, which nursing student statement indicates that further teaching is needed? A. Behavior is maladaptive when it is age inappropriate. B. Behavior is maladaptive when it interferes with adaptive functioning. C. Behavior is maladaptive when it is identified as inappropriate in the context of ones culture. D. Behavior is maladaptive when it results in change within an otherwise stable subsystem.

ANS: D Behaviors that result in change within a subsystem, even when it is stable, could be either adaptive or maladaptive behaviors. This statement, therefore, is incorrect.

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? A. Address only serious suicide threats to avoid the possibility of secondary gain. B. Promote trust by verbalizing a promise to keep suicide attempt information within the family. C. Offer a private environment to provide needed time alone at least once a day. D. Be available to actively listen, support, and accept feelings.

ANS: D Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

101. A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion? A. Socratic questioning B. Activity scheduling C. Distraction D. Cognitive rehearsal

ANS: D Cognitive rehearsal allows the employee to uncover potential automatic thoughts in advance of his or her meeting to request a promotion. This allows the employee to develop strategies to modify any dysfunctional thinking.

100. An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, Whats cognitive therapy and how can it help me? Which is the nurses most appropriate reply? A. It is a system of techniques in which you use positive thinking to improve your mood. B. It is a long-term interpersonal approach that emphasizes the role of early childhood experiences. C. It is an interpersonal treatment approach that specifically targets magical thinking. D. It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors.

ANS: D Cognitive therapy is meant to be a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances.

38. After restraints are removed from a client, the staff discusses the incident and establishes guidelines for the clients return to the therapeutic milieu. Which unit procedure is the staff implementing? A. Milieu reenactment B. Treatment planning C. Crisis intervention D. Debriefing

ANS: D Debriefing is an important part of restraint/seclusion. It allows the staff an opportunity to review and learn from the experience and to express feelings generated by the incident.

108. A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, I failed my battalion by giving the wrong order. Fortunately, no one was injured. Which nursing diagnosis should the nurse assign to this client? A. Chronic low self-esteem B. Risk for self-directed violence C. Powerlessness D. Situational low self-esteem

ANS: D Emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues. The nursing diagnosis of situational low self-esteem is used for individuals who have a negative perception of self-worth in response to a current situation. This clients cognitive appraisal of the situation has led to the diagnosis of major depressive disorder and low self-esteem.

124. A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a clients electroconvulsive therapy (ECT) procedure. What is the rationale for administering this medication? A. Robinul decreases anxiety during the ECT procedure. B. Robinul induces an unconscious state to prevent pain during the ECT procedure. C. Robinul prevents severe muscle contractions during the ECT procedure. D. Robinul decreases secretions to prevent aspiration during the ECT procedure.

ANS: D Glycopyrrolate (Robinul) is the standard preoperative medication given prior to ECT procedures to decrease secretions and prevent aspiration.

68. A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? A. Suicidal threats and gestures should be considered manipulative and/or attention-seeking. B. Suicide is the act of a psychotic person. C. All suicidal individuals are mentally ill. D. Fifty to eighty percent of all people who kill themselves have a history of a previous attempt.

ANS: D It is a fact that between 50% and 80% of all people who kill themselves have a history of a previous attempt. All other answer choices are myths about suicide.

76. A kindergarten rule states that if unacceptable behavior occurs, a child's personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy? A. Classical conditioning B. Conditioned response C. Positive reinforcement D. Negative reinforcement

ANS: D Negative reinforcement is increasing the probability that behavior (appropriate classroom behavior) will recur by removal of an undesirable reinforcing stimulus (personalized fish in sea grass).

58. The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the teams decision? A. No previous admissions for major depressive disorder B. Vital signs stable; no psychosis noted C. Able to comply with medication regimen; able to problem-solve life issues D. Able to participate in a plan for safety; family agrees to constant observation

ANS: D Participation in a plan of safety and constant family observation will decrease the risk for self-harm. All other answer choices are not directly focused on suicide prevention and safety.

92. Which assumption is most reflective of a behavioral theory model? A. Mental illness is characterized by structural and biochemical alterations. B. Thought processes influence behaviors. C. All personality development has a social context. D. There is a basic relationship between stimulus and response.

ANS: D That there is a basic relationship between stimulus and response is an assumption of a behavioral theory model. The connection between a stimulus and a response is strengthened or weakened by the consequences of the response.

36. After less restrictive means have been attempted, an order for client restraints has been obtained for a hostile, aggressive 30- year-old client. If client aggression continues, how long will the nurse expect the client to remain in restraints without a physician order renewal? A. 1 hour B. 2 hours C. 3 hours D. 4 hours

ANS: D The Joint Commission (JCAHO) requires that a physician or licensed independent provider (LIP) must reissue a new order for restraints every 4 hours for adults, every 1 hour for clients younger than 9, and every 2 hours for clients 9 to 17 years.

135. Which situation presents an example of the basic concept of a recovery model? A. The clients family is encouraged to make decisions in order to facilitate discharge. B. A social worker, discovering the clients income, changes the clients discharge placement. C. A psychiatrist prescribes an antipsychotic drug on the basis of observed symptoms. D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.

ANS: D The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care.

57. During a one-to-one session with a client, the client states, Nothing will ever get better, and Nobody can help me. Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time? A. Powerlessness R/T altered mood AEB client statements B. Risk for injury R/T altered mood AEB client statements C. Risk for suicide R/T altered mood AEB client statements D. Hopelessness R/T altered mood AEB client statements

ANS: D The clients statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the clients suicidal ideations and intent would be necessary.

116. A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of these? A. Try singing Happy Birthday until the voices are gone. B. Document what the voices are saying, to note cause and effect. C. Try listening to music using headphones for distraction. D. Remind yourself that the voices are symptoms of your disease.

ANS: D The focus of cognitive therapy is on the modification of distorted cognitions and maladaptive behaviors.

26. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior.

ANS: D The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client and does not reinforce appropriate behavior.

13. Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress.

27. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. You've really been helpful. Can I count on you for continued support? B. I don't work out anymore. C. Im really glad I didn't go home. It would have been hard to come back. D. I carry mace when I jog. It makes me feel safe and secure.

ANS: D The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention.

23. A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this clients crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6.

ANS: D The nurse should identify that a realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific, measurable, realistic, and contain a time frame.