Chapter 8 Flashcards
An adult female client becomes combative with the nurse during routine medication administration. What is the nurse’s primary responsibility in this situation?
a. To ensure that the client takes her medications
b. To ensure that the client is placed in physical restraints to protect the safety of the
staff and other clients
c. To ensure that chemical restraints are used in the future until the client displays
more appropriate and compliant behavior
d. To ensure that the client is kept safe while trying to protect staff safety and to reason with the client to try to de-escalate the combative behavior
ANS: D
The “Do no harm” principle of mental health care applies to this situation. Client and staff safety are imperative. Ensuring that the client takes her medications is not of greatest concern in this situation because this most likely would cause increased combativeness. Physical restraints and chemical restraints are not reasonable options in the care of this patient.
A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action by the nurse is going to best promote development of a mutually trusting relationship?
a. At the beginning of the shift, the nurse promises to play a game of cards with the
client at some point during that day and does so before the end of the shift.
b. The nurse promises to play a game of cards with the client on the following day.
c. The nurse leads a group discussion with clients about ways to develop trust in a relationship.
d. The nurse gives the client written information about the medications he is taking.
ANS: A
Developing mutual trust is one of the principles of mental health care. The nurse most likely would be able to carry out plans on a daily basis rather than trying to make plans for the next day. Making plans with the client is a very effective way to develop trust, as long as the plans can be carried out. Leading a group discussion and giving written information are helpful to clients but are not going to promote development of trust in the same way that making plans and carrying them out would do.
An adult female client is exhibiting behavior that the nurse interprets as anger toward another client. What is the nurse’s best action?
a. Continue to monitor the client’s behavior and document it as anger directed toward
another client
b. Talk with the client about the observations made, and ask whether she was displaying anger toward the other client
c. Ask the other client if she felt that the client was angry at her
d. Ask the client to write in a journal the emotions she was feeling at that time
ANS: B
Asking the client is an effective way of understanding the meaning of her behavior and is one of the principles of mental health care. Documentation of the nurse’s interpretations without clarification would not be appropriate, nor would involving another client by asking for her interpretation of the situation. Asking the client to write in a journal is fine, but not in this circumstance.
A nurse and an adolescent female client develop a plan of care together that addresses the client’s difficult relationship with her parents. The client says that her parents just don’t understand her, and she is always getting privileges taken away for not doing things that she is supposed to do. What is the nurse’s best action?
a. Talk with the client about how important it is that she carry through with actions
that her parents feel are important
b. Identify two priority responsibilities that are agreed upon between the client and
her parents, and monitor her ability to comply with the plan for 1 week
c. Discuss with the parents what responsibilities they feel are important, to determine what actions should be planned with the client
d. Identify what the client feels are reasonable responsibilities
ANS: B
Responsibility is one of the principles of mental health care that should be fostered. It is important to work in conjunction with all involved parties to set a realistic goal and plan of action. Remaining options do not include all parties and do not set a realistic goal or plan
__________ coping mechanisms are means of successfully solving a problem or reducing one’s stress level.
a. Defensive
b. Maladaptive
c. Constructive
d. Individual
ANS: C
Constructive, or adaptive, coping mechanisms are effective because they deal with the problem to attempt to solve it and in turn reduce stress. Defensive and maladaptive mechanisms do not deal with the problem effectively. Individual coping mechanisms may or may not be effective
A married woman, who is the mother of two children, has been in an abusive relationship for 4 years. She decides to leave her husband after suffering an episode of severe physical abuse. She and her children, ages 7 and 9, arrive at a crisis intervention center. What is the nurse’s priority intervention?
a. Offer immediate emotional support
b. Refer her to a woman’s domestic abuse center
c. Begin to develop a treatment plan for the client and her children
d. Thoroughly assess the situation from the most recent abusive episode to 2 weeks
prior to this incident
ANS: A
All of the options are steps in the crisis intervention process, but emotional support is the first priority for helping to reduce high anxiety levels.
A male client with the diagnosis of depression has not attended his last two group meetings.
The nurse provides a printed schedule of meeting dates and times to the client the next time she sees him. The nurse’s actions can be described as:
a. Insight
b. Self-awareness
c. Empathy
d. Client advocacy
ANS: D
Advocacy is when the nurse works on behalf of the client by providing him with the tools needed to make decisions. It is especially important to be an advocate for clients with mental health disorders because it often is difficult for them to make informed decisions. Insight refers to the ability to see intuitively, self-awareness is looking into and analyzing oneself, and empathy encompasses the ability to understand and enter into another person’s emotions. All of the options listed are skills needed if mental health care workers are to practice effectively
An adolescent female client continually displays a negative attitude toward everyone she comes into contact with and toward life in general. Which action should the nurse implement first that will be helpful in assisting this client to develop a more positive attitude?
a. Helping the client recognize negative thoughts, emotions, and attitudes
b. Pointing out every negative behavior that the client displays
c. Assisting the client to replace negative thoughts by frequently repeating positive
statements
d. Praising positive behavior exhibited by the client
ANS: A
The nurse must help the client to identify negative thoughts, emotions, and attitudes before the client can concentrate on changing this behavior. Pointing out every negative behavior would not be therapeutic, and assisting the client to replace negative thoughts and praising positive behavior promote development of a positive attitude but do not constitute the first step.
A caregiver is said to be practicing __________ care not only when she takes into consideration the client’s actual or potential problems but also when she considers the client’s family, work responsibilities, and social aspects of life. Which of the following best describes this caregiving concept?
a. Competent
b. Complete
c. Holistic
d. Crisis
ANS: C
Holistic care encompasses all aspects of an individual. Competent care and complete care are essential, but neither is the best choice to answer the description in this question. Crisis intervention components are not addressed in this scenario
A client is believed to have N adapted U R S I to N a G situation T B.C O when M he or she exhibits which characteristic?
a. The client has become accustomed to his or her surroundings.
b. The client has shown improvement in behavior as evidenced by the ability to carry out activities normal to his or her life.
c. The client has accepted his or her current behavior patterns.
d. The client has established a trusting relationship with the caregivers who are
providing care.
ANS: B
Adaptation, in mental health terms, is best shown in the client’s improved behavior and ability to carry out activities normal to his or her life; this displays effective coping skills. The other options do not show complete adaptation.
One of the goals of therapy established with a client on a mental health unit who has been given a diagnosis of obsessive-compulsive disorder (OCD) is to improve his feelings of stability in his environment. Much of his OCD behavior manifests as cleanliness and control of germs. Which nursing intervention most likely would help this client to feel more stable in his environment?
a. Encouraging visits from family members and friends
b. Rewarding him for acceptable behavior by increasing the number of times he is allowed to clean his bathroom daily
c. Encouraging him to participate in group activities
d. Allowing him to wash his hands only for an agreed upon number of times daily
ANS: D
Setting limits for clients with mental health disorders helps them to feel more stable in their environment because these clients often are incapable of setting limits on their own. Encouraging family visits may be beneficial for needs of comfort and love but not for stability. Rewarding this client by allowing him to increase the number of times he may clean the bathroom does not provide for stability because it fosters inconsistency in rules and routines. Encouraging group activities is beneficial for diversional purposes and love and belonging needs but does not best address the stability issue.
Which is the best way that a nursing unit manager can assist his or her staff in maintaining a professional commitment to their job and profession?
a. Frequently offering and requiring a specific number of hours of in-service training
on new care modalities within the facility
b. Requiring out-of-facility continuing education hours twice a year
c. Encouraging staff to subscribe to nursing journals to keep up-to-date on new
information
d. Keeping nursing journals on the unit for easy access to staff
ANS: A
Professional commitment is accomplished by keeping current with developments within one’s profession, improving therapeutic effectiveness, and seeking out new knowledge. Offering and requiring in-service training is the easiest way to seek new knowledge and remain current in the profession, while at the same time making the staff accountable to attend a certain number of sessions.
The nurse is working with a male client to instill a feeling of self-commitment, to improve his self-esteem. From which of the following interventions would the client most benefit?
a. Having the client promise himself that he will do the best he can in a particular
situation, knowing that failure is a possibility
b. Encouraging the client to do the best he can in any given situation, while
reminding him that failure is a possibility
c. Ensuring that the client limits activities to those in which he is sure to be successful
d. Allowing the client to set goals that are nearly impossible to achieve but giving
him the opportunity to try his best to meet these goals
ANS: A
Having the client promise himself, with the knowledge that failure is a possibility, is the most beneficial option because it is making the client active in the process and is also the most realistic approach. Simply encouraging the client does not make the client active in the situation. Ensuring that the client limits activities to those in which he will be successful is too protective. Allowing the client to set nearly impossible goals is setting him up for failure.
The nurse is working with a health care team with the philosophy of reality therapy. The nurse is aware that the team’s belief is centered around:
a. Reorientation of the client to his or her environment
b. Describing clients as irresponsible rather than mentally ill
c. Looking at the client’s past in determining how it has affected present behavior
d. Accepting the client’s perceptions of right and wrong behavior in the development
of his treatment plan
ANS: B
Reality therapy focuses on responsibility and does not accept the premise of mental illness. Reality therapists look at the present and future and do not look to the past for excuses for behavior. Reality therapy also emphasizes the morality of behavior and does not allow the client’s own interpretation of right and wrong.
A busy community mental health center treats a client who is in crisis. The client is provided with instruction on relaxation exercises, but throws them away. Two weeks later the staff is dismayed when the client returns with her condition worsened. This lack of success after the previous visit is due to which of the following factors?
a. Disorganization
b. Pseudoresolution
c. Self-awareness
d. Lack of commitment
ANS: B
The client and health care provider did not address the cause and opportunity for growth. This is termed pseudoresolution. Disorganization is preoccupation with the crisis situation. Self-awareness and lack of commitment are not considered in crisis.
