Psych Wk2
A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse?
"You must have been really upset."
The nurse has been asked to identify a location to conduct an interview with a psychiatric-mental health client. Which is an essential consideration when choosing a location?
The client's right to privacy
Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?
The client's room
The nurse assesses a client with a history of bipolar disorder. The client tells the nurse that that an intelligence agency has surveillance equipment set up in the client's bathroom. The nurse is observing which thought process or content?
delusional thinking
Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client:
is attempting to prolong the nurse-client relationship.
A client who is hospitalized with depression tells a nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be most appropriate?
"Have you ever thought about hurting yourself?"
When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager?
"What specifically makes you uncomfortable?"
Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can."
"You look like you are very angry this morning."
A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer.
"It sounds like this is very difficult for you, I can see why it causes you stress."
A female psychiatric client is talking to the nurse about her reasons for being hospitalized. The client begins to discuss her relationship with her female significant other. She is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse?
"It sounds like you're beginning to be uncomfortable in this relationship."
The nurse is assessing the behavior of a client. The client has a cheerful expression, erect posture, and a confident tone. Which statement made by the client along with these nonverbal cues conveys a congruent message?
"I feel great and am able to do my exercises properly."
A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response?
"I notice it has been a while since you have had a shower."
Which statement by the nurse is an example of assertive communication?
"I understand that group can be difficult to attend but coming late is disruptive."
The nurse is caring for a Native American client. After asking the client some questions, the nurse determines that the client closely follows the Native American culture. Which request would be consistent with this culture?
"I would like to use herbs and participate in a pipe ceremony to aid in healing."
A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response?
"I've been off for the past four days. What have you done since I last saw you?"
The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior?
"It looks like you're searching for something. Is that right?"
A client is speaking with the nurse about the client's difficult relationship with the client's father. The client states, "He never showed me love or approval unless I was perfect." Which response is most likely to encourage the client to continue elaborating?
"Tell me more about that."
Which statement would indicate that the nurse has a non-judgmental attitude?
"The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."
Which client statement indicates the most insight into his or her issue with auditory hallucinations?
"The voices aren't real but it's hard to ignore them."
The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication?
"This is overwhelming for you, it is okay to cry."
A client tells the nurse, "I had to slap my child, I couldn't help that." Which response of the nurse indicates that the nurse is in the state of unknowing?
"What was going on for you when this happened?"
A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response?
"What you are saying and how you say it does not seem to match."
A nurse is speaking to a client with a smiling expression. Which statement by the nurse would promote the most congruent communication?
"You hard work and determination has really helped you succeed."
When assessing orientation, the nurse completes the assessment by asking which questions? Select all that apply.
-"What is your name?" -"What day of the week is it?" -"Can you tell me where you are?"
A client has been brought to the psychiatric care unit. During the assessment, the nurse observes the client uses ineffective communication skills. Which are interpersonal factors that may influence the client's mental health? Select all that apply.
-Proxemics -Silence -Inability to use feeling words
During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply.
-Review with the client the learned methods to control the problems. -Reassure the client that they already covered these issues.
Which clinical situation provides an example of transference?
A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.
A 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depression associated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what?
A judgmental attitude
A client who recently immigrated from Eastern Europe comes to the clinic for an evaluation. During the assessment, the nurse notes that the client has adopted the local area's mannerisms and dress. The nurse interprets this as what?
Acculturation
The nurse is preparing to perform a psychosocial assessment of a client with schizophrenia. The client has a history of extreme aggression. What is the optimal setting for conducting an interview with the client?
A physician's intake room with other medical personnel nearby.
Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes?
Advocate
"Get the stuff from him" is an example of which type of message?
Abstract
A nurse documents that "the client describes the recent breakup of a dating relationship with an emotionless tone and a flat facial expression." In which section of the mental status exam would the nurse have documented this statement?
Affect
While conducting an interview with a psychiatric-mental health client, the nurse is observing the client's facial expressions and nonverbal cues. What are these physical manifestations known as?
Affect
The nurse who is preparing a Native American client for surgery notes that the client is wearing a medicine bag. What intervention should the nurse implement to best address the client's spiritual needs with respect to presurgical care needs?
Ask the client how the medicine bag can be respected while preparing for surgery.
A student nurse is preparing a presentation regarding different cultures. Which definition of culture is most accurate?
Belief system that guides behavior
Which is the primary religion of Cambodians?
Buddhism
On meeting a client for the first time, the nurse pats the client on the shoulder. The client expresses discomfort with the nurse's behavior. To which culture does the client most likely belong?
Chinese
A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship?
Client self-exploration
A 68-year-old parent is the sole care provider for a 39-year-old child who has a diagnosis of bipolar disorder. The 39-year-old has been experiencing worsening of the illness over several years. The nurse should recognize that the parent is at risk for what?
Compassion fatigue
A nurse is assessing a hospitalized client who is hearing voices due to psychosis. The client is easily distracted, and this is creating a barrier to completing the assessment. What is the most effective way for the nurse to proceed?
Complete the assessment in several short interactions.
Which is an inaccurate statement regarding a preconception?
It enables the nurse to get an accurate picture of the client's problems.
A nurse in a multicultural community knows that to give a client meaningful spiritual care within the health care context it must be what?
Congruent with the client's beliefs
Which includes the circumstances or parts that clarify the meaning of the content of the message?
Context
Which component of hardiness encompasses the ability to make appropriate decisions in life activities?
Control
The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term?
Countertransference
Which term is used to refer to signals that encourage effective communication?
Cue
A psychiatric-mental health nurse is working on developing cultural competence. Which would be most appropriate for the nurse to do?
Demonstrate an appreciation of, and a genuine interest in, the individual and his or her cultural beliefs.
A culturally competent nurse can identify that some cultural and ethnic groups feel that mental illness is caused by what?
Disruption of harmony
A nurse is aware that which of these represents a biochemical variation that may exist between clients of different cultures?
Drug metabolism
In what phase of the therapeutic relationship does the assessment process begin?
During the initiating or orienting phase
A group of nursing students is role playing situations to practice using therapeutic communication techniques. Which would the students identify as verbal communication?
Emotion underlying the words
Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic?
Emphasis
Children learn cultural characteristics as they associate with others. Which entity has the most profound influence on the development of traditional values and practices?
Family
Which is not involved in empathy?
Feeling the same emotions that the client is feeling at a given time
While talking with a schizophrenic client, the nurse observes that the client is looking straight ahead, maintains no eye contact, and moves facial muscles very little, even though the client is telling the nurse about a very emotional episode the client just experienced with a roommate. When describing the client's affect, the nurse documents it as what?
Flat
Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship?
Hildegard Peplau
A mental health nurse is caring for a client with schizophrenia. The nurse observes the client laughing about the recent death of the client's father. The nurse would correctly document this mood as what?
Incongruent
Which stage of Erikson's psychosocial development includes building confidence in one's own abilities?
Industry versus inferiority
A psychiatric-mental health nurse is feeling highly anxious before conducting an interview with a client. The nurse's experience of anxiety will impact the client assessment in which way?
It will be detrimental to the interaction by decreasing the nurse's focus and attention.
A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response?
It's important to get a break from time to time. How have the last few days been for you?
Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance than the client?
Know the client's cultural personal space preferences.
A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse?
Korean
A nurse interviews a new client in the day room of the psychiatric unit. The nurse is wearing a jacket and a bag and frequently asks the client to repeat the last statement. The nurse's demeanor with the client is reflective of what?
Lacking genuine interest
A client with psychosis who was recently admitted to a psychiatric unit says to the nurse, "The car is red. Are you ready for lunch? My head is hurting. Dogs bark loud." The client is exhibiting which type of speech?
Loose associations
As the nurse is conducting an interview with a client with a diagnosis of schizophrenia, the client states, "Bunnies are cute as a button, buttons are on my shirt, shirts can be bought in a store." Which is a term used to describe this thought process?
Loose associations
Which stage of psychosocial development involves establishing the next generation?
Middle adult
A nurse is conducting an interview with a psychiatric-mental health client and notices the client is using made-up words. This is known as what?
Neologisms
What is one way in which nurses can develop cultural self-awareness?
Objectively examine personal beliefs, values, and practices.
It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship?
Orientation
A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?
Orientation phase
A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to do what?
Permit the client to gather the client's thoughts
A female nurse is conducting a family assessment of a Hispanic client. When the nurse asks questions about family problems, the nurse notices that the client is reluctant to answer. A possible cause for this behavior is that members of the Hispanic culture believe what?
Personal matters are considered to be family problems.
When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what?
Presenting the information using language and terms the client will understand
Which would not be included as a purpose of the psychosocial assessment?
Previous compliance with treatment regimen
Which would be considered a "usual or expected" response during the first few sessions?
Rambling due to nervousness
Children of parents who abused alcohol and substances are able to develop self-esteem and self-efficacy by developing which characteristics?
Resilience
The most important tool of psychiatric nursing is the:
Self
A psychiatric-mental health nurse is working to develop a therapeutic relationship with a client. When doing so, which element would the nurse integrate as critical to building this relationship?
Self-awareness
When conducting an assessment with a client from another country, what can a nurse do to ensure the client receives culturally sensitive care?
Show genuine interest in the client's culture and personal life experiences.
Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client?
Sitting behind a desk
The nurse is caring for a client who has recently developed psychomotor retardation. Based on this information, which behavior would the nurse expect to see in this client?
Slowness of body movements
A mental health nurse is discussing the schedule of events for the day on the unit with a client. The nurse therapeutically communicates within which zone of distance awareness?
Social
The mental health nurse is interviewing a client of Asian descent regarding the client's health care practices. The nurse understands that cultural competence is important in the care of this client. Cultural competence in health care can be best described as what?
Striving to achieve the ability to work within the cultural context of an individual or community from a diverse cultural or ethnic background
A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?
The client is able to independently express feelings and emotions with the client's friends.
The nurse is assessing a client of Middle Eastern descent. The nurse finds that the client is standing at a distance of approximately 1.5 feet while speaking to the nurse. What should the nurse interpret from this behavior?
The client is behaving in a manner that is culturally acceptable.
A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior?
The client is nervous and insecure.
When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind?
The client is the primary focus of the interaction.
Avoiding which outcome is the primary reason for establishing professional boundaries with clients?
The loss of therapeutic effectiveness
Which behavior of the nurse indicates that the nurse has a therapeutic relationship with the client?
The nurse expresses empathy to a client who has recently lost the client's son in an accident.
Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit?
The nurse frequently refers to an elderly, cognitively impaired client as "my granny"
During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way?
The nurse may lack confidence in therapeutic communication.
Which is a nurse's primary tool for treating clients with mental disorders?
The therapeutic use of self
A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation?
The therapist must notify authorities and the potential victim.
A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship?
Trust
A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?
Working
During which phase of the nurse-client relationship does the client identify and explore specific problems?
Working
During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of:
empathy.
A nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of:
excessive probing.
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?
shifting the emphasis to the nurse
