Exam 1

Question 1

A nurse is reviewing the literature in preparation for a research study about eating disorders. The nurse wants to find out information about the total number of people with eating disorders occurring within a population of girls between the ages of 12 to 18 years. The nurse is not concerned about when the disorder had its onset for this population. Which epidemiological data would the nurse identify?

Answer 1

Prevalence

Prevalence refers to proportion of persons who HAVE A CONDITION AT OR DURING a particular time period.

Incidence refers to the proportion or rate of persons who DEVELOP A CONDITION DURING a particular time period.

Question 2

Difference between prevalence and incidence in an epidemiological study.

Answer 2

Prevalence refers to proportion of persons who HAVE A CONDITION AT OR DURING a particular time period.

Incidence refers to the proportion or rate of persons who DEVELOP A CONDITION DURING a particular time period.

Question 3

What statement would a nurse integrate into an education plan for a local community group about mental illness and mental disorders?

Answer 3

Clusters of behaviors, thoughts, and feelings define mental disorders.

Question 4

A client with a mental illness tells the nurse, “I’m just like what others say I am. I can never be normal.” The nurse interprets this statement as reflecting which of the following?

Manipulation
Label avoidance
Self-stigma
Public stigma

Answer 4

Self-stigma

Question 5

A client with depression participates in all areas of his treatment plan such that the client is managing the condition and living in a physically and emotionally healthy manner. The client’s status reflects which dimension of recovery?

Answer 5

Health

Question 6

A client has sought care for a prolonged history of depressed mood and has been diagnosed with major depression. The client is readily open to beginning pharmacologic treatment but is unwilling to attend a support group, despite easy geographic access and a flexible schedule. What explanation for the client’s behavior should the nurse explore?

• The client views depression as a purely psychosocial, rather than biologic, phenomenon.
• The client is uncomfortable with being labeled as mentally ill
• The client does not understand the relationship between the symptoms of depression and its diagnosis
• The client has an inaccurate understanding of the causes of depression.

Answer 6

The client is uncomfortable with being labeled as mentally ill.

Question 7

The nurse is caring for a group of clients in a primary care setting. When would the nurse determine a client is at greatest risk for developing a mental disorder?

• when emotional symptoms cause impaired daily functioning
• when a sad event causes emotional distress
• when coping strategies become difficult
• when emotional symptoms cause occasional stress

Answer 7

When emotional symptoms cause impaired daily functioning.

Question 8

Which of the following is accurate with regards to cultural syndromes?

Answer 8

They are specific disorders found in a particular locality.

Question 9

A family member of a client diagnosed with a mental illness asks the nurse, “What is mental illness, really?” Which information would the nurse most likely integrate into the response? Select all that apply.

• Mental illness can cause significant distress
• Mental illness is primarily due to social/cultural factors.
• Mental illness can interfere with a person’s ability to function.
• Individuals suffering from mental illness are usually able to cope effectively with daily life.
• Individuals suffering from mental illness may experience dissatisfaction with relationships and self.

Answer 9

• Mental illness can cause significant distress.
  • Mental illness can interfere with a person’s ability to function.
  • Individuals suffering from mental illness may experience dissatisfaction with relationships and self.

Question 10

A nurse is assessing a client who has come to the clinic for an evaluation. The nurse determines that the client is mentally healthy based on which finding? Select all that apply.

• Client talks readily about doing things with friends and family.
• Client describes actions used to appropriately cope with life stresses.
• Client verbalizes a realistic depiction of surroundings and events.
• Client reports moving from job to job to job over the years.
• Client identifies strengths and weaknesses in abilities.

Answer 10

• Client talks readily about doing things with friends and family.
• Client describes actions used to appropriately cope with life stresses.
• Client verbalizes a realistic depiction of surroundings and events.
• Client identifies strengths and weaknesses in abilities.

Question 11

A psychiatric-mental health nurse is developing a recovery-oriented plan of care for a client with obsessive-compulsive disorder. The nurse identifies interventions to strengthen the client’s social networks. The nurse is addressing which dimension to support recovery?

Answer 11

Community

Question 12

A nurse is teaching the family of a client with a mental illness who is receiving recovery-oriented treatment about this care. The nurse determines that the teaching was successful based on which statement made by the family?

Answer 12

Change is the underlying process involved with recovery.

Question 13

A psychiatric-mental health nurse working at a community mental health center is using epidemiological data to plan the development of programs for the population in the future. Based on the nurse’s knowledge associated with disease projections and the leading burden of disease, the nurse would work on developing programs for which condition?

• Depression
• Generalized anxiety disorder
• Schizophrenia
• Post traumatic stress syndrome

Answer 13

Depression

Question 14

The nurse would be more likely to witness uncontrolled weeping, anxiety attacks and somatization symptoms in which of the following clients?

• A client of Jewish heritage whose husband of several decades has recently died.
• A female, older adult client of Latin American descent.

Answer 14

Correct response:
A female, older adult client of Latin American descent

Question 15

One of the best ways to counteract the negative effects of stigma is to do what?

Answer 15

Have contact with the stigmatized group.

Question 16

A nurse is preparing a presentation about how mental health providers are often portrayed in the media, which leads to public stigma. Which of the following descriptors would the nurse most likely include?

• Group-oriented
• Caring
• Arrogant

Answer 16

Arrogant

Question 17

A nurse is performing an assessment on a client and notes the client has had five different jobs in the past 2 months, has a fifth-grade education, lacks health insurance, lives in a town with a high rate of violence, has a home with limited running water, and has limited family and friend support. Based on these findings, the nurse determines that the client is at risk for health problems. The nurse identifies which finding(s) as reflecting the social determinant domain of neighborhood and built environment? Select all that apply.

• fifth-grade education
• health insurance
• town violence
• housing situation
• support resources

Answer 17

• town violence
  
  • housing situation

HealthyPeople2020 classifies neighborhood and built environment factors into these four categories:
- Access to Healthy Foods.
- Quality of Housing.
- Crime and Violence.
- Environmental Conditions

Question 18

Which of the following would be associated with stigma? Select all that apply.

• Individualization
• Disapproval
• Shunning
• Stereotyping
• Understanding

Answer 18

• Dispproval
• Shunning
• Stereotyping

Question 19

When describing wellness and mental disorders, which of the following factors would the nurse address as commonly interfering with the individual’s ability to achieve wellness? Select all that apply.

• Lack of education
• Medication compliance
• Employment issues
• Poverty
• Trauma

Answer 19

Poverty
Employment issues
Trauma
Lack of education

Question 20

A nursing instructor is teaching a class about stigma and using nonstigmatizing language. The instructor determines that the education was successful when the students state which of the following as an example?

• Hypochondriac
• Schizophrenic
• Bipolar client
• Client with major depression

Answer 20

Client with major depression

Question 21

According to the World Health Organization, by 2030, which mental illness is projected to be the leading burden of disease worldwide?

• schizophrenia
• substance use
• depression
• anxiety

Answer 21

Depression

Question 22

A nurse is conducting a presentation for a local community group about mental health and mental illness. One of the participants asks the nurse, “How do you know that a person is mentally healthy?” Which characteristic(s) would the nurse include when responding to the participant? Select all that apply.

• contributes to society
• adapts to changes
• is irresponsible
• functions in their role
• has erratic behaviors

Answer 22

• contributes to society
• adapts to changes
• functions in their role

Question 23

A nurse is giving a presentation about preventing mental illness to college freshmen. A student asks, “What does it mean to be mentally healthy?” Which of the following potential responses by the nurse is best?

• “Mental health is marked by productivity, fulfilling relationships, and adaptability.”
• “Mental health is defined as behavior accepted as normal by the major cultural group.”
• “Mental health is the absence of mental illness.”
• “Mental health is difficult to define and depends on cultural norms.”

Answer 23

“Mental health is marked by productivity, fulfilling relationships, and adaptability.”

Question 24

A nurse is collaborating with a team of researchers to determine the annual incidence of schizophrenia is the community. In order to calculate the incidence, the team must know:

• the prevalence of schizophrenia at the beginning of the year and the end of the year.
• the odds of developing schizophrenia in the year preceding the year that is being examined.
• the point prevalence on or near June 30.
• the length of time that each resident with schizophrenia has been living with his or her diagnosis.

Answer 24

The prevalence of schizophrenia at the beginning of the year and the end of the year.

Question 25

In epidemiology, certain terms have specific meanings relative to what they measure. What represents the total number of people who have a disorder within a given population at a specified time, regardless of how long ago the disorder started?

• Prevalence
• Point prevalence
• Rate
• Incidence

Answer 25

Prevalence

Question 26

After educating a group of nursing students about mental health and wellness, which statement by a group member indicates the need for additional education?

• A person cannot be healthy without being mentally healthy.
• Poverty and unemployment are common in individuals with mental health issues.
• Mental health problems have minimal effect on the process of wellness.
• A person can be mentally healthy but still have a mental disorder.

Answer 26

Mental health problems have minimal effect on the process of wellness.

Question 27

A psychiatric-mental health nurse is collaborating with a client on ways to promote recovery. The client is diagnosed with a substance use problem. As part of the process, the person tells the nurse, “I want to be drug-free and show everyone that I can be a responsible person.” The nurse interprets this statement as reflecting which principle of recovery?

• Recovery is holistic.
• Recovery is based on respect.
• Recovery is person-driven.
• Recovery emerges from hope.

Answer 27

Recovery is person-driven.

Question 28

Which of the following is accurate with regards to cultural syndromes?

• They are conditions that are highly researched and documented
• They are based on the person’s ability to function overall.
• They are specific disorders found in a particular locality.
• They encompass nonrecurrent behavior.

Answer 28

• They are specific disorders found in a particular locality.

Question 29

A psychiatric-mental health nurse is working with a client who has a mental health disorder on ways to develop self-determination and self-direction. The nurse is integrating which principle of recovery into the plan of care?

• Recovery emerges from hope.
• Recovery is holistic.
• Recovery is based on respect.
• Recovery is person-driven.

Answer 29

• Recovery is person-driven.

Question 30

The nurse is teaching a group of community members about health, wellness, and living with mental illness. Which statement(s) made by a community member requires follow up by the nurse? Select all that apply.

• “One cannot have overall health without also being mentally healthy.”
• “One can improve overall wellness by improving physical health, but mental health is more difficult to improve.”
• “Overall wellness includes aspects of mental, emotional, and physical well-being.”
• “Overall health cannot exist if you also have a mental illness.”
• “Being well means you do not have disease, either physical or mental.”

Answer 30

• “One can improve overall wellness by improving physical health, but mental health is more difficult to improve.”
• “Overall health cannot exist if you also have a mental illness.”
• “Being well means you do not have disease, either physical or mental.”

Question 31

A key element in the definition of mental illness is that …

• The individual must need medications in order for the diagnosis to be of mental origin.
• The individual must have physiological symptoms that match with behaviors that are impaired.
• The individual must have difficulties in functioning that cause distress and/or impairment of some type.
• The individual must acknowledge that he or she is having difficulties in functioning.

Answer 31

• The individual must have difficulties in functioning that cause distress and/or impairment of some type.

Question 32

What is acculturation?

Answer 32

Assimilation to a different culture, typically the dominant one.

Question 33

What occurs when minority groups learn and adopt selective aspects of the dominant culture?

Answer 33

Acculturation

Question 34

What is is most consistent with spirituality?

Answer 34

Feeling a connection to a higher power.

Question 35

An adult client was born as a female gender but has a male gender identity. Which statement by the nurse demonstrates a therapeutic approach of respecting the client’s gender identity?

Answer 35

What pronouns do you go by?

Question 36

A psychiatric-mental health nurse is caring for a client on the unit. What is the best approach to learn the client’s preferences regarding the use of eye contact, greeting, and physical distance when caring for the client?

Answer 36

Observe the patient in the initial interview.

Question 37

The nurse is caring for an older adult whose spouse recently died. Which statement made by the client requires follow-up by the nurse?

• “My children think I should go to a grief support group.”
• “I haven’t talked to my friends lately.:

Answer 37

I haven’t talked to my friends lately.

The client is likely experiencing spiritual distress from the loss of a spouse. The nurse must be able to recognize that a client who has withdrawn socially may be experiencing spiritual distress.

Question 38

What population is most risk for being unable to escape the spiral of poverty?

Answer 38

Homeless people.

Question 39

What is acculturation?

Answer 39

When a person uses some of the aspects of the dominant culture in an effort to socialize and adapt to the new environment.

Question 40

What is cultural identity?

Answer 40

A set of cultural beliefs one feels is standard behavior.

Question 41

What is cultural idiom of distress?

Answer 41

Describes suffering among a group of people.

Question 42

What are cultural explanations?

Answer 42

The perceived causes of the symptoms the group is displaying.

Question 43

Is the following an accurate or inaccurate statement with regard to cultural competence and mental health?

Interventions need to work for various groups, not individuals.

Answer 43

Inaccurate

Question 44

What is the most common method of suicide in rural areas, where the suicide rate is higher than in urban areas?

Answer 44

Firearms

Even though rural residents are less likely than urban residents to have mental health diagnoses or receive mental health care, the suicide rate is higher in the rural areas with firearms being the most commonly used method, over hanging, suffocation, or poisoning.

Question 45

The nurse is taking care of a client from a culture different from the nurse’s culture. How might the nurse best provide culturally competent care?

Answer 45

Find out as much as possible about a client’s cultural values, beliefs, and health practices.

Question 46

A nurse is completing the initial interview with a newly admitted client. What statement made by the nurse would be most appropriate to get to know the client better in the initial interview?

• “How would you like to be cared for?”
• “Have you been in a facility like this before?”
• “Would you like a tour of your room and the unit?”
• “You are welcome to ask any questions that you may have.”

Answer 46

How would you like to be cared for?

To provide care, the nurse must find out as much as possible about a client’s values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to them. The nurse’s question, “How would you like to be cared for?” is an accepting and nonjudgmental approach to inquire about the client’s preferences; therefore, it would be the most appropriate in the initial interview. The nurse’s questions, “Have you been in a facility like this before?”, and “Would you like a tour of your room and the unit?” could be asked after the client has been greeted appropriately and assessed. The nurse’s statement, “You are welcome to ask any questions that you may have” is generic and not client centered.

Question 47

The nurse is caring for clients in a large metropolitan city outpatient clinic. Which cultural phenomenon will be assessed by the nurse that includes preference such as touch and eye contact?

• Communication
• Social organization
• Environmental control
• Biologic variations

Answer 47

Communication

Communication involves verbal and nonverbal communication such as touch and eye contact. Social organization refers to family structure and organization, religious values and beliefs, ethnicity, and culture. Environmental control refers to a client’s ability to control the surroundings or direct factors in the environment. Biologic variations do not directly affect preferences around touch and eye contact.

Question 48

A nurse is reviewing information about Taoism to gain a better understanding of a client. The nurse demonstrates an understanding of the information by identifying which of the following as behaviors leading to peace and contentment? Select all that apply.

Optimism
Aggressiveness
Humility
Calmness
Loyalty

Answer 48

Optimism
Humility
Calmness

According to Taoism, peace and contentment are found in the personal behaviors of optimism, passivity (not aggressiveness), humility and internal calmness. Loyalty to places and locations where one lives or works and purity and balance in physical and mental life are major motivators of personal conduct with Shintoism.

Question 49

A nurse is reviewing information about mental health, mental illness, and suicide in rural cultures. What would the nurse identify as the most common method of suicide in this group?

Answer 49

Firearms

Question 50

When describing wellness and mental disorders, which of the following factors would the nurse address as commonly interfering with the individual’s ability to achieve wellness?

a. Poverty
b. Employment issues
c. Medication compliance
d. Trauma
e. Lack of education

Answer 50

Poverty
Employment issues
Trauma
Lack of education

Question 51

A psychiatric-mental health nurse is providing recovery-oriented care for several clients with mental illness. When implementing this care, the nurse would assume which primary role?
a. Decision-maker
b. Partner
c. Leader
d. Educator

Answer 51

b Partner

In recovery-oriented care, the person with a mental health problem develops a partnership with a clinician to manage the illness, strengthen coping abilities, and build resilience for life’s challenges. The nurse would not be the decision-maker or leader. Although the nurse may assume the role of an educator throughout the process, this would not be the primary role.

Question 52

The nurse is teaching a group of community members about health, wellness, and living with mental illness. Which statement(s) made by a community member requires follow up by the nurse? Select all that apply.
a. “One cannot have overall health without also being mentally healthy.”
b. “Overall health cannot exist if you also have a mental illness.”
c. “Being well means you do not have disease, either physical or mental.”
d. “Overall wellness includes aspects of mental, emotional, and physical well-being.”
e. “One can improve overall wellness by improving physical health, but mental health is more difficult to improve.”

Answer 52

B, C, E.

A person cannot be healthy without being mentally healthy. However, it is possible to be mentally healthy and also have a mental or physical disorder. Improving both your physical and mental health may be challenging at times; however, mental health is not necessarily more difficult to improve.

Question 53

The nurse is educating a client, who has been recently diagnosed with a mental illness, on aspects of wellness. Which dimension(s) of wellness should the nurse include? Select all that apply.
a. Social aspects
b. Financial stability
c. Physical abilities
d. Behavioral episodes
e. Intellectual ability to learn
f. Spiritual beliefs

Answer 53

A, B, C, E, F.

Wellness is being in good physical and mental health. There are eight dimensions of wellness. These are emotional, financial, social, spiritual, occupational, physical, intellectual, and environmental. Behavioral is not a dimension of wellness, although many mental illnesses include behavioral aspects. These eight dimensions of wellness should be including in teaching to the client.

Question 54

A psychiatric-mental health nurse is conducting a program for a community group about the stigma faced by patients with mental illness. After teaching the group, the nurse determines that the program was successful when the group identifies which type? Select all that apply.

a. Private
b. Public
c. Self-stigma
d. Label avoidance
e. Community

Answer 54

b, c, d

Public stigma, self-stigma, and label avoidance are three types of stigma people with mental illnesses experience.

Question 55

A nurse is caring for a client with a different ethnic and cultural background from the nurse. Which action(s) by the nurse will promote cultural competence? Select all that apply.
a. Provide interventions according to the culture.
b. Demonstrate genuine interest and respect for the client.
c. Conduct a thorough social and cultural assessment.
d. Do not assume that all individuals of a racial/ethnic group are the same.
e. Learn about the client’s country of origin before assessing them.

Answer 55

B, D, E

Cultural competence in mental health includes learning about the client’s country of origin before assessment; conducting a thorough social and cultural assessment; demonstrating genuine interest in and respect for the individual; educating clients about mental health issues, including available treatment, benefits of obtaining services, and contributions and abilities of individuals with a mental illness; not assuming all individuals of a racial or ethnic group are the same. Being quiet and a lack of eye contact may be culturally appropriate and may indicate shyness, not depression or another mental illness. Tailor interventions to the individual; one intervention does not work for everyone. Tailoring interventions to the culture is not a part of cultural competence.

Question 56

The nurse is meeting with a client who changes topics and refuses to focus on a particular area. Which nurse behavior(s) indicate that the relationship is nontherapeutic? Select all that apply.
a) schedules longer meetings
b) schedules shorter meetings
c) encourages the client to stay on topic
d) assumes an aloof behavior during meetings
e) struggles to find common ground with the client

Answer 56

a, b, d, e
In a nontherapeutic relationship, both the nurse and client are frustrated and they will vary approaches with each other in an attempt to establish a meaningful relationship. The nurse may vary the length of the meetings–some may be longer or shorter than others. The nurse may alter demeanor during the meetings and may appear aloof. The nurse is struggling to find common ground with the client. Encouraging the client to stay on topic would be an action during the orientation, working, or termination phases of the therapeutic relationship.

Question 57

Which question(s) should the nurse include when assessing a client who is noncompliant with prescribed psychopharmacologic medications? Select all that apply.
a. “Are you having trouble paying for your prescribed medications?”
b. “Are the side effects to your medications causing problems at work?”
c. “Are you confused about when you should take each of your medications?”
d. “Are you afraid that you will become addicted to your prescribed medication?
e. “Are you concerned about the stigma associated with taking the prescribed medications?”

Answer 57

b, c, d, e

Nonadherence is an issue with clients diagnosed with a mental health condition. Reasons for nonadherence with prescribed medication treatment include a stigma associated with taking medications for a mental health disorder. Side effects of the medication is a common reason for a client to stop taking prescribed medications. The client may have an improvement in symptoms and stops taking the medication thinking that it is no longer needed. The client may deny having a mental health condition that requires medication and will not take the drug as prescribed. Cost is not identified as a reason for not taking medications as prescribed for this scenario, as patient is getting medication.

Question 58

A client with a mood disorder admits to frequently skipping doses of prescribed medications. On which area(s) would the nurse focus when assessing the reason for the client not adhering to medication therapy? Select all that apply.
a) cost
b) stigma
c) side effects
d) feeling better
e) denial of an illness

Answer 58

A, B, C, D, E

Common reasons for clients who are noncompliant to prescribed psychopharmacologic medications include the following: uncomfortable side effects and those that interfere with quality of life, such as work performance or intimate relationships; a lack of awareness or denial of illness; the associated stigma; the client begins to feel better; confusion about dosage or timing; difficulties in access to treatment; and a fear of substance use disorders. Based on this information, each of the questions from the nurse is appropriate when assessing a client who is nonadherent with the prescribed pharmacotherapy.

Question 59

A client with a diagnosis of major depressive disorder is admitted to the psychiatric–mental health unit. During the admission interview, the client states “I wish I knew what was going on, everything is strange.” Which response(s) by the nurse demonstrates empathy? Select all that apply.
a. “You wish that you understood what was happening.”
b. “When you say everything, do you mean since you arrived at the hospital?”
c. “Everything is strange, and you wish you knew what was happening?”
d. “I am so sorry this is happening to you; it must be hard to not understand.”
e. “Can you clarify what you mean when you say that everything is strange?”

Answer 59

a, b, c, e

Several therapeutic communication techniques, such as reflection (“You wish that you understood what was happening”), restatement (“Everything is strange and you wish you knew what was happening?”), and clarification (“When you say everything, do you mean since you arrived at the hospital?” and “Can you clarify what you mean when you say that everything is strange?”), help the nurse send empathetic messages to the client. Sympathetic messages (“I am so sorry this is happening to you; it must be hard to not understand.”) are nontherapeutic.

Question 60

The nurse is preparing to meet a new client. Which goal(s) would the nurse plan to achieve during the orientation phase of the nurse–client relationship? Select all that apply.

a. Explain the boundaries.
b. Identify problems to focus on.
c. Discuss the client’s expectations.
d. Explain the purpose of the relationship.
e. Listen to the client’s perception of problems.

Answer 60

a, c, d, e

The orientation phase begins when the nurse and client meet. During this phase, the nurse explains the boundaries of the relationship, discusses the client’s expectations, explains the purpose of the relationship, and listens to the client’s perception of problems. Identifying problems to focus on is an activity completed during the working phase of the nurse–client relationship.

Question 61

A psychiatric-mental health nurse is creating a therapeutic interaction with a client. Which factor(s) is/are included in a therapeutic interaction with a client? Select all that apply.
a. limiting self-disclosure
b. active listening
c. silence
d. giving advice
e. validation

Answer 61

A, B, C, E

A therapeutic interaction with a client is different from a social interaction. In a therapeutic interaction, the nurse focuses on the client and client-related issues. Activities should have a definite purpose, and the conversation should focus only on the client. The nurse should not attempt to meet their own social or other needs during the interaction. Limiting self-disclosure, using active listening, selecting appropriate therapeutic techniques, using silence and validation, and using strength-based communication are important factors in a therapeutic interaction. Being nice toward the client is not necessarily therapeutic and is not a factor in a therapeutic interaction. Giving advice to the client is a block to communication and is not a factor in a therapeutic interaction.

Question 62

A mental health nurse is working toward the avoidance of using nontherapeutic communication techniques when engaging with clients. Which technique(s) will the nurse most likely avoid using in order to use more therapeutic responses to clients? Select all that apply.
a. Silence
b. Voicing doubt
c. Agreeing
d. Challenging
e. Disapproving
f. Exploring

Answer 62

c, d, e

Silence is a therapeutic technique that involves the absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking. Voicing doubt is a therapeutic technique that involves expressing uncertainty about the reality of the client’s perceptions. Agreeing is a nontherapeutic technique that involves indicating accord with the client. Agreeing indicates the client is “right” rather than “wrong” and there is no opportunity for the client to change their mind without being “wrong.” Challenging is a nontherapeutic communication technique that involves demanding proof from the client, and this may cause the client to defend delusions or misperceptions more strongly than before. Disapproving is a nontherapeutic communication technique that involves judging the client’s situation and behaviors. Exploring is a therapeutic technique that involves delving further into a subject or idea.

Question 63

A new nurse is speaking to a client during a mental-health interview. Which technique(s) would indicate that the new nurse requires further teaching about therapeutic communication techniques? Select all the apply.
a. confronting the client
b. giving advice
c. agreeing with the client
d. providing reassurance
e. providing doubt
f. making observations

Answer 63

b, c, d

Techniques that inhibit communication are nontherapeutic for the client and include giving advice, agreeing with the client, challenging the client, providing reassurance, and disapproving of the client’s situation or behavior. Confronting the client, providing doubt, and making observations are therapeutic communication techniques that promote a therapeutic interaction.

Question 64

The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply.
a. skips the last session
b. expresses anger towards the nurse and other clients
c. lists actions to move forward at the conclusion of the meeting
d. asks to keep in touch with the nurse after the relationship ends
e. identifies a resolved problem as a new one needing to be addressed

Answer 64

a, b, e

Ending the therapeutic relationship can produce anxiety in the client. The client may skip the last session to avoid ending the relationship. Expressing anger towards the nurse and other clients indicates that the client does not want the relationship to end. Identifying a resolved problem as a new problem is an action to keep the relationship going. Listing actions to move forward is a desired outcome at the conclusion of a therapeutic relationship. Asking to keep in touch with the nurse after the relationship ends is testing the boundaries but does not necessarily indicate that the client does not want the relationship to end.

Question 65

A new nurse is conducting an admission interview and the client repeatedly uses the phrase “dirty whore” when talking about their spouse and children. Which action(s) by the nurse, if observed by the nurse manager, will require the nurse manager to intervene? Select all that apply.
a. asking another nurse to complete the interview
b. communicating distaste in the comment nonverbally
c. telling the client using the phrase may result in loss of privileges
d. asking the client to tell you the names of their spouse and children
e. maintaining a neutral facial expression

Answer 65

abc
The nurse–client relationship can be jeopardized if the new nurse finds the client’s behavior unacceptable or distasteful and allows those feelings to show by avoiding the client (by asking another nurse to complete the interview) or making verbal responses or facial expressions of annoyance or turning away from the client. Maintaining a neutral expression and asking the client to share the names of their spouse and children communicate active listening and promote insight into appropriate behaviors without communicating disapproval.

Question 66

A new nurse is speaking to a client during a mental-health interview. Which technique(s) would indicate that the new nurse requires further teaching about therapeutic communication techniques? Select all the apply.
a. confronting the client
b. giving advice
c. agreeing with the client
d. providing reassurance
e. providing doubt
f. making observations

Answer 66

b, c, d

Techniques that inhibit communication are nontherapeutic for the client and include giving advice, agreeing with the client, challenging the client, providing reassurance, and disapproving of the client’s situation or behavior. Confronting the client, providing doubt, and making observations are therapeutic communication techniques that promote a therapeutic interaction.

Question 67

Anhedonia

Answer 67

Anhedonia refers to the reduced ability to experience pleasure.

Question 68

Echopraxia

Answer 68

Meaningless imitation of movements just made by another person, occurring as a symptom of mental conditions.

Question 69

T/F: The Patient Self-Determination Act ensures that a person with a mental illness is not discriminated against in the workplace.

Answer 69

False. The Patient Self-Determination Act requires that agencies receiving Medicare and Medicaid reimbursement to inform patients at the time of admission of their right to be a central part of any and all health care decisions made about them or for them.

Question 70

T/F: Involuntary commitment requires a court order.

Answer 70

True. Involuntary commitment is the confined hospitalization of a person without the person’s consent but with a court order.

Three common elements:
Mentally disordered
Dangerous to self or others
Unable to provide for basic needs

Provisions for emergency short-term hospitalization of 48 to 92 hours

Question 71

List in order from least to most restrictive:

PRN medication offers
De-escalation techniques
Restraints
Seclusion room (open)
Time out
Locked seclusion

Answer 71

De-escalation techniques (From least)
PRN medication offers
Time out
Seclusion room (open)
Locked seclusion
Restraints (To most restrictive)

Question 72

The following list requirements for what type of intervention?

Nutrition and toileting needs
Close observation (1 to 1)
Neuro/sensation/movement checks
Timely physician order

Answer 72

Most restrictive restraint method (restraints)

Question 73

What is the Judgment that the client has harmed someone or is about to injure someone (safety is the key).

Answer 73

Duty to warn which is a breach in the confidentiality law.

Question 74

What is using knowledge of science and incorporating art of caring to achieve maximal health care potential?

Answer 74

Beneficence

Question 75

What is the fundamental right of self-determination?

Answer 75

Autonomy

Question 76

Duty to treat all fairly

Answer 76

Justice

Question 77

Duty to cause no harm

Answer 77

Nonmaleficence

Question 78

Professionals authorized to make decisions for good of client

Answer 78

Paternalism

Question 79

Duty to tell the truth

Answer 79

Veracity

Question 80

Faithfulness to obligations and duties

Answer 80

Fidelity

Question 81

Intense, emotional reaction to the loss of a loved one; biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation.

Answer 81

Grief

Question 82

Process of healing and learning to cope with the loss that begins immediately after the loss and can last months or years.

Answer 82

Bereavement.

Question 83

Frozen in chronic mourning (ex. Not being able to return to daily occupational or pleasurable activities).

Answer 83

Complicated bereavement

Question 84

T/F: The disaster event marks the first phase of a disaster.

Answer 84

False, prewarning of the disaster is considered the first phase of a disaster. This is followed by the disaster event and finally recuperative efforts.

Question 85

ABCs of nursing care

Answer 85

A—arousal, when present, the intervention goal is to decrease excitement by providing safety, comfort, and consolation
B—behavior, when abnormal or irrational behavior present, survivors should be assisted to function more effectively in the disaster
C—cognition, when cognitive disorientation occurs, reality testing and clear information should be provided

Question 86

When applying the ABCs of psychological first aid, the nurse addresses which action with cognition?
A. Decreasing excitement
B. Providing for safety
C. Assisting to function more effectively
D. Providing reality testing

Answer 86

D.
When applying the “C” of the ABCs, the nurse would perform reality testing and provide clear information. Decreasing excitement occurs with “A,” arousal. Providing for safety and assisting the person to function more effectively occurs with “B,” behavior.

Question 87

Which activity occurs during the orientation phase of the nurse–patient relationship?
A. Testing the relationship
B. Resolving the problem
C. Engaging in problem solving
D. Identifying problems

Answer 87

A.
During the orientation phase, the relationship is tested. Identifying the problems and engaging in problem solving occur during the working phase. The relationship terminates during the resolution phase.

Question 88

Rapid speech with quick changes from one thought to another. Topic doesn’t remain the same. Common in bipolar disorder in manic phase or someone who is psychotic.

Answer 88

Flight of ideas

Question 89

Thoughts are not organized and no connectivity. Trees to sky, to refrigerator, to television show.

Answer 89

Loose associations/derailment

Question 90

Digressions on the way to an eventual conclusion to answer the questions. Go around the mulberry bush but do get to point.

Answer 90

Circumstantiality

Question 91

Tangible, frequent digressions until the initial reason for discussion has been forgotten.

Answer 91

Incoherence

Question 92

Seeing things that are not there, that we might not see.

Answer 92

Hallucinations

Question 93

Fixed beliefs; accurate and false beliefs not corrected by reasoning.

Answer 93

Delusions

Question 94

People are out to get them.

Answer 94

Persecutory delusions

Question 95

Repeating same word.

Answer 95

Perseverating

Question 96

With what condition do you not ever tell the patient that it’s unlikely that you’re seeing that. They literally see those things.

Answer 96

Hallucinations

Question 97

When a patient is hearing voices, you should not what?

Answer 97

Not say you don’t hear them, you say, tell me more about those voices.

Question 98

If they’re being told to hurt themselves or others or potentially unsafe, we want to know that. Don’t say we don’t hear them, ask how they make them feel.

Answer 98

Hallucinations

Question 99

Which is mood and which is affect?

Sustained overall emotions that may be sustained for days or weeks or fluctuate during the day.

Capacity to vary outward emotions that fluctuate with thought content.

Answer 99

Mood: sustained overall emotions that may be sustained for days or weeks or fluctuate during the day.

Affect: Capacity to vary outward emotions that fluctuate with thought content.

Question 100

Which is judgement and which is insight?

Awareness of own thoughts/feelings and ability to compare them with thoughts/feelings of others. Meaning of behavior i.e. having hallucinations and delusions does not mean I have a mental illness.

Ability to reach a logical decision and to choose a course of action after considering various possibilities.

Answer 100

Insight: Awareness of own thoughts/feelings and ability to compare them with thoughts/feelings of others. Meaning of behavior i.e. having hallucinations and delusions does not mean I have a mental illness.

Judgement: Ability to reach a logical decision and to choose a course of action after considering various possibilities.

Question 101

Recovery-oriented nursing practice focuses on…

Answer 101

…collaborating with pt to help them be motivated to change.

Question 102

Reinforce desired behaviors and extinguish undesired ones. Used for eating disorders, addictions, anger mgmt., impulse control, care of children.

Answer 102

Behavior modification

Question 103

Patients rewarded for desired behaviors.

Answer 103

Token economy

Question 104

Little evidence that what follows pt outside of treatment facility.

Answer 104

Little evidence that transfer of new behaviors from token economy follows pt outside of treatment facility.

Question 105

The process of understanding one’s own beliefs, thoughts, motivations, biases, and limitations and recognizing how they affect others

Answer 105

Self-awareness

Question 106

Which are biologic, psychological and social?

• Physical characteristics
• Psychological makeup; emotions, motivations, beliefs
• Cultural beliefs; patterns of communication
• Genetic makeup, chronic illness, or unobservable physical disability
• Traumatic experiences
• Sociocultural values

Answer 106

Biologic
- Physical characteristics
- Genetic makeup, chronic illness, or unobservable physical disability
Psychological
- Psychological makeup; emotions, motivations, beliefs
- Traumatic experiences
Social
- Sociocultural values
- Cultural beliefs; patterns of communication

Question 107

What is the ongoing process of interaction in which meaning emerges and helps patient explain their perception and feelings?

Answer 107

Therapeutic communication

Question 108

What are the following?

Acceptance
Confrontation
Voicing Doubt
Interpretation
Observation
Open-ended statements
Reflection
Restatement
Silence
Listening (active)
Validation
Clarification

Answer 108

Verbal therapeutic communication techniques.

Question 109

Which of the following are nontherapeutic communication techniques (techniques that inhibit communication):

Interpretation
Advice/and personal opinions
Agreement
Reflection
Challenges
“Why” questions
Changing the subject matter
False Reassurance
Observation
Disapproval
Open-ended statements
Restatement
Silence

Answer 109

Advice/and personal opinions
Agreement
Challenges
False Reassurance
Disapproval
“Why” questions
Changing the subject matter

Question 110

What part of the brain is involved in motor functions and association in both the learning and the programming of behavior or activities that are repetitive and, done over time, become automatic

Answer 110

Basal ganglia

Question 111

Which parts of the brain do the following:

Stores information, especially emotions attached to memories

Relay-switching center of brain; relays all sensory information except smell

Basic human activities: sleep–rest patterns, body temperature, physical drives; secretes hormones; connected to pituitary gland

Answer 111

Hippocampus
Stores information, especially emotions attached to memories
Thalamus
Relay-switching center of brain; relays all sensory information except smell
Hypothalamus
Basic human activities: sleep–rest patterns, body temperature, physical drives; secretes hormones; connected to pituitary gland

Question 112

Which structures are found in the cerebrum?
Hemispheres
Basal ganglia
Hippocampus
Amygdala

Answer 112

Hemispheres

Question 113

Which neurotransmitter is the primary excitatory neurotransmitter
Greatest concentration in the peripheral nervous system
Possibly involved in higher intellectual functioning and memory

Answer 113

Acetylcholine

Question 114

Which biogenic amines are synthesized from tyrosine, which from tryptophan?

Answer 114

Synthesized from tyrosine
Also referred to as catecholamines
Dopamine
Norepinephrine
Epinephrine
Synthesized from tryptophan
Serotonin

Question 115

Which biogenic neurotransmitter is Excitatory and involved in Cognition
and Motor function?

Answer 115

Dopamine

Question 116

Which excitatory bioamine neurotransmitter is responsible for
Mood states
Fight-or-flight
Sleep and wakefulness

Answer 116

Norepinephrine

Question 117

Which biogenic amine neurotransmitter is involved in
Emotions
Cognition
Sensory perceptions
Sleep
Appetite
and is it excitatory or inhibitory?

Answer 117

Serotonin - excitatory

Question 118

Amino acid neurotransmitters

Answer 118

Histamine (anticholinergic) and GABA (primary inhibitory)

Question 119

What is the primary inhibitory amine neurotransmitter?

Answer 119

GABA

Question 120

What is the primary inhibitory neurotransmitter that controls neuronal excitability through brain (example: controls or reduce anxiety)

Answer 120

GABA

Question 121

What are neuropeptides involved in?

Answer 121

Pain (opiates category - endorphins)

Question 122

Receptors have capacity to change.
Changes in sensitivity of receptors most commonly caused by…

Answer 122

• The effect of a drug on a receptor site
• Disease that affects the normal functioning of a receptor site

Question 123

What do the following affect?

• The effect of a drug
• Disease that affects the normal functioning

Answer 123

Neurotransmitter receptor sites

Question 124

T/F: Neurotransmitter receptors are static and not subject to change.

Answer 124

False.

Receptors exhibit receptor sensitivity indicating that they have the capacity to change. This change is most commonly caused by the effect of a drug on a receptor site or a disease that affects the normal functioning of a receptor site.

Question 125

Four phases of drug treatment

Answer 125

Initiation
Stabilization
Maintenance
Discontinuation

Question 126

Biologic basis of addiction is in what brain part?

Answer 126

Midbrain nuclei