Test Questions

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Which of the following statements could be considered a violation of professional conduct? a. "You look very nice today". b. "Did you have good weekend". c. "I like your shoes. Are they comfortable?". d. "I think your comments about the patient's sexuality are inappropriate".

a. "You look very nice today".

A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline d. International Statistical Classification of Diseases and Related Health Problems (ICD)

a. Clinical algorithm A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patients needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases.

A psychiatric and mental health nurse finds herself feeling very angry toward a patient whose physical appearance and manner remind her of her abusive father. This is an example of which of the following? a. Countertransference. b. Transference. c. Displacement. d. Projection.

a. Countertransference.

13. The building blocks of Rogers' theory are: a. Energy, openness, pattern and four dimensionality b. Person, life process, pattern and organization, energy c. Person, environment, health, nursing d. Openness, environment, pattern and energy

a. Energy, openness, pattern and fourdimensionality

Which of the following would be the best example of an open-ended question? a. How did you come to be in the hospital? b. Did your husband bring you over to the hospital? c. Who brought you to the hospital? d. When did you come into the hospital?

a. How did you come to be in the hospital?

17. The nurse who utilizes Roy's model in providing nursing care will include in the second-level assessment: a. Identification of ineffective responses b. Identification of nursing diagnosis c. Identification of goals d. Patterns of physical functioning

a. Identification of ineffective responses

A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurses most caring comment. a. Lets discuss some means of coping other than suicide when you have these feelings. b. I understand why youre so depressed. When I got divorced, I was devastated too. c. You should forget about your marriage and move on with your life. d. How did you get so depressed that hospitalization was necessary?

a. Lets discuss some means of coping other than suicide when you have these feelings. The nurses communication should evidence caring and a commitment to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeutic interventions.

A nurse assesses that a patient is suspicious and frequently manipulates others. Using the Freudian theory, these traits are related to which psychosexual stage? a. Oral b. Anal c. Phallic d. Genital

a. Oral According to Freud, each of the behaviors mentioned develops as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, and a strong sense of personal identity.

Which of the following divisions of the International Society of Psychiatric-Mental Health Nurses (ISPN) actively promotes the autonomy of the advances practice nurse? a. Society for Education and Research in Psychiatric-Mental Health Nursing (SERPN) b. Association of Child and Adolescent Psychiatric Nurses (ACAPN) c. International Society of Psychiatric Liaison Nurses (ISPCLN) d. Adult and Geropsychiatric-Mental Health Nurses (AGPN)

a. Society for Education and Research in Psychiatric-Mental Health Nursing (SERPN)

A psychiatric technician says, Little of what takes place on the behavioral health unit seems to be theory based. A nurse educates the technician by identifying which common use of Sullivans theory? a. Structure of the therapeutic milieu of most behavioral health units b. Frequent use of restraint and seclusion for behavior modification c. Assessment tools based on age- appropriate versus arrested behaviors d. Use of the nursing process to determine the best sequence for nursing actions

a. Structure of the therapeutic milieu of most behavioral health units The structure of the therapeutic environment has, as its foci, an accepting atmosphere and provision of opportunities for practicing interpersonal skills. Both constructs are directly attributable to Sullivans theory of interpersonal relationships. Sullivans interpersonal theory did not specifically consider the use of restraint or seclusion. Assessment based on the developmental level is associated with Eriksons' theories. The nursing process applies concepts from multiple theories.

According to the Communication Process, at the end of the feedback loop, the sender becomes the receiver. a. True b. False

a. True

Considering para-verbal communication, if a person speaks slowly and in a low-pitched monotone voice, the listener is likely to feel that the speaker is: a. bored with conversation b. intelligent and deliberate c. confused about the topic of conversation d. angry about something

a. bored with conversation

An older adult with a urinary infection may exhibit: a. confusion. b. hallucinations. c. depression. d. anxiety

a. confusion.

If a psychiatric and mental health nurse knowns the employer of a patient and tells the employer that the patient is too mentally unstable to work, and the person loses his job as a result, this may constitute: a. defamation of character. b. libel. c. invasion of privacy. d. battery.

a. defamation of character.

A 40-year-old adult living with parents states, Im happy but I dont socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them. A nurse should identify interventions to improve this patients: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior.

a. self-concept. The patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept. Although the patient reports being happy, the subsequent comments refute that self-appraisal. The patients comments do not indicate that he/she is out of touch with reality. The patients needs are broader than control over own behavior.

9. Imogene King's theory of nursing is: a. A theory of personal systems b. A theory of goal attainment c. A theory of adaptation d. A behavioral systems theory

b. A theory of goal attainment

A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web sites address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in .org. b. Address ends in .com. c. Address ends in .gov. d. Address ends in .net.

b. Address ends in .com. Financial influences on a site are a clue that the information may be biased. .com at the end of the address indicates that the site is a commercial one. .gov indicates that the site is maintained by a government entity. .org indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. .net can have multiple meanings.

Which historical nursing leader helped focus practice to recognize the importance of science in psychiatric nursing? a. Abraham Maslow b. Hildegard Peplau c. Kris Martinsen d. Harriet Bailey

b. Hildegard Peplau Although all these leaders included science as an important component of practice, Hildegard Peplau most influenced its development in psychiatric nursing. Maslow was not a nurse, but his theories influence how nurses prioritize problems and care. Bailey wrote a textbook in the 1930s on psychiatric nursing interventions.

Which patient statement would lead a nurse to suspect that the developmental task of infancy was not successfully completed? a. I have very warm and close friendships. b. Im afraid to let anyone really get to know me. c. I am always right and confident about my decisions. d. Im ashamed that I didnt do it correctly in the first place.

b. Im afraid to let anyone really get to know me. According to Erikson, the developmental task of infancy is the development of trust. The patients statement that he or she is afraid of becoming acquainted with others clearly shows a lack of ability to trust other people. Having warm and close friendships suggests the developmental task of infancy was successfully completed. Believing one is always right suggests rigidity rather than mistrust. Feelings of shame suggest failure to resolve the crisis of Initiative versus Guilt.

23. According to Freudian theory, thoughts, feelings, and desires that are not in immediate awareness, but can be recalled to consciousness, are considered: a. Conscious b. Preconscious c. Subconscious d. Unconscious

b. Preconscious

6. Dorothea Orem's theory of nursing is also called the theory of: a. Behavioral Systems b. Self-care c. The environment d. Adaptation

b. Self-care

When completing the patient assessment and developing the plan of care with a patient with an eating disorder, it is especially important to ask the patient about: a. motivation to change behavior b. self-injurious behavior c. sexual dysfunction d. goal for weight

b. self-injurious behavior Patients with eating disorders often engage in superficial self-mutilating behaviors, such as cutting, burning, and hair pulling, and these actions may increase as an outlet for patient's emotional distress as the eating disorder is controlled. All patients with an eating disorder should be screened for self-injurious behavior and should be monitored carefully during therapy.

A psychiatric and mental health nurse feels sorry for a patient because his family won't support him. The nurses offers to visit the patient's family as well as purchase some items him. This nurse is: a. showing empathy. b. violating professional boundaries. c. building a strong therapeutic relationship. d. exhibiting negligence.

b. violating professional boundaries.

If a patient with psychosis divulges that he intends to kill his parents, healthcare providers must: a. have the patient arrested b. warn the parents c. increase patient oversight. d. advise the patient not to make threats.

b. warn the parents

A mother brings her adolescent son in to be seen by a psychiatric and mental health advanced practice nurse. The mother wishes to hospitalize the boy. She indicates that she can no longer control his behavior and that he is dating girls of whom she does not approve and staying out past his curfew. Based on the boy's right to treatment in the least restrictive setting, what is the psychiatric and mental health advanced practice nurse's best response? a. Determine the most secure facility to hospitalize the child because he is probably a "run risk." b. Seek a Day Treatment Program since the child's behavior is not dangerous. c. Offer to work with the mother and son in regard to appropriate expectations and discipline. d. Tell the mother that all adolescents act that way and that she is wrong to be upset about this normal behavior.

c. Offer to work with the mother and son in regard to appropriate expectations and discipline.

11. One of the basic assumptions in the theory of Martha Rogers is that: a. People come together to help and be helped to maintain health. b. The universe is a continuously expanding, evolving, growing field of energy. c. The person and environment are continually exchanging matter and energy with each other. d. Energy fields are four dimensional, unidirectional, expanding sources of knowledge.

c. The person and environment are continually exchanging matter and energy with each other.

2. Characteristics of theories include: a. They provide laws by which to govern practice. b. They have little in common with practice. c. They can guide and improve practice. d. They need not be logical.

c. They can guide and improve practice.

Which of the following is a healthy response to conflict with another person? a. Belief that other person's point of view is wrong. b. Resentment toward the other person. c. Willing to seek compromise with the other person. d. Siding with the other person despite feelings of abandonment.

c. Willing to seek compromise with the other person.

Patients who are treated with lithium to control the symptoms of bipolar disorder must be advised to avoid: a. sun exposure. b. sodium in the diet. c. dehydration. d. tobacco products.

c. dehydration. Patients who are treated with lithium to control the symptoms of bipolar disorder must be advised to avoid dehydration because this may cause the blood level of lithium to increase, resulting in toxicity. Patients should drink 8 to 10 glasses of liquid (primarily water) daily and may need increased fluids during hot weather. Patients should not be on a low sodium diet but should maintain a fairly consistent level of sodium intake because lithium levels increase with lower sodium levels and decrease with higher.

If a patient with severe postpartum depression admits she hates her infant but states, "I would never hurt it", the first priority should be to: a. encourage the patient to ask for help with childcare. b. advise the patient's husband to monitor childcare. c. remove the infant from the patient's care. d. advise the patient to find a family member to care for the child.

c. remove the infant from the patient's care.

Which of the following statements by a patient indicates a readiness to learn? a. "I don't need to be hospitalized as there's nothing wrong with me". b. "It's my mother's fault I ended up here"\. c. "I already know all I need to." d. "I need to be in better control of my life."

d. "I need to be in better control of my life."

Following the death of her infant daughter, a patient suddenly started attending church and praying obsessively while neglecting her husband other children. According to Kubler-Ross's stages of grief, the patient is probably at what stage? a. Denial b. Anger c. Depression d. Bargaining

d. Bargaining

In the mental health setting, the best prescribing practice includes: a. Assessing thoughts of harm to self or other b. Writing patient's height and weight on all prescriptions c. Selecting the appropriate medication for the identified patient d. Both a and c are correct

d. Both a and c are correct

Sarah has been at least 10 minutes late for each of her previous sessions. Today she arrives 20 minutes late. The nurse should: a. Express anger towards Sarah. b. Confront Sarah firmly and set limits on her behavior. c. Discuss terminating their sessions if she continues this pattern. d. Comment on her observations and assist Sarah to understand her behavior.

d. Comment on her observations and assist Sarah to understand her behavior.

4. Which of the following do theories NOT do? a. Guide practice b. Guide research c. Provide a common language for practitioners and researchers d. Limit autonomy of practice

d. Limit autonomy of practice

Which of the following characteristics is most indicative of success in a mental health team? a. A team leader with a decisive authoritarian approach b. A set of firm rules and regulations to cover most situations that could arise c. Many diverse philosophies of treatment d. Open communication

d. Open communication

Of the following advocacy guidelines, which is true? a. All clients are in need of advocacy as provided by the nurse. b. Joining forces with other groups with similar goals should be avoided since this leads to a large group that is difficult to handle. c. The maximum power possible should be brought to the task to ensure the maximum benefit. d. Patience and persistence are important characteristics of successful client advocates.

d. Patience and persistence are important characteristics of successful client advocates.

Ann and John lose their first child to Sudden Infant Death Syndrome. They decide to attend a hospital-sponsored group for people who have had this experience. What type of group will they be attending? a. Teaching group b. Psychotherapy group c. Task group d. Supportive/Therapeutic group

d. Supportive/Therapeutic group

The goal of Art therapy and Music therapy is: a. To assist clients in passing time in the hospital productively. b. To teach clients a new skill or hobby. c. To evaluate clients for possible job training. d. To stimulate the expression of feelings.

d. To stimulate the expression of feelings.

Therapy for obsessive-compulsive disorder (OCD) usually includes: a. psychodynamic psychotherapy b. flooding c. mediation d. exposure and response prevention

d. exposure and response prevention

If the patient is in the pre-contemplation stage of changing regarding smoking, according to the Transtheoretical Model (TTM), the initial step in helping the patient quit smoking through a self-help program should be to: a. advise the patient to wait until the patient is psychologically ready b. advise the patient to immediately begin the self-help program c. advise the patient the self-help programs are generally ineffective d. help the patient progress beyond the stage of pre-contemplation.

d. help the patient progress beyond the stage of pre-contemplation.

When assessing a 35-year old Arab American female, the psychiatric and mental health nurse notes that, while discussing her family, the patient uses a louder voice than while discussing other issues. This probably means that issues about her family are: a. a private matter b. a cause for shame c. of lesser importance than other issues d. of special importance.

d. of special importance.

If a 27-year-old patient with narcissistic personality disorder is pregnant and has made plans to have an abortion but the psychiatric and mental health nurses is opposed to abortion for religious reasons, the nurse should: a. discuss alternatives with the patients. b. provide literature about adoption. c. advise the patient her decision is morally wrong. d. support the patient's decision.

d. support the patient's decision.

Which of the following would be described as a component of mental health according to Johnson? A. Refusing to be involved in any relationship that limits independence B. Absence of anxiety under any circumstances C. Dependence on friends and family to assist with crises D. Ignoring cues from the environment when deciding what to do

C. Dependence on friends and family to assist with crises

In helping a client change, the nurse should: A. Encourage the client to move rapidly to avoid delay B. Realize that the problems the client is facing will make him or her eager to change C. Encourage feelings of hope D. Understand that change is a natural process that never involves anxiety and fear

C. Encourage feelings of hope

In facilitating change the nurse should: A. Avoid deliberate goal-directed activity since this will inhibit the process B. Restrict clients to few choices to avoid overwhelming them C. Give up if resistance is encountered D. Form a helping relationship and collaborate with clients

D. Form a helping relationship and collaborate with clients

According to traditional definitions of mental health, which of the following would the nurse be most likely to describe as mentally healthy? A. Jerry Jones, a Viet Nam veteran with no family ties, who has been unemployed for 10 years B. Tom Sarris, a CEO, who spends 14 hours at work each day and is too tired to do anything with his family on weekends C. George Connors, a shoe salesman who delights in playing affectionately with his children but has been unable to hold a steady job since they were born D. Sam Thomas, a restaurateur who loves his work, but sets limits on the hours he spends there in order to enjoy his family and friends

D. Sam Thomas, a restaurateur who loves his work, but sets limits on the hours he spends there in order to enjoy his family and friends

20. Cultural care accommodation refers to: a. Actions and decisions to help people of a given culture negotiate for a beneficial outcome with health caregivers b. Actions and decisions to help a client modify their lifeways for beneficial health care, while respecting their cultural values and beliefs c. Actions and decisions that help people retain relevant cultural care values d. Actions and decisions that are based on universal cultural care

a. Actions and decisions to help people of a given culture negotiate for a beneficial outcome with health caregivers

Cultural care accommodation refers to: a. Actions and decisions to help people of a given culture negotiate for a beneficial outcome with health caregivers b. Actions and decisions to help a client modify their lifeways for beneficial health care, while respecting their cultural values and beliefs c. Actions and decisions that help people retain relevant cultural care values d. Actions and decisions that are based on universal cultural care

a. Actions and decisions to help people of a given culture negotiate for a beneficial outcome with health caregivers

A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice

a. Advocacy An advocate defends or asserts anothers cause, particularly when the other person lacks the ability to do that for himself or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs.

Which of the following is NOT necessary for the nurse to make a spiritual assessment? a. Assure that the client has a religious affiliation. b. Determine if client believes in a higher power. c. Evaluate the client's relationship to others. d. Determine the client's philosophy of life.

a. Assure that the client has a religious affiliation

A psychiatric and mental health advanced practice nurse has been treating a client for several months. Recently the client has become increasingly agitated and expressed a great deal of hostility towards his ex-wife. At their last session, the client described a detailed plan to kill her and kidnap his children. What is the psychiatric and mental health advanced practice nurse's response? a. Call the client's ex-wife and inform her that she may be in danger. b. Call the police and discuss the case with them. c. Consult a lawyer about the case. d. Preserve the client's right to confidentiality.

a. Call the client's ex-wife and inform her that she may be in danger. Tarasoff—if therapist is reasonably certain that a client is going to harm someone, must breach confidentiality and inform potential victim.

1. The purpose of a theory is to: a. Describe, explain, predict or control a phenomenon b. Encourage the development of more research c. Prove that there can be one way to describe a phenomenon d. Prove that a phenomenon exists

a. Describe, explain, predict or control a phenomenon

a. Energy, openness, pattern and four dimensionality

The nurse asks the parents to keep a record of the number of nights the child stays in his own room and to reward him with a treat if he can do it three nights in a row. This intervention is known as: a. Homework b. Paradoxical prescription c. Sculpting d. Triangling

a. Homework Experiential activities a. Homework—tasks assigned by the therapist, which when enacted by the family members further the therapeutic process; completion or failure to complete the task is discussed at the next session. b. Paradoxical prescription—instructions are given to perform the opposite of what is intended in order to produce change. c. Sculpting—enactment of an experience with words omitted that when "frozen'' is a symbolic representation of the family members' relationships; by asking a family member to rearrange the "sculpture," change is modeled.

a. Identification of ineffective responses

A student nurse tells the instructor, I dont need to interact with my patients. I learn what I need to know by observation. The instructor can best interpret the nursing implications of Sullivans theory to the student by responding: a. Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills. b. Observing patient interactions can help you formulate priority nursing diagnoses and appropriate interventions. c. I wonder how accurate your assessment of the patients needs can be if you do not interact with the patient. d. Noting patient behavioral changes is important because these signify changes in personality.

a. Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills. Sullivan believed that the nurses role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivans theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The third response pertains to Maslows theory. The fourth response pertains to behavioral theory.

A nurse says, When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name. Which statement is the best appraisal of this nurses comment? a. One descriptive research study rarely provides enough evidence to change practice. b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New research findings should be incorporated into clinical algorithms before using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.

a. One descriptive research study rarely provides enough evidence to change practice. Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flow charts to manage problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change.

Which of the following is an example of the ego defense mechanism of rationalization? a. Patient states that she beats her child because the child needs to learn to have self-control. b. Patient who is prejudiced against other races accuses others in the group of being bigots. c. Patient attends outpatient therapy to placate spouse but refuses to participate. d. Patient who experienced loss of a child refuses to think about or discuss the child's death.

a. Patient states that she beats her child because the child needs to learn to have self-control.

15. Roy's adaptive modes are: a. Physiological function, self-concept, role function, and interdependence b. Regulator, cognator, external, and informational c. Value, belief, thought, and emotion d. Adaptive response, ineffective response, output

a. Physiological function, self-concept, role function, and interdependence

If a 16-year-old female is severely anorexic, weighing 85 pounds and experiencing amenorrhea, hair loss, and cardiac abnormalities, according to Maslow's Hierarchy of Needs, which of the following needs is most dominant in this patient? a. Physiological. b. Safety and security. c. Belonging/Love. d. Self-actualization.

a. Physiological.

A family with extremely rigid boundaries will probably NOT have: a. Positive links to society b. Clear boundaries c. Strong parental coalition d. Efficient negotiation and task performance

a. Positive links to society A rigid family boundary is the one that attempts to hold on to all of it's members without allowing any outsiders in or out. They are closed. In the same way, there are groups in society that function in a similar way.

Which of the following is not a responsibility of the generalist nurse? a. Psychotherapy b. 24-hour care c. Milieu management d. Safety

a. Psychotherapy

19. According to Leininger, the important factors to study in cultural care include: a. Religious factors b. Nutritional factors c. Rest patterns d. Prenatal care

a. Religious factors

According to Leininger, the important factors to study in cultural care include: a. Religious factors b. Nutritional factors c. Rest patterns d. Prenatal care

a. Religious factors

10. In King's theory, a set of behaviors expected of a person occupying a certain position is called a: a. Role b. Perception c. Transaction d. Developmental position

a. Role

10. In King's theory, a set of behaviors expected of a person occupying a certain position is called a: a. Role b. Perception c. Transaction d. Developmental position

a. Role

As they are walking down the hall, the nurse and client are discussing their favorite movies. This is an example of: a. Social communication b. Therapeutic communication c. Inappropriate communication d. Lack of communication

a. Social communication

A psychiatric and mental health advanced practice nurse has had several meetings with a therapy group. On this particular occasion it is noted that members seem angry with the nurse and each other. They seem to be competing with each other to see who can refrain from breaking the silence longest. Which stage of group development do these behaviors signify? a. Storming b. Norming c. Performing d. Mourning

a. Storming Group development stages (Tuckman, 1965) 1. Forming (orientation)—Group leader is more directive and active, members look to leader for structure and approval. Leader describes group contract (i.e., goals, confidentiality, and communication rules), encourages interaction among group, and maintains working level of anxiety. Members develop initial roles. 2. Storming—Conflict develops regarding control, power, and authority. Anxiety increases and resistance may occur as evidenced by client absence, shared silence, excessive dependency on leader, scapegoating, excessive hostility toward leader, formation of subgroups and acting out. Leader encourages healthy expression of anger. 3. Norming (cohesiveness stage)—Members express positive feelings toward one another and feel strongly attracted to group. Self-disclosure occurs and new roles are adopted. 4. Performing (working phase)—Leader's activity decreases and usually consists of keeping the group on course or dealing with resistance of group and individuals within. Responsibility for group is more equally shared. Anxiety of group is decreased, and energy is channeled to completing tasks. 5. Mourning (termination)—Begins during first phase but is most acutely felt in closed group when it approaches end and in open group when members or leaders leave. Leaders encourage discussion of ending and expression of pain and loss experienced in grieving process. Members may try to avoid, experience anxiety, anger, or regression; they should also be encouraged to reminisce, evaluate, and experience sense of accomplishment and give feedback to one another (Lasalle & Lasalle, 1991)

In working with the family, the nurse finds that the child is waking many times during the night and climbing into the parents' bed. Which of the following would the nurse probably NOT use as an intervention in this situation? a. Suggesting that one of the parents sleep in the child's room so everyone can get a good night's sleep b. Encouraging the parents to work together to set limits on the child's sleeping in their bed c. Asking the parents to talk together about how they will handle the situation when the child wakes up in the night d. Encouraging each member of the family to talk about his/her feelings in the matter

a. Suggesting that one of the parents sleep in the child's room so everyone can get a good night's sleep

Leroy Jones was committed to an inpatient psychiatric unit because of hallucinations that have not been controlled by oral medications prescribed on an outpatient basis. In the hospital, Mr. Jones has been prescribed I.M. Prolixin. When the nurse brings the first injection, Mr. Jones refuses the medication. What is the nurse's best immediate response in this situation? a. Talk with Mr. Jones about his objections to the medication. b. Tell Mr. Jones that he cannot refuse the medication since it is necessary for his treatment. c. Call his doctor and tell him/her that Mr. Jones has refused the medication. d. Call an emergency team to restrain Mr. Jones while the medication is being given.

a. Talk with Mr. Jones about his objections to the medication.

Which of the following behaviors would indicate a good client response to a nursing action? a. The client's body is noticeably less tense and he or she has stopped pacing. b. The client stops interacting with others on the unit. c. The client states "If I don't do what people want they won't like me." d. The client refuses to listen to feedback from other members of the community.

a. The client's body is noticeably less tense and he or she has stopped pacing.

An experienced nurse says to a new graduate, When youve practiced as long as I have, you will instantly know how to take care of psychotic patients. What is the new graduates best analysis of this comment? Select all that apply. a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings must be continually integrated into a nurses practice to provide the most effective care. c. Experience provides mental health nurses with the tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients needs.

a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings must be continually integrated into a nurses practice to provide the most effective care. Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.

Which of the following is most true about a psychiatric and mental health advanced practice nurse who testifies in court on behalf of a child who has been sexually abused? a. The nurse is functioning as an advocate for the child. b. The nurse is functioning as a case manager for the child. c. The nurse is exceeding her capabilities as a psychiatric and mental health advanced practice nurse. d. The nurse is functioning as a Psychiatric Liaison Nurse.

a. The nurse is functioning as an advocate for the child. Client Advocacy: Definition—interceding on behalf of clients who are unable to speak or act for themselves or are unaware of available options • Examples 1. Informing clients about treatment alternatives 2. Presenting information to the treatment team 3. Helping clients enter and navigate the healthcare system 4. Testifying on behalf of clients in court 5. Promoting respect for mentally ill in policy and law

A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet training and shouts, No! when given direction. What do you think is wrong? Select the nurses best reply. a. This is normal for your childs age. The child is striving for independence. b. The child needs firmer control. Punish the child for disobedience and say, No. c. There may be developmental problems. Most children are toilet trained by age 2 years. d. Some undesirable attitudes are developing. A child psychologist can help you develop a remedial plan.

a. This is normal for your childs age. The child is striving for independence. These negative behaviors are typical of a child around the age of 2 years whose developmental task is to develop autonomy. The incorrect options indicate the childs behavior is abnormal.

If the psychiatric and mental heath nurse delegates a task to an UAP who states she has no traning in the task and does not feel comfortable doing it, the most appropriate response is to: a. delegate the task to someone else. b. report the UAP to a supervisor. c. assure the UAP that the task is easy. d. tell the UAP that you will check in frequently.

a. delegate the task to someone else.

A patient who has had multiple arrests for driving under the influence of alcohol has agreed to begin treatment with disulfiram. Patient education should include advising the patient that: a. drinking alcohol may result in severe illness. b. the patient should avoid drinking. c. the patient may experience hallucinations. d. the patient must abstain from drinking for one week prior to initiating treatment.

a. drinking alcohol may result in severe illness. If a patient has agreed to begin treatment with disulfiram, the patient should be aware that drinking alchohol may result in severe illness. Patients must abstain from drinking for 12 hours before initiating treatment. Disulfuram interferes with the breakdown of acetaldehyde from ethanol, so the acetalaldehyde level increases, resulting in a syndrome that can include flushing, head, and neck pain, severe nausea and vomiting, third, excessive perspiration, tachycardia, hyperventilation, weakness, and blurred vision. Some people may develop more severe symptoms, such as myocardial infarction, acute heart failure, and/or respiratory depression.

A 4- year-old child grabs toys from siblings, saying, I want that toy now! The siblings cry, and the childs parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the childs behavior as a product of impulses originating in the: a. id. b. ego. c. superego. d. preconscious.

a. id. The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the parents wrath. The superego would oppose the impulsive behavior as not nice. The preconscious is a level of awareness.

If the psychiatric and mental health nurse overhears other staff beginning to discuss difficulties caring for an unnamed patient in the staff dining room where other staff are present, the nurse should: a. intervene to tell staff that their comments can be overheard. b. reprimand the staff for violating privacy. c. take no action as the patient was unnamed. d. report the violation of privacy to a supervisor.

a. intervene to tell staff that their comments can be overheard.

When utilizing sensory stimulation therapy (SST) to improve cognition in a patient with dementia, it is important to choose sensory input that is: a. meaningful to the patient. b. identified through testing. c. easy to demonstrate. d. beneficial to multiple patients.

a. meaningful to the patient. If utilizing sensory stimulation therapy (SST) to improve cognition in a patient with dementia, it is important to choose sensory input that is meaningful to the patient. For example, the psychiatric and mental health nurse may show the patient family pictures and talk with the patient about the family, encouraging the patient to retrieve memories, or may play music that the patient has previously enjoyed. Certain smells, such as perfume of food smells, may also be used to elicit memories.

An advanced practice nurse determines a group of patients would benefit from therapy in which peers and interdisciplinary staff all have a voice in determining the level of the patients privileges. The nurse would arrange for: a. milieu therapy b. cognitive therapy c. short-term dynamic therapy d. systematic desensitization

a. milieu therapy Milieu therapy is based on the idea that all members of the environment contribute to the planning and functioning of the setting. The other therapies are all individual therapies that do not fit the description.

An example of primary prevention is: a. providing parenting classes for prospective parents. b. referring patients for treatment. c. conducting ongoing assessment of high-risk patients. d. monitoring effectives of treatment and services.

a. providing parenting classes for prospective parents. An example of primary prevention is providing parenting classes for prospective parents because the goal is to prevent issues, such as abuse and neglect, by providing education and support. Primary prevention goals are to identify high-risk populations and to intervene in order to decrease risk or to minimize negative consequences. Other examples of primary prevention include teaching mental health concepts to community members, providing education on dealing with life transitions, and educating people about the negative effects of alcohol and drugs.

A nurse uses Maslows hierarchy of needs to plan care for a psychotic patient. Which problem will receive priority? The patient: a. refuses to eat or bathe. b. reports feelings of alienation from family. c. is reluctant to participate in unit social activities. d. needs to be taught about medication action and side effects.

a. refuses to eat or bathe. The need for food and hygiene is physiological and therefore takes priority over psychological or meta-needs in care planning.

Which patient statements identify qualities of nursing practice with high therapeutic value? (Select all that apply.) My nurse: a. talks in language I can understand. b. helps me keep track of my medications. c. is willing to go to social activities with me. d. lets me do whatever I choose without interfering. e. looks at me as a whole person with different needs.

a. talks in language I can understand. b. helps me keep track of my medications. e. looks at me as a whole person with different needs. Each correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez-faire attitude on the part of the nurse, when the nurse should instead provide thoughtful feedback and help patients test alternative solutions or violate boundaries.

If a psychiatric and mental health nurse is giving a series of classes about psychotropic drugs and symptom management to a group of patients with bipolar disease, this type of group would be classified as: a. teaching b. supportive therapy c. self-help d. task

a. teaching

If a family member of a patient asks the psychiatric and mental health nurse what constitutes probable cause for involuntary commitment, the best response is: a. "You should ask an attorney about that" b. "The person is a threat to herself or others" c. "The person is uncooperative with the family" d. "The person is no longer able to work and is homeless"

b. "The person is a threat to herself or others"

Which of the following is an example of giving a broad opening as a therapeutic communication technique? a. "What seemed to lead up to your panic attack" b. "What would you like to discuss this morning?" c. "I notice that you are wringing your hands" d. "I understand what you are saying"

b. "What would you like to discuss this morning?"

9. Imogene King's theory of nursing is: . a. A theory of personal systems b. A theory of goal attainment c. A theory of adaptation d. A behavioral systems theory

b. A theory of goal attainment

Which of the following is NOT true? a. Milieu therapy implies that all activity is therapeutic. b. A therapeutic environment cannot exist without community meetings. c. Token communities use privileges to reward appropriate behavior. d. The physical environment is an important part of the milieu.

b. A therapeutic environment cannot exist without community meetings. Milieu therapy—scientific planning of the social and physical environment so that every interaction and activity is therapeutic

A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when given directions. Using Freuds stages of psychosexual development, a nurse would assess the childs behavior is based on which stage? a. Oral b. Anal c. Phallic d. Genital

b. Anal In Freuds stages of psychosexual development, the anal stage occurs from age 1 to 3 years and has, as its focus, toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1 year, the phallic stage occurs between 3 and 5 years, and the genital stage occurs between 13 and 20 years.

When the nurse asks potentially suicidal clients to relinquish any sharp objects they have in their possession, which ethical principle is being utilized? a. Autonomy b. Beneficence c. Nonmaleficence d. Justice

b. Beneficence a. Autonomy—individuals are respected for themselves and should have control over their own choices whether or not these are in their best interest or agree with our opinions. If someone decides what is best for another it is termed paternalism. Children, the mentally retarded, and the mentally ill are often thought not to be competent enough to be autonomous. b. Beneficence—promoting the good of others and preventing them from harm c. Nonmaleficence—responsibility to do no harm; many suggest that it is more important to avoid harm than to do good. Some interpret it as a person's duty to prevent someone else from harming a third person. d. Justice—distribution of resources, benefits and burdens fairly among members of a society

18. The main concept in Leininger's Theory of Culture Care Diversity and Universality is that: a. Culture is the learned, shared, and transmitted values, beliefs, norms, and lifeways of a group. b. Care is the essence of nursing. c. There is diversity and universality in every culture. d. Nurses should seek to know the universality of Transcultural nursing.

b. Care is the essence of nursing

b. Care is the essence of nursing.

12. According to Rogers, which of the following does NOT describe the human being? a. Characterized by the capacity for abstraction and imagery b. Characterized by the capacity for reversibility and multi-directionality c. Characterized by the capacity for language and thought d. Characterized by the capacity for sensation and emotion

b. Characterized by the capacity for reversibility and multidirectionality

A psychiatric and mental health advanced practice nurse working as a group psychotherapist makes observations about the effective way members handled a participant who was acting out in the group. What type of leadership style does this nurse exhibit? a. Autocratic b. Democratic c. Laissez faire d. Materialistic

b. Democratic Style of leader a. Autocratic—leader is in charge and controls. b. Democratic—leader shares responsibility with members. c. Laissez Faire—leader is nondirective.

A patient who lost his job because of his inability to complete his work tasks yells at this psychiatric and mental health nurse that she is "mean and stupid" and ruining his life. Which ego defense mechanism is the patient using? a. Identification. b. Displacement. c. Sublimation. d. Projection.

b. Displacement.

In an assertiveness group, a nurse encourages a client to role play a distressing interaction she has had repeatedly with her mother-in-law. The nurse has the client play herself while the nurse plays the mother-in-law. Which methods of learning are exemplified in this situation? a. Lecture b. Experiential c. Self-instruction d. Audio presentation

b. Experiential

A nurse who is unaware of standards of care and fails to provide care that results in harm to the client is not subject to being charged with malpractice. a. True b. False

b. False

21. The two most famous psychoanalytic theorists are: a. Homey and Adler b. Freud and Jung c. Kohlberg and Gilligan d. Adler and Sullivan

b. Freud and Jung

A psychiatric and mental health advanced practice nurse is called in as a consultant to a nursing home seeking to enhance the morale of its residents. The psychiatric and mental health advanced practice nurse decides to begin an ongoing Resocialization Group since many of the clients have been pretty much isolated from others in their previous living situations. How would such a group be classified? a. Homogeneous, closed ended b. Heterogeneous, open ended c. Open ended, task d. Closed ended, psychotherapy

b. Heterogeneous, open ended Descriptors of groups 1. Homogeneous—members chosen from preselected criteria, e.g., sexually abused women 2. Heterogeneous—mix of individuals regarding diagnosis, sex, age, etc. 3. Mixed—sharing an essential feature, i.e., same diagnosis but varying sex, age, etc. 4. Closed—after group begins, no new members are added 5. Open—members and leaders change

Which of the following ethnic groups is most likely to believe that mental illness is the result of a loss of self-control of punishment for bad behavior> a. Mexican Americans b. Japanese Americans c. Puerto Ricans. d. Chinese

b. Japanese Americans

Which of the following is an example of elder neglect? a. Insulting, name calling. b. Lack of dentures. c. Physically restraining the patient. d. Misusing patient's financial resources.

b. Lack of dentures.

Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as In Our Own Voice (IOOV)? a. American Psychiatric Association (APA) b. National Alliance on Mental Illness (NAMI) c. United States Department of Health and Human Services (USDHHS) d. North American Nursing Diagnosis Association International

b. National Alliance on Mental Illness (NAMI) Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. NANDA-I defines approved nursing diagnoses. The APA publishes the DSM 5. The USDHHS regulates and administers health policies.

The nurse suggests that if the child cannot sleep, that he play a cassette tape on his recorder and try to listen to as many cassettes as he can, making sure that he gets out of bed, so that he does not fall asleep in the process. This intervention is known as: a. Homework b. Paradoxical prescription c. Sculpting d. Triangling

b. Paradoxical prescription Experiential activities a. Homework—tasks assigned by the therapist, which when enacted by the family members further the therapeutic process; completion or failure to complete the task is discussed at the next session. b. Paradoxical prescription—instructions are given to perform the opposite of what is intended in order to produce change. c. Sculpting—enactment of an experience with words omitted that when "frozen'' is a symbolic representation of the family members' relationships; by asking a family member to rearrange the "sculpture," change is modeled.

Sobbing and grunting would be forms of what kind of nonverbal messages? a. Kinesics b. Paralanguage c. Proxemics d. Appearance

b. Paralanguage 1. Kinesics—body motion, i.e., facial expression, posture, position of arms and legs, eye contact, touch 2. Paralanguage—tone of voice, inflection, emphasis, pauses, sighs, laughter 3. Proxemics—use of personal space, territoriality, i.e., backing away or moving closer, selection of a particular seating arrangement 4. Appearance—personal image, i.e., clothing, makeup, hair, beard

A nurse brings a client the Clozapine medication that she has been taking. The client does not look well and complains of a sore throat. The nurse notes that her temperature is elevated and concludes that the client has an upper respiratory infection. After giving the client the medication, she states that she will ask the doctor for a PRN aspirin order. The doctor orders a CBC and determines that the client has agranulocytosis. At which step of the nursing process did this nurse's problem begin? a. Diagnosis b. Planning c. Intervention d. Revision of plan

b. Planning Planning provides goals and actions that are specific, individualized and collaborative.

Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills. Select the best response by the student interested in psychiatric nursing. a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of patients problems. b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. Im challenged by those situations. c. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate. d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical nurses. That appeals to me.

b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. Im challenged by those situations. The practice of psychiatric nursing requires a different set of skills than medical surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice, not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain.

Which research evidence would most influence a group of nurses to change their practice? a. Expert committee report of recommendations for practice b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway

b. Systematic review of randomized controlled trials Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is Level A and provides the strongest evidence for changing practice. Expert committee recommendations and descriptive studies lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed.

Which of the following is NOT true of the Resolution or Termination phase of the nurse-client relationship? a. Preliminaries for this phase are introduced in the Orientation phase. b. Talk about the impending separation should be avoided so that the client does not decompensate. c. The client should be encouraged to review his progress and goals. d. The nurse should model appropriate expression of feelings.

b. Talk about the impending separation should be avoided so that the client does not decompensate.

Terry Barr is describing to the nurse that he sees himself as extremely patient and laid back. As he speaks, he drums his fingers on the arm of the chair. What can the nurse infer from this communication? a. Terry is obviously lying and trying to fool the nurse. b. Terry's verbal and nonverbal communications are not congruent. c. Terry is in touch with his feelings and expressing them openly and honestly. d. Terry's culture is interfering with his ability to communicate.

b. Terry's verbal and nonverbal communications are not congruent.

A Middle Eastern client comes to the nurses' station and stands face to face less than a foot away from the nurse. The nurse should be aware that: a. The client is becoming aggressive and trying to intimidate the nurse. b. The client has a different sense of personal space than the predominant American culture. c. The client is testing the nurse and needs to be confronted. d. The client is being seductive with the nurse.

b. The client has a different sense of personal space than the predominant American culture.

Members of a therapeutic community decide at a community meeting that it is not right for two extremely demanding clients to determine the activities for the entire group. This decision can best be classified under which ethical perspective? a. Egoism b. Utilitarianism c. Deontology d. Formalism

b. Utilitarianism

According to Piaget's stages of development, adjusting the schemas in response to new information is a process called: a. assimilation. b. accommodation. c. acclimation. d. actuation.

b. accommodation.

If a patient who has an advance directive stating specifically that the patient does no want to be resuscitated attempts suicide by hanging and is found by a family member but is nonresponsive after being cut down, the correct action is to: a. allow the patient to die. b. attempt to resuscitate the patient. c. attempt resuscitation while contacting legal counsel. d. ask family member for guidance regarding resuscitation.

b. attempt to resuscitate the patient.

A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction by a patient indicates this nurse is effective? A patient reports feeling: a. distrustful of others. b. connected with others. c. uneasy about the future. d. discouraged with efforts to improve.

b. connected with others. A patient is likely to respond to caring with a sense of connectedness with others. The absence of caring can make patients feel distrustful, disconnected, uneasy, and discouraged.

A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a mental illness? The patient: a. describes coping and relaxation strategies used when feeling anxious. b. describes mood as consistently sad, discouraged, and hopeless. c. can perform tasks attempted within the limits of own abilities. d. reports occasional problems with insomnia.

b. describes mood as consistently sad, discouraged, and hopeless. A patient who reports having a consistently negative mood is describing a mood alteration. The incorrect options describe mentally healthy behaviors and common problems that do not indicate mental illness.

A nurse uses Peplaus interpersonal therapy while working with an anxious, withdrawn patient. Interventions should focus on: a. changing the patients perceptions about self. b. improving the patients interactional skills. c. using medications to relieve anxiety. d. reinforcing specific behaviors.

b. improving the patients interactional skills. The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Changing the patients perceptions about his- or herself would be appropriate for cognitive therapy. Reinforcing specific behaviors would be used in behavioral therapy. Using medications is the focus of biological therapy.

A male patient has been following a female patient and claims that the female is "flirting" with him and using "sexual innuendos", however, the female patient complains that the male patient is harassing and scaring her, and staff observations concur with the female patient's complaints. The male patient is most likely exhibiting: a. introjection b. projection c. compensation d. identification

b. projection

Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will: a. deny suicidal ideation. b. report a sense of well-being. c. take medications as prescribed. d. attend clinic appointments on time.

b. report a sense of well-being. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model rather than recovery.

Jim, a 14-year-old client, is discussing his drug abuse problem with his nurse. When she asks him to clarify the types of substances he routinely uses, he responds by saying "How about you, have you ever used marijuana?" How should the nurse respond? a. "That's none of your business, Jim, now let's get back to your problem." b. "Why, yes I have, but I was older and more responsible." c. "As you recall, Jim, we agreed to work on your problems with drugs in our sessions. I wonder what concerns you about whether I have used drugs." d. "That's an inappropriate question. I don't have to answer that and wonder why you'd even ask it."

c. "As you recall, Jim, we agreed to work on your problems with drugs in our sessions. I wonder what concerns you about whether I have used drugs."

Which of the following statements would the nurse NOT make in negotiating a contract with the client within the nurse-client relationship? a. "I would like to meet with you on a once a week basis while we are trying to resolve this crisis." b. "We need about 10 sessions to work on this problem." c. "I have malpractice insurance in case there is any problem." d. "We will not be exploring your past, but only looking at things that are going on now."

c. "I have malpractice insurance in case there is any problem."

8. Nurse A, who utilizes Orem's theory, is caring for Patient B. Patient B requires a complete bed bath. When charting, Nurse A will describe Patient B's inability to provide complete self- care as: a. A health deviation b. Illness c. A self-care deficit d. A diagnostic indication

c. A self-care deficit

8. Nurse A, who utilizes Orem's theory, is caring for Patient B. Patient B requires a complete bed bath. When charting, Nurse A will describe Patient B's inability to provide complete selfcare as: a. A health deviation b. Illness c. A self-care deficit d. A diagnostic indication

c. A self-care deficit

Prescription writing is: a. A standard of practice granted to nurses by the American Medical Association b. A standard of practice granted to all nurses by the American Nurses Association c. A standard of practice granted to advanced practice nurses by federal and state law d. The singular function of advanced practice psychiatric nurse practitioners

c. A standard of practice granted to advanced practice nurses by federal and state law d. The singular function of advanced practice psychiatric nurse practitioners

A patient comments, I never know the right answer and My opinion is not important. Using Eriksons theory, which psychosocial crisis did the patient have difficulty resolving? a. Initiative versus Guilt b. Trust versus Mistrust c. Autonomy versus Shame and Doubt d. Generativity versus Self-Absorption

c. Autonomy versus Shame and Doubt These statements show severe self-doubt, indicating that the crisis of gaining control over the environment is not being successfully met. Unsuccessful resolution of the crisis of Initiative versus Guilt results in feelings of guilt. Unsuccessful resolution of the crisis of Trust versus Mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of Generativity versus Self-Absorption results in self- absorption that limits the ability to grow as a person.

12. According to Rogers, which of the following does NOT describe the human being? a. Characterized by the capacity for abstraction and imagery b. Characterized by the capacity for reversibility and multidirectionality c. Characterized by the capacity for language and thought d. Characterized by the capacity for sensation and emotion

c. Characterized by the capacity for language and thought

22. According to Freudian theory, unconscious actions or thoughts to protect the ego from anxiety are called: a. Freudian slips b. Unconscious motivation c. Defense mechanisms d. Transference

c. Defense mechanisms

To which of the following values would the nurse working within the therapeutic milieu probably NOT subscribe? a. The need for accessible team members and cooperative working relationships b. Empowerment of clients and staff to make decisions that affect the group c. Emphasis on the individual at the expense of the group d. Encouragement of risk taking and growth

c. Emphasis on the individual at the expense of the group

Susan, a new graduate, has recently joined the staff of an inner-city mental health clinic. She is shocked at some of the parenting behaviors of her initial client and tells other clinicians that she thinks her client should know better. How could her attitude be labeled? a. Stereotyping b. Culturally relativistic c. Ethnocentric d. Culturally deprived

c. Ethnocentric Ethnocentricism—judging others' behavior by the values of our own culture Cultural relativism—attempting to understand the behavior of others within the context of their own culture Stereotyping—overgeneralizations based on culture or ethnicity; may occur unconsciously

A 16-year-old male admitted to the mental health unit for alcohol use disorder has repeatedly failed to maintain sobriety and consistently missed support meetings while parting with his friends. What is the most likely reason that the patient is not compliant with treatment? a. Disturbance of body image. b. Embarrassment. c. Fear of being different from peers. d. Guild about illness.

c. Fear of being different from peers.

Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would a nurse include in the treatment plan? a. Ignore the child for using silence. b. Have the child observe others talking. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques, then coax speech.

c. Give the child a small treat for speaking. Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards to reinforce speech. Ignoring the child will not change the behavior. Having the child observe others describes modeling. Teaching relaxation techniques and then coaxing speech is an example of systematic desensitization.

A nursing group has convened to make decisions about renovation plans for a psychiatric unit. One of the members is discussing how little the hospital ever pays attention to input from nursing staff. Which member role is this participant exhibiting? a. Maintenance role b. Task role c. Individual role d. Gatekeeper role

c. Individual role Roles of members a. Building or maintenance roles—contribute to group process and functioning, e.g., encourager, gatekeeper, harmonizer. b. Task roles—emphasize completing the task, e.g., initiator, opinion giver, evaluator, energizer, information seeker. c. Individual roles—not related to group tasks or maintenance and may inhibit group, e.g., aggressor, dominator, helpseeker, playboy, special-interest pleader, blocker.

Carmine d'Angelo is a 29-year-old client with a diagnosis of Schizophrenia, Paranoid Type. When he is denied off-unit privileges at a community meeting, he becomes hostile and accuses certain community members of "having it in for me." What would be the most appropriate response of the nurse? a. Ignore the behavior because it is inappropriate. b. Confront Mr. D'Angelo with his inappropriate behavior and put him in seclusion. c. Meet with him at their usual time and clarify his misperceptions. d. Ask the community members that he accused to have nothing more to do with him.

c. Meet with him at their usual time and clarify his misperceptions

A psychiatric and mental health advanced practice nurse notes that members of her therapy group have become most supportive of one another and very attached to the group. Which stage of group development do these behaviors signify? a. Forming b. Storming c. Norming d. Performing

c. Norming Group development stages (Tuckman, 1965) 1. Forming (orientation)—Group leader is more directive and active, members look to leader for structure and approval. Leader describes group contract (i.e., goals, confidentiality, and communication rules), encourages interaction among group, and maintains working level of anxiety. Members develop initial roles. 2. Storming—Conflict develops regarding control, power, and authority. Anxiety increases and resistance may occur as evidenced by client absence, shared silence, excessive dependency on leader, scapegoating, excessive hostility toward leader, formation of subgroups and acting out. Leader encourages healthy expression of anger. 3. Norming (cohesiveness stage)—Members express positive feelings toward one another and feel strongly attracted to group. Self-disclosure occurs and new roles are adopted. 4. Performing (working phase)—Leader's activity decreases and usually consists of keeping the group on course or dealing with resistance of group and individuals within. Responsibility for group is more equally shared. Anxiety of group is decreased, and energy is channeled to completing tasks. 5. Mourning (termination)—Begins during first phase but is most acutely felt in closed group when it approaches end and in open group when members or leaders leave. Leaders encourage discussion of ending and expression of pain and loss experienced in grieving process. Members may try to avoid, experience anxiety, anger, or regression; they should also be encouraged to reminisce, evaluate, and experience sense of accomplishment and give feedback to one another (Lasalle & Lasalle, 1991)

A 68-year-old woman with increasing confusion is to be assessed for dementia relayed to Alzheimer's. Which of the following would generally preclude the use of the Mini-Mental Status Exam (MMSE) to measure cognitive impairment? A. Patient is highly intelligent and well educated b. Patient is bilingual in English and Spanish c. Patient attended school for only 5 years. d. Patient has Parkinson's disease.

c. Patient attended school for only 5 years.

Susan finds herself frustrated when her client uses some money she receives to buy winter coats for her nephews instead of saving it to buy a car so she could commute to a better job. Susan's client is demonstrating which cultural values? a. Present oriented, individualistic b. Future oriented, individualistic c. Present oriented, collectivist d. Future oriented, collectivist

c. Present oriented, collectivist

The parent of a child diagnosed with schizophrenia tearfully asks a nurse, What could I have done differently to prevent this illness? Select the nurses most caring response. a. Although schizophrenia is caused by impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance. b. Most of the damage is done, but there is still hope. Changing your parenting style can help your child learn to cope more effectively with the environment. c. Schizophrenia is a biological illness with similarities to diabetes and heart disease. You are not to blame for your childs illness. d. Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.

c. Schizophrenia is a biological illness with similarities to diabetes and heart disease. You are not to blame for your childs illness. Patients and families need reassurance that the major mental disorders are biological in origin and are not the fault of parents. Knowing the biological nature of the disorder relieves feelings of guilt over being responsible for the illness. The incorrect responses are neither wholly accurate nor reassuring; they fall short of being reassurin

A person received an invitation to be in the wedding of a friend who lives across the country. The individual is afraid of flying. What type of therapy should the nurse recommend? a. Psychoanalysis b. Milieu therapy c. Systematic desensitization d. Short-term dynamic therapy

c. Systematic desensitization Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy are aimed at uncovering conflicts. Milieu therapy involves environmental factors.

Which of the following statements is true concerning communication? a. Some behavior is random and does not communicate a message. b. The message sent by the sender is obvious and does not have to be interpreted by the receiver. c. The main goal of communication is understanding. d. The only real form of communication is the verbal message, either written or spoken.

c. The main goal of communication is understanding.

Whose responsibility is it to deal with transference issues in group therapy? a. The nurse b. The group members c. The nurse and the group members d. The group member who is involved in the transference

c. The nurse and the group members

Which of the following best summarizes the family therapist's position on how mental illness occurs? a. The symptomatic person is the innocent victim of other members of the family. b. If other family members are given education and support, they can help the symptomatic person. c. The symptomatic person is the result of pathology throughout the entire family system. d. If other family members set limits and confront the symptomatic person with reality, they can help him or her.

c. The symptomatic person is the result of pathology throughout the entire family system.

In a session with the nurse, the client begins to whine about his inability to complete his assigned task from the previous session. The nurse responds by scolding him for his failure. This is an example of: a. Transference b. Countertransference c. Transference and Countertransference d. Goal setting

c. Transference and Countertransference Transference-client experiences emotional reaction towards nurse based on unconscious feelings that originated in past relationships. Nursing response is to confront distortions of reality gently in order to facilitate client selfawareness. Countertransference—nurse responds to client with feelings from own earlier conflicts. Nurse must increase self-awareness and access supervision to assist in dealing with client more effectively.

A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of: a. the degree of conformity of the individual to societys norms. b. the degree to which an individual is logical and rational. c. a continuum from mentally healthy to unhealthy. d. the rate of intellectual and emotional growth.

c. a continuum from mentally healthy to unhealthy. Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to societys norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness.

The four nonverbal behaviors that are associated with active listening include sitting: a. beside the patient, maintaining open posture, leaning back comfortably, and maintaining eye contact. b. across from the patient, maintaining closed posture, leaning forward, and avoiding eye contact. c. across from the patient, maintaining open posture, leaning forward, and maintaining eye contact. d. beside the patient, maintaining open posture, leaning forward, and maintaining eye contact.

c. across from the patient, maintaining open posture, leaning forward, and maintaining eye contact.

A patient who has developed sudden onset of blindness with no identifiable physical cause seems completely unconcerned about the deficit. This suggests: a. somatization disorder b. pain disorder c. conversion disorder d. body dysmorphic disorder

c. conversion disorder Conversion disorder: Sudden onset of sensory or motor deficits without identifiable physical cause. La belle indifference (unconcern) is common. Somatization disorder: Combination of multiple physical symptoms, usually involving pain and sexual, gastrointestinal and/or pseudoneurological symptoms. Pain disorder: Pain that is unrelieved by analgesia and is affected by psychological status. Body dysmorphic disorder: preoccupation with imagined physical defect or exaggeration of a physical defect, such as belief that one's nose is hideous, and often seeking surgical correction.

A patient who has been diagnosed with bipolar disorder but has consistently refused to take medications or attend therapy, insisting that he has been misdiagnosed and has only "mild stress", is probably experiencing: a. dissociation. b. resistance. c. denial. d. suppression.

c. denial.

A psychiatric and mental health nurse has developed a successful strategy for working with a difficult patient and would like to share this strategy with other team members. The best method is likely to: a. ask the supervisor to direct the team to use the strategy. b. write out the steps to the strategy and give to each team member. c. discuss the strategy during a team meeting. d. ask the physician to write the strategy as a physician order.

c. discuss the strategy during a team meeting.

Patients with bipolar disorder are often treated with interpersonal and social rhythm therapy. This therapy helps patients: a. recognize triggers to mood changes b. manage stress c. establish consistent sleep and physical activity schedules d. cope with bipolar disorder

c. establish consistent sleep and physical activity schedules Interpersonal and social rhythm therapy helps patients with bipolar disorder establish consistent sleep and physical activity schedules. The patients utilize a self-monitoring instrument to monitor their daily activities, including their sleep patterns. Maintaining consistent patterns of activities and sleeping at the same time and for the same duration each night helps to reduce manic and depressive episodes.

A cognitive strategy a nurse could use to assist a very dependent patient would be to help the patient: a. reveal dream content. b. take prescribed medications. c. examine thoughts about being autonomous. d. role model ways to ask for help from others.

c. examine thoughts about being autonomous. Cognitive theory suggests that ones thought processes are the basis of emotions and behavior. Changing faulty learning makes the development of new adaptive behaviors possible. Revealing dream content would be used in psychoanalytical therapy. Taking prescribed medications is an intervention associated with biological therapy. A dependent patient needs to develop independence.

A group cognitive behavioral therapy (CBT) approach that focuses on relapse prevention for substance use disorders will likely: a. stress the importance of attending Alcoholics or Narcotics Anonymous meetings b. stress mindfulness and accepting oneself. c. help patients identify situations that make them vulnerable to relapse. d. advise patients to serve as mentors for each other.

c. help patients identify situations that make them vulnerable to relapse. A CBT approach that focuses on relapse prevention for drug use disorders will likely help patients identify situations that make them vulnerable to relapse. Therapy may include training in behavioral skills and the use of cognitive interventions to assist them to identify triggers or situations that result in relapse as well as to provide tools they can use if faced with a situation that is placing the patient at risk, such as when associates are engaging in addictive behavior.

The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will: a. describe feelings associated with loss and stress. b. meet own needs without considering the rights of others. c. identify healthy coping behaviors in response to stressful events. d. allow others to assume responsibility for major areas of own life.

c. identify healthy coping behaviors in response to stressful events. The patients ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors.

If a 30-year-old patient with paranoid and schizophrenia states he does not want his parents (who are paying for his care) to visit because he believes they are "possessed by devils", the psychiatric and mental health nurse should: a. ask the physician to intervene. b. allow the parents to visit. c. respect the patient's request. d. suggest the parents get a court order to allow visits.

c. respect the patient's request.

The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. A nurse supports the use of praise because, according to the Freudian theory, these qualities will likely be internalized and become part of the childs: a. id. b. ego. c. superego. d. preconscious.

c. superego. In the Freudian theory, the superego contains the thou shalts or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be easily retrieved with conscious effort.

Timmy, a 6-year-old, is accompanying his parents to a family therapy session to deal with his school phobia. Which of the following behaviors by the nurse would NOT constitute therapeutic communication skills with a child? a. "Let's pick out some toys from the closet to play with while I talk to your Mom and Dad." b. "What do you like best about school, Timmy? What do you like least?" c. "Tell me about the picture you drew of your family." d. "Is there something that makes you anxious about going to school, Timmy?''

d. "Is there something that makes you anxious about going to school, Timmy?''

Adrienne has just finished describing how devastated she was at the recent loss of her mother. Which of the following responses by the nurse would NOT be a barrier to therapeutic communication? a. "I know how you feel. I lost my mother recently, too." b. "Well, it's better to have loved and lost, if you know what I mean." c. "When did she die? Of what? Does anyone else in your family have that problem?" d. "It sounds like it's been a really tough period for you."

d. "It sounds like it's been a really tough period for you."

The parents of an autistic child consult a psychiatric and mental health advanced practice nurse about their failure to relate to their child. The nurse decides that some education would be helpful to this family in dealing with the problem. What could the family NOT expect to receive as a result of the nurse's teaching intervention? a. An objective perspective b. Decreased blame and guilt c. Clarification of expectations d. A solution to their problems

d. A solution to their problems

John Korman is a 36-year-old male recently admitted to a psychiatric unit. The nurse taking his history observes that his speech is slurred, and he states that he cannot remember where he has been for the past 12 hours, but the police who brought him in stated that he was arrested driving the wrong way on a one-way street. Which of the following items on the mental status exam would the nurse NOT mark "impaired"? a. Behavior b. Judgment c. Memory d. Affect

d. Affect

The spouse of a patient diagnosed with schizophrenia says, I dont understand why childhood experiences have anything to do with this disabling illness. Select the nurses response that will best help the spouse understand this condition. a. Psychological stress is actually at the root of most mental disorders. b. We now know that all mental illnesses are the result of genetic factors. c. It must be frustrating for you that your spouse is sick so much of the time. d. Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important.

d. Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important. Many of the most prevalent and disabling mental disorders have been found to have strong biological influences. Helping the spouse understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouses level of knowledge about the cause of the patients condition. Not all mental illnesses are the result of genetic factors. Psychological stress is not at the root of most mental disorders.

A participant at a community education conference asks, What is the most prevalent type of mental disorder in the United States? Select the nurses best response. a. Why do you ask? b. Schizophrenia c. Affective disorders d. Anxiety disorders

d. Anxiety disorders The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%.

Which of the following interventions would be labeled as an independent nursing intervention on a psychiatric unit? a. Giving medications b. Making discharge plans c. Deciding privileges d. Assuring safety

d. Assuring safety

The staff of a day treatment program have determined that all clients must participate in a group outing to a local museum because all of the staff want to see the exhibit. Two women clients in the group voice their opposition to visiting the museum because they do not wish to risk being identified as psychiatric clients by others in the community. The staff refuse to listen to their concerns and insist that they go on the trip, but do not describe any particular reason. Which adjective describes the type of goal planning evident in this situation? a. Specific b. Individualized c. Collaborative d. Authoritarian

d. Authoritarian

A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when given direction. The nurses counseling with the parent should be based on the premise that the child is engaged in which of Eriksons psychosocial crises? a. Trust versus Mistrust b. Initiative versus Guilt c. Industry versus Inferiority d. Autonomy versus Shame and Doubt

d. Autonomy versus Shame and Doubt The crisis of Autonomy versus Shame and Doubt is related to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus Mistrust is the crisis of the infant, Initiative versus Guilt is the crisis of the preschool and early school-aged child, and Industry versus Inferiority is the crisis of the 6- to 12-year-old child.

Which of the following disorders is frequently associated with sexual abuse and incest? a. Conduct disorder. b. Antisocial personality disorder. c. Bipolar disorder. d. Borderline personality disorder.

d. Borderline personality disorder. Borderline personality disorder is frequently associated with a history of neglect and abuse, especially sexual abuse and incest. Studies indicated to 20 to 70% of patients with borderline personality disorder report having experienced sexual abuse, but authorities believe the percentage is higher because of patients' reluctance to admit to having been victims of sexual abuse or incest. BPD is characterized by fear of abandonment, unstable interpersonal relationships, poor self-image, impulsivity, suicidal ideation/self-mutilating behavior, affective instability, poor anger control, feeling of emptiness, and dissociative reactions.

Alice Walsh is a 46-year-old admitted to a psychiatric unit with Major Depression. Her doctor prescribes an MAO inhibitor that she will be taking when she leaves the hospital in four days. Her nurse wants to teach her about the side effects of her medication, particularly the dietary restrictions. She prepares a 45-minute presentation that covers everything about the medication. Afterwards Mrs. Walsh seems confused and still cannot relate several essential facts about the medication. What is the best nursing response to the situation? a. Phone the doctor and suggest that Mrs. Walsh be placed on another medication with fewer restrictions. b. Realize that Mrs. Walsh will probably not be able to understand the essentials regarding her medication and teach a relative instead. c. Realize that Mrs. Walsh's depression is probably inhibiting her ability to learn and repeat the presentation in a few days when she is a little better. d. Break down the essential facts into a few brief sessions that can be repeated over the next several days and assess Mrs. Walsh's knowledge of the previous session before proceeding.

d. Break down the essential facts into a few brief sessions that can be repeated over the next several days and assess Mrs. Walsh's knowledge of the previous session before proceeding.

A psychiatric and mental health advanced practice nurse is the family therapist for a family whose youngest child is the identified patient. The child has been brought in for therapy because he has been doing poorly and acting out at school. How will the nurse begin the initial session with the family? a. By asking the child why he is doing poorly in school b. By asking the parents why they think he is doing poorly at school c. By asking each family member how they did in school d. By asking questions about the family in general

d. By asking questions about the family in general

Which of the following is NOT an accurate statement regarding client rights? a. Committed clients may petition the courts for release. b. Committed clients may demand an evaluation by any physician. c. Committed clients may not have letters restricted. d. Committed clients may not be hospitalized involuntarily.

d. Committed clients may not be hospitalized involuntarily.

16. The nurse who utilizes Roy's model in providing nursing care would first: a. Identify focal stimuli b. Manipulate focal stimuli c. Identify input and internal processes d. Conduct a first-level assessment

d. Conduct a first-level assessment

A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patients insurance form.Which resource should the nurse consult to discern the criteria used to establish this diagnosis? a. A psychiatric nursing textbook b. NANDA International (NANDA-I ) c. A behavioral health reference manual d. Diagnostic and Statistical Manual of Mental Disorders

d. Diagnostic and Statistical Manual of Mental Disorders The DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses on nursing diagnoses. A psychiatric nursing textbook or behavioral health reference manual may not contain diagnostic criteria.

A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult? a. U.S. Department of Health and Human Services b. Journal of the American Psychiatric Association c. North American Nursing Diagnosis Association International (NANDA-I) d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) The DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful information but are not the best resources for finding a description of the diagnostic criteria for a psychiatric disorder.

A patients history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patients needs are not met. Which aspect of mental health is a problem? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships

d. Fulfilling relationships The information provided centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.

A nurse listens to a group of recent retirees. One says, I volunteer with Meals on Wheels, coach teen sports, and do church visitation. Another laughs and says, Im too busy taking care of myself to volunteer. I dont have time to help others. These comments contrast which developmental tasks? a. Trust versus Mistrust b. Industry versus Inferiority c. Intimacy versus Isolation d. Generativity versus Self-Absorption

d. Generativity versus Self-Absorption Both retirees are in middle adulthood, when the developmental crisis to be resolved is Generativity versus Self-Absorption. One exemplifies generativity; the other embodies self- absorption. The developmental crisis of Trust versus Mistrust would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate the developmental crisis of Industry versus Inferiority would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted in the crisis of Intimacy versus Isolation would be emotional isolation and the ability to love and commit to oneself.

After a particularly difficult community meeting, the staff of a unit sit down and begin to talk about which clients were seated in close proximity and who agreed with whom on the issues that came up. What is the staff discussing? a. Gossip b. Rank and Status c. Group Content d. Group Process

d. Group Process Group dynamic issues according to Long and McMahon (1992) 1. Rank—position member holds in relation to other members of the group; members who participate frequently and actively usually rank high in the group and thus have greater influence on group behavior 2. Status—prestige given to certain positions or individuals in a group; members vie for status in group; may be due to member characteristics or behavior 3. Group content—what is said in a group, i.e., information discussed 4. Group process—activities in a group, i.e., how interactions occur among members, timing of interactions, roles of members, seating arrangements, tone of voice of members, and nonverbal behaviors 5. Sociogram—method of recording group process

A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of attending? a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world. b. Tell me why you felt you had to be hospitalized to receive treatment for your depression. c. You will feel better after we get some antidepressant medication started for you. d. Id like to sit with you a while so you may feel more comfortable talking with me.

d. Id like to sit with you a while so you may feel more comfortable talking with me. Attending is a technique that demonstrates the nurses commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are non-therapeutic.

A person tells a nurse, I was the only survivor in a small plane crash, but three business associates died. I got anxious and depressed and saw a counselor three times a week for a month. We talked about my feelings elated to being a survivor, and now Im fine, back to my old self. Which type of therapy was used? a. Milieu therapy b. Psychoanalysis c. Behavior modification d. Interpersonal therapy

d. Interpersonal therapy Interpersonal therapy returns the patient to the former level of functioning by helping the patient come to terms with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy. Psychoanalysis calls for a long period of exploration of unconscious material. Behavior modification focuses on changing a behavior rather than helping the patient understand what is going on in his or her life.

A patient tells a nurse, I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems. Select the nurses best response. a. Comparing yourself with others has no real advantages. b. Why do you blame yourself for having a psychiatric illness? c. Mental illness affects 50% of the adult population in any given year. d. It sounds like you are concerned that others dont experience the same challenges as you.

d. It sounds like you are concerned that others dont experience the same challenges as you. Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the challenges of mental illness. The correct response also demonstrates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year.

How should a member terminating be handled in groups? a. Little attention should be paid to it since this person is now ready to leave and other members are more in need of assistance. b. Members may discuss it if they wish, but should be allowed to avoid it if it causes anxiety. c. Members should be encouraged to focus only on the positive aspects of the leaving so that negative feelings do not arise. d. Members should be encouraged to express whatever feelings arise in the process of leaving.

d. Members should be encouraged to express whatever feelings arise in the process of leaving.

An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patients perception that his or her nurse is caring? a. My nurse always asks me which type of juice I want to help me swallow my medication. b. My nurse explained my treatment plan to me and asked for my ideas about how to make it better. c. My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon. d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not alone.

d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not alone. Caring evidences empathic understanding, as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The incorrect options give examples of statements that demonstrate advocacy or giving advice.

An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult has needs related to which of Freuds stages of psychosexual development? a. Latency b. Phallic c. Anal d. Oral

d. Oral According to Freud, fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in a difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty.

Which of the following is an appropriate intervention for a nursing diagnosis of "disturbed though process?" a. Encourage patient discuss delusions. b. Give detailed explanations about unit procedures. c. Keep a dim light on during the night to comfort the patient. d. Orient the patient to reality frequently and in various ways.

d. Orient the patient to reality frequently and in various ways.

In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. This is a psychiatric hospital. Craziness is what we are all about. b. Lets all show acceptance of this patient by wearing lots of makeup too. c. Your comments are inconsiderate and inappropriate. Keep the report objective. d. Our patients need our help to learn behaviors that will help them get along in society.

d. Our patients need our help to learn behaviors that will help them get along in society. Accepting patients needs for self-expression and seeking to teach skills that will contribute to their well-being demonstrate respect and are important parts of advocacy. The oncoming nurse needs to take action to ensure that others are not prejudiced against the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show compassion for each other.

In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill? a. Person who is usually pessimistic but strives to meet personal goals b. Wealthy person who gives $20 bills to needy individuals in the community c. Person with an optimistic viewpoint about life and getting his or her own needs met d. Person who attends a charismatic church and describes hearing Gods voice

d. Person who attends a charismatic church and describes hearing Gods voice Hearing voices is generally associated with mental illness; however, in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. In this situation, cultural norms vary, making it more difficult to make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill.

5. The concepts central to nursing theoretical models are: a. Self-care, self-care deficit, and nursing systems b. Caring and curing c. Assessment, diagnosis, intervention, and evaluation d. Person, environment, health, and nursing

d. Person, environment, health, and nursing

3. Inductive theory construction: a. Consists largely of concepts borrowed from other disciplines b. Validates deductive theory construction c. Proceeds from the general to the specific d. Proceeds from the specific to the general

d. Proceeds from the specific to the general

A patient underwent psychotherapy weekly for 3 years. The therapist used free association, dream analysis, and facilitated transference to help the patient understand unconscious processes and foster personality changes. Which type of therapy was used? a. Short-term dynamic psychotherapy b. Transactional analysis c. Cognitive therapy d. Psychoanalysis

d. Psychoanalysis The therapy described is traditional psychoanalysis. Short-term dynamic psychotherapy would last less than 1 year. Neither transactional analysis nor cognitive therapy makes use of the techniques described.

Sharon Getty has been admitted to a neurological unit with a complaint of chronic pain. She has been referred to the psychiatric and mental health advanced practice nurse who functions as the Psychiatric Liaison Nurse for that unit. Which might be a response of the liaison nurse? a. Discussion with R.N.s on the unit about the need for them not to talk with the client about the emotional components of her pain b. Avoiding talking with the client's family because they will probably be upset to learn that they might be contributing to the client's problems with pain c. Realizing that individual psychotherapy with the client is the role of the psychiatrist d. Referring the client to occupational therapy if appropriate

d. Referring the client to occupational therapy if appropriate An advanced practice psychiatric and mental health nurse (Clinical Nurse Specialist), as member of the healthcare team, provides direct care, including psychotherapy, to individuals, groups, and families as well as consultation to nursing and other hospital staff, around client, unit, or institutional issues.

A government agency doing a security check on an individual calls a psychiatric and mental health advanced practice nurse seeking information about any mental health problems that the individual might have. What initial response is the best for the psychiatric and mental health advanced practice nurse? a. Turn all written records over to the investigators. b. Submit a treatment summary describing the client's problems. c. Write a report that describes the client's problems in the least damaging way possible. d. Refuse to acknowledge that the client is in therapy until a release of information form is signed by the client.

d. Refuse to acknowledge that the client is in therapy until a release of information form is signed by the client.

A nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt b. Anxiety c. Loneliness d. Self-esteem

d. Self-esteem The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect; each represents a negative feeling.

Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are constant from culture to culture. d. Some symptoms of mental disorders may reflect a persons cultural patterns.

d. Some symptoms of mental disorders may reflect a persons cultural patterns. A nurse who understands that a patients symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little relevance to patient advocacy. Symptoms of mental disorders change from culture to culture.

Cognitive therapy was provided for a patient who frequently said, Im stupid. Which statement by the patient indicates the therapy was effective? a. Im disappointed in my lack of ability. b. I always fail when I try new things. c. Things always go wrong for me. d. Sometimes I do stupid things.

d. Sometimes I do stupid things. Im stupid is a cognitive distortion or irrational thought. A more rational thought is, Sometimes I do stupid things. The latter thinking promotes emotional self-control. The incorrect options reflect irrational thinking.

A patient with opioid use disorder is to be maintained as an outpatient on SubaxONE (buprenorphine and naloxone). The psychiatric and mental health nurse expects that the patient will begin with: a. Subaxone, with first administration 24 hours after last opioid. b. Subutex for one day and then switch to suboxone. c. Suboxone, with first administration immediately after last opioid d. Subutex for two days and then switch to Suboxone.

d. Subutex for two days and then switch to Suboxone.

14. Sister Callista Roy's theory of nursing is: a. The Interpersonal Relations Model b. The Problem Solving Model c. The Communication Model d. The Adaptation Model

d. The Adaptation Model

14. Sister Callista Roy's theory of nursing is: a. The Interpersonal Relations Model b. The Problem Solving Model c. The Communication Model d. The Adaptation Model

d. The Adaptation Model

A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurses best response. a. No functional difference exists between the two diagnoses. Both serve to identify a human deviance. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables. c. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems. d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience.

d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience. The medical diagnosis, defined according to the DSM-5, is concerned with the patients disease state, causes, and cures, whereas the nursing diagnosis focuses on the patients response to stress and possible caring interventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider potential problems.

In a well-functioning mental health team who is the most important member? a. The doctor b. The nurse c. The psychologist d. The client

d. The client

Mrs. C. S. is an extremely shy individual who was admitted to the hospital with a depressive disorder. What characteristics of therapy groups will best serve her needs? a. The realization that no one else in the group has anything like the problem she has b. The fact that two members of the group are talking constantly without interruption will protect her from feeling like she must participate. c. The experience of being left alone by other group members will protect her autonomy and decrease her performance anxiety. d. The fact that others support one another in learning to change will encourage her to take the risks needed to grow.

d. The fact that others support one another in learning to change will encourage her to take the risks needed to grow.

In a peer supervision group a nurse is discussing a recent self-disclosure to a client. The group is most likely to question the appropriateness of the behavior if: a. The nurse has been using a humanistic theoretical approach. b. The nurse-client relationship was in the termination phase. c. The nurse-client relationship was in the working phase. d. The nurse-client relationship was in the orientation phase.

d. The nurse-client relationship was in the orientation phase. Nurse self-disclosure can enhance or inhibit therapeutic communication depending on its use. Like all interventions, it requires timing and judgment. Its use, according to Auvil and Silver (1984) depends on: 1. Nurse's theoretical framework—i.e., more likely to occur if working from a humanist perspective than from a psychoanalytic or behaviorist approach 2. Stage of the relationship a. Orientation—nurse self-disclosure that occurs early in the relationship more likely to meet nurses' needs b. Working phase—appropriate if used by nurse to hasten therapeutic alliance to help clients learn about themselves and others, encourage their catharsis of feelings, support their goals, and validate their reality (McMahon, 1997) c. Termination—expression of feelings about end of relationship to model appropriate behaviors for client

An Asian American client arrives for her first session with the nurse. She speaks softly and avoids discussion of her problem directly. The nurse should: a. Understand that she has low self-esteem and suggest that they work on this problem. b. Realize that this behavior is due to extreme guilt and shame and indicates a secret that needs disclosing. c. Be aware that this is defensive behavior and probably foreshadows a great deal of resistance. d. Understand that this is culturally appropriate behavior and should be respected and mirrored.

d. Understand that this is culturally appropriate behavior and should be respected and mirrored.

In a therapy group, a client makes inappropriate demands of the psychiatric and mental health advanced practice nurse who is the group therapist. The psychiatric and mental health advanced practice nurse responds assertively and effectively resolves the problem to the satisfaction of all concerned. What curative factor, according to Yalom does this situation exemplify? a. Altruism b. Catharsis c. Interpersonal Learning d. Universality

d. Universality

Jerry Coleman is a 46-year-old client with Bipolar Disorder who has recently had an exacerbation of his manic symptoms. He has been referred for appropriate services to a psychiatric and mental health advanced practice nurse by his disability insurance company. What kind of services might he expect to receive from his case manager? a. A thorough evaluation of his case and coordination of all services b. Referral for medication evaluation and maintenance c. Referral for vocational rehabilitation if necessary d. Weekly reports to his boss concerning the details of his disability

d. Weekly reports to his boss concerning the details of his disability Case management—assessment for, and coordination of, individualized, culturally appropriate mentalhealth, and other health and social services, for clients and their families or residential care groups

What types of things would the nurse NOT work on with Mr. D'Angelo over the next few sessions? a. How his thoughts and feelings influence his behavior b. Whether or not his behavior at the previous community meeting achieved his purpose c. What other coping strategies might be more effective d. Who seems to be "most out to get" him

d. Who seems to be "most out to get" him

7. In Orem's theory, Nursing Systems are described as: a. Descriptions of a variety of ideal hospital staffing models b. The theories that she drew from c. Simple, complex, and combined d. Wholly compensatory, partly compensatory, and supportive-educative

d. Wholly compensatory, partly compensatory, and supportive-educative

The Peer-to-Peer program of the National Alliance on Mental Illness (NAMI) focuses on providing classes for: a. family and caregivers of a children and adolescents with mental health conditions. b. families, partners, and friends of adults with mental illness. c. families, partners, and friends of military service members or veterans. d. adults with mental illness about mental illnesses.

d. adults with mental illness about mental illnesses.

When facilitating change to incorporate evidence-based findings into patient care management, the first step is: a. understanding. b. acting. c. deciding. d. believing.

d. believing.

A nurse psychotherapist works with an anxious, dependent patient. The therapeutic strategy most consistent with the framework of psychoanalytic psychotherapy is: a. emphasizing medication compliance. b. identifying the patients strengths and assets. c. offering psychoeducational materials and groups. d. focusing on feelings developed by the patient toward the nurse.

d. focusing on feelings developed by the patient toward the nurse. Positive or negative feelings of the patient toward the nurse or therapist represent transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. Emphasizing medication compliance is more related to biological therapy. Identifying patient strengths and assets would be consistent with supportive psychotherapy. The use of psychoeducational materials is a common homework assignment used in cognitive therapy.

A single parent is experiencing feelings of inadequacy related to work and family since one teenaged child ran away several weeks ago. The parent seeks the help of a therapist specializing in cognitive therapy. The psychotherapist who uses cognitive therapy will treat the patient by: a. discussing ego states. b. focusing on unconscious mental processes. c. negatively reinforcing an undesirable behavior. d. helping the patient identify and change faulty thinking.

d. helping the patient identify and change faulty thinking. Cognitive therapy emphasizes the importance of changing erroneous ways people think about themselves. Once faulty thinking changes, the individuals behavior changes. Focusing on unconscious mental processes is a psychoanalytic approach. Negatively reinforcing undesirable behaviors is behavior modification, and discussing ego states relates to transactional analysis.

The primary purpose of the American Nurses Credentialing Center (ANCC) is tp: a. provide political support for nurses. b. provide nursing education. c. promote the career of nursing. d. promote nursing excellence.

d. promote nursing excellence.

During the orientation phase of building a therapeutic relationship, the psychiatric and mental health nurse discovers that he had come to the first meeting with preconceptions about the patient. Based on this, the nurse should: a. ask another nurse to work with the patient. b. apologize to the patient. c. spend extra time with the patient. d. recognize and set aside the preconceptions.

d. recognize and set aside the preconceptions.

An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient: a. says, I knew this would happen eventually. b. stops attending her weekly water aerobics class. c. refuses to use a walker and says, I don't need that silly thing. d. says, Maybe some physical therapy will help me with my balance.

d. says, Maybe some physical therapy will help me with my balance. Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying I knew this would happen eventually and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial.

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