1-4 NCLEX Q's Flashcards
Considering the administration of medications, the nurse applying evidence-based practice (EBP) will engage in which nursing activity?
Determining the client’s preference about when a medication prescribed once daily is administered
A noteworthy concept of EBP is that the approach utilized in nursing incorporates more than clinical research. Evidence is not limited to what is found in research studies, but also incorporates the nurse’s clinical knowledge and experience, as well as the patient’s preferences and desires. EBP is associated in this case with determining the client’s preference regarding the administration of the medication.
In order to demonstrate the integration of evidence-based practice (EBP) into the care of a client who has been hospitalized for severe depression and prescribed a selective serotonin reuptake inhibitor (SSRI), the novice nurse will include which action into the plan of care?
Assess the client for the presence of suicidal ideations with a plausible plan.
A simple method to state the process of integrating EBP into clinical practice is referred to as the 5 A’s: Ask the question; Acquire the literature; Appraise the literature; Apply the evidence; Assess the performance. By assessing the client for suicidal ideations and a plausible plan, the nurse is assessing the performance of the SSRI
Which institution-specific clinical practice resource will the nurse use to integrate evidence-based practice (EBP) into the care of a client hospitalized for the purpose of the evaluation of his or her current therapy plan?
Implementing a clinical pathway to provide expected outcomes using a measurable format
Clinical practice resources for the implementation of EBP include Internet resources, clinical practice guidelines, clinical algorithms, and clinical pathways. Clinical pathways are the only resource that is specific to the institution using them.
Which statement by the nurse best demonstrates a dilemma associated with the utilization of evidence-based practice (EBP) in the mental health clinical setting?
“It’s hard to review the literature about this new treatment when we are so short staffed.”
There are dilemmas associated with the utilization of EBP including the practical issue of nursing environments that are short staffed and dealing with budgetary constraints making it difficult to spend time and money on the evaluation of the literature in order to make decisions of clinical practice based on best evidence.
The decision to intervene as a patient advocate is clearly identified by the American Nurses Association’s (ANA) code of ethics in which situation?
A suspicion that a staff member is unfit to provide client care
A nurse advocate speaks up for a client when he or she is unable to do so for him- or herself. The ANA’s Code of Ethics for Nurses clearly states the nurse’s responsibility to take appropriate actions to safeguard the client from incompetent or impaired practices of any member of the health team.
Which question will the nurse ask in order to assess a client’s ability to think critically?
“How do you plan to afford getting your own apartment?”
Critical thinking is demonstrated by the ability to problem solve using good judgment and logically reasoning to arrive at an insightful conclusion. Clear thinking would be demonstrated by arriving at a plan to live independently that demonstrates those qualities.
Which client statement supports the nurse’s assessment that the client has demonstrated resiliency?
“I’ve learned from experiencing other losses that I’ll be okay.”
Resiliency is the ability to recover from or adjust successfully to trauma or change. Being resilient does not mean that people are unaffected by stressors. Rather than becoming paralyzed by the negative emotions, resilient people recognize the feelings, readily deal with them, and learn from the experience. A successful transition through a crisis builds resiliency for the next difficult trial.
The nurse, striving to minimize the bias of a Western view on what is considered acceptable behavior, will consult which mental health-associated resource?
Cultural Formulation Interview (CFI)
The CFI assesses the client’s cultural perception of distress, social supports such as family and religion, and relationship factors between the patient and provider including language and discrimination experiences in the societal majority.
When considering prevalence, the nurse will focus on which disorder(s) when identifying the focus of a community mental health screening?
Anxiety disorders
Over a 12-month period, anxiety disorders have an 18.1% prevalence affecting an estimated 57 million people. Affective disorders 9.5% (30 million); alcohol dependence 6.3% (16.5 million); any substance abuse 9.4% (24.6 million).
The nurse recognizes that the greatest barrier to successful mental health treatment and recovery is demonstrated by which client?
The teenager who fears being rejected by his peers.
Stigma is defined as a collection of negative attitudes, beliefs, and thoughts that influence public perception of the mentally ill. Stigma contributes to fear, rejection, and discrimination against the mentally ill that taint and discount the individual, and stigma has been acknowledged as a major barrier to mental health treatment and recovery. The teenager is afraid of being stigmatized by peers and so is much less likely to seek and/or comply with mental health treatment.
Which nursing assessment question is focused on securing information about what Freud called the client’s conscious mind?
“What are your beliefs about interracial marriage?”
Freud identified three layers of mental activity: the conscious, the preconscious, and the unconscious mind. The conscious mind is your current awareness—thoughts, beliefs, and feelings. Expressing one’s beliefs about a subject would be demonstrating one’s conscious mind. Erikson’s development task, integrity vs. despair, stresses the need to feel satisfaction with one’s life and the resulting wisdom. Maslow was concerned with a person’s sense of esteem that includes feeling valued. It was Sullivan that introduced the concept of the good me vs. the bad me.
When a client expresses an irrational belief, which response by the nurse demonstrates reframing?
“Your teacher’s suggestions about improving your grades, don’t mean you’re stupid.”
An irrational belief is a type of cognitive distortion. Cognitive behavioral therapy (CBT) identifies the negative patterns of thought that are believed to result in negative emotions. Reframing is a technique that challenges the negative thought with rational evidence.
A hospitalized client has a history of resorting to aggressive verbal abuse when angry. Which nursing action demonstrates a behavioral modification technique?
A nutritious snack is earned each time an abusive outburst is avoided.
Behavioral therapy, or behavior modification, uses basic tenets from each of the behaviorists described previously. It attempts to correct or eliminate maladaptive behaviors or responses by rewarding and reinforcing adaptive behavior. The snack is such a reward.
A novice nurse has been assigned to the mental health inpatient unit. In order to best facilitate growth in both experience and skills, which assignment should be delegated to the nurse?
Co-leader of a self-care group
Co-leadership of groups is a common practice and has several benefits: it provides training for less experienced staff; it allows for immediate feedback between the leaders after each session; and it gives two role models for teaching communication skills to members.
A client has been diagnosed with a social phobia. Which statement made by the nurse best supports the milieu of the outpatient day clinic regarding this client’s treatment?
“This is a safe place to learn to interact with people comfortably.”
A therapeutic milieu, or healthy environment, combined with a healthy social structure within an inpatient setting or structured outpatient clinic is essential to supporting and treating those with mental illness. Within these small versions of society, people are safe to test new behaviors and increase their ability to interact adaptively within the outside community. This is especially appropriate for this client. The milieu does experience change related to the client members and so there is no guarantee that all members will understand the specific fears of individuals but it does present a fairly stable environment that is guided by rules and consequences.
