Foundations of Mental Health

Question 1

How should clients be treated?

Answer 1

With R-E-S-P-E-C-T.

• be considerate of cultural, spiritual and religious beliefs
• use appropriate limits and boundaries
• use therapeutic communication
• be nonjudgmental

Question 2

When will a mental health client be discharged?

Answer 2

When the HCP has deemed that the client is safe.

Question 3

What is the goal of the nurse-client relationship?

Answer 3

To assist client with problem-solving and coping skills to help make them well.

Question 4

What are the 4 phases of a nurse-client relationship?

Answer 4

1. pre-interaction phase
2. orientation or introductory phase
3. working phase
4. termination or separation phase

Question 5

What is the pre-interaction phase?

Answer 5

What occurs before the nurse meets with the client. The nurse:

• gets a comfortable environment set up before the client arrives
• anticipates problems the client may be dealing with
• determines how to approach the client
• self reflects on own biases that could affect relationship

Question 6

What is the orientation or introductory phase?

Answer 6

When the nurse first meets the client:

• establishes trust and boundaries
• identifies strengths and needs
• collects data and makes goals or a contract with client

Question 7

What is the working phase?

Answer 7

When the nurse is actively working with the client:

• active listening, so client can express thoughts and feelings
• encourages self-direction
• work on goal-solving

Question 8

What is the termination or separation phase?

Answer 8

When the relationship ends:

• prepares for separation and feelings
• evaluates goals and progress
• anticipates follow up care
• makes referrals for support groups

Question 9

What role do family members play in a client’s care?

Answer 9

Active members in the care of the client.

Include family when possible.

Question 10

What is a mental health problem?

Answer 10

When the client has thoughts or behavior that impair normal life functioning and causes distress.

Question 11

What are defense mechanisms?

Answer 11

What a client uses to cope with unmanageable stress and to decrease anxiety.

Question 12

What is denial?

Answer 12

A defense mechanism when the client ignores the unpleasant or intolerable thoughts, feelings, needs or impulses.

Example: a husband ignores his wife’s infidelity even though there are obvious signs.

Question 13

What is displacement?

Answer 13

A defense mechanism when the client directs their feelings to another less-threatening person or object.

Example: an angry client hits the wall instead of a person.

Question 14

What is projection?

Answer 14

A defense mechanism when the client transfers their own feelings on to someone else.

Example: a hostile husband will blame his hostility on his wife and will say she has an anger management problem.

Question 15

What is rationalization?

Answer 15

A defense mechanism when a client attempts to make unacceptable feelings and behaviors acceptable by justifying the behavior.

Example: a rude person will justify behavior by saying the bad traffic from the morning commute caused it.

Question 16

What is regression?

Answer 16

A defense mechanism when the client returns to an earlier developmental behavior to deal with anxiety.

Example: A ten-year-old is in the hospital to get his tonsils removed and begins sucking his thumb like he did when he was a toddler.

Question 17

What is repression?

Answer 17

A defense mechanism when the client unconsciously blocks the unacceptable thoughts or ideas.

Example: a child who is abused by a parent later has no recollection of the events, but has trouble forming relationships.

Question 18

What is compensation?

Answer 18

A defense mechanism when the client uses a lot of extra effort on strengths to make up for deficiencies.

Example: a client that fails in relationships will put in extra effort to be extremely physically fit.

Question 19

What is therapeutic communication?

Answer 19

A face-to-face interaction that focuses on advancing the physical and emotional well-being of a client.

It is frequently used to get the client to open up about concerns and reflect on a situation for problem-solving.

Question 20

What is active listening?

Answer 20

A therapeutic communication technique that shows that the nurse is actively listening to the client.

Example: repeat key points, nod, or ask open-ended questions.

Question 21

What is an open-ended question?

Answer 21

A therapeutic communication technique that encourages conversation because it gets the client to open up and requires more than one-word answers.

Example: “Tell me about your relationship with your children.”

Question 22

What is restating/clarification?

Answer 22

A therapeutic communication technique that repeats what the client has said to give the client an opportunity to agree, disagree, or clarify the message further.

Example: a severely anorexic client says, “I am ready to eat breakfast today.”
The nurse responds with, “Did I hear that you are ready to eat today?”

Question 23

What is silence?

Answer 23

A therapeutic communication technique where nothing is said by the nurse, but sits with the client silently.

This allows time for thoughts to formulate before discussing them.

Question 24

What is presenting reality?

Answer 24

A therapeutic communication technique where the nurse states the facts to show the client there is a problem.

Example: the nurse states to the client, “you say you are not an alcoholic but you drink a 6-pack of beer every night.”

Question 25

What is NON-therapeutic communication?

Answer 25

An ineffective communication. This type of communication doesn’t focus on the client and closes off communication.

Examples:

• “Nice weather we are having.”
• “I’m fine. How are you?”
• “Don’t worry, I think you’ll be fine.”
• “You need this procedure or you won’t get better.”

Question 26

What is approval?

Answer 26

A non-therapeutic communication technique. It is implying that the client is doing or not doing the right thing and may focus on what pleases the nurse instead of what is best for the client.

Example: the nurse states, “That’s so good!”

Question 27

What is changing the subject?

Answer 27

A non-therapeutic communication. The client’s feelings, thoughts, and concerns are avoided.

Example: The client states, “I want to die!”.
The nurse responds with, “Did your parents visit you today?”

Question 28

What are closed-ended questions?

Answer 28

A non-therapeutic communication. These questions elicit a yes/no response and prevent the client from opening up.

Example: “Do you feel bad about what happened?” (Sometimes the nurse needs to ask a close-ended question if the client is showing signs of harming themselves are someone else. An example would be “Do you have a plan for suicide?”)

Question 29

What is false reassurance?

Answer 29

A non-therapeutic communication technique. It’s when a statement is made that the client has no reason to be worried.

Example: the nurse states, “Don’t worry, you’ll be fine.”

Question 30

What is giving advice?

Answer 30

A non-therapeutic communication. It assumes that the client cannot think for themselves. This prevents problem-solving.

Example: the nurse states, “I think you should just listen to your father and do what he says.”

Question 31

What are “why” questions?

Answer 31

Non-therapeutic communication. Starting a question with “why? can cause the client to feel defensive. In general, if the client knew “why?”, then they would not be making the statement.

Example: “Why are you so depressed?”

Question 32

What are value judgments?

Answer 32

Non-therapeutic communication. A comment is made that addresses their morals and can cause anger or guilt.

Example: the nurse states, “I think you should always listen to your parents even if you don’t like what they say.”

Question 33

What are some important client rights?

Answer 33

• refuse care or meds
• be treated
• confidentiality
• privacy
• communicate with those outside the hospital
• least restrictive care

Question 34

What is a voluntary admission?

Answer 34

When the client (or guardian) seeks admission for care.

Question 35

What is an involuntary admission?

Answer 35

When a client is admitted against their will.

This occurs because the client is an imminent danger to themselves or others.

Question 36

If a client is involuntarily admitted, what is the proper legal procedure?

Answer 36

An order from the court, psychiatrist, or primary health care provider is necessary.

If the admission is an immediate emergency, the order can then be gotten later.

Question 37

If a client is involuntarily admitted, what must be provided to the client?

Answer 37

Legal counsel.

Question 38

When can a client lose their right to refuse treatment?

Answer 38

When they are in immediate danger to self or others.

Question 39

What is “discharge against medical advice”?

Answer 39

When the voluntary client is discharged even though the HCP had advised against leaving.

Question 40

What is milieu therapy?

Answer 40

The environment in which a client is empowered by setting their own goals and developing relationships with the staff to achieve these goals.

Question 41

What is behavior therapy?

Answer 41

When the client changes their negative behavior with positive behavior.

Question 42

What is group therapy?

Answer 42

When a therapist leads a small group of individuals all experiencing the same problem.

The group setting allows for feedback and support of each other.

Question 43

Should you ever argue with a client?

Answer 43

Never.

Question 44

What is reaction formation?

Answer 44

Doing the opposite.

Example: a client with a substance use disorder wil preach about abstinence.

Question 45

What is suppression?

Answer 45

A defense mechanism when there is a conscious choice to not remember something.

Example: client doesn’t remember abuse as a child.

Question 46

When is it OK to ask a “why” question to a client?

Answer 46

If the client is not following the treatment plan or not taking their medications. There may be financial or social problems that the nurse can help the client with.

Question 47

What is cognitive therapy?

Answer 47

When a client changes how they think in order to change how they feel.