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Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition: A How-To Guide for EvidenceBased Practice 2nd Edition Test Bank Chapter 1. The Nurse Psychotherapist and a Framework for Practice Question 1 The nurses new job description at the generalist level of practice reflects the definition of psychiatricmental health nursing and the PsychiatricMental Health Nursing Standards of Practice (ANA, APNA, ISPN). In which of the following areas might the nurse plan programs and intervention to fulfill employment expectations?

Standard Text: Select all that apply.

1. Stress management strategies 2. Early diagnosis of psychiatric disorders 3. Parenting classes for new parents 4. Family and group psychotherapy 5. Medication teaching for anti-anxiety medications Correct Answer: 1,3,4,5 Rationale 1: Stress management strategies address health, wellness, and care of mental health problems and are appropriate for psychiatricmental health nursing at the generalist level of practice.

Rationale 2: Early diagnosis of psychiatric disorders is generally not consistent with the definition or practice of psychiatricmental health nursing especially at the generalist level.

Rationale 3: Parenting classes for new parents provide teaching that is consistent with the prevention of mental health problems and is consistent with psychiatricmental health nursing at the generalist level of practice.

Rationale 4: Family and group psychotherapy is consistent at the advanced practice registered nurse level but not the generalist level.

Rationale 5: Medication teaching for anti-anxiety medications promotes quality of care for persons with psychiatric disorders and is vital for psychiatricmental health nursing practice at the generalist level of practice.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatricmental health nursing.

Question 2 Type: MCSA The nurse is serving on a committee charged with reviewing the roles and responsibilities of the nurses on the psychiatric unit. Which publication should the nurse bring to the first meeting?

1. Diagnostic and Statistical Manual of Mental Disorders 2. American Nurses Credentialing Center certification requirements 3. American Nurses Association, Code of Ethics 4. PsychiatricMental Health Nursing Standards of Practice Correct Answer: 4 Rationale 1: The PsychiatricMental Health Nursing Standards of Practice delineates psychiatricmental health nursing roles and functions and serves as guidelines for providing quality care. The Diagnostic and Statistical Manual of Mental Disorders is used by the mental health care team, particularly the psychiatrist, to diagnose clients with mental disorders and is not specific to nursing care issues. The Code of Ethics helps to clarify right and wrong actions by the nurse, but does not clarify roles and nursing care actions. Certification requirements outline steps toward certification that acknowledge knowledge and expertise, but do not delineate roles and responsibilities.

Rationale 2: The PsychiatricMental Health Nursing Standards of Practice delineates psychiatricmental health nursing roles and functions and serves as guidelines for providing quality care. The Diagnostic and Statistical Manual of Mental Disorders is used by the mental health care team, particularly the psychiatrist, to diagnose clients with mental disorders and is not specific to nursing care issues. The Code of Ethics helps to clarify right and wrong actions by the nurse, but does not clarify roles and nursing care actions. Certification requirements outline steps toward certification that acknowledge knowledge and expertise, but do not delineate roles and responsibilities.

Rationale 3: The PsychiatricMental Health Nursing Standards of Practice delineates psychiatricmental health nursing roles and functions and serves as guidelines for providing quality care. The Diagnostic and Statistical Manual of Mental Disorders is used by the mental health care team, particularly the psychiatrist, to diagnose clients with mental disorders and is not specific to nursing care issues. The Code of Ethics helps to clarify right and wrong actions by the nurse, but does not clarify roles and nursing care actions. Certification requirements outline steps toward certification that acknowledge knowledge and expertise, but do not delineate roles and responsibilities.

Rationale 4: The PsychiatricMental Health Nursing Standards of Practice delineates psychiatricmental health nursing roles and functions and serves as guidelines for providing quality care. The Diagnostic and Statistical Manual of Mental Disorders is used by the mental health care team, particularly the psychiatrist, to diagnose clients with mental disorders and is not specific to nursing care issues. The Code of Ethics helps to clarify right and wrong actions by the nurse, but does not clarify roles and nursing care actions. Certification requirements outline steps toward certification that acknowledge knowledge and expertise, but do not delineate roles and responsibilities.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatricmental health nursing.

Question 3

Type: MCSA The psychiatricmental health nurse reflecting on professional role activities is referred to the standards of professional performance by a colleague. To which organization should the nurse look for guidance?

1. North American Nursing Diagnosis Association 2. American Nurses Credentialing Center 3. National League for Nursing 4. American Nurses Association Correct Answer: 4 Rationale 1: The American Nurses Association will be the best resource as professional performance is addressed in standards 715 of ANAs PsychiatricMental Health Nursing Standards of Practice. The National League for Nursing primarily addresses nursing education, while the American Nurses Association Credentialing Center focuses on certification. The North American Nursing Diagnosis Association develops a classification system for nursing diagnoses.

Rationale 2: The American Nurses Association will be the best resource as professional performance is addressed in standards 715 of ANAs PsychiatricMental Health Nursing Standards of Practice. The National League for Nursing primarily addresses nursing education, while the American Nurses Association Credentialing Center focuses on certification. The North American Nursing Diagnosis Association develops a classification system for nursing diagnoses.

Rationale 3: The American Nurses Association will be the best resource as professional performance is addressed in standards 715 of ANAs PsychiatricMental Health Nursing Standards of Practice. The National League for Nursing primarily addresses nursing education, while the American Nurses Association Credentialing Center focuses on certification. The North American Nursing Diagnosis Association develops a classification system for nursing diagnoses.

Rationale 4: The American Nurses Association will be the best resource as professional performance is addressed in standards 715 of ANAs PsychiatricMental Health Nursing Standards of Practice. The National League for Nursing primarily addresses nursing education, while the American Nurses Association Credentialing Center focuses on certification. The North American Nursing Diagnosis Association develops a classification system for nursing diagnoses.

Global Rationale:

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatricmental health nursing.

Question 4 Type: MCSA The psychiatricmental health nurse is working with the new graduate nurse who is orienting to the psychiatric unit. Which comment by the new graduate indicates further clarification of the generalist-nursing role is needed?

1. I would feel better if you would look at my documentation that addresses progress toward treatment goals.

2. I will spend time each day evaluating the effectiveness of the therapeutic milieu.

3. I am a little nervous about conducting psychotherapy with clients.

4. I am doing some reading on how to incorporate complementary interventions into treatment plans.

Correct Answer: 3 Rationale 1: The intent to conduct psychotherapy with clients is not consistent with the role of the nurse at the generalist level of practice as outlined in the PsychiatricMental Health Nursing Standards of Practice and indicates a need for role clarification. Evaluation of the therapeutic milieu, documenting progress toward treatment goals, and incorporating complementary interventions are consistent with the roles of the psychiatricmental health nurse practicing at the generalist level.

Rationale 2: The intent to conduct psychotherapy with clients is not consistent with the role of the nurse at the generalist level of practice as outlined in the PsychiatricMental Health Nursing Standards of Practice and indicates a need for role clarification. Evaluation of the therapeutic milieu, documenting progress toward treatment goals, and incorporating complementary interventions are consistent with the roles of the psychiatricmental health nurse practicing at the generalist level.

Rationale 3: The intent to conduct psychotherapy with clients is not consistent with the role of the nurse at the generalist level of practice as outlined in the PsychiatricMental Health Nursing Standards of Practice and indicates a need for role clarification. Evaluation of the therapeutic milieu, documenting progress toward treatment goals, and incorporating complementary interventions are consistent with the roles of the psychiatricmental health nurse practicing at the generalist level.

Rationale 4: The intent to conduct psychotherapy with clients is not consistent with the role of the nurse at the generalist level of practice as outlined in the PsychiatricMental Health Nursing Standards of Practice and indicates a need for role clarification. Evaluation of the therapeutic milieu, documenting progress toward treatment goals, and incorporating complementary interventions are consistent with the roles of the psychiatricmental health nurse practicing at the generalist level.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatricmental health nursing.

Question 5 Type: MCSA The client on the psychiatric unit is asking questions about prevention of sexually transmitted diseases. Given the PsychiatricMental Health Nursing Standards of Practice, which action would be most appropriate for the nurse to take at this time?

1. Consult with the mental health care team.

2. Teach safer sexual practices.

3. Investigate the questions in individual psychotherapy.

4. Notify the attending psychiatrist.

Correct Answer: 2 Rationale 1: The psychiatricmental health nurse employs strategies to promote health and a safe environment and teaches safer sexual practices to the client who is asking for the information. Notifying the psychiatrist and consulting with the mental health care team is not necessary as health teaching is within the independent practice of the RN. Conducting individual psychotherapy is not within the practice standards for the generalist nurse.

Rationale 2: The psychiatricmental health nurse employs strategies to promote health and a safe environment and teaches safer sexual practices to the client who is asking for the information. Notifying the psychiatrist and consulting with the mental health care team is not necessary as health teaching is within the independent practice of the RN. Conducting individual psychotherapy is not within the practice standards for the generalist nurse.

Rationale 3: The psychiatricmental health nurse employs strategies to promote health and a safe environment and teaches safer sexual practices to the client who is asking for the information. Notifying the psychiatrist and consulting with the mental health care team is not necessary as health teaching is within the independent practice of the RN. Conducting individual psychotherapy is not within the practice standards for the generalist nurse.

Rationale 4: The psychiatricmental health nurse employs strategies to promote health and a safe environment and teaches safer sexual practices to the client who is asking for the information. Notifying the psychiatrist and consulting with the mental health care team is not necessary as health teaching is within the independent practice of the RN. Conducting individual psychotherapy is not within the practice standards for the generalist nurse.

Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatricmental health nursing.

Question 6

Type: MCSA The client asks the nurse if certain changes can be made in the unit milieu. Which action by the nurse indicates understanding of the nursing role in the therapeutic milieu?

1. The nurse refers the clients requests to the psychiatric social worker.

2. The nurse discusses the desired changes with the client.

3. The nurse refers the clients requests to the psychosocial rehabilitation worker.

4. The nurse instructs the client that no changes can be made.

Correct Answer: 2 Rationale 1: The psychiatricmental health nurse has major responsibility for the milieu; therefore, it is appropriate to discuss requested changes in order to gather information regarding the effectiveness of the milieu. The psychiatric social worker identifies community resources and may perform counseling. It is nontherapeutic to instruct the client that no changes can be made before gathering data in relation to the clients requests. The psychosocial rehabilitation worker teaches day-to-day skills for living and may provide case management services.

Rationale 2: The psychiatricmental health nurse has major responsibility for the milieu; therefore, it is appropriate to discuss requested changes in order to gather information regarding the effectiveness of the milieu. The psychiatric social worker identifies community resources and may perform counseling. It is nontherapeutic to instruct the client that no changes can be made before gathering data in relation to the clients requests. The psychosocial rehabilitation worker teaches day-to-day skills for living and may provide case management services.

Rationale 3: The psychiatricmental health nurse has major responsibility for the milieu; therefore, it is appropriate to discuss requested changes in order to gather information regarding the effectiveness of the milieu. The psychiatric social worker identifies community resources and may perform counseling. It is nontherapeutic to instruct the client that no changes can be made before gathering data in relation to the clients requests. The psychosocial rehabilitation worker teaches day-to-day skills for living and may provide case management services.

Rationale 4: The psychiatricmental health nurse has major responsibility for the milieu; therefore, it is appropriate to discuss requested changes in order to gather information regarding the effectiveness of the milieu. The psychiatric social worker identifies community resources and may perform counseling. It is non-

therapeutic to instruct the client that no changes can be made before gathering data in relation to the clients requests. The psychosocial rehabilitation worker teaches day-to-day skills for living and may provide case management services.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatricmental health nurse and other members of the mental health team.

Question 7 Type: MCSA The nurse assesses that the mental health client has problems choosing productive, safe leisure activities. Which member of the mental health team should the nurse consult with?

1. Recreational therapist 2. Occupational therapist 3. Attending psychiatrist 4. Clinical psychologist Correct Answer: 1 Rationale 1: The recreational therapist plans and guides recreational activities to provide socialization, healthful recreation, and desirable interpersonal and intrapsychic experiences and will be the member of the healthcare team to take the lead in the implementation of this portion of the treatment plan. While all members of the team work together, the psychiatrist is responsible for the diagnosis and treatment of the mental illness.

The occupational therapist teaches self-help activities and helps prepare the client for employment. The clinical psychologists foci are psychotherapy, behavior modification, and psychological testing.

Rationale 2: The recreational therapist plans and guides recreational activities to provide socialization, healthful recreation, and desirable interpersonal and intrapsychic experiences and will be the member of the healthcare team to take the lead in the implementation of this portion of the treatment plan. While all members of the team work together, the psychiatrist is responsible for the diagnosis and treatment of the mental illness.

The occupational therapist teaches self-help activities and helps prepare the client for employment. The clinical psychologists foci are psychotherapy, behavior modification, and psychological testing.

Rationale 3: The recreational therapist plans and guides recreational activities to provide socialization, healthful recreation, and desirable interpersonal and intrapsychic experiences and will be the member of the healthcare team to take the lead in the implementation of this portion of the treatment plan. While all members of the team work together, the psychiatrist is responsible for the diagnosis and treatment of the mental illness.

The occupational therapist teaches self-help activities and helps prepare the client for employment. The clinical psychologists foci are psychotherapy, behavior modification, and psychological testing.

Rationale 4: The recreational therapist plans and guides recreational activities to provide socialization, healthful recreation, and desirable interpersonal and intrapsychic experiences and will be the member of the healthcare team to take the lead in the implementation of this portion of the treatment plan. While all members of the team work together, the psychiatrist is responsible for the diagnosis and treatment of the mental illness.

The occupational therapist teaches self-help activities and helps prepare the client for employment. The clinical psychologists foci are psychotherapy, behavior modification, and psychological testing.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatricmental health nurse and other members of the mental health team.

Question 8 Type: MCSA Upon arrival on the psychiatric unit this morning, which activity should be the nurses focus? The nurse should do which of the following?

1. Review psychological testing results for all clients.

2. Schedule the individual therapy sessions for all clients.

3. Identify community resources for clients to be discharged this morning.

4. Assess each client for whom the nurse will be providing care.

Correct Answer: 4 Rationale 1: The nurse is responsible for implementing the nursing process and nursing care for clients. The psychiatric social worker has major responsibility for the identification of post-discharge community resources.

The clinical psychologists primary foci are psychotherapy and psychological testing.

Rationale 2: The nurse is responsible for implementing the nursing process and nursing care for clients. The psychiatric social worker has major responsibility for the identification of post-discharge community resources.

The clinical psychologists primary foci are psychotherapy and psychological testing.

Rationale 3: The nurse is responsible for implementing the nursing process and nursing care for clients. The psychiatric social worker has major responsibility for the identification of post-discharge community resources.

The clinical psychologists primary foci are psychotherapy and psychological testing.

Rationale 4: The nurse is responsible for implementing the nursing process and nursing care for clients. The psychiatric social worker has major responsibility for the identification of post-discharge community resources.

The clinical psychologists primary foci are psychotherapy and psychological testing.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatricmental health nurse and other members of the mental health team.

Question 9

Type: MCSA Due to a staff members absence, the nurse is reviewing staff assignments for the day. Which task can the nurse delegate to the psychosocial rehabilitation worker?

1. Conflict resolution teaching to a small group of clients 2. Comparison of physicians orders with the medication records 3. Routine medication administration to a stable client 4. Assessment of a long-term client Correct Answer: 1 Rationale 1: The psychiatric rehabilitation worker teaches clients practical, day-to-day skills for living in the community, which might include conflict resolution. Medication administration, comparison of physician orders with medication records, and assessment fall within the nursing role and cannot be delegated.

Rationale 2: The psychiatric rehabilitation worker teaches clients practical, day-to-day skills for living in the community, which might include conflict resolution. Medication administration, comparison of physician orders with medication records, and assessment fall within the nursing role and cannot be delegated.

Rationale 3: The psychiatric rehabilitation worker teaches clients practical, day-to-day skills for living in the community, which might include conflict resolution. Medication administration, comparison of physician orders with medication records, and assessment fall within the nursing role and cannot be delegated.

Rationale 4: The psychiatric rehabilitation worker teaches clients practical, day-to-day skills for living in the community, which might include conflict resolution. Medication administration, comparison of physician orders with medication records, and assessment fall within the nursing role and cannot be delegated.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatricmental health nurse and other members of the mental health team.

Question 10 Type: MCSA The clients treatment plan includes teaching related to possible side effects of psychotropic medications. Which member of the mental health team should plan to implement the teaching?

1. The psychosocial rehabilitation worker 2. The primary therapist 3. The psychiatrist 4. The nurse Correct Answer: 4 Rationale 1: The nurse is responsible for the nursing care of the client including medication administration and teaching. While the psychiatrist may also do some teaching, he/she is primarily responsible for the diagnosis and medication prescription. The primary therapist is most likely a clinical psychologist or psychiatric social worker who would not have the educational preparation or license consistent with medication teaching. The psychosocial rehabilitation worker is an unlicensed member of the team and would not have the role of medication teaching.

Rationale 2: The nurse is responsible for the nursing care of the client including medication administration and teaching. While the psychiatrist may also do some teaching, he/she is primarily responsible for the diagnosis and medication prescription. The primary therapist is most likely a clinical psychologist or psychiatric social worker who would not have the educational preparation or license consistent with medication teaching. The psychosocial rehabilitation worker is an unlicensed member of the team and would not have the role of medication teaching.

Rationale 3: The nurse is responsible for the nursing care of the client including medication administration and teaching. While the psychiatrist may also do some teaching, he/she is primarily responsible for the diagnosis and medication prescription. The primary therapist is most likely a clinical psychologist or psychiatric social worker who would not have the educational preparation or license consistent with medication teaching. The psychosocial rehabilitation worker is an unlicensed member of the team and would not have the role of medication teaching.

Rationale 4: The nurse is responsible for the nursing care of the client including medication administration and teaching. While the psychiatrist may also do some teaching, he/she is primarily responsible for the diagnosis and medication prescription. The primary therapist is most likely a clinical psychologist or psychiatric social worker who would not have the educational preparation or license consistent with medication teaching. The psychosocial rehabilitation worker is an unlicensed member of the team and would not have the role of medication teaching.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatricmental health nurse and other members of the mental health team.

Question 11 Type: MCSA The mental health team nurse is having some role issues regarding how best to facilitate client progress toward therapeutic goals. What is the priority action by the nurse in order to aid the team as they assist the client?

1. Acknowledge the diversity of the mental health team.

2. Recognize that conflict is natural and expected.

3. Determine personal values, biases, and goals.

4. Attend all mental health team meetings.

Correct Answer: 3 Rationale 1: The priority nursing action is to determine personal values, biases, and goals; these, especially if out of the awareness of the nurse, may be a factor in team dynamics. Acknowledging the diversity of the team, recognizing that conflict is natural, and attending all mental health team meetings are appropriate actions, but not the priority.

Rationale 2: The priority nursing action is to determine personal values, biases, and goals; these, especially if out of the awareness of the nurse, may be a factor in team dynamics. Acknowledging the diversity of the team, recognizing that conflict is natural, and attending all mental health team meetings are appropriate actions, but not the priority.

Rationale 3: The priority nursing action is to determine personal values, biases, and goals; these, especially if out of the awareness of the nurse, may be a factor in team dynamics. Acknowledging the diversity of the team, recognizing that conflict is natural, and attending all mental health team meetings are appropriate actions, but not the priority.

Rationale 4: The priority nursing action is to determine personal values, biases, and goals; these, especially if out of the awareness of the nurse, may be a factor in team dynamics. Acknowledging the diversity of the team, recognizing that conflict is natural, and attending all mental health team meetings are appropriate actions, but not the priority.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others.

Question 12 Type: MCSA The nurse reflecting on the nursing role within the mental health team, understands that the main purpose of delivering care using a multidisciplinary team is to do which of the following?

1. Maximize the efficiency of the health care team with each team member learning from the others.

2. Increase the opportunity for interpersonal interaction among the client, family, and team members.

3. Facilitate the case management process by delivering care using a multidisciplinary health care team.

4. Make the best use of the different abilities of mental health team members in order to facilitate client progress.

Correct Answer: 4 Rationale 1: The purpose of partnering and collaborating with other disciplines is to make the best use of the different abilities of mental health team members in order to facilitate client progress toward therapeutic goals.

While client-centered interpersonal interaction within a therapeutic relationship is a vital piece of the treatment plan, interpersonal interaction unto itself may not be the needed focus. Facilitating the case management process and maximizing efficiency of the health care team are not primary purposes of a team approach. All care must be focused on the clients and their needs.

Rationale 2: The purpose of partnering and collaborating with other disciplines is to make the best use of the different abilities of mental health team members in order to facilitate client progress toward therapeutic goals.

While client-centered interpersonal interaction within a therapeutic relationship is a vital piece of the treatment plan, interpersonal interaction unto itself may not be the needed focus. Facilitating the case management process and maximizing efficiency of the health care team are not primary purposes of a team approach. All care must be focused on the clients and their needs.

Rationale 3: The purpose of partnering and collaborating with other disciplines is to make the best use of the different abilities of mental health team members in order to facilitate client progress toward therapeutic goals.

While client-centered interpersonal interaction within a therapeutic relationship is a vital piece of the treatment plan, interpersonal interaction unto itself may not be the needed focus. Facilitating the case management process and maximizing efficiency of the health care team are not primary purposes of a team approach. All care must be focused on the clients and their needs.

Rationale 4: The purpose of partnering and collaborating with other disciplines is to make the best use of the different abilities of mental health team members in order to facilitate client progress toward therapeutic goals.

While client-centered interpersonal interaction within a therapeutic relationship is a vital piece of the treatment plan, interpersonal interaction unto itself may not be the needed focus. Facilitating the case management process and maximizing efficiency of the health care team are not primary purposes of a team approach. All care must be focused on the clients and their needs.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others.

Question 13 Type: MCSA Observation of the behavior of the mental health team seems to indicate that one team member is primarily interested in client progress as a measure of their knowledge and expertise. Given the nurses knowledge of game theories, this team member might be functioning as which of the following?

1. Rivalist 2. Leader 3. Enabler 4. Maximizer Correct Answer: 4 Rationale 1: The maximizer is one who is primarily interested only in his or her own gain. A rivalist would be a person whose primary interest is defeating other team members. An enabler is one who facilitates the continuation of what are usually inappropriate behaviors in others and usually not associated with game theory.

A leader would function more in the role of a cooperator, one who is interested in helping both themselves and their partners.

Rationale 2: The maximizer is one who is primarily interested only in his or her own gain. A rivalist would be a person whose primary interest is defeating other team members. An enabler is one who facilitates the continuation of what are usually inappropriate behaviors in others and usually not associated with game theory.

A leader would function more in the role of a cooperator, one who is interested in helping both themselves and their partners.

Rationale 3: The maximizer is one who is primarily interested only in his or her own gain. A rivalist would be a person whose primary interest is defeating other team members. An enabler is one who facilitates the continuation of what are usually inappropriate behaviors in others and usually not associated with game theory.

A leader would function more in the role of a cooperator, one who is interested in helping both themselves and their partners.

Rationale 4: The maximizer is one who is primarily interested only in his or her own gain. A rivalist would be a person whose primary interest is defeating other team members. An enabler is one who facilitates the continuation of what are usually inappropriate behaviors in others and usually not associated with game theory.

A leader would function more in the role of a cooperator, one who is interested in helping both themselves and their partners.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others.

Question 14 Type: MCMA The nurse is planning activities to enhance collaboration within the mental health care team. Which activities will be helpful toward this goal?

Standard Text: Select all that apply.

1. Identification of ways to minimize diversity among team members 2. Discussion of decisions that require team unity 3. Identification of ways to ignore individual power bases 4. Review of interpersonal communication skills 5. Discussion of decisions that can be made autonomously

Correct Answer: 2,5 Rationale 1: Identification of ways to minimize diversity among team members. Effective collaboration on a team involves the ability to value diversity and turn differences into assets. An inability to value diversity may be a detriment to the teams efforts.

Rationale 2: Discussion of decisions that require team unity. Unity should be balanced with autonomy.

Identification of parameters for nursing collaboration would be useful toward the goal.

Rationale 3: Identification of ways to ignore individual power bases. Team members should recognize rather than ignore personal power bases and share power with others. Ignoring this element may decrease the effectiveness of collaboration.

Rationale 4: Review of interpersonal communication skills. Effective communication and processing skills will enhance effective collaboration.

Rationale 5: Discussion of decisions that can be made autonomously. Unity should be balanced with autonomy. Collaboration is not required for all decisions.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others.

Question 15 Type: MCSA The nurse is admitting a client to the psychiatric unit. Which nursing action is correct?

1. Instruct the client that all information gathered during the assessment will be shared with the mental health team.

2. Alert the client that the psychiatrist will do all the intake assessment to maximize the efficiency of the team.

3. Discuss with the client information that is to be shared with family members and the mental health team.

4. Instruct the client that the mental health team will decide what the client needs to do in treatment.

Correct Answer: 3 Rationale 1: Discussing with the client information that is to be shared with family members and the mental health team is an action that promotes a partnership with the client and enhances effectiveness of treatment. The nurse should communicate to the client that decisions related to the sharing of information would take into consideration any agreement regarding disclosure that exists between the nurse and the client and how the receiving party will use the information in the clients best interest. Not all information is significant to the clients reason for treatment. The nurse should communicate circumstances where significant information will be shared. In the spirit of collaboration, the mental health team should involve the client. This assures that clients are informed consumers of mental health services. While the psychiatrist will assess the client from the medical perspective, the nurse must assess the clients responses to the mental disorder in order to plan appropriate nursing care.

Rationale 2: Discussing with the client information that is to be shared with family members and the mental health team is an action that promotes a partnership with the client and enhances effectiveness of treatment. The nurse should communicate to the client that decisions related to the sharing of information would take into consideration any agreement regarding disclosure that exists between the nurse and the client and how the receiving party will use the information in the clients best interest. Not all information is significant to the clients reason for treatment. The nurse should communicate circumstances where significant information will be shared. In the spirit of collaboration, the mental health team should involve the client. This assures that clients are informed consumers of mental health services. While the psychiatrist will assess the client from the medical perspective, the nurse must assess the clients responses to the mental disorder in order to plan appropriate nursing care.

Rationale 3: Discussing with the client information that is to be shared with family members and the mental health team is an action that promotes a partnership with the client and enhances effectiveness of treatment. The nurse should communicate to the client that decisions related to the sharing of information would take into consideration any agreement regarding disclosure that exists between the nurse and the client and how the receiving party will use the information in the clients best interest. Not all information is significant to the clients reason for treatment. The nurse should communicate circumstances where significant information will be shared. In the spirit of collaboration, the mental health team should involve the client. This assures that clients are informed consumers of mental health services. While the psychiatrist will assess the client from the medical

perspective, the nurse must assess the clients responses to the mental disorder in order to plan appropriate nursing care.

Rationale 4: Discussing with the client information that is to be shared with family members and the mental health team is an action that promotes a partnership with the client and enhances effectiveness of treatment. The nurse should communicate to the client that decisions related to the sharing of information would take into consideration any agreement regarding disclosure that exists between the nurse and the client and how the receiving party will use the information in the clients best interest. Not all information is significant to the clients reason for treatment. The nurse should communicate circumstances where significant information will be shared. In the spirit of collaboration, the mental health team should involve the client. This assures that clients are informed consumers of mental health services. While the psychiatrist will assess the client from the medical perspective, the nurse must assess the clients responses to the mental disorder in order to plan appropriate nursing care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others.

Question 16 Type: MCSA The correct response of the nurse who is asked if Florence Nightingale had any impact on the role of the nurse in psychiatricmental health nursing should be which of the following?

1. No, Nightingale focused her ideas on nursing education rather than direct client care.

2. Yes, Nightingale was among the first to note that the influence of nurses has psychological components.

3. No, Nightingale emphasized the physical environment for healing.

4. Yes, Nightingale developed the idea of the therapeutic relationship.

Correct Answer: 2 Rationale 1: Although it is true that in the context of her time Nightingale emphasized the physical environment, she did have an impact on psychiatricmental health nursing. Nightingale was among the first to note that the influence of nurses on their clients goes beyond physical care and has psychological and social components; hence, the value of making her famous evening rounds to say goodnight. Nightingale focused her ideas on both direct client care and nursing education. Hildegard Peplau is credited with theory related to the therapeutic nurseclient relationship.

Rationale 2: Although it is true that in the context of her time Nightingale emphasized the physical environment, she did have an impact on psychiatricmental health nursing. Nightingale was among the first to note that the influence of nurses on their clients goes beyond physical care and has psychological and social components; hence, the value of making her famous evening rounds to say goodnight. Nightingale focused her ideas on both direct client care and nursing education. Hildegard Peplau is credited with theory related to the therapeutic nurseclient relationship.

Rationale 3: Although it is true that in the context of her time Nightingale emphasized the physical environment, she did have an impact on psychiatricmental health nursing. Nightingale was among the first to note that the influence of nurses on their clients goes beyond physical care and has psychological and social components; hence, the value of making her famous evening rounds to say goodnight. Nightingale focused her ideas on both direct client care and nursing education. Hildegard Peplau is credited with theory related to the therapeutic nurseclient relationship.

Rationale 4: Although it is true that in the context of her time Nightingale emphasized the physical environment, she did have an impact on psychiatricmental health nursing. Nightingale was among the first to note that the influence of nurses on their clients goes beyond physical care and has psychological and social components; hence, the value of making her famous evening rounds to say goodnight. Nightingale focused her ideas on both direct client care and nursing education. Hildegard Peplau is credited with theory related to the therapeutic nurseclient relationship.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 17 Type: MCSA The nurse planning a brief presentation about the first American psychiatric nurse will research which of the following?

1. Hildegard Peplau 2. Harriet Bailey 3. Linda Richards 4. Gwen Tudor (Will) Correct Answer: 3 Rationale 1: Linda Richards, the first American psychiatric nurse, opened the first American school for psychiatric nurses and spent a significant part of her career developing better nursing care in psychiatric hospitals. Hildegard Peplau developed the first systematic theoretic framework in psychiatric nursing. Harriet Bailey wrote the first psychiatric nursing text, Nursing Mental Diseases. Gwen Tudor (Will) was the first nurse to publish an article in the journal Psychiatry. While the last three nurses made significant contributions, the title of first American psychiatric nurse, falls to Linda Richards.

Rationale 2: Linda Richards, the first American psychiatric nurse, opened the first American school for psychiatric nurses and spent a significant part of her career developing better nursing care in psychiatric hospitals. Hildegard Peplau developed the first systematic theoretic framework in psychiatric nursing. Harriet Bailey wrote the first psychiatric nursing text, Nursing Mental Diseases. Gwen Tudor (Will) was the first nurse to publish an article in the journal Psychiatry. While the last three nurses made significant contributions, the title of first American psychiatric nurse, falls to Linda Richards.

Rationale 3: Linda Richards, the first American psychiatric nurse, opened the first American school for psychiatric nurses and spent a significant part of her career developing better nursing care in psychiatric hospitals. Hildegard Peplau developed the first systematic theoretic framework in psychiatric nursing. Harriet Bailey wrote the first psychiatric nursing text, Nursing Mental Diseases. Gwen Tudor (Will) was the first nurse to publish an article in the journal Psychiatry. While the last three nurses made significant contributions, the title of first American psychiatric nurse, falls to Linda Richards.

Rationale 4: Linda Richards, the first American psychiatric nurse, opened the first American school for psychiatric nurses and spent a significant part of her career developing better nursing care in psychiatric hospitals. Hildegard Peplau developed the first systematic theoretic framework in psychiatric nursing. Harriet Bailey wrote the first psychiatric nursing text, Nursing Mental Diseases. Gwen Tudor (Will) was the first nurse to publish an article in the journal Psychiatry. While the last three nurses made significant contributions, the title of first American psychiatric nurse, falls to Linda Richards.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 18 Type: MCSA The nurse is reflecting on psychiatric nursing care in the 19th century. Which nursing diagnosis is most consistent with the focus of psychiatric nursing care during the 19th century?

1. Ineffective individual coping 2. Self-care deficit 3. Anxiety 4. Altered thought processes Correct Answer: 2 Rationale 1: During the 19th century, psychiatric nurses attended mainly to the physical needs of clients and did not pursue systematic interpersonal work with them. Psychiatric nursing practice was primarily custodial.

Nursing care that systematically addresses anxiety, coping, and altered-thought processes did not come about until the mid 20th century.

Rationale 2: During the 19th century, psychiatric nurses attended mainly to the physical needs of clients and did not pursue systematic interpersonal work with them. Psychiatric nursing practice was primarily custodial.

Nursing care that systematically addresses anxiety, coping, and altered-thought processes did not come about until the mid 20th century.

Rationale 3: During the 19th century, psychiatric nurses attended mainly to the physical needs of clients and did not pursue systematic interpersonal work with them. Psychiatric nursing practice was primarily custodial.

Nursing care that systematically addresses anxiety, coping, and altered-thought processes did not come about until the mid 20th century.

Rationale 4: During the 19th century, psychiatric nurses attended mainly to the physical needs of clients and did not pursue systematic interpersonal work with them. Psychiatric nursing practice was primarily custodial.

Nursing care that systematically addresses anxiety, coping, and altered-thought processes did not come about until the mid 20th century.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 19 Type: MCSA On which dimension would the nurse most likely focus data collection if the nurse was assessing the client from primarily a 19th century perspective?

1. Spiritual 2. Physical 3. Social

4. Emotional Correct Answer: 2 Rationale 1: Up until the early to mid-20th century, psychiatric nurses attended primarily to the physical needs of the clients and did not pursue interpersonal work with them. Psychiatric nursing care during this period emphasized a physical environment that would promote recovery. More holistic care (including emotionalsocial-spiritual dimensions) is a product of more recent history.

Rationale 2: Up until the early to mid-20th century, psychiatric nurses attended primarily to the physical needs of the clients and did not pursue interpersonal work with them. Psychiatric nursing care during this period emphasized a physical environment that would promote recovery. More holistic care (including emotionalsocial-spiritual dimensions) is a product of more recent history.

Rationale 3: Up until the early to mid-20th century, psychiatric nurses attended primarily to the physical needs of the clients and did not pursue interpersonal work with them. Psychiatric nursing care during this period emphasized a physical environment that would promote recovery. More holistic care (including emotionalsocial-spiritual dimensions) is a product of more recent history.

Rationale 4: Up until the early to mid-20th century, psychiatric nurses attended primarily to the physical needs of the clients and did not pursue interpersonal work with them. Psychiatric nursing care during this period emphasized a physical environment that would promote recovery. More holistic care (including emotionalsocial-spiritual dimensions) is a product of more recent history.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 20 Type: MCSA

The nursing student is asked which historical event was most significant in the development of psychiatric nursing as a specialty and psychotherapeutic roles for nurses. Which response by the nursing student indicates understanding of important events related to development of the psychiatric nursing role?

1. Release of the report Nursing for the Future 2. Passage of the Community Mental Health Centers Act 3. Publication of Commonsense Psychiatry 4. Passage of the National Mental Health Act Correct Answer: 4 Rationale 1: The National Mental Health Act of 1946 is probably the most significant piece of legislation affecting the development of psychiatricmental health nursing. Within this act, psychiatric nursing was added to psychiatry, psychology, and social work as a field in which the highest priority became the preparation of clinically capable persons for positions of leadership. Commonsense Psychiatry, written by Adolf Meyer, had great impact on psychiatry; however, it did not have a noticeable influence on psychiatric nursing. Nursing for the Future eliminated single-focus schools of psychiatric nursing. The Community Mental Health Centers Act of 1963 encouraged the closing of large mental hospitals and further encouraged the trend toward expanded nursing roles at the graduate level.

Rationale 2: The National Mental Health Act of 1946 is probably the most significant piece of legislation affecting the development of psychiatricmental health nursing. Within this act, psychiatric nursing was added to psychiatry, psychology, and social work as a field in which the highest priority became the preparation of clinically capable persons for positions of leadership. Commonsense Psychiatry, written by Adolf Meyer, had great impact on psychiatry; however, it did not have a noticeable influence on psychiatric nursing. Nursing for the Future eliminated single-focus schools of psychiatric nursing. The Community Mental Health Centers Act of 1963 encouraged the closing of large mental hospitals and further encouraged the trend toward expanded nursing roles at the graduate level.

Rationale 3: The National Mental Health Act of 1946 is probably the most significant piece of legislation affecting the development of psychiatricmental health nursing. Within this act, psychiatric nursing was added to psychiatry, psychology, and social work as a field in which the highest priority became the preparation of clinically capable persons for positions of leadership. Commonsense Psychiatry, written by Adolf Meyer, had great impact on psychiatry; however, it did not have a noticeable influence on psychiatric nursing. Nursing for the Future eliminated single-focus schools of psychiatric nursing. The Community Mental Health Centers Act

of 1963 encouraged the closing of large mental hospitals and further encouraged the trend toward expanded nursing roles at the graduate level.

Rationale 4: The National Mental Health Act of 1946 is probably the most significant piece of legislation affecting the development of psychiatricmental health nursing. Within this act, psychiatric nursing was added to psychiatry, psychology, and social work as a field in which the highest priority became the preparation of clinically capable persons for positions of leadership. Commonsense Psychiatry, written by Adolf Meyer, had great impact on psychiatry; however, it did not have a noticeable influence on psychiatric nursing. Nursing for the Future eliminated single-focus schools of psychiatric nursing. The Community Mental Health Centers Act of 1963 encouraged the closing of large mental hospitals and further encouraged the trend toward expanded nursing roles at the graduate level.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 21 Type: MCMA The nurse is writing a scholarly paper on early nursing leaders who made major contributions to the development of the multifaceted psychiatric nursing role of today. The nurse should include which of the following nurses when writing the paper?

Standard Text: Select all that apply.

1. Florence Nightingale 2. Frances Sleeper 3. Linda Richards

4. Gwen Tudor (Will) 5. Hildegard Peplau Correct Answer: 4,5 Rationale 1: Florence Nightingale. Noted that the influence of nurses went beyond physical care; however, she emphasized physical care and made no other significant contributions to the role of the psychiatric nurse.

Rationale 2: Frances Sleeper. Advocated the use of psychiatric nurses as psychotherapists.

Rationale 3: Linda Richards. Worked toward better nursing care in psychiatric hospitals; however, had minimal impact on the current role of psychiatric nurses. Nurses of her era focused on more custodial physical nursing care.

Rationale 4: Gwen Tudor (Will). Designed a nursing intervention that demonstrated that nurses can promote emotional growth in clients and that the psychotherapeutic nursing role can be taught to others.

Rationale 5: Hildegard Peplau. Published Interpersonal Relations in Nursing, the first systematic theoretic framework in psychiatric nursing, a milestone in the development of the psychiatric nursing roles and practice.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 22 Type: MCMA The psychiatric-mental health nurse is planning a personal program of continuing education to better meet the challenges of the future in psychiatric nursing practice. What areas should be included in the nurses plan for continuing education?

Standard Text: Select all that apply.

1. Psychiatric nursing care in nontraditional settings 2. Psychopharmacology 3. Genetic research 4. Psychobiology 5. Physical health of psychiatric clients Correct Answer: 1,2,3,4,5 Rationale 1: Psychiatric nursing care in nontraditional settings. Settings continue to expand from hospitals and traditional settings to alternative and nontraditional settings.

Rationale 2: Psychopharmacology. Newer psychopharmacologic agents with fewer side effects continue to grow.

Rationale 3: Genetic research resulted in significant knowledge related to the genetic basis of inherited mental disorders that must be integrated into various areas of psychiatric nursing practice.

Rationale 4: Psychobiology. As there has been a knowledge explosion in psychobiology, the greatest challenge for psychiatric nursing is the integration of psychobiologic knowledge into clinical practice while maintaining a focus on caring.

Rationale 5: Physical health of psychiatric clients is a sometimes overlooked dimension of care especially among the severely and persistently mentally ill clients living in community settings is a new area of focus and challenge for psychiatric nurses.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Describe how the role of the psychiatricmental health nurse changed over the years from that of custodian to a multifaceted role.

Question 23 Type: MCSA While caring for the client with a mental illness, which action by the psychiatricmental health nurse best indicates use of Hildegard Peplaus nursing theory?

1. Establishing a therapeutic nurse-client relationship 2. Intervening to enhance the clients abilities to perform self-care 3. Assessing clients interactions with their environment 4. Evaluating the effectiveness of the clients coping and adaptation skills Correct Answer: 1 Rationale 1: Peplau conceptualized the one-to-one nurseclient relationship in which the client can accomplish developmental tasks and practice healthy behaviors. Dorothea Orem identified the goal of self-care and focused on the clients abilities to perform self-care to maintain life, health, and well-being. Martha Rogers work gave psychiatric nurses a mandate to use holistic principles and to consider human beings and environmental interactions. Sister Callista Roys adaptation theory related the notion of coping or adapting to stimuli as humans interact with their environment.

Rationale 2: Peplau conceptualized the one-to-one nurseclient relationship in which the client can accomplish developmental tasks and practice healthy behaviors. Dorothea Orem identified the goal of self-care and focused on the clients abilities to perform self-care to maintain life, health, and well-being. Martha Rogers work gave psychiatric nurses a mandate to use holistic principles and to consider human beings and environmental interactions. Sister Callista Roys adaptation theory related the notion of coping or adapting to stimuli as humans interact with their environment.

Rationale 3: Peplau conceptualized the one-to-one nurseclient relationship in which the client can accomplish developmental tasks and practice healthy behaviors. Dorothea Orem identified the goal of self-care and focused on the clients abilities to perform self-care to maintain life, health, and well-being. Martha Rogers work gave psychiatric nurses a mandate to use holistic principles and to consider human beings and environmental interactions. Sister Callista Roys adaptation theory related the notion of coping or adapting to stimuli as humans interact with their environment.

Rationale 4: Peplau conceptualized the one-to-one nurseclient relationship in which the client can accomplish developmental tasks and practice healthy behaviors. Dorothea Orem identified the goal of self-care and focused on the clients abilities to perform self-care to maintain life, health, and well-being. Martha Rogers work gave psychiatric nurses a mandate to use holistic principles and to consider human beings and environmental interactions. Sister Callista Roys adaptation theory related the notion of coping or adapting to stimuli as humans interact with their environment.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatricmental health nursing most directly.

Question 24 Type: MCSA If psychiatric nurses used Orems theory for structuring much of their nursing practice, a major focus area for assessment would be the clients ability to do which of the following?

1. Adapt and function to meet various role expectations.

2. Care about self and participate in self-healing.

3. Implement self-care to meet psychosocial needs.

4. Enter into a therapeutic one-to-one relationship with the nurse.

Correct Answer: 3 Rationale 1: Orems theory of self-care identifies universal self-care requisites and categories that encompass both physical and psychosocial human needs. Orem focuses on abilities to perform self-care to maintain life, health, and well-being. Peplau conceptualizes the one-to-one nurseclient relationship. Roys adaptation theory

identifies modes of human adapting, including the area of role function. Watsons theory of human caring emphasizes self-caring and self-healing.

Rationale 2: Orems theory of self-care identifies universal self-care requisites and categories that encompass both physical and psychosocial human needs. Orem focuses on abilities to perform self-care to maintain life, health, and well-being. Peplau conceptualizes the one-to-one nurseclient relationship. Roys adaptation theory identifies modes of human adapting, including the area of role function. Watsons theory of human caring emphasizes self-caring and self-healing.

Rationale 3: Orems theory of self-care identifies universal self-care requisites and categories that encompass both physical and psychosocial human needs. Orem focuses on abilities to perform self-care to maintain life, health, and well-being. Peplau conceptualizes the one-to-one nurseclient relationship. Roys adaptation theory identifies modes of human adapting, including the area of role function. Watsons theory of human caring emphasizes self-caring and self-healing.

Rationale 4: Orems theory of self-care identifies universal self-care requisites and categories that encompass both physical and psychosocial human needs. Orem focuses on abilities to perform self-care to maintain life, health, and well-being. Peplau conceptualizes the one-to-one nurseclient relationship. Roys adaptation theory identifies modes of human adapting, including the area of role function. Watsons theory of human caring emphasizes self-caring and self-healing.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatricmental health nursing most directly.

Question 25 Type: MCSA The psychiatricmental health nurse is asked to develop an intervention for the nursing unit based on Watsons theory of caring. Given this assignment, which intervention is most appropriate for the nurse to implement?

1. One-to-one debriefing sessions each week with individual unit nurses and the unit manager 2. Clarification of values and cultural beliefs that might pose barriers to caring for clients 3. Identification of additional coping skills for new nurses on the unit 4. Discussion of the impact of recent changes in hospital policy on the nursing staff Correct Answer: 2 Rationale 1: Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose barriers to transpersonal caring. Identification of coping skills for new nurses is consistent with Roys theory of adaptation. Discussion of the impact of change on the nursing staff is consistent with Rogerss theory that considers humans and environmental interactions and change. One-to-one debriefing sessions are more consistent with Peplaus theory; however, this intervention could be used in a variety of theoretical approaches.

Rationale 2: Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose barriers to transpersonal caring. Identification of coping skills for new nurses is consistent with Roys theory of adaptation. Discussion of the impact of change on the nursing staff is consistent with Rogerss theory that considers humans and environmental interactions and change. One-to-one debriefing sessions are more consistent with Peplaus theory; however, this intervention could be used in a variety of theoretical approaches.

Rationale 3: Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose barriers to transpersonal caring. Identification of coping skills for new nurses is consistent with Roys theory of adaptation. Discussion of the impact of change on the nursing staff is consistent with Rogerss theory that considers humans and environmental interactions and change. One-to-one debriefing sessions are more consistent with Peplaus theory; however, this intervention could be used in a variety of theoretical approaches.

Rationale 4: Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose barriers to transpersonal caring. Identification of coping skills for new nurses is consistent with Roys theory of adaptation. Discussion of the impact of change on the nursing staff is consistent with Rogerss theory that considers humans and environmental interactions and change. One-to-one debriefing sessions are more consistent with Peplaus theory; however, this intervention could be used in a variety of theoretical approaches.

Global Rationale:

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatricmental health nursing most directly.

Question 26 Type: MCSA The unit manager is consistently advocating for self-awareness among the psychiatricmental health nursing staff in order to promote quality care. From which theoretical base is the unit manager operating?

1. Jean Watsons theory of human caring 2. Dorothea Orems theory of self-care 3. Martha Rogerss principles of homeodynamics 4. Sister Callista Roys adaptation theory Correct Answer: 1 Rationale 1: Jean Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose as barriers to transpersonal caring. Roys adaptation theory (coping and adapting to environmental stimuli), Rogerss principles of homeodynamics (human and environmental interaction), and Orems theory of self-care (matching nursing systems of care with clients levels of self-care functioning) have different emphases.

Rationale 2: Jean Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose as barriers to transpersonal caring. Roys adaptation theory (coping and adapting to environmental stimuli), Rogerss principles of homeodynamics (human and environmental interaction), and Orems theory of self-care (matching nursing systems of care with clients levels of self-care functioning) have different emphases.

Rationale 3: Jean Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose as barriers to transpersonal caring. Roys adaptation theory (coping and adapting to environmental stimuli), Rogerss principles of homeodynamics (human and environmental interaction), and Orems theory of self-care (matching nursing systems of care with clients levels of self-care functioning) have different emphases.

Rationale 4: Jean Watsons theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose as barriers to transpersonal caring. Roys adaptation theory (coping and adapting to environmental stimuli), Rogerss principles of homeodynamics (human and environmental interaction), and Orems theory of self-care (matching nursing systems of care with clients levels of self-care functioning) have different emphases.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatricmental health nursing most directly.

Question 27 Type: MCSA Upon the clients arrival on the patient care unit, the nurse begins implementation of the nursing process. Of which nursing theorist should the nurses practice be most reflective?

1. Ida Jean Orlando 2. Jean Watson 3. Dorothea Orem 4. Hildegard Peplau Correct Answer: 4

Rationale 1: Some say that the phases of Peplaus therapeutic nurseclient relationship are ancestors of the phases of the nursing process. While Orem, Watson, and Orlando guide the nurse in areas for assessment, analysis, planning, intervention, evaluation, etc., they do not identify specific phases or steps of the nurseclient interaction process.

Rationale 2: Some say that the phases of Peplaus therapeutic nurseclient relationship are ancestors of the phases of the nursing process. While Orem, Watson, and Orlando guide the nurse in areas for assessment, analysis, planning, intervention, evaluation, etc., they do not identify specific phases or steps of the nurseclient interaction process.

Rationale 3: Some say that the phases of Peplaus therapeutic nurseclient relationship are ancestors of the phases of the nursing process. While Orem, Watson, and Orlando guide the nurse in areas for assessment, analysis, planning, intervention, evaluation, etc., they do not identify specific phases or steps of the nurseclient interaction process.

Rationale 4: Some say that the phases of Peplaus therapeutic nurseclient relationship are ancestors of the phases of the nursing process. While Orem, Watson, and Orlando guide the nurse in areas for assessment, analysis, planning, intervention, evaluation, etc., they do not identify specific phases or steps of the nurseclient interaction process.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatricmental health nursing most directly.

Question 28 Type: MCMA The nursing student asks the nurse the reason that knowledge of nursing theories is important. The nurse should respond that nurses use nursing theories to do which of the following?

Standard Text: Select all that apply.

1. Organize assessment data.

2. Generate goals.

3. Evaluate outcomes.

4. Plan interventions.

5. Generate nursing actions.

Correct Answer: 1,2,4,5 Rationale 1: Organize assessment data. Nurses use theories to assist them to organize and think about human responses and data in meaningful ways.

Rationale 2: Generate goals. Nurses use theories to generate goals that have meaning for clients and reflect desired outcomes to promote health and well-being.

Rationale 3: Evaluate outcomes. Nurses use theories to assist in the identification of areas for evaluation of client progress toward goals.

Rationale 4: Plan interventions. Nurses use theories to plan interventions that address human responses as they interact with both the internal and external environments.

Rationale 5: Generate nursing actions. Nurses use theories to provide guidance in the focus for nursing actions that promote health as defined by each theory.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain why you should be capable of functioning in all theories of care.

Question 29

Type: MCSA If the nurse is using the nursing theory that has shaped psychiatricmental health most directly, which nursing action is priority?

1. Assessing the clients abilities in areas of self-care 2. Teaching effective coping skills 3. Establishing a therapeutic nurseclient relationship 4. Encouraging the clients sensitivity and caring for self Correct Answer: 3 Rationale 1: The interpersonal theory of psychiatricmental health nursing and the therapeutic relationship originated by Peplau remains the theory that has shaped psychiatricmental health nursing most directly. While assessing self-care abilities, encouraging sensitivity and caring for self, and teaching effective coping skills are important areas for nursing action, all efforts are supported by a therapeutic nurseclient relationship.

Rationale 2: The interpersonal theory of psychiatric-mental health nursing and the therapeutic relationship originated by Peplau remains the theory that has shaped psychiatricmental health nursing most directly. While assessing self-care abilities, encouraging sensitivity and caring for self, and teaching effective coping skills are important areas for nursing action, all efforts are supported by a therapeutic nurseclient relationship.

Rationale 3: The interpersonal theory of psychiatricmental health nursing and the therapeutic relationship originated by Peplau remains the theory that has shaped psychiatricmental health nursing most directly. While assessing self-care abilities, encouraging sensitivity and caring for self, and teaching effective coping skills are important areas for nursing action, all efforts are supported by a therapeutic nurseclient relationship.

Rationale 4: The interpersonal theory of psychiatricmental health nursing and the therapeutic relationship originated by Peplau remains the theory that has shaped psychiatricmental health nursing most directly. While assessing self-care abilities, encouraging sensitivity and caring for self, and teaching effective coping skills are important areas for nursing action, all efforts are supported by a therapeutic nurseclient relationship.

Chapter 2. The Neurophysiology of Trauma and Psychotherapy MULTIPLE CHOICE

1. A patient asks, What are neurotransmitters? The doctor said mine are imbalanced. Select the nurses best response. a. How do you feel about having imbalanced neurotransmitters? b. Neurotransmitters protect us from harmful effects of free radicals. c. Neurotransmitters are substances we consume that influence memory and mood. d. Neurotransmitters are natural chemicals that pass messages between brain cells.

ANS: D The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the patients question or provide untrue, misleading information.

2. The parent of an adolescent diagnosed with schizophrenia asks the nurse, My childs doctor ordered a PET. What kind of test is that? Select the nurses best reply. a. This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants? b. PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain. c. A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures. d. Its a special x-ray that shows structures of the brain and whether there has ever been a brain injury.

ANS: B The parent is seeking information about PET scans. It is important to use terms the parent can understand, so the nurse should identify what the initials mean. The correct response is the only option that provides information relevant to PET scans. The distracters describe MRI, CT scans, and EEG. See relationship to audience response question.

3. A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimers disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first? a. Skull x-rays

b. Computed tomography (CT) scan c. Positron-emission tomography (PET) d. Single-photon emission computed tomography (SPECT) ANS: B A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarct, information that would be helpful to the health care provider. PET and SPECT show brain activity rather than structure and may occur later. See relationship to audience response question.

4. A patients history shows drinking 4 to 6 liters of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient? a. Amydala

c. Hippocampus

b. Parietal lobe

d. Hypothalamus

ANS: D The hypothalamus, a small area in the ventral superior portion of the brainstem, plays a vital role in such basic drives as hunger, thirst, and sex. See relationship to audience response question.

5. The nurse prepares to assess a patient diagnosed with major depression for disturbances in circadian rhythms.

Which question should the nurse ask this patient? a. Have you ever seen or heard things that others do not? b. What are your worst and best times of the day? c. How would you describe your thinking? d. Do you think your memory is failing?

ANS: B Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep pattern are also relevant to circadian rhythms. The distracters apply to assessment for illusions and hallucinations, thought processes, and memory.

6. The nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which effect would be expected?

a. Reduced anxiety

c. More organized thinking

b. Improved memory

d. Fewer sensory perceptual alterations

ANS: A Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations. See relationship to audience response question.

7. A nurse would anticipate that treatment for a patient with memory difficulties might include medications designed to: a. inhibit gamma-aminobutyric acid (GABA). b. prevent destruction of acetylcholine. c. reduce serotonin metabolism. d. increase dopamine activity.

ANS: B Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory.

GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with Parkinsons disease rather than improving memory.

8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show dysfunction in which part of the brain? a. Hippocampus

c. Cerebellum

b. Frontal lobe

d. Brainstem

ANS: B The frontal lobe is responsible for intellectual functioning. The hippocampus is involved in emotions and learning. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.

9. The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the:

a. parasympathetic nervous system.

c. reticular activating system.

b. sympathetic nervous system.

d. medulla oblongata.

ANS: A Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.

10. The therapeutic action of neurotransmitter inhibitors that block reuptake cause: a. decreased concentration of the blocked neurotransmitter in the central nervous system. b. increased concentration of the blocked neurotransmitter in the synaptic gap. c. destruction of receptor sites specific to the blocked neurotransmitter. d. limbic system stimulation.

ANS: B If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.

11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop? a. Anticholinergic effects

c. Endocrine-stimulating effects

b. Dopamine-blocking effects

d. Ability to stimulate spinal nerves

ANS: B Medication that blocks dopamine often produces disturbances of movement, such as akathisia, because dopamine affects neurons involved in both thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.

12. A patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter?

a. Gamma-aminobutyric acid (GABA)

c. Acetylcholine

b. Norepinephrine

d. Histamine

ANS: B Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for fight or flight. GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation.

13. A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group? a. Tricyclic antidepressants

c. Antimanic drugs

b. Antipsychotic drugs

d. Benzodiazepines

ANS: D Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression.

Antimanic drugs are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis.

14. A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about: a. chlordiazepoxide (Librium).

c. sertraline (Zoloft).

b. clozapine (Clozaril).

d. tacrine (Cognex).

ANS: C Sertraline (Zoloft) is an SSRI. This antidepressant blocks the reuptake of serotonin, with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimers disease.

15. A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group? a. Psychostimulants

c. Anticholinergics

b. Mood stabilizers

d. Antidepressants

ANS: B The symptoms describe mania, which is effectively treated by mood stabilizers, such as lithium, and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are not effective in the treatment of mania.

16. A drug causes muscarinic receptor blockade. The nurse will assess the patient for: a. dry mouth.

c. pseudoparkinsonism.

b. gynecomastia.

d. orthostatic hypotension.

ANS: A Muscarinic receptor blockade includes atropine-like side effects, such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with

1 antagonism.

17. A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drugs strong dopaminergic effect? a. Chew sugarless gum.

c. Arise slowly from bed.

b. Increase dietary fiber.

d. Report changes in muscle movement.

ANS: D Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Movement disorders and motor abnormalities (extrapyramidal side effects), such as parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia, are likely to occur early in the course of treatment. They are often heralded by sensations of muscle stiffness. Early intervention with antiparkinsonism medication can increase the patients comfort and prevent dystonic reactions. The distracters are related to anticholinergic effects.

18. A patient tells the nurse, My doctor prescribed Paxil (paroxetine) for my depression. I assume Ill have side effects like I had when I was taking Tofranil (imipramine). The nurses reply should be based on the knowledge that paroxetine is a(n): a. selective norepinephrine reuptake inhibitor. b. tricyclic antidepressant. c. MAO inhibitor.

d. SSRI. ANS: D Paroxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic hypotension.

19. A nurse can anticipate anticholinergic side effects are likely when a patient takes: a. lithium (Lithobid).

c. imipramine (Tofranil).

b. buspirone (BuSpar).

d. risperidone (Risperdal).

ANS: C Imipramine (Tofranil) is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.

20. Which instruction has priority when teaching a patient about clozapine (Clozaril)? a. Avoid unprotected sex. b. Report sore throat and fever immediately. c. Reduce foods high in polyunsaturated fats. d. Use over-the-counter preparations for rashes.

ANS: B Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly. The other options are not relevant to clozapine.

21. A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes: a. carbamazepine.

c. phenelzine.

b. haloperidol.

d. trazodone.

ANS: C Patients taking phenelzine, an MAO inhibitor, must be on a low tyramine diet to prevent hypertensive crisis.

There are no specific dietary precautions associated with the distracters.

22. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. cardiac dysrhythmia.

c. hypertensive crisis.

b. hypotensive shock.

d. hypoglycemia.

ANS: C Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.

23. A nurse caring for a patient taking a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to: a. coherent thought processes.

c. reduced levels of motor activity.

b. improvement in depression.

d. decreased extrapyramidal symptoms.

ANS: B SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.

24. By which mechanism do selective serotonin reuptake inhibitors (SSRI) improve depression? a. Destroying increased amounts of serotonin b. Making more serotonin available at the synaptic gap c. Increasing production of acetylcholine and dopamine d. Blocking muscarinic and ANS: B

1 norepinephrine receptors

Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or

1 norepinephrine blockade.

25. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3.

Select the nurses best action. a. Report the results to the health care provider immediately. b. Administer the next dose as prescribed. c. Give aspirin and force fluids. d. Repeat the laboratory test.

ANS: A These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy.

These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld. Caution: This question requires students to apply previous learning regarding normal and abnormal values of white blood cell counts.

26. A drug blocks the attachment of norepinephrine to

1 receptors. The patient may experience:

a. hypertensive crisis.

c. severe appetite disturbance.

b. orthostatic hypotension.

d. an increase in psychotic symptoms.

ANS: B Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of

1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension

may cause fainting and falls. Teach patients ways of minimizing this phenomenon.

27. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. With which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance? The patient receiving: a. lithium (Lithobid).

c. fluoxetine (Prozac).

b. clozapine (Clozaril).

d. venlafaxine (Effexor).

ANS: A Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, edema, and other symptoms of imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety.

28. An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain? a. H1

c. Acetylcholine

b. 5 HT2

d. Gamma-aminobutyric acid (GABA)

ANS: A H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patients weight.

29. An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individuals vital signs is most likely? a. Pulse rate changes from 90 to 72. b. Respiratory rate changes from 22 to 18. c. Complaints of intestinal cramping begin. d. Blood pressure changes from 114/62 to 136/78.

ANS: D This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system.

30. Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin).

Which medication below also belongs with this group? a. Galantamine (Reminyl)

c. Buspirone (BuSpar)

b. Valproate (Depakote)

d. Tacrine (Cognex)

ANS: B The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimers disease and anxiety.

31. A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient remembers the appointment? a. Write the appointment day, time, and location on a piece of paper and give it to the player. b. Log the appointment day, time, and location into the players cell phone calendar feature. c. Ask the health care provider to admit the patient to the hospital overnight. d. Verbally inform the patient of the appointment day, time, and location.

ANS: B This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has significant role in maintaining memory. Logging the appointment into the players cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the patient is unlikely to remember verbal instruction. Hospitalization is unnecessary. See relationship to audience response question. Caution: This question requires students to apply previous learning regarding central nervous system anatomy and physiology.

MULTIPLE RESPONSE 1. A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which comorbid health problems? Select all that apply. a. Parkinsons disease b. Graves disease c. Hyperlipidemia d. Osteoarthritis e. Diabetes ANS: A, C, E

Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes, and increase serum triglycerides, which would complicate care of a patient with hyperlipidemia. Parkinsons disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient. Osteoarthritis and Graves disease should have no synergistic effect with this medication.

2. Questions the nurse could ask that would be nonjudgmental when obtaining information about patient use of herbal remedies include: (select all that apply) a. You dont regularly take herbal remedies, do you? b. What herbal medicines have you used to relieve your symptoms? c. What over-the-counter medicines and nutritional supplements do you use? d. What differences in your symptoms do you notice when you take herbal supplements? e. Have you experienced problems from using herbal and prescription drugs at the same time?

ANS: B, C, D, E The correct responses are neutral in tone and do not express bias for or against the use of herbal medicines. The distracter, worded in a negative way, makes the nurses bias evident.

3. An individual is experiencing problems with memory. Which of these structures are most likely to be involved in this deficit? Select all that apply. a. Amygdala b. Hippocampus c. Occipital lobe d. Temporal lobe e. Basal ganglia ANS: A, B, D The frontal, parietal, and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The amygdala and hippocampus also play roles in memory. The occipital lobe is predominantly involved with vision. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions.

4. A patients sibling says, My brother has a mental illness, but the doctor ordered a functional magnetic resonance image (fMRI) test. That test is too expensive and will just increase the hospital bill. Select the nurses best responses. Select all that apply. a. Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation. b. Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother. c. Tell me more about what kinds of tests your brothers health insurance plan covers. d. It sounds like you do not truly believe your brother had a mental illness. e. It would be better for you to discuss your concerns with the doctor.

ANS: A, B The correct responses provide information to the sibling. Modern imaging techniques are important tools in assessing molecular changes in mental disease and marking the receptor sites of drug action, which can help in treatment planning. Psychiatric symptoms can be caused by anatomical or physiologic abnormalities. There is no evidence of denial in the siblings comment. The nurse can answer this question rather than referring it to the physician. It would be inappropriate to discuss finances with the patients sibling.

Chapter 3. Assessment and Diagnosis Question 1 Type: MCSA Which of the following best describes the information the nurse will use to construct a nursing care plan?

1. A mental status examination 2. An intake assessment and reason for admission 3. A psychiatric history and mental status examination 4. A detailed psychiatric history Correct Answer: 3

Rationale 1: The psychiatric examination consists of the psychiatric history and mental status examination. The intake assessment and reason for admission are part of the psychiatric history, which includes the clients current condition, previous diagnosis, interventions, treatments, and a family history.

Rationale 2: The psychiatric examination consists of the psychiatric history and mental status examination. The intake assessment and reason for admission are part of the psychiatric history, which includes the clients current condition, previous diagnosis, interventions, treatments, and a family history.

Rationale 3: The psychiatric examination consists of the psychiatric history and mental status examination. The intake assessment and reason for admission are part of the psychiatric history, which includes the clients current condition, previous diagnosis, interventions, treatments, and a family history.

Rationale 4: The psychiatric examination consists of the psychiatric history and mental status examination. The intake assessment and reason for admission are part of the psychiatric history, which includes the clients current condition, previous diagnosis, interventions, treatments, and a family history.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Perform an ongoing psychiatricmental health assessment of clients in your care.

Question 2 Type: MCSA A nursing student is working to develop assessment skills. The student knows that nurses utilize principles of assessment: 1. Upon admission.

2. Throughout hospitalization.

3. At the point of entry to care.

4. Prior to discharge.

Correct Answer: 2 Rationale 1: Assessment is essential to the delivery of nursing care and is included at all phases of a clients hospitalization, beginning at the point of entry to care through discharge.

Rationale 2: Assessment is essential to the delivery of nursing care and is included at all phases of a clients hospitalization, beginning at the point of entry to care through discharge.

Rationale 3: Assessment is essential to the delivery of nursing care and is included at all phases of a clients hospitalization, beginning at the point of entry to care through discharge.

Rationale 4: Assessment is essential to the delivery of nursing care and is included at all phases of a clients hospitalization, beginning at the point of entry to care through discharge.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Determine how and when to apply assessment principles in professional practice.

Question 3 Type: MCMA A nurse who is admitting a client to the inpatient unit conducts a comprehensive assessment. How does the nurse use the data gathered from the assessment?

Standard Text: Select all that apply.

1. To support nursing diagnoses 2. To determine the length of stay 3. To exclude data from secondary sources

4. To plan appropriate interventions 5. To make sound clinical judgments Correct Answer: 1,4,5 Rationale 1: To support nursing diagnoses. Data obtained from the comprehensive assessment is used as support or evidence for the nursing diagnoses.

Rationale 2: To determine the length of stay. The length of stay may be estimated at the time of admission, but the determining factor is the clients progression in response to care.

Rationale 3: To exclude data from secondary sources. Data are obtained from both primary (client) and secondary (other) sources.

Rationale 4: To plan appropriate interventions. Assessment data are used in planning appropriate interventions related to the clients need(s).

Rationale 5: To make sound clinical judgments. Information obtained from the comprehensive assessment is used to make clinical decisions related to the clients need(s).

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Determine how and when to apply assessment principles in professional practice.

Question 4 Type: MCSA As part of the comprehensive admission assessment, the nurse talks with family and friends who may contribute additional data to a clients psychiatric history. When reviewing the data obtained from these sources, the nurse keeps in mind which of the following perspectives of the data? The information provided:

1. Will vary according to the sources relationship to the client.

2. Comes from each individuals perspective.

3. Is considered false.

4. Is considered accurate.

Correct Answer: 2 Rationale 1: Family and friends have their own perspectives through which they filter events. The sources of the information to be included in the psychiatric history and the sources relationship to the client should always be clearly indicated. Information given by these collateral sources should be reviewed and understood in terms of that relationship.

Rationale 2: Family and friends have their own perspectives through which they filter events. The sources of the information to be included in the psychiatric history and the sources relationship to the client should always be clearly indicated. Information given by these collateral sources should be reviewed and understood in terms of that relationship.

Rationale 3: Family and friends have their own perspectives through which they filter events. The sources of the information to be included in the psychiatric history and the sources relationship to the client should always be clearly indicated. Information given by these collateral sources should be reviewed and understood in terms of that relationship.

Rationale 4: Family and friends have their own perspectives through which they filter events. The sources of the information to be included in the psychiatric history and the sources relationship to the client should always be clearly indicated. Information given by these collateral sources should be reviewed and understood in terms of that relationship.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Elicit a psychiatric history from a client and the clients family.

Question 5 Type: MCSA The nurse reviews the data family and friends provided in the comprehensive assessment of a clients situation.

The nurse knows to treat the data as: 1. Invalid until confirmed with the client.

2. Subjective data.

3. Primary data.

4. Peripheral to the assessment.

Correct Answer: 2 Rationale 1: Information provided by family and friends is subjective, secondary data. Information from family and friends is not peripheral, but is treated as important data to be contributed to the whole assessment while recognizing that it does not provide a total picture of the client. Secondary data does not need to be confirmed with the client.

Rationale 2: Information provided by family and friends is subjective, secondary data. Information from family and friends is not peripheral, but is treated as important data to be contributed to the whole assessment while recognizing that it does not provide a total picture of the client. Secondary data does not need to be confirmed with the client.

Rationale 3: Information provided by family and friends is subjective, secondary data. Information from family and friends is not peripheral, but is treated as important data to be contributed to the whole assessment while recognizing that it does not provide a total picture of the client. Secondary data does not need to be confirmed with the client.

Rationale 4: Information provided by family and friends is subjective, secondary data. Information from family and friends is not peripheral, but is treated as important data to be contributed to the whole assessment while recognizing that it does not provide a total picture of the client. Secondary data does not need to be confirmed with the client.

Global Rationale: Cognitive Level: Applying

Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Elicit a psychiatric history from a client and the clients family.

Question 6 Type: MCSA The nurse is talking with the family of a mentally ill client who lives with them. The client is being admitted to the inpatient psychiatric unit. What is the priority information to gather from the family?

1. Whether the client had a flu shot recently 2. The number of medications prescribed for the client 3. How the clients symptoms are expressed at home 4. The type of soap the client prefers to use Correct Answer: 3 Rationale 1: The most important information to be obtained from the family at the time of admission is how the symptoms of the clients illness are being expressed at home. This would be closely aligned to the chief complaint and provides a baseline for monitoring. The other information may be needed, but it is not the most important at the time of admission.

Rationale 2: The most important information to be obtained from the family at the time of admission is how the symptoms of the clients illness are being expressed at home. This would be closely aligned to the chief complaint and provides a baseline for monitoring. The other information may be needed, but it is not the most important at the time of admission.

Rationale 3: The most important information to be obtained from the family at the time of admission is how the symptoms of the clients illness are being expressed at home. This would be closely aligned to the chief complaint and provides a baseline for monitoring. The other information may be needed, but it is not the most important at the time of admission.

Rationale 4: The most important information to be obtained from the family at the time of admission is how the symptoms of the clients illness are being expressed at home. This would be closely aligned to the chief complaint and provides a baseline for monitoring. The other information may be needed, but it is not the most important at the time of admission.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Elicit a psychiatric history from a client and the clients family.

Question 7 Type: MCMA The psychiatric examination includes a psychiatric history and a mental status assessment. When conducting the mental status assessment, the nurse: Standard Text: Select all that apply.

1. Includes observations.

2. Limits the assessment to verbal responses.

3. Provides the client with a form to complete.

4. May or may not follow a strict sequence.

5. Uses a group format.

Correct Answer: 1,4 Rationale 1: Includes observations. Several components of the assessment require observational skills of the nurse.

Rationale 2: Limits the assessment to verbal responses. Observations of the clients nonverbal communication and other behaviors made by the nurse are included in the assessment.

Rationale 3: Provides the client with a form to complete. The nurse conducts the mental status assessment; the client is not given a form to complete.

Rationale 4: May or may not follow a strict sequence. The nurse is not required to follow a strict sequence or format.

Rationale 5: Uses a group format. The client is not assessed during group sessions, but the client is assessed during a one-to-one interaction.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Conduct a mental status examination on a client.

Question 8 Type: MCSA A client makes the following statement during a mental status assessment: I cant use the phones; the CIA has bugged all the wires. Which of the following categories will the nurse use to document the clients response?

1. Orientation 2. Content of thought 3. Emotional state 4. General behavior Correct Answer: 2

Rationale 1: Content of thought includes special preoccupations and experiences, including delusions. General behavior describes the clients physical characteristics. Emotional state refers to the persons pervasive or dominant mood. Orientation includes time, place, person, and self or purpose.

Rationale 2: Content of thought includes special preoccupations and experiences, including delusions. General behavior describes the clients physical characteristics. Emotional state refers to the persons pervasive or dominant mood. Orientation includes time, place, person, and self or purpose.

Rationale 3: Content of thought includes special preoccupations and experiences, including delusions. General behavior describes the clients physical characteristics. Emotional state refers to the persons pervasive or dominant mood. Orientation includes time, place, person, and self or purpose.

Rationale 4: Content of thought includes special preoccupations and experiences, including delusions. General behavior describes the clients physical characteristics. Emotional state refers to the persons pervasive or dominant mood. Orientation includes time, place, person, and self or purpose.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Conduct a mental status examination on a client.

Question 9 Type: MCSA During a mental status assessment, the examiner asks the client to repeat these words: motorcar, teacup, and lilies. Five minutes later the client is asked to repeat the words again. The purpose of this exercise is to test the clients: 1. Insight.

2. Retention and recall.

3. Recall of recent past experiences.

4. Abstract thinking.

Correct Answer: 2 Rationale 1: Retention and recall is used to test immediate impressions. Recall of recent past experiences relates to the events leading to the present seeking of treatment. Abstract thinking relates to the clients ability to interpret simple fables of proverbs. Insight provides information about the clients ability to recognize the significance of the present situation.

Rationale 2: Retention and recall is used to test immediate impressions. Recall of recent past experiences relates to the events leading to the present seeking of treatment. Abstract thinking relates to the clients ability to interpret simple fables of proverbs. Insight provides information about the clients ability to recognize the significance of the present situation.

Rationale 3: Retention and recall is used to test immediate impressions. Recall of recent past experiences relates to the events leading to the present seeking of treatment. Abstract thinking relates to the clients ability to interpret simple fables of proverbs. Insight provides information about the clients ability to recognize the significance of the present situation.

Rationale 4: Retention and recall is used to test immediate impressions. Recall of recent past experiences relates to the events leading to the present seeking of treatment. Abstract thinking relates to the clients ability to interpret simple fables of proverbs. Insight provides information about the clients ability to recognize the significance of the present situation.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Conduct a mental status examination on a client.

Question 10 Type: MCSA

An anxious client is to complete the Minnesota Multiphasic Personality Inventory-2 as part of the psychological testing. The client is worried about not having enough time to prepare for the test. To decrease anxiety, the nurse reviews the purpose of the test and explains that the client will: 1. Just need to complete a series of sentences.

2. Interpret ink blots.

3. Only have to copy geometric designs.

4. Be answering true or false questions.

Correct Answer: 4 Rationale 1: The MMPI-2 contains true or false questions. The Rorschach test involves the interpretation of ink blots. The Mini-Mental State Exam measures the ability to copy geometric designs. The Sentence Completion Test requires the completion of a series of sentences.

Rationale 2: The MMPI-2 contains true or false questions. The Rorschach test involves the interpretation of ink blots. The Mini-Mental State Exam measures the ability to copy geometric designs. The Sentence Completion Test requires the completion of a series of sentences.

Rationale 3: The MMPI-2 contains true or false questions. The Rorschach test involves the interpretation of ink blots. The Mini-Mental State Exam measures the ability to copy geometric designs. The Sentence Completion Test requires the completion of a series of sentences.

Rationale 4: The MMPI-2 contains true or false questions. The Rorschach test involves the interpretation of ink blots. The Mini-Mental State Exam measures the ability to copy geometric designs. The Sentence Completion Test requires the completion of a series of sentences.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the essential components of physiological assessment, neurologic assessment, psychological testing, and psychosocial assessment.

Question 11 Type: MCSA A family member reports that his mother has started hiding valuables around the house, then cant remember where she put them. He asks the nurse to explain what is happening. Which of the following assessment tools might the nurse utilize to screen the mother for signs of cognitive dysfunction?

1. Benton Visual Retention Test 2. Thematic Apperception Test 3. Ravens Progressive Matrices Test 4. Sentence Completion Test Correct Answer: 1 Rationale 1: The Benton Visual Retention Test is an example of a neuropsychological assessment instrument that can yield valuable data on aspects of a persons cognitive functioning. It is sometimes used as a quick screening device to see if the test taker may be manifesting signs of cognitive dysfunction. The Sentence Completion Test asks clients to complete an extensive series of incomplete sentences with the first thoughts that come to mind. The sentences are designed to elicit responses concerning fantasies, fears, daydreams, and aspirations, among other things, and are not used to screen for cognitive dysfunction. The Thematic Apperception Test is used to reveal very important information about the clients emotional and interpersonal tendencies and not as a screening tool for signs of cognitive dysfunction. Ravens Progressive Matrices Test is designed to provide data on intellectual ability in a relatively culturally unbiased manner and is not used to screen for cognitive dysfunction.

Rationale 2: The Benton Visual Retention Test is an example of a neuropsychological assessment instrument that can yield valuable data on aspects of a persons cognitive functioning. It is sometimes used as a quick screening device to see if the test taker may be manifesting signs of cognitive dysfunction. The Sentence Completion Test asks clients to complete an extensive series of incomplete sentences with the first thoughts that come to mind. The sentences are designed to elicit responses concerning fantasies, fears, daydreams, and aspirations, among other things, and are not used to screen for cognitive dysfunction. The Thematic Apperception Test is used to reveal very important information about the clients emotional and interpersonal

tendencies and not as a screening tool for signs of cognitive dysfunction. Ravens Progressive Matrices Test is designed to provide data on intellectual ability in a relatively culturally unbiased manner and is not used to screen for cognitive dysfunction.

Rationale 3: The Benton Visual Retention Test is an example of a neuropsychological assessment instrument that can yield valuable data on aspects of a persons cognitive functioning. It is sometimes used as a quick screening device to see if the test taker may be manifesting signs of cognitive dysfunction. The Sentence Completion Test asks clients to complete an extensive series of incomplete sentences with the first thoughts that come to mind. The sentences are designed to elicit responses concerning fantasies, fears, daydreams, and aspirations, among other things, and are not used to screen for cognitive dysfunction. The Thematic Apperception Test is used to reveal very important information about the clients emotional and interpersonal tendencies and not as a screening tool for signs of cognitive dysfunction. Ravens Progressive Matrices Test is designed to provide data on intellectual ability in a relatively culturally unbiased manner and is not used to screen for cognitive dysfunction.

Rationale 4: The Benton Visual Retention Test is an example of a neuropsychological assessment instrument that can yield valuable data on aspects of a persons cognitive functioning. It is sometimes used as a quick screening device to see if the test taker may be manifesting signs of cognitive dysfunction. The Sentence Completion Test asks clients to complete an extensive series of incomplete sentences with the first thoughts that come to mind. The sentences are designed to elicit responses concerning fantasies, fears, daydreams, and aspirations, among other things, and are not used to screen for cognitive dysfunction. The Thematic Apperception Test is used to reveal very important information about the clients emotional and interpersonal tendencies and not as a screening tool for signs of cognitive dysfunction. Ravens Progressive Matrices Test is designed to provide data on intellectual ability in a relatively culturally unbiased manner and is not used to screen for cognitive dysfunction.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the essential components of physiological assessment, neurologic assessment, psychological testing, and psychosocial assessment.

Question 12 Type: MCSA A depressed client asks why a physical exam is necessary before being admitted for outpatient treatment. The nurse explains to the client that a physical exam will: 1. Provide information about medications the client will need.

2. Make sure the client gets all necessary treatment.

3. Complete the admission process.

4. Ensure the client has not ingested any caustic material or inhaled noxious vapors.

Correct Answer: 2 Rationale 1: The clients symptoms may be due to a biological or neurological problem causing depressive symptoms. The value of careful assessment of general health issues and screening for biologic disorders cannot be overemphasized; in some community settings, psychiatric-mental health nurses are the only mental health care providers prepared to undertake such an assessment and interpret the results. The exams scope is not limited to exposure to dangerous chemicals, nor is it performed solely to comply with institutional policy. Its findings will guide all aspects of the clients care, not just medication therapy.

Rationale 2: The clients symptoms may be due to a biological or neurological problem causing depressive symptoms. The value of careful assessment of general health issues and screening for biologic disorders cannot be overemphasized; in some community settings, psychiatricmental health nurses are the only mental health care providers prepared to undertake such an assessment and interpret the results. The exams scope is not limited to exposure to dangerous chemicals, nor is it performed solely to comply with institutional policy. Its findings will guide all aspects of the clients care, not just medication therapy.

Rationale 3: The clients symptoms may be due to a biological or neurological problem causing depressive symptoms. The value of careful assessment of general health issues and screening for biologic disorders cannot be overemphasized; in some community settings, psychiatric-mental health nurses are the only mental health care providers prepared to undertake such an assessment and interpret the results. The exams scope is not limited to exposure to dangerous chemicals, nor is it performed solely to comply with institutional policy. Its findings will guide all aspects of the clients care, not just medication therapy.

Rationale 4: The clients symptoms may be due to a biological or neurological problem causing depressive symptoms. The value of careful assessment of general health issues and screening for biologic disorders cannot

be overemphasized; in some community settings, psychiatric-mental health nurses are the only mental health care providers prepared to undertake such an assessment and interpret the results. The exams scope is not limited to exposure to dangerous chemicals, nor is it performed solely to comply with institutional policy. Its findings will guide all aspects of the clients care, not just medication therapy.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the essential components of physiological assessment, neurologic assessment, psychological testing, and psychosocial assessment.

Question 13 Type: MCSA The nurse in the community mental health clinic assesses a client and determines the presence of an Axis II diagnosis. What conclusions can the nurse draw?

1. The client is in need of further evaluation.

2. The client has a personality disorder.

3. The client will need a special diet.

4. The client is a candidate for the least restrictive environment.

Correct Answer: 2 Rationale 1: Axis II contains the personality disorders usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. Axis II is also used to report maladaptive personality traits. Information about diet and the level of care needed are written in the admission orders, not the multiaxial diagnosis.

Rationale 2: Axis II contains the personality disorders usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. Axis II is also used to report maladaptive personality traits. Information about diet and the level of care needed are written in the admission orders, not the multiaxial diagnosis.

Rationale 3: Axis II contains the personality disorders usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. Axis II is also used to report maladaptive personality traits. Information about diet and the level of care needed are written in the admission orders, not the multiaxial diagnosis.

Rationale 4: Axis II contains the personality disorders usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. Axis II is also used to report maladaptive personality traits. Information about diet and the level of care needed are written in the admission orders, not the multiaxial diagnosis.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain the importance of each of the five axes of the DSM multiaxial system to the overall assessment of clients and their families.

Question 14 Type: MCSA A female client disclosed to the nurse that she is in an abusive situation. This information will be used to contribute to: 1. Axis IV. 2. Axis III. 3. Nothing, since this is confidential information and should not be shared.

4. Axis I. Correct Answer: 1 Rationale 1: Axis IV is used to identify psychosocial problems that may affect the diagnosis and treatment of mental disorders. Clinicians use Axis III too.

Rationale 2: Axis IV is used to identify psychosocial problems that may affect the diagnosis and treatment of mental disorders. Clinicians use Axis III too.

Rationale 3: Axis IV is used to identify psychosocial problems that may affect the diagnosis and treatment of mental disorders. Clinicians use Axis III too.

Rationale 4: Axis IV is used to identify psychosocial problems that may affect the diagnosis and treatment of mental disorders. Clinicians use Axis III too.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the importance of each of the five axes of the DSM multiaxial system to the overall assessment of clients and their families.

Question 15 Type: MCSA The nurse on the inpatient unit is reviewing the record of a client admitted the previous day, and notes the client has an Axis I diagnosis. What inferences can the nurse make about the client?

1. The client has a clinical psychiatric disorder.

2. The client is in need of immediate medical attention.

3. The client has a chronic condition.

4. The client lacks a support system.

Correct Answer: 1 Rationale 1: Axis I provides information regarding major mental disorders, as well as developmental and learning disorders. Axis I does not provide information about support systems, chronic conditions, or indicate if the client is in need of immediate medical attention.

Rationale 2: Axis I provides information regarding major mental disorders, as well as developmental and learning disorders. Axis I does not provide information about support systems, chronic conditions, or indicate if the client is in need of immediate medical attention.

Rationale 3: Axis I provides information regarding major mental disorders, as well as developmental and learning disorders. Axis I does not provide information about support systems, chronic conditions, or indicate if the client is in need of immediate medical attention.

Rationale 4: Axis I provides information regarding major mental disorders, as well as developmental and learning disorders. Axis I does not provide information about support systems, chronic conditions, or indicate if the client is in need of immediate medical attention.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the importance of each of the five axes of the DSM multiaxial system to the overall assessment of clients and their families.

Question 16 Type: MCMA How might the nurse make use of the information contained in a clients multiaxial diagnosis?

Standard Text: Select all that apply.

1. To address physiological problems 2. To plan client-centered interventions 3. To communicate client needs 4. To assess client strengths 5. To identify nursing diagnoses Correct Answer: 1,2,3,4,5 Rationale 1: The diagnosis and information contained in Axis I-IV can be utilized at all phases of the nursing process in developing and delivering client-centered nursing care.

Rationale 2: The diagnosis and information contained in Axis IIV can be utilized at all phases of the nursing process in developing and delivering client-centered nursing care.

Rationale 3: The diagnosis and information contained in Axis IIV can be utilized at all phases of the nursing process in developing and delivering client-centered nursing care.

Rationale 4: The diagnosis and information contained in Axis IIV can be utilized at all phases of the nursing process in developing and delivering client-centered nursing care.

Rationale 5: The diagnosis and information contained in Axis IIV can be utilized at all phases of the nursing process in developing and delivering client-centered nursing care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain the importance of each of the five axes of the DSM multiaxial system to the overall assessment of clients and their families.

Question 17

Type: MCSA A client is admitted with the following diagnosis: Axis I: 300.01 Panic disorder without agoraphobia Axis II: 301.83 Borderline personality disorder Axis III: No diagnosis Axis IV: Unemployment What conclusions can the nurse make relative to the clients Axis III information?

1. This client has problems with environment, but they are not related to mental disorder.

2. The clients environment has not been evaluated.

3. The clients health status has not been evaluated.

4. The client has no diagnosed physiological health problems relevant to mental disorder at the time of admission.

Correct Answer: 4 Rationale 1: Clinicians use Axis III to record physical disorders and medical conditions that must be taken into account in planning treatment at the time of admission. Axis IV is used to identify problems or issues of a psychosocial and environmental nature.

Rationale 2: Clinicians use Axis III to record physical disorders and medical conditions that must be taken into account in planning treatment at the time of admission. Axis IV is used to identify problems or issues of a psychosocial and environmental nature.

Rationale 3: Clinicians use Axis III to record physical disorders and medical conditions that must be taken into account in planning treatment at the time of admission. Axis IV is used to identify problems or issues of a psychosocial and environmental nature.

Rationale 4: Clinicians use Axis III to record physical disorders and medical conditions that must be taken into account in planning treatment at the time of admission. Axis IV is used to identify problems or issues of a psychosocial and environmental nature.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the importance of each of the five axes of the DSM multiaxial system to the overall assessment of clients and their families.

Question 18 Type: MCSA The school nurse, who must be familiar with mental health issues, will find child clinical disorders classified under: 1. Axis II. 2. Axis I. 3. Axis X. 4. Axis VII. Correct Answer: 2 Rationale 1: Axis I includes all of the Adult and Child Clinical Disorders. Axis II contains the personality disorders, usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. There is no Axis VII or X in the multiaxial system.

Rationale 2: Axis I includes all of the Adult and Child Clinical Disorders. Axis II contains the personality disorders, usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. There is no Axis VII or X in the multiaxial system.

Rationale 3: Axis I includes all of the Adult and Child Clinical Disorders. Axis II contains the personality disorders, usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. There is no Axis VII or X in the multiaxial system.

Rationale 4: Axis I includes all of the Adult and Child Clinical Disorders. Axis II contains the personality disorders, usually diagnosed in adults, and developmental disorders including mental retardation, diagnosed in children and adolescents. There is no Axis VII or X in the multiaxial system.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the importance of each of the five axes of the DSM multiaxial system to the overall assessment of clients and their families.

Question 19 Type: MCSA After interviewing a client for admission, the nurse gives the client a score of 50 on the Global Assessment of Functioning Scale (GAF). The nurse selected this score based on the clients level of functioning: 1. Since being given a psychiatric diagnosis.

2. Within the past week.

3. Since beginning the psychotropic medication.

4. Within the past year.

Correct Answer: 2 Rationale 1: The GAF Scale rates the clients lowest level of functioning within the previous seven days. The GAF Scale does not include impairment due to physical or environmental limitations.

Rationale 2: The GAF Scale rates the clients lowest level of functioning within the previous seven days. The GAF Scale does not include impairment due to physical or environmental limitations.

Rationale 3: The GAF Scale rates the clients lowest level of functioning within the previous seven days. The GAF Scale does not include impairment due to physical or environmental limitations.

Rationale 4: The GAF Scale rates the clients lowest level of functioning within the previous seven days. The GAF Scale does not include impairment due to physical or environmental limitations.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Incorporate the result of the GAF scale in a nursing care plan for a client with mental disorder.

Question 20 Type: MCSA Select the priority nursing diagnosis for a client with a Global Assessment of Functioning (GAF) score of 10.

1. Risk for Impaired Social Interaction 2. Risk for Injury 3. Knowledge Deficit 4. Risk for Communication Deficit Correct Answer: 2 Rationale 1: The client with a GAF of 10 manifests persistent danger of severely hurting self or others. In this case, the nurse wants to prevent the occurrence of an injury; therefore, the risk for injury supersedes the risk for impaired social interaction, risk for communication deficit, and knowledge deficit.

Rationale 2: The client with a GAF of 10 manifests persistent danger of severely hurting self or others. In this case, the nurse wants to prevent the occurrence of an injury; therefore, the risk for injury supersedes the risk for impaired social interaction, risk for communication deficit, and knowledge deficit.

Rationale 3: The client with a GAF of 10 manifests persistent danger of severely hurting self or others. In this case, the nurse wants to prevent the occurrence of an injury; therefore, the risk for injury supersedes the risk for impaired social interaction, risk for communication deficit, and knowledge deficit.

Rationale 4: The client with a GAF of 10 manifests persistent danger of severely hurting self or others. In this case, the nurse wants to prevent the occurrence of an injury; therefore, the risk for injury supersedes the risk for impaired social interaction, risk for communication deficit, and knowledge deficit.

Global Rationale: Cognitive Level: Evaluating Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate the result of the GAF scale in a nursing care plan for a client with mental disorder.

Question 21 Type: MCSA The psychiatric home health nurse is evaluating whether a clients level of functioning has improved since starting the prescribed psychotropic medication. What evidence does the nurse look for?

1. There is no change in the GAF score.

2. There is a significant decrease (by 10 or more points) in the clients GAF score.

3. The client no longer qualifies for a GAF score.

4. There is an increase in the clients GAF score.

Correct Answer: 4

Rationale 1: The range of the Global Assessment of Functioning (GAF) score is 0100 with 0 indicating there is inadequate information and 100 indicating the client has superior functioning in a wide range of activities, lifes problems never seem to get out of hand, the client is sought out by others because of his or her many positive qualities, and the client is having no symptoms. When evaluating the GAF score, generally an increase over the score at admission indicates there is some improvement in the clients level of functioning.

Rationale 2: The range of the Global Assessment of Functioning (GAF) score is 0100 with 0 indicating there is inadequate information and 100 indicating the client has superior functioning in a wide range of activities, lifes problems never seem to get out of hand, the client is sought out by others because of his or her many positive qualities, and the client is having no symptoms. When evaluating the GAF score, generally an increase over the score at admission indicates there is some improvement in the clients level of functioning.

Rationale 3: The range of the Global Assessment of Functioning (GAF) score is 0100 with 0 indicating there is inadequate information and 100 indicating the client has superior functioning in a wide range of activities, lifes problems never seem to get out of hand, the client is sought out by others because of his or her many positive qualities, and the client is having no symptoms. When evaluating the GAF score, generally an increase over the score at admission indicates there is some improvement in the clients level of functioning.

Rationale 4: The range of the Global Assessment of Functioning (GAF) score is 0100 with 0 indicating there is inadequate information and 100 indicating the client has superior functioning in a wide range of activities, lifes problems never seem to get out of hand, the client is sought out by others because of his or her many positive qualities, and the client is having no symptoms. When evaluating the GAF score, generally an increase over the score at admission indicates there is some improvement in the clients level of functioning.

Chapter 4. The Initial Contact and Maintaining the Frame Question 1 Type: MCSA The nurse is establishing a therapeutic alliance with a new client. Which of the following behaviors would enhance the development of a therapeutic one-to-one relationship?

1. Specifically defining emotional and social goals for the client 2. Eagerly encouraging the client to communicate on a superficial level 3. Instinctively sharing personal experiences with the client

4. Spontaneously assisting the client to identify thoughts and feelings Correct Answer: 4 Rationale 1: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationship than a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Rationale 2: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationship than a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Rationale 3: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationship than a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Rationale 4: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationship than a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 2 Type: MCSA An experienced nurse is describing the characteristics of a therapeutic one-to-one relationship to a nursing student. Which of the following is the most accurate description?

1. The relationship between the nurse and client is reciprocal.

2. The nursing process is the cornerstone of the relationship.

3. The essential feature of the relationship is a therapeutic alliance.

4. The nurse must meet the clients needs throughout the relationship.

Correct Answer: 3 Rationale 1: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Rationale 2: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Rationale 3: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Rationale 4: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 3 Type: MCSA A nursing student asks the nurse educator the differences between social and professional relationships. The nurse educator knows that the defining characteristic of a professional relationship is which of the following?

1. Can be either spontaneous or planned 2. Is the only relationship where roles are defined 3. Requires more planning, consistency, and time 4. Does not address the personal needs of the nurse Correct Answer: 4 Rationale 1: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Rationale 2: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to

professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Rationale 3: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Rationale 4: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 4 Type: MCMA The nurse is explaining the nurseclient relationship to a client in their first formal counseling session. Which of the following characteristics should the nurse describe as part of this one-to-one relationship?

Standard Text: Select all that apply.

1. Sympathetic 2. Shared dignity

3. Harmonious 4. Mutually defined 5. Goal directed Correct Answer: 2,4,5 Rationale 1: Sympathetic. The nurse is expected to be caring and empathetic, but should not let personal feelings interfere with objectivity and the ability to help the client cope effectively.

Rationale 2: Shared dignity. The nurse encourages clients to share freely and openly in an atmosphere of mutual respect and courtesy.

Rationale 3: Harmonious. Nurses and clients may not always be in agreement, particularly if clients do not accept responsibility for their actions. Resistance may be present in one-to-one relationships when clients struggle against change.

Rationale 4: Mutually defined. The terms under which the relationship is to evolve are equally determined by nurse and client and require the commitment of both parties.

Rationale 5: Goal directed. The client is expected to identify and work toward specific objectives within the context of the therapeutic relationship.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 5 Type: MCSA

The nurse is working with the client to identify self-defeating thoughts, feelings, and behaviors. Which behavior by the client does the nurse identify as resistance to the therapeutic process?

1. Changing the subject when asked to explore a specific topic 2. Becoming silent when asked to identify unhealthy behaviors 3. Sharing feelings, fantasies and motives with the nurse 4. Changing behavior outside of the one-to-one therapeutic relationship Correct Answer: 1 Rationale 1: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Rationale 2: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Rationale 3: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Rationale 4: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 6 Type: MCSA The nurse suspects a client is unwilling to demonstrate self-sufficiency or independence in the therapeutic relationship when the client says, You are the only person I can talk to or trust. Lets go out to dinner tonight so we can spend more time together. Which one of the following nurse responses is most appropriate in this situation?

1. I sense we are beginning to make real progress; I think thats a great idea.

2. Maybe some other time, but right now Im involved in a significant relationship and dont feel right about meeting you for dinner.

3. I sense youve become too dependent on this relationship; lets examine your feelings toward me.

4. Youve become too dependent on me, so I will have to terminate our relationship.

Correct Answer: 3 Rationale 1: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Rationale 2: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could

encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Rationale 3: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Rationale 4: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 7 Type: MCMA

The nurse is working with a client who has demonstrated an unwillingness to change self-defeating behaviors.

The nurse determines that the patient is exhibiting resistance. Which of the following phenomena are forms of client resistance?

Standard Text: Select all that apply.

1. Overdisclosure 2. Negative transference 3. Acting-out 4. Countertransference 5. Positive transference Correct Answer: 2,3 Rationale 1: Overdisclosure. Overdisclosure refers to an excessive amount of self-disclosure by the nurse that can overwhelm and engulf the client. Overdisclosure can impede therapeutic progress, especially with clients who have poor ego boundaries, but it is not a form of client resistance.

Rationale 2: Negative transference. When a client displays hostility, loathing, bitterness, contempt, and annoyance toward the nurse, the therapeutic process is impeded.

Rationale 3: Acting-out. Displaying inappropriate behavior or acting out a memory that was forgotten or repressed is a particularly destructive form of client resistance.

Rationale 4: Countertransference. Countertransference involves the nurses inappropriate reaction to the client and is not a form of client resistance.

Rationale 5: Positive transference. Positive feelings of the client toward the therapist due, in part, to past relationships with significant others, can help to facilitate therapeutic progress.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 8 Type: MCSA The nurse is working with a client who appears unwilling to explore a specific topic during the working phase of the therapeutic relationship, by continually changing the subject. Which of the following nursing strategies would be most helpful?

1. Clarify the clients refusal to explore the topic by labeling it as resistance.

2. Accept the clients refusal to talk about the topic by changing the subject.

3. Allow the client to decide the appropriate time to explore the topic.

4. Insist the client discuss the topic by examining the origin of the behavior.

Correct Answer: 1 Rationale 1: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Rationale 2: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Rationale 3: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Rationale 4: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 9 Type: MCSA During the orientation phase of the nurseclient relationship, the client presents the nurse with a framed picture that was painted during recreational therapy. What is the best response by the nurse?

1. Im sorry but Im not allowed to accept any gifts from clients.

2. How thoughtful; Ill take this home with me so I will be reminded of you every time I see it.

3. Lets examine your motives for trying to bribe me with this picture.

4. Thats a lovely picture; lets put it in the day room for everyone to enjoy.

Correct Answer: 4 Rationale 1: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship.

Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Rationale 2: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship.

Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Rationale 3: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship.

Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Rationale 4: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship.

Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 10 Type: MCSA A client who is being discharged offers the nurse a ceramic bowl made during hospitalization as a symbol of the open vessel the client has become for accepting new ideas. What is the best response by the nurse?

1. This is a beautiful gesture, I will place it in the day room for everyone to enjoy.

2. I wish I could accept this, but you know Im not allowed to.

3. Let me pay you for this. I dont feel I should just accept it after all the hard work you put into it.

4. You worked very hard on becoming receptive to new ideas this past month; I would be honored to accept this symbol of your progress.

Correct Answer: 4 Rationale 1: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal.

Paying the client for any item is discouraged and usually against hospital policy.

Rationale 2: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal.

Paying the client for any item is discouraged and usually against hospital policy.

Rationale 3: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal.

Paying the client for any item is discouraged and usually against hospital policy.

Rationale 4: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal.

Paying the client for any item is discouraged and usually against hospital policy.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 11 Type: MCSA A client is proud of a recent breakthrough in his ability to control his anger when another client had criticized his behavior. The nurse shakes the clients hand and praises him on his accomplishment. How should this nurses behavior be interpreted?

1. This gesture is inappropriate because it could seem condescending to the client.

2. This gesture is appropriately timed and suitable in this situation.

3. The use of touch is inappropriate with any client no matter the reason.

4. The use of touch may be perceived as a sexual overture in this situation.

Correct Answer: 2 Rationale 1: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Rationale 2: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Rationale 3: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Rationale 4: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 12 Type: MCMA A client familiar to the nurse is grief-stricken and in tears after learning that his wife has decided to file for divorce and sue for full custody of their children. Which of the following actions by the nurse are appropriate?

Standard Text: Select all that apply.

1. Wiping away the clients tears without permission 2. Asking the client if it is okay to give him a hug 3. Holding the clients hand with his permission 4. Patting the client on the shoulder and offering reassurance Correct Answer: 2,3 Rationale 1: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Rationale 2: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Rationale 3: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Rationale 4: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 13 Type: MCSA The nurse is working with a client in the dayroom. Which of the following behavioral cues by the nurse may indicate a countertransference reaction?

1. Annoyance and hostility toward a client 2. Ordinary concern for the client 3. Feeling comfortable after meeting with the client 4. Thinking about the interaction after meeting with a client Correct Answer: 1

Rationale 1: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with the client are expected behaviors and do not indicate countertransference.

Rationale 2: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with the client are expected behaviors and do not indicate countertransference.

Rationale 3: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with the client are expected behaviors and do not indicate countertransference.

Rationale 4: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with the client are expected behaviors and do not indicate countertransference.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 14 Type: MCSA The nurse is planning care for a new patient admitted to the behavioral health unit. Which of the following activities can the nurse expect to occur in the orientation phase of a therapeutic nurseclient relationship?

1. Explore in-depth how the client relates to others.

2. Emphasize growth and positive aspects of the relationship.

3. Discuss with the client how to work together toward a common goal.

4. Identify dysfunctional client thoughts and emotional patterns.

Correct Answer: 3 Rationale 1: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Rationale 2: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Rationale 3: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Rationale 4: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 15 Type: MCSA The nurse is in the orientation phase of the nurseclient relationship with the client. Which of the following questions would the nurse commonly ask in this phase?

1. Which of your behaviors cause you the most problems in relationships with others?

2. What would you like to accomplish in the time we spend together?

3. What is the most satisfying accomplishment you feel you have made in your relationships with others?

4. How would you describe your relationships with members of your family?

Correct Answer: 2 Rationale 1: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Rationale 2: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Rationale 3: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the

client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Rationale 4: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 16 Type: MCSA The nurse and client have moved from the orientation phase to the working phase of the nurse-client relationship. Which of the following nursing strategies would assist the client to make constructive changes in a dysfunctional response pattern that is occurring during the early working phase of the nurseclient relationship?

1. Teach the client specific problem-solving strategies.

2. Determine a time and place for working on constructive changes.

3. Remind the client that constructive changes are expected before discharge occurs.

4. Reassure the client that confidentiality will be maintained.

Correct Answer: 1

Rationale 1: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase.

Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Rationale 2: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase.

Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Rationale 3: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase.

Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Rationale 4: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase.

Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 17 Type: MCSA

The nurse educator is teaching a group of students about the phases of the nurseclient relationship. Which of the following objectives does the educator include as indicative of the working phase of the nurseclient relationship?

1. Client accomplishments are honestly evaluated.

2. Plans for follow-up are clearly arranged.

3. Client behaviors and response patterns are openly analyzed.

4. Roles and responsibilities of the client are explicitly defined.

Correct Answer: 3 Rationale 1: Open analysis of client behaviors and response patterns is one of the primary objectives during the working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Rationale 2: Open analysis of client behaviors and response patterns is one of the primary objectives during the working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Rationale 3: Open analysis of client behaviors and response patterns is one of the primary objectives during the working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Rationale 4: Open analysis of client behaviors and response patterns is one of the primary objectives during the working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 18 Type: MCSA The nurse is assessing a clients current progress in the nurseclient relationship. Which of the following behaviors would indicate to the nurse that the client is beginning the termination phase of the nurseclient relationship?

1. The client verbalizes willingness to change ineffective coping patterns and self-defeating behaviors.

2. The client expresses awareness of potential causes of dysfunctional behavioral patterns.

3. The client uses effective problem-solving strategies on a daily basis.

4. The client requests clarification of the roles and responsibilities in relationship work.

Correct Answer: 3 Rationale 1: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Rationale 2: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Rationale 3: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be

necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Rationale 4: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 19 Type: MCSA Which of the following statements by the nurse may prevent successful separation between client and nurse at the end of a therapeutic one-to-one relationship?

1. Im going to miss our sessions together, but I think youre ready to handle difficult situations on your own.

2. I think two or three more sessions are necessary for you to develop more confidence in using this new coping skill effectively.

3. Im skeptical of your ability to assert yourself when new conflicts occur in future relationships, so be careful.

4. I suggest you contact me if you experience any new crisis that you feel unprepared to deal with on your own.

Correct Answer: 3

Rationale 1: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Rationale 2: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Rationale 3: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Rationale 4: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 20 Type: MCSA During the initial interview with a client, the nurse notices that the client changes the topic when the subject of the clients marital relationship is approached. The nurse is guided by the knowledge of which of the following?

1. Discussion of sensitive issues should only occur in the working phase.

2. Formulation of nursing diagnoses should be avoided until all essential data is obtained.

3. Information that is avoided or omitted is often more crucial than what is shared.

4. Avoidance of a topic is a sign of resistance that will disappear when initial anxiety is decreased.

Correct Answer: 3 Rationale 1: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Rationale 2: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Rationale 3: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues

that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Rationale 4: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 21 Type: MCSA A client states that she is unhappy and miserable in her marriage and has been for several years. Which of the following responses indicates the nurse is tuning in to the process of the clients interaction rather than thecontent?

1. Do you have any children from this marriage?

2. How long have you been married?

3. It sounds like you have been miserable for quite some time.

4. Has your husband ever cheated on you?

Correct Answer: 3

Rationale 1: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Rationale 2: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Rationale 3: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Rationale 4: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 22 Type: MCSA

A client states that he is unhappy in his marriage and has felt miserable for several years. Which of the following client responses would indicate that the nurses response to the theme of marital distress was most effective?

1. I guess youre right; I should start thinking about a divorce.

2. I feel so depressed all the time. I dont know what to do or who to turn to.

3. I never thought about her cheating on me before; do you think thats possible?

4. I guess weve stayed together all these years because of the children.

Correct Answer: 2 Rationale 1: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress.

Rationale 2: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress.

Rationale 3: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress.

Rationale 4: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 23 Type: MCSA The nurse has been working with a depressed client for several months. Which of the following signs would indicate that an ineffective working relationship has evolved between the client and the nurse?

1. The clients sense of relaxation and confidence with the nurse 2. The nurses and clients sense of commitment to addressing the clients problems 3. The nurses sense of the clients severe dysfunction that cannot result in client growth 4. The nurses sense of making contact with the client Correct Answer: 3 Rationale 1: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Rationale 2: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Rationale 3: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Rationale 4: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and

is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 24 Type: MCMA The nurse is working with a client who started therapy after losing his wife in an automobile accident. Which of the following client behaviors indicates he is ready to terminate the therapeutic nurse-client relationship?

Standard Text: Select all that apply.

1. Initial client treatment goals have been accomplished.

2. Symptoms no longer interfere with the clients comfort.

3. The client refuses to change due to unresolved resistances.

4. Dissatisfaction with interpersonal relationships is expressed.

5. Client well-being and satisfaction is dependent upon the nurse.

Correct Answer: 1,2 Rationale 1: Initial client treatment goals have been accomplished. Planned goals have been achieved.

Rationale 2: Symptoms no longer interfere with the clients comfort. Relief from the presenting problem has occurred.

Rationale 3: The client refuses to change due to unresolved resistances. A disruption in the one-to-one relationship has occurred due to a major impasse.

Rationale 4: Dissatisfaction with interpersonal relationships is expressed. The client has not developed sufficient improvement in social functioning for the relationship to end.

Rationale 5: Client well-being and satisfaction is dependent upon the nurse. The client should experience self-satisfaction and attainment of an independent identity before termination can occur.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 25 Type: MCSA The nurse notices that a client is unable to control anger when criticized during a group meeting, even though the client had been able to do this effectively for several weeks. Which of the following interventions would be most appropriate in the nurses next one-to-one therapeutic session with the client?

1. Encourage the client to express responses to criticism freely.

2. Insist the client take a time-out until anger is back under control.

3. Offer the client a PRN dose of ziprasidone (Geodon).

4. Encourage a detailed exploration of how the client reacts to criticism.

Correct Answer: 4 Rationale 1: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the

clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offering the client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Rationale 2: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offering the client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Rationale 3: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offering the client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Rationale 4: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offering the client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 26

Type: MCSA The nurse educator is reviewing a students care plan. Which of the following nursing diagnoses would not be appropriate to include when a patient experiences regressive behavior during the termination phase of the nurseclient relationship?

1. Ineffective Coping 2. Self-care Deficit 3. Powerlessness 4. Knowledge Deficit Correct Answer: 4 Rationale 1: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Rationale 2: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Rationale 3: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Rationale 4: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 27 Type: MCSA Establishing and maintaining the therapeutic nurseclient relationship differs according to the clients cultural background. The nurse is guided by knowledge of which of the following?

1. A clients religious beliefs may interfere with constructive change.

2. Alternative values should always be discussed with the client.

3. Clients who believe family problems should not be discussed with strangers should not be coaxed into doing so.

4. Exploring religious beliefs with the client is not recommended.

Correct Answer: 1 Rationale 1: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action.

Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Rationale 2: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action.

Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Rationale 3: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action.

Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Rationale 4: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action.

Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Establish and maintain one-to-one relationships within the context of the clients cultural background.

Question 28 Type: MCSA A client who grew up with alcoholic parents is reluctant to discuss thoughts, feelings, and self-defeating behaviors with the nurse. Which of the following responses by the nurse would be most helpful?

1. We dont have to talk about your feelings if you dont want to. Lets discuss the behaviors you would like to change.

2. Some clients who were raised in alcoholic families are reluctant to discuss their feelings. How has this impacted you?

3. I understand that you are not used to discussing your feelings; however, we cant continue unless you open up to me.

4. I understand that opening up to others is difficult for you, but you need to change your view about discussing family issues with me.

Correct Answer: 2 Rationale 1: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Rationale 2: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Rationale 3: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Rationale 4: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Establish and maintain one-to-one relationships within the context of the clients cultural background.

Question 29

Type: MCSA Which of the following professionals would be most helpful in providing interdisciplinary supervision regarding specific culture-bound syndromes that interfere with the therapeutic nurseclient relationship?

1. Religious consultant 2. Ethnic consultant 3. Psychologist 4. Psychiatrist Correct Answer: 2 Rationale 1: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Rationale 2: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Rationale 3: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Rationale 4: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Chapter 5. Supportive and Psychodynamic Psychotherapy Question 1 Type: MCSA The nurse is documenting observations of client interactions during a group session. The nurse strives to document the behaviors of the client interactions with:

1. Objectivity.

2. Serendipity.

3. Sympathy.

4. Empathy.

Correct Answer: 1 Rationale 1: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective.

Serendipity is not used when documenting behaviors of client interaction.

Rationale 2: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective.

Serendipity is not used when documenting behaviors of client interaction.

Rationale 3: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective.

Serendipity is not used when documenting behaviors of client interaction.

Rationale 4: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective.

Serendipity is not used when documenting behaviors of client interaction.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe the factors that influence the process of human communication.

Question 2 Type: MCSA The nurse is validating what was observed before documenting in the progress note. Validation is used as a mechanism to ensure which of the following?

1. The clients affect is appropriate to the situation 2. The clients perception of the response is communicated 3. The clients request is clarified 4. The clients need for further intervention is understood Correct Answer: 2 Rationale 1: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Rationale 2: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Rationale 3: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Rationale 4: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe the factors that influence the process of human communication.

Question 3 Type: MCMA Which of the following are included when documenting client education?

Standard Text: Select all that apply.

1. The educational content discussed with the client 2. The clients response 3. The purpose for the educational interaction 4. The assessment of the client 5. The nursing diagnosis Correct Answer: 1,2,3 Rationale 1: The educational content discussed with the client. When documenting client education, the nurse documents the content discussed.

Rationale 2: The clients response. When documenting client education, the nurse documents the clients response.

Rationale 3: The purpose for the educational interaction. When documenting client education, the nurse documents the rationale for the interaction.

Rationale 4: The assessment of the client. The assessment is not part of the client education.

Rationale 5: The nursing diagnosis. The nursing diagnosis and client goal is part of the planning phase, not the intervention phase.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the factors that influence the process of human communication.

Question 4 Type: MCSA The nurse is developing a plan of care for a client. Which of the following interventions must the nurse be careful to avoid?

1. Discussing expectations with the client 2. Selecting interventions that conflict with the clients value system 3. Identifying the clients perception of the problem 4. Addressing issues related to the clients past experiences Correct Answer: 2 Rationale 1: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developing a plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Rationale 2: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developing a plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Rationale 3: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developing a plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Rationale 4: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developing a plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Global Rationale: Cognitive Level: Evaluating Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Describe the factors that influence the process of human communication.

Question 5 Type: MCSA The student nurse asks why the nurse is documenting the clients nonverbal responses in addition to verbal responses during the initial assessment. Which of the following statements made by the nurse reflects the rationale for documenting both verbal and nonverbal responses?

1. It is the hospital policy to document both.

2. It is important to be thorough when documenting.

3. Documenting both permits the reader to compare the behaviors for congruence.

4. Charting verbal and nonverbal helps me remain objective.

Correct Answer: 3

Rationale 1: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Rationale 2: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Rationale 3: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Rationale 4: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 6 Type: MCMA Which of the following interventions are used by the nurse to demonstrate active listening?

Standard Text: Select all that apply.

1. Using silence 2. Covering ones mouth when yawning 3. Leaning in toward the client 4. Nodding ones head in response to clients verbal comments 5. Rocking back and forth in the chair Correct Answer: 3,4 Rationale 1: Using silence. Using silence is a therapeutic communication technique, but not used to communicate active listening.

Rationale 2: Covering ones mouth when yawning. Covering the mouth when yawning is good manners, but does not communicate active listening.

Rationale 3: Leaning in toward the client. Leaning in is an intervention that communicates one is listening.

Rationale 4: Nodding ones head in response to clients verbal comments. Nodding ones head to a clients verbal response communicates that one is listening.

Rationale 5: Rocking back and forth in the chair. Rocking back and forth in the chair is viewed as a distraction and does not communicate openness.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 7 Type: MCSA During a group session, the clients are asked to make one positive statement about their home life. The nurse notices that one of the clients begins to fidget in the chair and interprets this behavior as: 1. A form of nonlanguage vocalization.

2. A therapeutic use of space.

3. An expression of discomfort.

4. An excuse to avoid answering the question.

Correct Answer: 3 Rationale 1: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away.

Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Rationale 2: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away.

Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Rationale 3: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away.

Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Rationale 4: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away.

Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Global Rationale: Cognitive Level: Evaluating Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 8 Type: MCSA During a group session, a client expresses anger at the nurse. The nurse sits tensely with arms and legs crossed while verbally agreeing that the clients point of view is correct. Which of the following messages is being sent by the nurse?

1. The nurse is expressing warmth toward the client 2. The nurse is being patient

3. The nurse is demonstrating empathy 4. The nurse is sending a mixed message Correct Answer: 4 Rationale 1: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Rationale 2: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Rationale 3: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Rationale 4: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 9 Type: MCSA The nurse observed that during a teaching session, the overall emotional tone of a client remained unchanged.

The nurse documents this as: 1. Affect that has range.

2. Flat affect.

3. Incongruent verbal and nonverbal responses.

4. Muted behavior.

Correct Answer: 2 Rationale 1: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Rationale 2: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Rationale 3: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Rationale 4: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Global Rationale:

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 10 Type: MCSA The nurse is working with a teen admitted with a diagnosis of depression. Which of the following interventions demonstrates that the nurse is sensitive to the clients needs?

1. Avoiding the use of silence to decrease anxiety 2. Asking for details to demonstrate interest in the client 3. Using closed-ended questions 4. Listening to the clients feelings Correct Answer: 4 Rationale 1: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Rationale 2: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Rationale 3: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Rationale 4: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 11 Type: MCSA A working goal for the nurseclient relationship is to achieve: 1. Facilitative intimacy.

2. Self-disclosure.

3. Interdependence.

4. Social superficiality.

Correct Answer: 1 Rationale 1: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves.

Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Rationale 2: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves.

Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Rationale 3: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves.

Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Rationale 4: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves.

Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 12 Type: MCSA During the first interaction with a client, the nurse makes an introduction and identifies the purpose of the interaction. This serves to accomplish which of the following in developing a trusting relationship?

1. Setting goals

2. Building 3. Initiating 4. Maintaining Correct Answer: 3 Rationale 1: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Rationale 2: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Rationale 3: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Rationale 4: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 13 Type: MCSA

The nurse engaged in a therapeutic relationship with a client uses nonverbal communication to: 1. Enhance verbal messages.

2. Avoid the use of verbal messages.

3. Detract from verbal messages.

4. Terminate the therapeutic relationship.

Correct Answer: 1 Rationale 1: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Rationale 2: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Rationale 3: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Rationale 4: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 14 Type: MCSA A nurse acknowledges feeling anxious about meeting new people. By acknowledging feelings to the client, the nurse is demonstrating: 1. Sympathy.

2. Genuineness.

3. Empathy.

4. Superficiality.

Correct Answer: 2 Rationale 1: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Rationale 2: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Rationale 3: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Rationale 4: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 15 Type: MCSA Psychiatricmental health nursing interventions occur at which of the following levels of communication?

1. Public 2. Intrapersonal 3. Interpersonal 4. International Correct Answer: 3 Rationale 1: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Rationale 2: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Rationale 3: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Rationale 4: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 16 Type: MCSA In planning care for a client who is gaining mental stability, the nurse develops measures to confirm the clients view of self. Which of the following responses made by the nurse would be categorized as disturbed communication?

1. I do not understand what you are telling me.

2. You are wrong.

3. How might you go about that differently?

4. Do you want to try that again?

Correct Answer: 2 Rationale 1: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual.

Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Rationale 2: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual.

Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Rationale 3: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the

nurse does not understand what is being said communicates information about the message, not the individual.

Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Rationale 4: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual.

Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 17 Type: MCSA Which of the following communication theories provides the most appropriate rationale for a nursing intervention to utilize the perceived strengths of the client in promoting effective communication?

1. Behavioral Effects and Human Communication Theory 2. Neurolinguistic Programming Theory 3. Theory of Communication Levels 4. Therapeutic Communication Theory Correct Answer: 4

Rationale 1: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Rationale 2: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Rationale 3: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Rationale 4: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 18 Type: MCSA Which of the following is not related to the theory of successful versus disturbed communication patterns during an admission assessment?

1. The appropriateness of the content of the message.

2. The quality of the feedback provided.

3. The language level of the assessment nurse.

4. How efficiently the client delivers a message.

Correct Answer: 3 Rationale 1: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Rationale 2: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Rationale 3: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Rationale 4: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 19 Type: MCSA A client asks the nurse about the doctors comment that he may have problems due to delayed synaptic transmission in his brain. The nurse explains that the best way to describe a synaptic transmission is which of the following?

1. An electrochemical process called neurotransmission 2. Where the axon is released 3. When the receptors bind to neurons

4. The space where neurotransmitters match up with receptors Correct Answer: 1 Rationale 1: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Rationale 2: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Rationale 3: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Rationale 4: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 20 Type: MCSA

A client is admitted to the psychiatric unit exhibiting behaviors indicating a high level of anxiety following a personal crisis. Which of the following communication skills should the nurse utilize when interacting with this client?

1. Closed-ended questions 2. Providing reassurance 3. Open-ended questions 4. Providing the client with advice Correct Answer: 1 Rationale 1: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Rationale 2: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Rationale 3: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Rationale 4: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 21 Type: MCSA During a nurseclient interaction, the client tells the nurse, I dont think I can deal with feeling so sad much longer. The nurses best response is which of the following?

1. Is there a history of depression in your family?

2. We all have times of sadness.

3. Are you saying you feel sad?

4. Tell me about your feelings of sadness.

Correct Answer: 4 Rationale 1: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Rationale 2: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family;

the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Rationale 3: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Rationale 4: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 22 Type: MCSA While reviewing therapeutic communication techniques, a nursing student made a list of things not to do or say to a client. Which of the following comments should be on the students list?

1. How do you feel about being discharged today?

2. What happened when you quit taking your medications?

3. What are your concerns about your living situation?

4. Why do you think you will never get well?

Correct Answer: 4 Rationale 1: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Rationale 2: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Rationale 3: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Rationale 4: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 23 Type: MCSA A client states, I just know my brother will not come back from the war. Which of the following examples would be used to encourage the client to explore this concern?

1. Maybe he will be one of the lucky ones.

2. How do you know this?

3. Where is your brother going?

4. What do you feel will happen to him?

Correct Answer: 4 Rationale 1: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Rationale 2: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Rationale 3: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking

where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Rationale 4: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 24 Type: MCSA Which of the following is an example of clarifying a clients verbal response?

1. Are you saying you feel the medicine is helping you?

2. See, the medicine does work.

3. I knew it would work; it just takes time.

4. Everything seems to work out eventually.

Correct Answer: 1

Rationale 1: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Rationale 2: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Rationale 3: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Rationale 4: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 25 Type: MCSA A delusional client walks up to the nurse and says, I am the appointed overseer. Who are you and why are you here? The most therapeutic response is which of the following?

1. I am your nurse and I will be here to help you until suppertime.

2. You dont know who I am?

3. You know who I am.

4. You are not the overseer; you are a client in the hospital.

Correct Answer: 1 Rationale 1: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Rationale 2: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Rationale 3: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Rationale 4: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Global Rationale:

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 26 Type: MCSA Which of the following interventions promotes mindful listening in any health care setting?

1. Telling the client to get off the phone 2. Encouraging the family to step outside before assessing the client 3. Turning off the television before interviewing a client 4. Asking clients what they would like to drink when taking medication Correct Answer: 3 Rationale 1: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Rationale 2: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Rationale 3: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Rationale 4: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 27 Type: MCSA In the immunization clinic, the nurse notices a client displaying tense body posture. Which of the following is the most therapeutic response for the nurse to make?

1. This wont hurt a bit.

2. You need to relax.

3. I can tell youve had a bad experience before.

4. I notice you are clenching your fists.

Correct Answer: 4 Rationale 1: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance.

Directing the client to relax is a form of giving advice, which is not therapeutic.

Rationale 2: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance.

Directing the client to relax is a form of giving advice, which is not therapeutic.

Rationale 3: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance.

Directing the client to relax is a form of giving advice, which is not therapeutic.

Rationale 4: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance.

Directing the client to relax is a form of giving advice, which is not therapeutic.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 28 Type: MCSA The nurse gathering data from a client admitted to labor and delivery is overheard making the comment, You are lying. You need to tell me the truth so we can do what is best for your baby. The nurses communication is: 1. A perception check.

2. Nontherapeutic.

3. Necessary.

4. Therapeutic.

Correct Answer: 2 Rationale 1: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Rationale 2: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Rationale 3: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Rationale 4: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 29 Type: MCSA

When considering communication skills, the nurse caring for an older client anticipates that the client will: 1. Interrupt frequently.

2. Take longer to respond.

3. Answer questions with one-word responses.

4. Remain silent.

Correct Answer: 2 Rationale 1: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Rationale 2: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Rationale 3: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Rationale 4: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 30 Type: MCSA The nurse is admitting a client from the emergency room. Which of the following would be used to clarify the nurses understanding of the clients chief complaint?

1. If you are bleeding, where is the blood?

2. I feel your pain when I see you hold your side.

3. Are you saying you feel that you are bleeding inside?

4. Dont worry; we have the technology to take care of you.

Correct Answer: 3 Rationale 1: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic.

Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint.

Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Rationale 2: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic.

Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint.

Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Rationale 3: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic.

Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint.

Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Rationale 4: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic.

Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint.

Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Chapter 6. Eye Movement Desensitization and Reprocessing Therapy Question 1 Type: MCSA What is the history of EMDR?

Global Rationale: EMDR has created by Francine Shapiro PhD, discovered that moving her eyes in certain directions reduced emotional tension. Francine did further investigation into this phenomenon making EMDR the subject of her doctoral thesis in 1987. Integrating her clinical experience, Francine has formulated a unique method which she calls EMDR.

Question 2 Type: MCSA Who can benefit from EMDR?

Global Rationale: Anyone who has ever experienced an upset that they have not recovered from. Often these people have one or more of the following symptoms in varying degrees: feeling “stuck”, excess stress/tension, depression, anxiety, restlessness, sleep trouble, fatigue, appetite disturbances, and ongoing physical health concerns despite treatment. In the more severe cases: panic attacks, flashbacks, nightmares, obsessions, compulsions, eating disorder, and suicidal tendencies.

Question 3 Type: MCSA How does EMDR treatment work?

Global Rationale:

When an upset is experienced, it can become locked in the nervous system with the original picture, sounds, thoughts, feelings, and body sensations. This upset is stored in the brain (and also the body) in an isolated memory network preventing learning from taking place. Old material just keeps getting triggered over & over again and you end up feeling “stuck” emotionally. In another part of your brain, in a separate network, is most of the information you need to resolve the upset. It’s just prevented from linking up to the old stuff. Once processing starts with EMDR, the 2 networks can link up. New information can then come to mind to resolve the old problems.

Question 4 Type: MCSA

How effective is EMDR?

Global Rationale:

When compared to other methods of therapy (psychoanalysis, cognitive, behavioral, etc), EMDR has been rated as far more effective by mental health professionals. Clients experience emotional healing at an accelerated rate. If we use the metaphor of a driving a car through a tunnel to get to the other side, (where the tunnel represents the journey of healing and the other side of the tunnel represents the healed state), EMDR is like driving your car through the tunnel at very high speeds. Because of this accelerated processing, you should notice improvement within each session.

Question 5 Type: MCSA Global Rationale:

How does the overall treatment with EMDR look?

EMDR focuses first on the past, second on the present and third on the future. The past is focused on first because it is the past unresolved pain (whether it is childhood or the more recent past) which is causing pain in the present.

Dealing with the past is therefore going to the root of the problem. For example, if a client comes in with depression and she has a history of being depressed since a death in her family, we would focus on the time around the death first because it is the root of the depression. To only focus on the symptoms of the depression in the present would be like taking an aspirin for a headache caused by a brain tumor rather than working with the brain tumor.

Chapter 7. Motivational Interviewing MULTIPLE CHOICE 1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which response should the nurse use to clarify the patients comment? a. It sounds as though you were uncomfortable with the content of your dream. b. I understand what youre saying. Bad dreams leave me feeling tired, too. c. So you feel as though you did not get enough quality sleep last night?

d. Can you give me an example of what you mean by stoned?

ANS: D The technique of clarification is therapeutic and helps the nurse examine the meaning of the patients statement.

Asking for a definition of stoned directly asks for clarification. Restating that the patient is uncomfortable with the dreams content is parroting, a non-therapeutic technique. The other responses fail to clarify the meaning of the patients comment.

2. A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic? a. Lets talk about something other than the CIA. b. It sounds like youre concerned about your privacy. c. The CIA is prohibited from operating in health care facilities. d. You have lost touch with reality, which is a symptom of your illness.

ANS: B It is important not to challenge the patients beliefs, even if they are unrealistic. Challenging undermines the patients trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patients message conveys. The correct response uses the therapeutic technique of reflection. The other comments are non-therapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful, but uncompassionate.

3. The patient says, My marriage is just great. My spouse and I always agree. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patients communication is: a. clear.

c. precise.

b. mixed.

d. inadequate.

ANS: B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patients verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety.

Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self. a. Ive also had traumatic life experiences. Maybe it would help if I told you about them. b. Why do you think you had so much difficulty adjusting to this change in your life? c. I hope you will feel better after getting accustomed to how this unit operates. d. Id like to sit with you for a while to help you get comfortable talking to me.

ANS: D Offering self is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of offering self, helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and non-therapeutic. The other incorrect response is therapeutic but is an example of offering hope.

5. Which technique will best communicate to a patient that the nurse is interested in listening? a. Restating a feeling or thought the patient has expressed. b. Asking a direct question, such as Did you feel angry? c. Making a judgment about the patients problem. d. Saying, I understand what youre saying.

ANS: A Restating allows the patient to validate the nurses understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as Did you feel angry? ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patients words, the patient has no way of measuring the understanding.

6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. What are the common elements here? b. Tell me again about your experiences. c. Am I correct in understanding that . . .

d. Tell me everything from the beginning.

ANS: C Asking, Am I correct in understanding that permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.

7. A patient tells the nurse, I dont think Ill ever get out of here. Select the nurses most therapeutic response. a. Dont talk that way. Of course you will leave here! b. Keep up the good work, and you certainly will. c. You dont think youre making progress? d. Everyone feels that way sometimes.

ANS: C By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are non-therapeutic techniques. Telling the patient not to talk that way is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

8. Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you. Which analysis is most accurate? a. The patient is giving positive feedback about the nurses communication techniques. b. The nurse is viewing the patients behavior through a cultural filter. c. The patients verbal and nonverbal messages are incongruent. d. The patient is demonstrating psychotic behaviors.

ANS: C When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent.

Some clinicians call it a mixed message. It is inaccurate to say that the patient is giving positive feedback about the nurses communication techniques. The concept of a cultural filter is not relevant to the situation because a

cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

9. While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication

c. A cultural barrier

b. A message filter

d. Social skills

ANS: A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patients social skills or whether a cultural barrier exists.

10. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patients hand. Select the correct analysis of the nurses behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patients cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Psychiatric patients should not be touched.

ANS: B Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.

11. During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication. a. I notice you keep looking toward the door. b. This is our time together. No one is going to interrupt us. c. It looks as if you are eager to end our discussion for today. d. If you are uncomfortable in this room, we can move someplace else.

ANS: A Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.

12. A black patient says to a white nurse, Theres no sense talking. You wouldnt understand because you live in a white world. The nurses best action would be to: a. explain, Yes, I do understand. Everyone goes through the same experiences. b. say, Please give an example of something you think I wouldnt understand. c. reassure the patient that nurses interact with people from all cultures. d. change the subject to one that is less emotionally disturbing.

ANS: B Having the patient speak in specifics rather than globally will help the nurse understand the patients perspective.

This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.

13. A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patients self-esteem, but after 3 weeks, the patients eye contact did not improve. What is the most accurate analysis of this scenario? a. The patients eye contact should have been directly addressed by role-playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patients poor eye contact is indicative of anger and hostility that were unaddressed. d. The nurse should have assessed the patients culture before making this diagnosis and plan.

ANS: D The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

14. When a female Mexican American patient and a female nurse sit together, the patient often holds the nurses hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior.

Which analysis is most accurate? a. The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures. b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The patient is trying to manipulate the nurse using nonverbal techniques.

ANS: A The most likely answer is that the patients behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.

15. A Puerto Rican American patient uses dramatic body language when describing emotional discomfort.

Which analysis most likely explains the patients behavior? The patient: a. has a histrionic personality disorder. b. believes dramatic body language is sexually appealing. c. wishes to impress staff with the degree of emotional pain. d. belongs to a culture in which dramatic body language is the norm.

ANS: D Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

16. During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions.

The nurse should respond by saying: a. Why do you keep asking about me? b. Nurses direct the interviews with patients. c. Do not ask questions about my personal life. d. The time we spend together is to discuss your concerns.

ANS: D When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way.

Telling patients not to ask about the nurses personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Why questions are probing and non-therapeutic.

17. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? a. A nurse is responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence can provide meaningful moments for reflection. d. Silence helps patients know that what they said was understood.

ANS: C Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.

18. A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice: a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy.

ANS: A Giving advice fosters dependence on the nurse and interferes with the patients right to make personal decisions.

It robs patients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.

19. A school age child tells the school nurse, Other kids call me mean names and will not sit with me at lunch.

Nobody likes me. Select the nurses most therapeutic response.

a. Just ignore them and they will leave you alone. b. You should make friends with other children. c. Call them names if they do that to you. d. Tell me more about how you feel.

ANS: D The correct response uses exploring, a therapeutic technique. The distracters give advice, a non-therapeutic technique.

20. A patient with acute depression states, God is punishing me for my past sins. What is the nurses most therapeutic response? a. You sound very upset about this. b. God always forgives us for our sins. c. Why do you think you are being punished? d. If you feel this way, you should talk to your minister.

ANS: A The nurse reflects the patients comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are non-therapeutic.

MULTIPLE RESPONSE 1. A patient cries as the nurse explores the patients feelings about the death of a close friend. The patient sobs, I shouldnt be crying like this. It happened a long time ago. Which responses by the nurse facilitate communication?Select all that apply. a. Why do you think you are so upset? b. I can see that you feel sad about this situation. c. The loss of a close friend is very painful for you. d. Crying is a way of expressing the hurt you are experiencing. e. Lets talk about something else because this subject is upsetting you.

ANS: B, C, D

Reflecting (I can see that you feel sad, This is very painful for you) and giving information (Crying is a way of expressing hurt) are therapeutic techniques. Why questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

2. Which benefits are most associated with use of telehealth technologies? Select all that apply. a. Cost savings for patients b. Maximize care management c. Access to services for patients in rural areas d. Prompt reimbursement by third party payers e. Rapid development of trusting relationships with patients ANS: A, B, C Telehealth has shown it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those problems. Although telehealths improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third party payers.

Telehealth technologies have not shown rapid development of trusting relationships.

3. Which comments by a nurse demonstrate use of therapeutic communication techniques? Select all that apply. a. Why do you think these events have happened to you? b. There are people with problems much worse than yours. c. Im glad you were able to tell me how you felt about your loss. d. I noticed your hands trembling when you told me about your accident. e. You look very nice today. Im proud you took more time with your appearance.

ANS: C, D The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are non-therapeutic techniques.

4. A nurse is interacting with patients in a psychiatric unit. Which statements reflect use of therapeutic communication? Select all that apply. a. Tell me more about that situation.

b. Lets talk about something else. c. I notice you are pacing a lot. d. Ill stay with you a while. e. Why did you do that?

ANS: A, C, D The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate changing the subject and probing, which are non-therapeutic techniques.

Chapter 8. Cognitive Behavioral Therapy MULTIPLE CHOICE 1. Which intervention best reflects the nursing role regarding effective implementation of behavioral therapy goals? a. Administering the prescribed medications accurately b. Interacting effectively with members of the health care team c. Being aware of all the patient related therapeutic modalities d. Evaluating patient behaviors to reward economic tokens appropriately ANS: D The primary role of the nurse who is involved in behavioral therapy is to assess and identify the patients problem behaviors in collaboration with the multidisciplinary team. A token economy is a system of behavior reinforcements in which patients earn tokens by performing predetermined desired behaviors. The remaining options are generalized responsibilities that are relevant to any therapy format.

2. A new nurse asks the mentor, How can I be sure Im developing a therapeutic environment for my unit? The mentor uses as a basis for the response the fact that a therapeutic milieu is characterized by: a. Rigid adherence to timelines and unit routine b. Relaxation of boundaries when doing so is accepted by all c. The focus of the staff is directed to the most critically disturbed patients

d. Specific patient-centered goals are established mutually by patient and staff ANS: D Factors that determine the therapeutic effectiveness of the social environment includes the presence of two-way communication between the patients and the members of the multidisciplinary team for purposes of goal setting.

In a therapeutic relationship, boundaries are established early and maintained throughout and although adherence to routine is important, there is room for adjustment when it benefits the therapeutic nature of the milieu. Although short-term attention may require focus on the patient in crisis, attention of the staff is equally shared.

3. To plan care for a patient with a psychiatric disorder, the nurse keeps in mind that the primary nursing role related to therapeutic activities is: a. Assisting the patient in accomplishing the activity b. Ensuring that the patient will comply with the rules of the activity c. Ensuring that the patient can accomplish the activity in a timely manner d. Providing a support system for the patient if they fail to complete the activity ANS: A The nurses role in therapeutic activities is that of a professional observer and participant who works with the therapist to enhance the patients capabilities and functioning within the parameters of the assigned activity.

Assuring accomplishment, compliance, or providing failure support are not nursing roles.

4. Which statement would the nurse use to describe the primary purpose of boundaries? a. Boundaries define responsibilities and duties to ones self in relation to others. b. Boundaries determine objectives of the various working stage of the relationship. c. Boundaries differentiate the assumed roles of both the nurse and of the patient. d. Boundaries prevent undesired material from emerging during the interaction.

ANS: A Boundaries are the social, physical, and emotional limits of the interaction. As such, they serve to define the responsibilities and duties of the nurse in relation to the patient. Objectives and roles are determined during the orientation stage. Emergence of undesired material may be a significant issue for the patient.

5. Which action will best facilitate the development of trust between a nurse and patient? a. Responding positively to the patients demands b. Following through with whatever was promised c. Clarifying with the patient whenever there is doubt d. Staying available to the patient for the entire shift ANS: B Being consistent in keeping ones word implies that the nurse is trustworthy and does what is agreed upon.

Being responsive to demands may not be therapeutic. Instead, the patient will need to learn new techniques for meeting needs. Clarification is important but is not the best method for promoting trust. Trust is better served by shorter contacts at agreed-upon intervals.

6. Which statement best defines the nurses initial role as the patients source of help in addressing interpersonal problems? a. Ill work with your doctor to help you get better. b. Ill be working with you to help solve your marital troubles. c. Your medications will help you feel better as soon as they take effect. d. You will be expected to attend the group activities while you are here.

ANS: B This statement clearly specifies the nurses purpose as a helping professional, and establishes the relationship as therapeutic, rather than social. The nurse has independent functions and does not work exclusively with the doctor. Identifying only medication overlooks the contributions of staff and the therapeutic milieu. Giving information is appropriate, but this statement does not define the nurses role as resource.

7. The nurse is determining whether the patients needs could be best met in a task or a process group. The decision is based on the understanding that a task group focuses on: a. Content issues b. The here and now c. Communication styles d. Relations among the members ANS: A

Content-oriented groups focus on goals and tasks of the group. Thus a task-oriented group would focus on content issues. Process groups focus on interpersonal relationships. Communication styles are not relevant to describing task-oriented groups. Here and now refers to dealing with issues that are taking place at the present time.

8. The treatment team was engaged in planning how group therapy could be included as a part of the structured daily activities of the unit. A new team member asked, Why is it so important to include group therapy for the patients? The most accurate response would be based on the assumption that: a. Hidden agendas frequently surface in group sessions. b. Some persons do not relate well on an individual basis. c. Group therapy is far more cost-effective for the patients. d. Psychopathology has its source in disordered relationships.

ANS: D A key assumption of group therapy is that psychopathology has its source in disordered relationships. It follows that individuals will behave in the group as they do in other settings, so group provides an opportunity to help individuals develop more functional relationships. Ability to relate is not relevant to group work. It is dealt with in one-to-one therapy. Hidden agenda is not a reason to offer group therapy. Cost-effectiveness is not an assumption about the reason group therapy is effective.

9. Which patient would the group co-leaders determine is demonstrating Yaloms therapeutic factor termed universality? a. Patient A, who states he realizes he is not the only person who has a problem with loneliness b. Patient B, who displays dysfunctional interaction patterns learned in his family of origin c. Patient C, who states he finally feels a strong sense of belonging d. Patient D, who openly expresses his anger about his work ANS: A Universality is the factor that refers to understanding that one is not unique, that others share thoughts, reactions, and discomforts like your own. Dysfunctional interaction refers to corrective recapitulation of the family group. A strong sense of belonging provides an example of cohesiveness. Display of anger is an example of catharsis.

10. A nurse, leading an inpatient group dealing with womens issues, identifies a patient who is assuming the role of aggressor. Which behavior characterizes this role? a. Attempting to manipulate others b. Mediating conflicts and disagreements c. Criticizing the contributions of others d. Seeking a position between contending sides ANS: C An aggressor acts in negative ways, displaying hostility, attacking the group, or criticizing the members.

Seeking a position between contending sides describes the compromiser. Mediating conflicts and disagreements describes the harmonizer. Attempting to manipulate others describes the dominator.

11. Which statement by a 16-year-old is considered as positive evidence that the familys involvement in therapy is moving them towards effective functioning? a. My dad has finally stopped giving me advice on how to live my life. b. I stopped playing football since practice required me to be away from home so often. c. Since my mother quit her job, she is more available to keep the home running smoothly. d. Eating dinner with my parents on Sunday nights has helped us be more aware of each others needs.

ANS: D This statement shows the family has made an effort to improve communication and deal with alienation without any one member bearing complete responsibility. Withdrawing from the team suggests he felt solely responsible for the family problem. Quitting the job suggests the mother saw herself as responsible; however, being home does not guarantee unification. A lack of advisement suggests withdrawal of the father from participation in family matters.

12. In response to the nurses statement, Tell me about your family, the patient became silent and displayed nonverbally that he is uncomfortable. Which statement by the nurse reflects sensitivity to the patient? a. Im so sorry. I didnt realize your family was a problem for you. b. Learning to express negative feelings will assist you in getting well.

c. Perhaps you can talk about your feelings to the physician next time you meet. d. That seems to be a difficult subject for you. We can discuss when you are ready.

ANS: D This response acknowledges the situation, is respectful, and allows the patient to choose when to refocus the therapeutic interaction. Referring to the family as a problem is not sensitively worded. Offering false reassurance implies that feelings are negative. Suggesting postponing the discussion represents avoidance of dealing with the patients feelings.

13. When sharing her feelings about separating from a therapy group, the patient stated, I feel a bit sad and empty that I wont be seeing you folks again. What is the most accurate evaluation of the patients statement? a. It indicates regression and her lack of readiness to terminate. b. Unconsciously, she is hoping she will be permitted to continue the group. c. She is demonstrating normal feelings associated with termination of therapy. d. She needs further evaluation by her therapist to determine readiness to terminate.

ANS: C The patient is expressing feelings of sadness over the loss of the therapeutic group relationships that have been helpful to her. Such feelings are considered normal, just as they are considered normal when the nurse-patient relationship terminates. The feelings expressed are normal, not regressive. No hidden meaning is present; the patient openly expressed genuine feelings. Further evaluation is not needed.

14. A patient asks the nurse manager to help resolve a situation between her and another patient. Which action would best support the patients feelings of safety when experimenting with new ways of being? a. Encouraging the patient to report the incident to the other patients physician b. Intervening on the patients behalf and sorting out the incident with the other patient c. Suggesting that the patient ignore the situation since the other patient was probably not aware of her behavior d. Offering to be present and help the patient discusses her feelings about the incident with the other patient ANS: D

Offering to be with the patient affords her a safe nonthreatening opportunity to assume responsibility for meeting her own needs assertively by encouraging skills that affect positive communication. Intervening removes the responsibility from the patient. Ignoring supports passive behavior. There is no need to bring in another person. The patient is capable of addressing the problem herself.

15. A patient tells the nurse, I really like you. Youre the only true friend I have. The patients remarks call for the nurse to revisit the issue of: a. Trust b. Safety c. Boundaries d. Countertransference ANS: C The patients remarks call for the nurse to remind the patient of the parameters of the nurse-patient relationship.

The remark would also give the nurse the opening to go on to discuss the matter of friendship. The patients remarks do not suggest the need to deal with trust, safety, or countertransference.

16. By the end of the orientation phase, which outcome can be identified for a newly admitted patient? The patient will demonstrate: a. Ability to problem solve one issue b. Trust in at least one nurse on the unit c. Positive transference with a staff member d. Ability to ask for help in meeting needs ANS: B Establishing trust in the nurse is a fundamental task of the orientation phase of the relationship; thus it is an appropriate outcome to identify. When trust is present, the patient is free to focus on the work and tasks of therapy. The ability to problem solve is an outcome appropriate for the working phase. Positive transference would not be an identified outcome. The ability to ask for help would not be an identified outcome for the orientation phase.

17. The patient and the nurse have agreed on problems to be addressed during a short course of outpatient therapy. At the beginning of the appointment, the patient states, Id like to work on the issue of relationships today. Which assessment can be made?

a. Nurse-patient roles have not been clearly delineated. b. The nurse should suggest several alternative behaviors. c. The patient must be able to manage emotions before continuing. d. The relationship is moving from orientation to working phase.

ANS: D Once the patient and nurse have collaborated to define and prioritize problems, the relationship moves from orientation to working phase. The remaining options have no relevance to the scenario since there is no reference to roles, alternative behaviors, or managing behaviors.

18. A nurse and patient are entering the termination phase in the group experience. An important nursing intervention will be to: a. Encourage the group to describe goals for change. b. Inquire whether the group needs more time to accomplish goals. c. Assist the group to explore alternative coping strategies for problems. d. Discuss feelings about leaving the group and the support found with the group.

ANS: D Healthy termination is facilitated when the group and nurse express reactions to termination. The nurse serves as a role model by being open and genuine as the feelings about the losses incurred with ending are discussed.

On a positive note, accomplishments and growth are acknowledged and the transfer of safety and trust to the group members is accomplished. Describing goals is accomplished in the orientation phase. Accomplishing goals is part of the working phase in a relationship that does not have a strict time limit. Exploring alternative coping strategies would be part of the working stage.

19. A patient attending group therapy mentions, In the beginning, I was so sick that everyone had to help me.

For the last few days, its felt good to be able to give something back to the group. This statement can be assessed as an example of Yaloms factor of: a. Altruism b. Harmonizing c. Cohesiveness d. Imitative behavior

ANS: A Altruism refers to the experience of being helpful to others and is clearly what the patient is displaying in the scenario. The other factors are not applicable.

20. During the first family therapy session, the mother of a child being treated for truancy and emotional outbursts asks the nurse, Why are you bothering to ask the rest of us questions? My son is the one with the problems. The best response for the nurse would be: a. Well get more accurate information if the entire family is involved. b. It may seem strange to you, but well get better results doing it this way. c. When one family member is sick, the whole family system is sick as well. d. Every family members perceptions are very important to the total picture.

ANS: D This response orients the family to the idea that each persons opinion will be valued. Having the family present for assessment prepares them for working together to identify family issues, identify outcomes, and solve problems. It may or may not be true that this will result in accurate information. Getting better results doesnt convey the real reason. Referring to the family as sick is pessimistic and conveys a threatening message.

21. A novice mental health nurse shares that, Ill never get used to playing cards or other games with patients. It seems like a poor use of scarce nursing time. The best response for the nurses mentor would be: a. Perhaps youll want to rethink your transfer to this unit if youre really uncomfortable. b. Your comments make a point about scarce resources. Ill ask the treatment team to review our position on activities. c. Activity co-leadership puts us in a position to help patients develop social skills and support them as they take small risks. d. Managed care has cost us activities therapists. Activities are necessary to give patients something to do, so we have to fill in.

ANS: C Nurses who engage in co-leadership of therapeutic activities recognize that each activity contributes to outcome attainment. During activities, patients practice skills needed in life situations, process emotions, and give and receive validation and feedback. Suggesting a rethink is not supportive of the nurse. The remaining options do not acknowledge the value of activities therapy.

22. What is the primary reason for the nurse to have an understanding of the various types of activity and adjunct therapies? a. The nurse chooses the most cost-effective therapy group. b. The nurse is expected to encourage patients involvement in the therapies. c. The nurse is responsible for placing the patient in the appropriate group. d. The nurse needs to be supportive of the treatment team members who direct these therapies.

ANS: B The nurse must interpret to patients and others that the purpose of activity therapies is to increase patient awareness of feelings and behaviors and to minimize pathology and promote mental health. Although they are important, supportiveness, encouragement, and economics are not the primary reason.

23. Which activity therapy should the nurse recommend to the treatment team to assist the patient to relieve tension and achieve increased body awareness? a. Psychodrama b. Music therapy c. Dance therapy d. Recreation ANS: C The large movements involved in dance therapy would enable the patient to relieve tension and move with greater body awareness and freedom. The other options will not promote body awareness.

24. To effectively plan care for a patient, the nurse will understand that activity and adjunct therapies may be more useful in some situations than verbal therapies because adjunct therapies: a. Are readily available in the treatment setting b. Do not require specific training or expertise to facilitate c. Provide the patient the opportunity to use ego-protective mechanisms d. Allow the patient to express feelings on multiple levels at the same time ANS: D

A patient is able to express feelings on the emotional, physical, and symbolic levels during activity therapy, whereas verbal therapies are limited to one dimension. The primary facilitator of the selected therapy is required to have formal education and supervised experience. Adjunct therapy does not provide this opportunity, which would be considered nontherapeutic. Treatment settings are not always readily available.

25. A patient is scheduled to attend an occupational therapy group to work on the identified goal of recognizing and using more effective coping techniques. What measure can the nurse use to continue to support the patients attainment of this goal after he returns to the unit? a. Isolating him from more seriously ill patients b. Praising him for positive behavioral changes c. Avoiding setting limits that would increase his anxiety level d. Permitting him to make mistakes prior to intervening on his behalf ANS: B Recognizing and pointing out positive changes provides encouragement to continue pursuing change. The remaining option would not achieve the nurses goal of supporting the patients use of effective coping techniques.

26. How can the nurse encourage an extremely shy patient to participate therapeutically in a dance activity group? a. Offer to dance with the patient. b. Ask the patient if this is the first dance he has attended. c. Sit with the patient away from the group. d. Encourage another patient to ask him to dance.

ANS: A If trust has been established, the patient may feel safe enough to dance with the nurse. If trust has not yet been established, the patient will see the nurses invitation as demonstrating respect and reaching out to him. Either way, the action will encourage participation. The nurse should not make another patient responsible for this patients participation. The remaining options do not encourage participation.

27. When leading a therapeutic group, the nurse demonstrates an understanding of the need to act as the groups executive when:

a. Restating rules when a new member joins b. Being available to orient the new members c. Helping a member defuse the anger they are experiencing d. Working with a member to help improve their communication skills ANS: A Executive functioning refers to monitoring and attending to group rules and procedures. Caring demonstrates expressions of kindness. Meaning attribution includes accepting of feelings, although emotional stimulation would reflect working communication skills.

28. When another patient serves as alter ego during an outpatient group session, the nurse documents that the group had been engaged in: a. Role-playing b. Psychodrama c. Cognitive therapy d. Consensus building ANS: B Psychodrama uses spontaneous dramas to act out emotional problems to promote health through development of new perceptions, behaviors, and connections with others. Others in the group take the role of significant others. Role-playing and cognitive therapy do not use the technique of alter egos. Consensus building is not a form of therapy.

29. The nurse is collecting the paintings from the patients after the art session is over. After art therapy, a patient hands the nurse a paper that consists of several black scribbles. Which statement demonstrates the nurse understands the goals and objectives of the therapy? a. Do you want to complete your painting? b. I see that you dont take this very seriously. c. Can you tell me what happened to prompt such work? d. Thank you. Ill put this away in a safe place for you.

ANS: D

Art therapy is used to help resolve conflicts and promote self-awareness. The nurse should not comment on the quality of the art or the patients talents, but rather treat the project with respect and value. The work is simply each patients self-expression. The other options make judgments about the work or the patients willingness to participate.

30. When asked, Why do you go to music therapy every morning at 10? The nurse explains that the nurses role in music therapy as: a. Fostering and encouraging performance talent b. Teaching patients about various styles of music c. Noting patient verbal and nonverbal expression of feelings d. Selecting and playing numbers that will reduce anxiety and stress ANS: C A goal of music therapy is to promote expression and social connection. The nurse should observe and document expression of feelings as they occur. The observations may be used later, as a basis for further consideration by the nurse and patient. The other options do not reflect aspects of the nurses role in music therapy.

31. When a novice nurse asks why the unit has a multidisciplinary approach to therapeutic activities, the nurse should explain that multidisciplinary collaboration: a. Produces a higher level of insurance reimbursement b. Reduces the incidence of aggressive behavior by patients c. Produces quicker results and earlier discharge to the community d. Produces better outcomes than when only one perspective is used ANS: D Broader input in problem identification and resolution enhances patient outcomes. The remaining options are either untrue or irrelevant.

32. When a patient asks the nurse, How can jolting me with an electrical shock possibly do me any good? the answer most reflective of current biologic theory would be: a. ECT must sound like a very frightening treatment alternative to you. b. ECT produces a change in brain chemistry that results in improved mood.

c. ECT interrupts brain impulses that are causing hallucinations and delusions. d. ECT provides you with external punishment so you can stop punishing yourself.

ANS: B Current theory regarding use of ECT is that the electrical stimulus causes electrochemical changes within the brain, resulting in increased availability of neurotransmitters at the synapses and improvement of mood. To suggest that the treatment is frightening does not answer the patients question. The treatment is not appropriate for hallucinations or delusions. The remaining option is not appropriate or founded in psychiatric therapy.

33. Which statement made by a patient just prior to being transported for a scheduled ECT treatment would result in cancellation of the treatment? a. Ill be so glad when this treatment is over. b. Will I remember having this treatment? c. Did eating some crackers cause any problems? d. Im so tired of being depressed; I dont think I can go on.

ANS: C Because the patient is to receive general anesthesia and has orders to remain without food or liquids (NPO), the nurse should notify the physician immediately. The introduction of food into the stomach could result in aspiration of stomach contents during treatment. An expression of hopelessness related to depression would be reason to continue with the treatment. The other options offer no contraindication to treatment.

34. The physician has ordered atropine 0.5 mg intramuscularly (IM) for a patient to be administered 30 minutes prior to ECT. The rationale for use of this medication is that it reduces secretions and: a. Protects against vagal bradycardia b. Improves the scope of convulsive activity c. Reduces the need for recovery room staff d. Prevents incontinence of bladder and bowel ANS: A Atropine is used for its ability to prevent vagal bradycardia associated with the electrical stimulus. The other options are neither relevant nor true.

35. Which statement by a patient who has given informed consent for ECT confirms that the patient understands the side effects of this treatment? a. I wont remember the pain. b. It will take several weeks before I feel good again. c. My short-term memory loss will be only temporary. d. I will be at increased risk for developing epilepsy later.

ANS: C Temporary impairment of recent memory is an expected side effect that occurs to some degree during the course of ECT. The other options suggest the patients understanding of treatment and side effects is flawed.

36. In the ECT treatment preparation period the morning of treatment, the nurse should: a. Adequately hydrate the patient. b. Assess the patients cognitive function. c. Have the patient exercise for 10 minutes. d. Ensure that the patient produces a urine sample.

ANS: B Patient assessment is advisable to provide a baseline against which changes resulting from ECT can be measured. Although taking vital signs and performing other preparatory tasks, the nurse can assess orientation, immediate memory, thought processes, and attention span. The other options are interventions the nurse should not undertake.

37. Immediately after electroconvulsive therapy (ECT), nursing care of the patient is most similar to care of a patient: a. With severe dementia b. With delirium tremens c. Recovering from conscious sedation d. Recovering from general anesthesia ANS: D

The patient who has ECT receives a short-acting IV anesthetic and a skeletal muscle relaxant. Thus care is most similar to the patient recovering from general anesthesia. The nurse will assess vital signs, quality of respirations, presence or absence of the gag reflex, level of consciousness, orientation, and motor abilities during the post-treatment period.

38. A novice nurse who will be assessing a patient after electroconvulsive therapy (ECT) asks her mentor, What sort of memory impairment is present after several ECT treatments? The best response for the mentor would be: a. Its hard to say. Treatment affects everyone differently. b. Usually the patient has severe difficulty remembering remote events. c. Patients have mild difficulty remembering recent events, like what was eaten for breakfast. d. Both recent and remote memory is affected, producing profound confused, cognitive states.

ANS: C Most patients experience transient recent memory impairment after electroconvulsive therapy (ECT). The cognitive deficit becomes more pronounced as the number of treatments increases. When the course of treatments is completed, cognitive deficit generally improves to the pretreatment level. The other options are incorrect.

39. About an hour after the patient has ECT, he complains of having a headache. The nurse should: a. Notify the physician stat. b. Administer an as needed (prn) dose of acetaminophen. c. Take the patient through a progressive relaxation sequence. d. Advise going to activities to expend energy and relieve tension.

ANS: B Post-ECT headache is common. Most physicians routinely write an as needed (prn) order for a headache remedy. Notifying the physician is unnecessary, because this is an expected side effect. Options c and d would not be as useful as medication in this instance.

40. For which patient is the nurse most likely to need to schedule a pre-ECT workup and teaching? a. Patient A, who is newly diagnosed with dysthymic disorder

b. Patient B, who has melancholic depression that responded well to ECT 2 years ago c. Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant therapy d. Patient D, who has depression associated with diagnosis of inoperable brain tumor ANS: B Indications for ECT include patients with major mood disorders; patients who have responded to ECT in the past; patients who are unresponsive to antidepressants or unable to tolerate their side effects; and patients who are acutely suicidal or in danger of fluid and electrolyte imbalance related to inability to eat due to depression, severe mania, or severe catatonia. Patients with dysthymia are not candidates for ECT. The patient has not run out of medication options when prescribed only an SSRI. Patients with space-occupying lesions of the brain are not candidates for ECT. 41. Which intervention will the nurse implement in the first half hour after the patient has received ECT? a. Continually stimulate patient to respond, using physical and verbal means. b. Continue bagging patient to improve respiratory function until patient is responsive for 10 minutes. c. Reorient as necessary to time, place, and person as level of consciousness improves. d. Encourage walking and eating breakfast as quickly as possible.

ANS: C Patient memory is likely to be impaired in the immediate post-ECT period. Reorientation will be necessary to help the individual return to a functional state. Continual stimulation is not necessary. Bagging is unnecessary.

The patient may be allowed to rest and recover at his own pace.

42. What milieu factor would need most attention from the nurse who is caring for a patient who has received six ECT treatments and has two more scheduled? a. Safety b. Trust attainment c. Therapeutic activities d. Boundary maintenance ANS: A

To feel safe, patients need to know what is expected of them in their role as patients. The patient receiving ECT often has impaired recent memory and may become confused about the milieu and expectations. The nurse will need to reorient and reteach the patient with cognitive deficit. Options b, c, and d will require attention but not to the same extent as safety.

MULTIPLE RESPONSE 1. Which behaviors are reflective of legitimate phases of a groups development? Select all that apply. a. Stating the goals of the group b. Establishing who will assume the leadership role c. Inviting family members to attend and provide their input d. Feeling safe enough to discuss painful personal situations e. Showing concern about assuming personal responsibility for life ANS: A, B, E All groups progress through the phases of development that are governed by group dynamics and include orientation where goals are identified, conflict where leadership is determined and tested, cohesion where a sense of safety is achieved, and termination where discharge concerns are acted out and addressed. Family input may not necessarily be introduced unless it was a defined goal of the group.

Chapter 9. Interpersonal Psychotherapy Multiple Choice Identify the choice that best completes the statement or answers the question.

1. Which question by the nurse would gain the most information from a patient experiencing a marital crisis?

A. Do you hate your spouse?

B. Do you get along with your in-laws?

C. Do you talk out your problems with your spouse?

D. What is it like at home with your spouse?

2. Mrs. R., the mother of a young schizophrenic patient, seeks you out and begins to cry. She expresses concern over her daughters behavior. Your best response to this woman is: A. What is it that concerns you the most, Mrs. R.?

B. Well, you know, that is part of the illness.

C. Here is a book on schizophrenia. This will help you.

D. Are you afraid your daughter will always be like this?

3. Linda is pacing the floor and appears extremely anxious. The day shift nurse approaches Linda in an attempt to lessen her anxiety. The most therapeutic statement by the nurse would be: A. How about watching a football game?

B. Tell me how you are feeling today.

C. What do you have to be upset about now?

D. Ignore the client.

4. A patient states, I dont know what the pills are for or why I am taking them, so I dont want them. What therapeutic communication would help this patient?

A. Ask for what you need B. Silence C. Using general leads D. Giving information 5. To practice effectively in mental health, the nurse should be able to: A. Solve his or her own personal problems without assistance from others.

B. Comfortably point out the patient shortcomings and provide advice about how to improve.

C. Bring patients and coworkers into compliance with societal rules and norms.

D. Demonstrate therapeutic communication.

Completion Complete each statement.

6. The nurse plans to have a therapeutic communication with the client. To begin that therapeutic communication the nurse must first establish

with the client.

7. Communication has three parts: the sender, the message, and the 8. When appropriate, the nurse can use

.

as part of an interaction when there is no

talking. This can communicate support.

9. A theory of communication that emphasizes the three ways to communicatehearing, seeing, and touchingis called 10. Expressive, receptive, and global are types of

.

11. Advising, asking closed-ended questions, and changing the subject are examples of

to

therapeutic communication.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

12. A nurse is working with a patient and attempts to communicate effectively with him or her.

Techniques the nurse can use to help communication include (select all that apply): A. Clarifying terms.

B. Remaining silent.

C. Asking open-ended questions.

D. Offering false reassurance E. Discouraging the person from expressing feelings that are unacceptable.

13. The nurse may find that patients from other countries use different terminology than the nurse born in the United States. The difference in terminology may seem harmless to us but offensive to the foreign patient.

Differences noted between different cultures are (select all that apply): A. Eye contact.

B. Slang terms.

C. Hand gestures.

D. Gender references.

14. The three components of communication are (select all that apply):

A. Impairment.

B. Message.

C. Sender.

D. Receiver.

15. Nurses understand that when caring for patients with mental illnesses, a nurses communication is (select all that apply): A. An active process that includes participating and listening and speaking.

B. A complex activity.

C. Exchanging information.

D. Verbal and nonverbal.

E. A one way path from nurse to patient.

F. Advising.

16. The patient is concerned about his doctor and what the doctor has prescribed. The nurse making rounds notices the patient sitting on the side of the bed in deep thought. The nurse comes into the room and the patient begins to tell her his concerns about a new order. The nurse advises the patient, If I were you, I would find another doctor.

How does this statement by the nurse block communication (select all that apply)?

A. It tells the patient that his concerns are not valid.

B. It gives the idea that the nurses values are the correct ones.

C. It puts words in the patients mouth.

D. It hurts the nurses credibility if the solution doesnt help the patient.

E. It discourages yes or no answers.

F. It inhibits the patient from telling you what his concerns are.

17. The following types of patients require adaptive communication techniques (select all that apply): A. A patient who is blind.

B. A patient who has dysphasia.

C. A patient who is schizophrenic.

D. A patient who is elderly.

E. A patient with dysphagia.

F. A patient who has language differences from the staff.

18. Which of the following are characteristics of assertive communication (select all that apply)?

A. Statements begin with the word you.

B. Statements deal with thoughts and feelings.

C. It is a form of blaming.

D. It puts responsibility for the interaction on the other person.

E. It is a technique of personal empowerment.

F. It is self-responsible.

Answer Section MULTIPLE CHOICE 1. ANS: D Encourages expression of feelings rather than a yes/no answer. Use of open-ended questions facilitates more open communication.

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Therapeutic communication 2. ANS: A The correct response is open ended to seek out more specifically why she is upset. Responses B and C shut down communication. Response D is making an assumption of why she is upset.

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders: Therapeutic nursing process | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication 3. ANS: B To keep open communication with the patient, the nurse should ask open-ended questions.

4. ANS: D

Giving information can increase rapport, reduce patient anxiety, and suggest patient collaboration.

5. ANS: A Good communication skills are essential for working in mental health. Good communication skills center around being able to promote open communication with such techniques as good listening, use of open-ended questions, and appropriate use of silence to be therapeutic.

COMPLETION 6. ANS: rapport Rapport implies there is mutual understanding and trust. The communication can be both verbal and nonverbal.

7. ANS: receiver Communication is not just about getting your message out, it also includes how the message is received.

8. ANS: silence Silence allows the nurse and the patient time to collect their thoughts. It is a therapeutic technique of communication and demonstrates support and acceptance.

9. ANS: neurolinguistic programming Neurolinguistic programming (NLP) was developed by Milton Erickson, John Grinder, and Richard Bandler.

NLP can be used in conjunction with hypnosis and other treatment modalities giving insight into how one views the world.

10. ANS: aphasia

Patients with speech difficulties or challenges have an aphasic disorder. Expressive is difficulty in verbal expression, receptive is difficulty with interpretation of written or verbal communication, and global is a combination of receptive and expressive.

11. ANS: blocks or barriers These blocks to communication interfere with patient-nurse interaction to inhibit good communication.

MULTIPLE RESPONSE 12. ANS: A, B, C Effective communication between the nurse and the patient includes approaches that give the patient opportunities to express himself or herself.

13. ANS: A, B, C, D Verbal and nonverbal communication doesnt always have the same meaning in other cultures. The same communication can be understood by another culture as offensive.

14. ANS: B, C, D Communication with others requires these three components.

15. ANS: A, B, C, D Communication is important when determining the patients needs. It is not a passive process but an active, twoway activity between patient and nurse. Generally the nurses role is not to advise patients but to listen and support.

16. ANS: B, C, D, F Communication with patients should be purposeful and unbiased. Giving advice when the patient has not fully expressed his concerns inhibits and distracts the patient from what he is trying to communicate.

17. ANS: A, B, F

Although communication can be challenging, there may be temporary or permanent techniques to assist with communication. Patients with challenges to sight, sound, and speech require adaptive techniques. Those who speak a different language than the provider also need adaptive techniques.

18. ANS: B, E, F Assertive communication begins with the word I. Other characteristics include speaking up for oneself in a respectful manner, verbalizing ones thoughts and feelings, and being honest.

Chapter 10. Humanistic–Existential and Solution-Focused Approaches to Psychotherapy 1. Which person is not associated with the existential movement? a. Rollo May b. Victor Frankl c. Irvin Yalom d. B. F. Skinner

ANSWER:

d

2. The central goal of existential psychotherapy is to: a. decrease selfawareness. b. increase awareness. c. help clients reject the responsibility of choosing. d. keep the client from experiencing authentic existence.

ANSWER:

b

3. Finding the "courage to be" involves: a. confronting a specific phobia. b. learning to be alone. c. discarding old values. d. developing a will to move forward in spite of anxietyproducingsituations.

ANSWER:

d

4. The British scholar working to develop training programs in existential therapy is: a. Roll May. b. Irvin Yalom. c. Emmy van Deurzen. d. J. Michael Russell.

ANSWER:

c

5. Which is not an essential aim of existential-humanistic therapy?

a. To help clients become more present to both themselves and others b. To assist clients in identifying ways they block themselves from fuller presence c. To dispute clients’ irrationalbeliefs d. To challenge clients to assume responsibility for designing their present lives

ANSWER:

c

6. Existential therapy is best considered as: a. an approach to understand the subjective world of the client. b. a school of therapy. c. a system of techniques designed to create authentic humans. d. a strategy for uncovering dysfunctional behavior.

ANSWER:

a

7. Which of the following was not part of Stan’s work in existential therapy? a. Challenging his feelings of loneliness b. Working on his inauthentic relationship with hissiblings c. Confronting his responsibility for his drug and alcoholuse d. Exploring Stan’s human potential

ANSWER:

b

8. Philosophically, the existentialists would agree that: a. the final decisions and choices rest with the therapist. b. people do not redefine themselves by their choices. c. a person cannot go beyond early conditioning. d. making choices can create anxiety.

ANSWER:

d

9. The characteristic existential theme includes: a. freedom and responsibility. b. resistance. c. transference. d. examining irrational beliefs.

ANSWER:

a

10. According to the existential viewpoint, death: a. makes life absurd. b. makes life meaningless and hopeless. c. gives significance to living. d. should not be explored in therapy.

ANSWER:

c

11. In regards to techniques, existential practitioners believe: a. free association is essential to the growth and healing of the client. b. no set of techniques is considered essential. c. analysis of dysfunctional family patterns is imperative. d. role playing is the most important techniqueused.

ANSWER:

b

12. In a group based on existential principles, clients learn all of the following, except: a. that there are no ultimate answers for ultimate concerns. b. to view themselves through others’ eyes. c. to come to terms with the paradoxes of existence. d. that pain is not a reality of the human experience.

ANSWER: 13.

d

emphasizes the subjective and spiritual dimensions of human existence. a. Existential analysis b. Existential anxiety c. Self-awareness d. Existential guilt ANSWER:

a

14. Existential therapy is: a. a deterministic approach to therapy. b. an expansion of the Adlerian school of therapy. c. a phenomenological approach to therapy. d. a structured approach to therapy.

ANSWER:

c

15. Existential therapists prefer to be thought of as: a. an observer-technician. b. philosophical companions, not as people who repair psyches. c. a teacher and coach. d. an advocate for socialchange.

ANSWER:

b

16. When is the counseling process at its best from an existential viewpoint? a. When the client feels comfortable enough to engage in shame-attacking exercises outside of counseling

sessions. b. When the deepest self of the therapist meets the deepest part of the client. c. When the therapist uses his or her influence to convince the client to let go of his or her anxiety. d. When sessions begin with progressive muscle relaxation exercises.

ANSWER:

b

17. Viktor Frankl’s approach to existential therapy is known as: a. individual psychology. b. logotherapy. c. reality therapy. d. redecision therapy.

ANSWER:

b

18. Which of the following is not true about Rollo May? a. He is most responsible for translating European existentialism into American psychotherapeutic

theory and practice. b. He focuses on the subjective dimension of therapy. c. He is a significant spokesman for the existential approach in the United States. d. He believes that we can only escape anxiety by exercising our freedom.

ANSWER:

d

19. In regards to freedom and responsibility, existential therapy embraces three values. Which of the following is

not one of these values? a. The freedom to become within the context of natural and self-imposed limitations b. The capacity to reflect on the meaning of our choices c. The capacity to act on the choices we make d. The freedom to choose our past and the choices of our parents ANSWER:

d

20. Ursula lived in New York City on 9/11. Ever since experiencing the aftermath of the terrorist attacks, she

has felt anxiety about going to the upper level floors of tall buildings. As an existentially oriented therapist, you might concludethat: a. Ursula is highlyneurotic. b. Ursula’s fears are completelyunfounded. c. Ursula’s anxiety is normal in light of the traumatic experience she had on 9/11. d. Ursula is on the verge of becoming psychotic.

ANSWER:

c

21. Who was the Danish philosopher that addressed the role of anxiety and uncertainty in life? a. Medard Boss b. JeanPaul Sartre c. Soren Kierkegaard d. Martin Buber

ANSWER:

c

22. Existentialists contend that the experience of relatedness to other human beings: a. is a neurotically dependent attachment. b. should be based on our needs and theirs. c. is healthy when we are able to stand alone and tap into our ownstrength. d. is not necessary, since we are basically alone.

ANSWER:

c

23. According to existentialists, our search for meaning involves all of these except: a. discarding old values. b. meaninglessness. c. creating our own value system. d. exploring unfinished business.

ANSWER:

d

24. Therapy is viewed as a

in the sense that the interpersonal and existential problems of the client will become apparent in the here and now of the therapy relationship. a. social microcosm b. “touchy feely”encounter c. living laboratory d. tension-filled encounter ANSWER:

a

25. The central theme running through the works of Viktor Frankl is: a. that freedom is a myth. b. the will to meaning. c. selfdisclosure as the key to mental health. d. the notion of selfactualization.

ANSWER:

b

26. According to Yalom, the concerns that make up the core of existential

psychodynamics include all of the following, except: a. death. b. freedom. c. togetherness. d. meaninglessness.

ANSWER:

c

27. A statement that best illustrates “bad faith” is: a. Naturally I’m this way, because I grew up in an alcoholic family. b. I will not consider others in the choices I make. c. I must live by commitments I make. d. I am responsible for the choices that I make.

ANSWER:

a

28. For Sartre, existential guilt is what we experience when we: a. do not live by the Ten Commandments. b. fail to think about the welfare of others. c. allow others to define us or to make our choices for us. d. reflect on all that we might have done and failed to do.

ANSWER:

c

29. The therapist’s presenceis: a. a condition of therapeuticchange. b. a goal of therapeuticchange. c. both a condition and a goal of therapeutic change. d. neither a condition nor a goal of therapeutic change.

ANSWER:

c

30. Which of the following is not an example of how existential therapy is unlike many other

therapies? a. It does not have a well-defined set of techniques. b. It stresses the I/Thou encounter in the therapy process. c. It focuses on the use of the specific techniques created for this theory. d. It allows for incorporation of techniques from many other approaches.

ANSWER:

c

31. Which of the following is not considered a basic dimension of the human condition? a. Capacity for self-awareness b. Striving for acceptance of others c. Establishing meaningful relationships with others d. Freedom and responsibility

ANSWER:

b

32. Being alone is a process by which we do all of the followingexcept: a. learn to tolerate feelings of isolation. b. develop strength and self-reliance. c. develop a deep understanding of ourselves. d. reject the social overtures of others.

ANSWER:

d

Chapter 11. Group Therapy Question 1 Type: MCSA The student nurse asks if advance practice training is needed to lead psychoeducation groups and assist families. The instructor tells the nurse that all nurses can lead the groups as long as they: 1. Support a loss of autonomy.

2. Promote rigidity and chaos.

3. Understand family and group dynamics.

4. Isolate family members from one another.

Correct Answer: 3 Rationale 1: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Rationale 2: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Rationale 3: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Rationale 4: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the general principles of the Johari Window to create opportunities for change and learning in small groups.

Question 2 Type: MCSA The nurse facilitating a group session is concerned that the members are hesitant about sharing feelings and experiences. The nurse knows that there is a low level of trust among the group members, which will also determine the level of: 1. Cohesion.

2. Family history.

3. Risk-taking.

4. Uniqueness.

Correct Answer: 3 Rationale 1: Trusting and being trusted are intimately linked to risk-taking. The level of trust among the members of a group determines the extent of risk-taking behavior in the group. The group member who makes a suggestion, discloses an attitude, feeling, experience, or perception, gives feedback, or confronts another member engages in trusting behavior and assumes the risks inherent in trusting. Cohesion is not necessarily linked to trust. Family history and uniqueness are not related to trust.

Rationale 2: Trusting and being trusted are intimately linked to risk-taking. The level of trust among the members of a group determines the extent of risk-taking behavior in the group. The group member who makes a suggestion, discloses an attitude, feeling, experience, or perception, gives feedback, or confronts another member engages in trusting behavior and assumes the risks inherent in trusting. Cohesion is not necessarily linked to trust. Family history and uniqueness are not related to trust.

Rationale 3: Trusting and being trusted are intimately linked to risk-taking. The level of trust among the members of a group determines the extent of risk-taking behavior in the group. The group member who makes a suggestion, discloses an attitude, feeling, experience, or perception, gives feedback, or confronts another member engages in trusting behavior and assumes the risks inherent in trusting. Cohesion is not necessarily linked to trust. Family history and uniqueness are not related to trust.

Rationale 4: Trusting and being trusted are intimately linked to risk-taking. The level of trust among the members of a group determines the extent of risk-taking behavior in the group. The group member who makes a suggestion, discloses an attitude, feeling, experience, or perception, gives feedback, or confronts another member engages in trusting behavior and assumes the risks inherent in trusting. Cohesion is not necessarily linked to trust. Family history and uniqueness are not related to trust.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply the general principles of the Johari Window to create opportunities for change and learning in small groups.

Question 3 Type: MCSA The nurse knows the Johari Window is a theoretical tool used to represent: 1. The id and the superego in relation to self-awareness.

2. Depression in family members.

3. A multidimensional model of self.

4. Self-disclosure in relation to others.

Correct Answer: 4 Rationale 1: There are many ways to think about self-awareness. Some theorists have used the image of multiple masks that people wear under a variety of circumstances. Others have written about the true self versus the false self or the good me, the bad me, and the real me. Common to all these concepts is the idea that self-awareness is a complex, multidimensional phenomenon, often contradictory and partly undiscovered. The Johari Awareness Model, often called simply the Johari Window, is a theoretical tool used to represent self-awareness and self-disclosure in relation to other people. Depression, a multidimensional model of self, and the id and superego are not parts of the Johari Window.

Rationale 2: There are many ways to think about self-awareness. Some theorists have used the image of multiple masks that people wear under a variety of circumstances. Others have written about the true self versus the false self or the good me, the bad me, and the real me. Common to all these concepts is the idea that self-awareness is a complex, multidimensional phenomenon, often contradictory and partly undiscovered. The Johari Awareness Model, often called simply the Johari Window, is a theoretical tool used to represent self-awareness and self-disclosure in relation to other people. Depression, a multidimensional model of self, and the id and superego are not parts of the Johari Window.

Rationale 3: There are many ways to think about self-awareness. Some theorists have used the image of multiple masks that people wear under a variety of circumstances. Others have written about the true self versus the false self or the good me, the bad me, and the real me. Common to all these concepts is the idea that self-awareness is a complex, multidimensional phenomenon, often contradictory and partly undiscovered. The Johari Awareness Model, often called simply the Johari Window, is a theoretical tool used to represent self-awareness and self-disclosure in relation to other people. Depression, a multidimensional model of self, and the id and superego are not parts of the Johari Window.

Rationale 4: There are many ways to think about self-awareness. Some theorists have used the image of multiple masks that people wear under a variety of circumstances. Others have written

about the true self versus the false self or the good me, the bad me, and the real me. Common to all these concepts is the idea that self-awareness is a complex, multidimensional phenomenon, often contradictory and partly undiscovered. The Johari Awareness Model, often called simply the Johari Window, is a theoretical tool used to represent self-awareness and self-disclosure in relation to other people. Depression, a multidimensional model of self, and the id and superego are not parts of the Johari Window.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the general principles of the Johari Window to create opportunities for change and learning in small groups.

Question 4 Type: MCSA The nurse mentions to a colleague that yesterdays therapy group was developing cohesion and understands that this is important for: 1. Flexibility.

2. Boundaries.

3. Goal attainment.

4. Communication.

Correct Answer: 3

Rationale 1: A group is cohesive when its members are attracted to it. An attractive group has explicit, mutual, and attainable group goals with clear paths to goal attainment. Flexibility, boundaries, and communication are not dependent on cohesion.

Rationale 2: A group is cohesive when its members are attracted to it. An attractive group has explicit, mutual, and attainable group goals with clear paths to goal attainment. Flexibility, boundaries, and communication are not dependent on cohesion.

Rationale 3: A group is cohesive when its members are attracted to it. An attractive group has explicit, mutual, and attainable group goals with clear paths to goal attainment. Flexibility, boundaries, and communication are not dependent on cohesion.

Rationale 4: A group is cohesive when its members are attracted to it. An attractive group has explicit, mutual, and attainable group goals with clear paths to goal attainment. Flexibility, boundaries, and communication are not dependent on cohesion.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the general principles of the Johari Window to create opportunities for change and learning in small groups.

Question 5 Type: MCSA The nurse leading a group of inpatient clients observes a client trying to control the group by monopolizing the discussion. The nurse knows this will most likely decrease: 1. Therapeutic alliance.

2. Leader credibility.

3. Cohesion.

4. Power and influence.

Correct Answer: 3 Rationale 1: The unequal distribution of power affects both the task and the maintenance functions of a group. Members who believe they have little influence within the group are unlikely to feel committed to group goals and to the implementation of group decisions. Their dissatisfaction with the group decreases its attractiveness and reduces its cohesion.

Rationale 2: The unequal distribution of power affects both the task and the maintenance functions of a group. Members who believe they have little influence within the group are unlikely to feel committed to group goals and to the implementation of group decisions. Their dissatisfaction with the group decreases its attractiveness and reduces its cohesion.

Rationale 3: The unequal distribution of power affects both the task and the maintenance functions of a group. Members who believe they have little influence within the group are unlikely to feel committed to group goals and to the implementation of group decisions. Their dissatisfaction with the group decreases its attractiveness and reduces its cohesion.

Rationale 4: The unequal distribution of power affects both the task and the maintenance functions of a group. Members who believe they have little influence within the group are unlikely to feel committed to group goals and to the implementation of group decisions. Their dissatisfaction with the group decreases its attractiveness and reduces its cohesion.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Encourage the assumption of appropriate task roles and maintenance roles among members of small groups.

Question 6 Type: MCSA When planning sessions for a group of battered women, which stage of group development would it be most appropriate for the nurse to lead a discussion regarding legal solutions and alternative living arrangements?

1. Forming 2. Norming 3. Storming 4. Performing Correct Answer: 4 Rationale 1: During the performing stage, members increase their focus on the task at hand.

There is an open exchange of information and the giving and receiving of feedback. In the forming stage, members are reluctant to self-disclose until issues of confidentiality are understood. In the storming phase, communication is more open and authentic, but conflicts that erupt may cause reticence among members to disclose personal feelings. In the norming phase, relationships among members are more open and trusting and cooperation among the members has increased but the rules and expectations are still being negotiated.

Rationale 2: During the performing stage, members increase their focus on the task at hand.

There is an open exchange of information and the giving and receiving of feedback. In the forming stage, members are reluctant to self-disclose until issues of confidentiality are understood. In the storming phase, communication is more open and authentic, but conflicts that erupt may cause reticence among members to disclose personal feelings. In the norming phase, relationships among members are more open and trusting and cooperation among the members has increased but the rules and expectations are still being negotiated.

Rationale 3: During the performing stage, members increase their focus on the task at hand.

There is an open exchange of information and the giving and receiving of feedback. In the forming stage, members are reluctant to self-disclose until issues of confidentiality are understood. In the storming phase, communication is more open and authentic, but conflicts that erupt may cause reticence among members to disclose personal feelings. In the norming phase, relationships among members are more open and trusting and cooperation among the members has increased but the rules and expectations are still being negotiated.

Rationale 4: During the performing stage, members increase their focus on the task at hand.

There is an open exchange of information and the giving and receiving of feedback. In the forming stage, members are reluctant to self-disclose until issues of confidentiality are understood. In the storming phase, communication is more open and authentic, but conflicts that erupt may cause reticence among members to disclose personal feelings. In the norming phase, relationships among members are more open and trusting and cooperation among the members has increased but the rules and expectations are still being negotiated.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Encourage the assumption of appropriate task roles and maintenance roles among members of small groups.

Question 7 Type: MCSA An inpatient group has decided to focus on developing better communication skills. Each member will practice initiating a conversation with a partner while a third member observes the

interaction and provide feedback. Which stage of group development best describes these actions?

1. Performing 2. Forming 3. Norming 4. Storming Correct Answer: 3 Rationale 1: During the norming stage, the group settles on specific ruleshow discussions take place, how decisions will be made, how the labor in the group is to be divided, and how goals, roles, and expectations are negotiated.

Rationale 2: During the norming stage, the group settles on specific ruleshow discussions take place, how decisions will be made, how the labor in the group is to be divided, and how goals, roles, and expectations are negotiated.

Rationale 3: During the norming stage, the group settles on specific ruleshow discussions take place, how decisions will be made, how the labor in the group is to be divided, and how goals, roles, and expectations are negotiated.

Rationale 4: During the norming stage, the group settles on specific ruleshow discussions take place, how decisions will be made, how the labor in the group is to be divided, and how goals, roles, and expectations are negotiated.

Global

Rationale:

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Encourage the assumption of appropriate task roles and maintenance roles among members of small groups.

Question 8 Type: MCSA The nurse notices that one of the group members seems frustrated. He is very friendly with everyone in the group but seems upset when some group members do not reciprocate with an equal amount of friendliness. The nurse understands that the group member is demonstrating his interpersonal needs for: 1. Love 2. Affection 3. Grief 4. Reasoning Correct Answer: 2 Rationale 1: The affection need consists of being able to love other people or to be close and intimate to a satisfactory degree, and having others love you or be close and intimate with you to a satisfactory degree. Love is a component of the need for affection. Grief and reasoning do not apply to the scenario.

Rationale 2: The affection need consists of being able to love other people or to be close and intimate to a satisfactory degree, and having others love you or be close and intimate with you to a satisfactory degree. Love is a component of the need for affection. Grief and reasoning do not apply to the scenario.

Rationale 3: The affection need consists of being able to love other people or to be close and intimate to a satisfactory degree, and having others love you or be close and intimate with you to

a satisfactory degree. Love is a component of the need for affection. Grief and reasoning do not apply to the scenario.

Rationale 4: The affection need consists of being able to love other people or to be close and intimate to a satisfactory degree, and having others love you or be close and intimate with you to a satisfactory degree. Love is a component of the need for affection. Grief and reasoning do not apply to the scenario.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Improve the dynamics of small groups by incorporating an understanding of the interpersonal needs of inclusion, affection, and control.

Question 9 Type: MCSA The nursing student knows that clients need for inclusion allows the group members to: 1. Remain emotionally available.

2. Become great communicators.

3. Interact with one another satisfactorily.

4. Use the clients need to obtain group privacy.

Correct Answer: 3

Rationale 1: The interpersonal need for inclusion is the need to establish and maintain relationships with others that offer interactions and associations satisfying to the individual. This need determines whether a person is outgoing or prefers privacy but does not relate to obtaining group privacy. The need for inclusion does not require a person to remain emotionally available or be a great communicator.

Rationale 2: The interpersonal need for inclusion is the need to establish and maintain relationships with others that offer interactions and associations satisfying to the individual. This need determines whether a person is outgoing or prefers privacy but does not relate to obtaining group privacy. The need for inclusion does not require a person to remain emotionally available or be a great communicator.

Rationale 3: The interpersonal need for inclusion is the need to establish and maintain relationships with others that offer interactions and associations satisfying to the individual. This need determines whether a person is outgoing or prefers privacy but does not relate to obtaining group privacy. The need for inclusion does not require a person to remain emotionally available or be a great communicator.

Rationale 4: The interpersonal need for inclusion is the need to establish and maintain relationships with others that offer interactions and associations satisfying to the individual. This need determines whether a person is outgoing or prefers privacy but does not relate to obtaining group privacy. The need for inclusion does not require a person to remain emotionally available or be a great communicator.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Improve the dynamics of small groups by incorporating an understanding of the interpersonal needs of inclusion, affection, and control.

Question 10 Type: MCSA A group leader states that he respects the competence and responsibility of members of the group but gets annoyed when one of the group members takes over a group meeting. The group leader is demonstrating the interpersonal need for: 1. Self-respect.

2. Religion.

3. Control.

4. Social reasoning.

Correct Answer: 3 Rationale 1: The interpersonal need for control is the need to establish and maintain a satisfactory relationship between oneself and other people with regard to power and influence and maintain a feeling of respect for the competence and responsibility of others to a satisfying degree to oneself. The group leader has a desire to control the group, but does not want to be controlled by any of its members. Religion, self-respect, and social reasoning are not among the three basic interpersonal needs.

Rationale 2: The interpersonal need for control is the need to establish and maintain a satisfactory relationship between oneself and other people with regard to power and influence and maintain a feeling of respect for the competence and responsibility of others to a satisfying degree to oneself. The group leader has a desire to control the group, but does not want to be controlled by any of its members. Religion, self-respect, and social reasoning are not among the three basic interpersonal needs.

Rationale 3: The interpersonal need for control is the need to establish and maintain a satisfactory relationship between oneself and other people with regard to power and influence and maintain a feeling of respect for the competence and responsibility of others to a satisfying degree to oneself. The group leader has a desire to control the group, but does not want to be

controlled by any of its members. Religion, self-respect, and social reasoning are not among the three basic interpersonal needs.

Rationale 4: The interpersonal need for control is the need to establish and maintain a satisfactory relationship between oneself and other people with regard to power and influence and maintain a feeling of respect for the competence and responsibility of others to a satisfying degree to oneself. The group leader has a desire to control the group, but does not want to be controlled by any of its members. Religion, self-respect, and social reasoning are not among the three basic interpersonal needs.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Improve the dynamics of small groups by incorporating an understanding of the interpersonal needs of inclusion, affection, and control.

Question 11 Type: MCSA The nurse knows that any group moves through three interpersonal phases in a particular order, which includes: 1. Inclusion, control, and affection.

2. Reasoning, inclusion, and self-confidence.

3. Control, love, and affection.

4. Reasoning, self-confidence, and religion.

Correct Answer: 1 Rationale 1: Any group, given enough time, moves through three interpersonal phasesinclusion, control, and affection, in that orderthat correspond to the three basic interpersonal needs. Love, reasoning, self-confidence, and religion are not interpersonal phases.

Rationale 2: Any group, given enough time, moves through three interpersonal phasesinclusion, control, and affection, in that orderthat correspond to the three basic interpersonal needs. Love, reasoning, self-confidence, and religion are not interpersonal phases.

Rationale 3: Any group, given enough time, moves through three interpersonal phasesinclusion, control, and affection, in that orderthat correspond to the three basic interpersonal needs. Love, reasoning, self-confidence, and religion are not interpersonal phases.

Rationale 4: Any group, given enough time, moves through three interpersonal phasesinclusion, control, and affection, in that orderthat correspond to the three basic interpersonal needs. Love, reasoning, self-confidence, and religion are not interpersonal phases.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Improve the dynamics of small groups by incorporating an understanding of the interpersonal needs of inclusion, affection, and control.

Question 12 Type: MCSA A nursing student learns that group therapy reveals distortions in interpersonal relationships in an effort to:

1. Learn how to stifle emotions.

2. Examine and resolve issues.

3. Process and examine emotions.

4. Effectively handle emotions.

Correct Answer: 2 Rationale 1: Group therapy provides stimuli from multiple sources, revealing distortions in interpersonal relationships so that they can be examined and resolved. The goal of group therapy is not to stifle emotions. A result of examining and resolving issues may be to effectively process and handle emotions.

Rationale 2: Group therapy provides stimuli from multiple sources, revealing distortions in interpersonal relationships so that they can be examined and resolved. The goal of group therapy is not to stifle emotions. A result of examining and resolving issues may be to effectively process and handle emotions.

Rationale 3: Group therapy provides stimuli from multiple sources, revealing distortions in interpersonal relationships so that they can be examined and resolved. The goal of group therapy is not to stifle emotions. A result of examining and resolving issues may be to effectively process and handle emotions.

Rationale 4: Group therapy provides stimuli from multiple sources, revealing distortions in interpersonal relationships so that they can be examined and resolved. The goal of group therapy is not to stifle emotions. A result of examining and resolving issues may be to effectively process and handle emotions.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the purposes that therapeutic groups fulfill.

Question 13 Type: MCSA A nurse has been working one-to-one therapy with a client but now tells the client it would be beneficial for the client to be part of a group. The nurse knows that the advantage of group therapy is: 1. A therapeutic experience for the benefit of many therapists.

2. The nurse can work with more people at one time.

3. Multiple associations with various therapists.

4. The presence of many people participating in a therapeutic experience.

Correct Answer: 4 Rationale 1: The advantages of group therapy stem from one major factor: the presence of many people, rather than a solitary therapist, who participate in the therapeutic experience. Group therapy is not for the benefit of the therapist. While the nurse can work with more people in a group setting and, over time, the client may work with various therapists, these are not the most advantageous aspects of group therapy.

Rationale 2: The advantages of group therapy stem from one major factor: the presence of many people, rather than a solitary therapist, who participate in the therapeutic experience. Group therapy is not for the benefit of the therapist. While the nurse can work with more people in a group setting and, over time, the client may work with various therapists, these are not the most advantageous aspects of group therapy.

Rationale 3: The advantages of group therapy stem from one major factor: the presence of many people, rather than a solitary therapist, who participate in the therapeutic experience. Group therapy is not for the benefit of the therapist. While the nurse can work with more people in a

group setting and, over time, the client may work with various therapists, these are not the most advantageous aspects of group therapy.

Rationale 4: The advantages of group therapy stem from one major factor: the presence of many people, rather than a solitary therapist, who participate in the therapeutic experience. Group therapy is not for the benefit of the therapist. While the nurse can work with more people in a group setting and, over time, the client may work with various therapists, these are not the most advantageous aspects of group therapy.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the purposes that therapeutic groups fulfill.

Question 14 Type: MCSA The client is being discharged from an inpatient facility. The nurse explains that part of the outpatient treatment will be to take part in group therapy because it provides a structure for: 1. Supporting clients on a regular basis.

2. Trying out old and new ways of acting and reacting.

3. Using health care benefits in new and exciting ways.

4. Supporting clients and families.

Correct Answer: 2

Rationale 1: Group therapy provides an interpersonal testing ground that allows members to try out old and new ways of being in an environment specifically structured for that purpose. Group therapy may, indeed, provide support for clients and families on a regular basis, but the emphasis is to provide a structured environment for the client to experiment with new behaviors. Using health care benefits is not a reason to participate in group therapy.

Rationale 2: Group therapy provides an interpersonal testing ground that allows members to try out old and new ways of being in an environment specifically structured for that purpose. Group therapy may, indeed, provide support for clients and families on a regular basis, but the emphasis is to provide a structured environment for the client to experiment with new behaviors. Using health care benefits is not a reason to participate in group therapy.

Rationale 3: Group therapy provides an interpersonal testing ground that allows members to try out old and new ways of being in an environment specifically structured for that purpose. Group therapy may, indeed, provide support for clients and families on a regular basis, but the emphasis is to provide a structured environment for the client to experiment with new behaviors. Using health care benefits is not a reason to participate in group therapy.

Rationale 4: Group therapy provides an interpersonal testing ground that allows members to try out old and new ways of being in an environment specifically structured for that purpose. Group therapy may, indeed, provide support for clients and families on a regular basis, but the emphasis is to provide a structured environment for the client to experiment with new behaviors. Using health care benefits is not a reason to participate in group therapy.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the purposes that therapeutic groups fulfill.

Question 15 Type: MCSA Clients with mental disorders benefit from therapeutic groups because they provide: 1. Feedback from a number of sources.

2. A monitoring system that helps clients control impulses.

3. The best stimuli for clients.

4. A way for them to feel normal.

Correct Answer: 1 Rationale 1: Due to the presence of many people, group therapy provides multiple sources of feedback. Group therapy may or may not provide the best stimuli, is not designed to help people feel normal, and is not a monitoring system.

Rationale 2: Due to the presence of many people, group therapy provides multiple sources of feedback. Group therapy may or may not provide the best stimuli, is not designed to help people feel normal, and is not a monitoring system.

Rationale 3: Due to the presence of many people, group therapy provides multiple sources of feedback. Group therapy may or may not provide the best stimuli, is not designed to help people feel normal, and is not a monitoring system.

Rationale 4: Due to the presence of many people, group therapy provides multiple sources of feedback. Group therapy may or may not provide the best stimuli, is not designed to help people feel normal, and is not a monitoring system.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain the purposes that therapeutic groups fulfill.

Question 16 Type: MCSA The nurse is planning a psychoeducation group for substance abusers and is conducting selection interviews. Which of the following individuals with substance abuse issues would not be an appropriate member?

1. A client who has attended AA meetings in the past 2. A client who has been court ordered to attend group therapy 3. A client who has recently been promoted to district manager 4. A client who is also being treated for a psychiatric illness Correct Answer: 3 Rationale 1: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Rationale 2: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Rationale 3: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Rationale 4: Major life changes may prevent the clients full and continued participation in the group. The client who has been court ordered to attend group may be in denial but has an external motivation to attend group. Clients being treated for a psychiatric illness and who have attended AA meetings in the past have a history of group involvement and know what to expect from group therapy.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Design a therapeutic group based on the needs and personality characteristics of potential members.

Question 17 Type: MCSA The nurse is planning a group to rehabilitate sex offenders in a forensic psychiatric hospital.

Which of the following factors would most likely decrease the degree of trust and cohesion among the members?

1. One hour weekly sessions 2. Addition of new members

3. Confidentiality rights of victims 4. Member interaction outside the group Correct Answer: 2 Rationale 1: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Rationale 2: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Rationale 3: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Rationale 4: Closed groups with a stable membership experience a higher degree of trust and cohesion. If new members or outsiders are allowed to attend, a new dynamic occurs and time is needed to rebuild trust. One hour weekly sessions would encourage trust and cohesion. There are no confidentiality rights of victims to consider. Member interaction outside the group cannot be avoided in a locked environment such as a prison or forensic psychiatric hospital and would most likely not be an issue in the development of trust and cohesion.

Global Rationale:

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Design a therapeutic group based on the needs and personality characteristics of potential members.

Question 18 Type: MCSA A few members of an outpatient group have begun meeting socially in a local restaurant for coffee and donuts before going to work each day. What should the group therapist leader do in this situation?

1. Discourage social meetings outside regular group sessions 2. Encourage all members to meet for coffee and donuts each morning 3. Join the members a few mornings a week 4. Suggest meeting for dinner once a week instead Correct Answer: 1 Rationale 1: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Rationale 2: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Rationale 3: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Rationale 4: Members in outpatient groups are discouraged from having relationships with other members outside the meetings. Relationships outside of the group are likely to interfere with the group dynamics because of the formation of social coalitions or dyads.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Design a therapeutic group based on the needs and personality characteristics of potential members.

Question 19 Type: MCSA The nursing student knows that group interaction requires the therapist to focus attention on each members feelings toward other group members, the therapists, and the group to illuminate relationship implications of interpersonal transactions. This process is known as: 1. Interactional group therapy.

2. The here-and-now.

3. Process illumination.

4. Objective family burden.

Correct Answer: 2 Rationale 1: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Rationale 2: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Rationale 3: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Rationale 4: The core of interactional group therapy is the here-and-now. According to Yalom (2005), the here-and-now work of the interactional group therapist occurs on two levels: focusing attention on each members feelings toward other group members, the therapists, and the group and illuminating the process (the relationship implications of interpersonal transactions).

Objective family burden refers to the impact on the family of a person with mental illness. The here-and-now is an aspect of interactional group therapy.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the process of here-and-now activation to a therapeutic group.

Question 20 Type: MCSA During a group session, a client becomes very angry at a comment by another member of the group. The therapist asks why the client became so angry. The group is using: 1. Events for emotional awareness.

2. Interpersonal conflict issues to resolve personal issues.

3. The self-reflective loop.

4. Fear.

Correct Answer: 3 Rationale 1: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Rationale 2: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Rationale 3: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Rationale 4: The self-reflective loop considers what happened and reflects back on why it happened. The self-reflective loop process may result in emotional awareness and resolution of personal issues. Fear is not a factor in the self-reflective loop.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the process of here-and-now activation to a therapeutic group.

Question 21 Type: MCSA The nurse knows that the primary task of the interactional group therapist is to make sure events in the session take precedence over: 1. Outside events.

2. Illness prevention.

3. Family matters.

4. Individual therapy.

Correct Answer: 1 Rationale 1: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Rationale 2: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Rationale 3: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Rationale 4: A primary task of the therapist is to actively steer the group discourse toward events in the session (the here-and-now) over those that occur outside or have occurred outside (the there-and-then).The work of the interactional group is not intended to displace individual therapy, prevent illness, or place priority on outside family matters.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the process of here-and-now activation to a therapeutic group.

Question 22 Type: MCSA The therapist for an interactive therapy group has noticed some behaviors among the members that need to be made overt. The therapist would be concerned about: 1. Expressing affection and sorrow.

2. Suggesting alternatives and denigrating each other.

3. Power struggles and attention-seeking.

4. Seeking social support and increasing conflict.

Correct Answer: 3 Rationale 1: Power struggles between members in therapy groups should be made overt.

Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Rationale 2: Power struggles between members in therapy groups should be made overt.

Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Rationale 3: Power struggles between members in therapy groups should be made overt.

Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Rationale 4: Power struggles between members in therapy groups should be made overt.

Seeking social support, suggesting alternatives, and expressing affection are usually appropriate activities in therapy groups. Increasing conflict and denigrating other group members is inappropriate behavior. Expressing sorrow may or may not be appropriate behavior.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Develop process commentary appropriate to the level and purposes of the group.

Question 23 Type: MCSA During group therapy, a male client laughs inappropriately and rolls his eyes when another male client discusses his feelings about coming out as a homosexual. The group therapist asks the first client to explain his reaction to the rest of the group. This process is an example of: 1. Taboo behavior.

2. Clearing the air.

3. Hidden homosexuality.

4. Attention-seeking and power struggles.

Correct Answer: 2 Rationale 1: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Rationale 2: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Rationale 3: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and

understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Rationale 4: Clearing the air (making covert interpersonal difficulties overt) is an integral part of illuminating the process. The group must move beyond a focus on content toward a focus on processthe how and the why of an interaction. The members must recognize, examine, and understand the process and be willing to self-disclose to avoid future conflicts and detrimental behaviors.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Develop process commentary appropriate to the level and purposes of the group.

Question 24 Type: MCSA Which of the following group therapies would be most helpful for clients diagnosed with severe and persistent schizophrenia who are living in a nursing home?

1. Bible-study groups 2. Dialectical behavior groups 3. Mutual-help groups 4. Social skills training groups

Correct Answer: 4 Rationale 1: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Rationale 2: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Rationale 3: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Rationale 4: Older people with severe and persistent schizophrenia can learn and maintain new skills and report improved functioning after cognitive behavioral social skills training. Mutual help groups do not provide enough structure for schizophrenic clients. Bible study groups may increase religious delusions. Dialectical behavior groups require understanding of abstract concepts that may be too difficult for severe and persistent schizophrenic clients to grasp.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Maintain a therapeutic group based on the needs of a specific population in inpatient or community settings.

Question 25 Type: MCSA Clients with chronic persistent mental illness have been attending a creative activities group which focuses on expression of feelings through poetry, music, and art. What client behaviors would be expected?

1. Increased paranoid delusions 2. Increased physical activity 3. Increased auditory hallucinations 4. Increased social interaction and self-esteem Correct Answer: 4 Rationale 1: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Rationale 2: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Rationale 3: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Rationale 4: Activity therapies are manual, recreational, and creative techniques to facilitate personal experiences and increase social responses and self-esteem.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Maintain a therapeutic group based on the needs of a specific population in inpatient or community settings.

Question 26 Type: MCSA You are a nurse manager of an ICU in a local hospital and have lost two nurses on your staff.

One nurse quit and the other nurse is receiving treatment in a center for alcohol abuse. What type of group would you recommend to your staff before considering a transfer or quitting?

1. Nurse-to-nurse support group 2. Nurse storytelling group 3. Nurse bibliotherapy group 4. Nurse Alcoholics Anonymous group Correct Answer: 1 Rationale 1: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Rationale 2: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings

identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Rationale 3: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Rationale 4: Nurses who work together may form discussion and counseling groups to help reduce their job-related stress and to help them deal with problems of interpersonal relationships in more satisfying ways. Nurses in various intensive care and other high-pressure settings identify with increasing frequency the need for group work services that the psychiatricmental health nurse can provide.

Chapter 12. Family Therapy Question 1 Type: MCSA A client with a diagnosis of bipolar disorder lives with his family and discontinues taking medication when he begins feeling his symptoms are under control. Family members express their concern to the clients therapist whenever they realize the client is off his meds. The therapist understands that within the clients family, each persons behavior is contingent on and: 1. Reflects the characteristics of the clients family.

2. Affects the behavior of others.

3. Is affected by the functionality of the group.

4. Is reflective of the clients mental illness.

Correct Answer: 2

Rationale 1: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Rationale 2: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Rationale 3: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Rationale 4: Whether they are functional or dysfunctional, families have certain characteristics and dynamics. In a family, each persons behavior is contingent on and affects the behavior of the others. Family members behavior is not necessarily reflective of the clients mental illness. Each family members behavior affects the behavior of others, which may, in turn, reflect the characteristics of the family as a whole. The functionality of the group does not address family relationships.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe families and their dynamics in terms of relationships, associations, and connections.

Question 2 Type: MCSA The nurse knows that when clients are unable or unwilling to perform assigned family roles, the family experiences: 1. Stress and disequilibrium.

2. Recognition and communication.

3. Personal and political advocacy.

4. Acceptance.

Correct Answer: 1 Rationale 1: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Rationale 2: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Rationale 3: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Rationale 4: When members are unable or unwilling to perform assigned roles, the family experiences stress. For the health of the family systemnot only family members but also their relationships, their communication with one another, and their interactions with the environmentroles often must be negotiated in other than stereotyped ways. When the roles are not negotiated satisfactorily, family disequilibrium results. Not following assigned family roles does not result in recognition, communication, advocacy, or acceptance.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe families and their dynamics in terms of relationships, associations, and connections.

Question 3 Type: MCSA For the last three generations, the men of the family have worked in logging. The younger son wants to go to college and become a marine biologist. His parents tell him that logging is what our family does and refuse to discuss the issue. The son chooses to pursue employment in logging rather than upset his parents desires for their son. This family is experiencing:

1. Enmeshment.

2. Pseudohostility.

3. Pseudomutuality.

4. Schism.

Correct Answer: 3 Rationale 1: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility.

Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Rationale 2: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility.

Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Rationale 3: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility.

Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Rationale 4: A family in which pseudomutuality occurs experiences persistent sameness in the structuring of roles, insistence on the desirability and appropriateness of family role structures, and intense concern over deviations from the role structure or emerging autonomy, and requires its members to give up their sense of personal identity. The family is not exhibiting pseudohostility in which there is chronic conflict, remoteness, or denial to negate hostility.

Enmeshed families have diffuse boundaries. In schismatic families, adult partners devalue and undercut each other.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Describe families and their dynamics in terms of relationships, associations, and connections.

Question 4 Type: MCSA The nursing student taking care of a client in the mental health clinic learns through assessment that the clients wife insisted he admit himself into the clinic even though his wife is the one with a documented history of mental illness. The client states, I just want her to be happy. The nursing student suspects that the clients relationship with his wife may be: 1. Enmeshed.

2. Disengaged.

3. Hostile.

4. Skewed.

Correct Answer: 4 Rationale 1: Families in which one mate is severely dysfunctional are called skewed families.

The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Rationale 2: Families in which one mate is severely dysfunctional are called skewed families.

The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Rationale 3: Families in which one mate is severely dysfunctional are called skewed families.

The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Rationale 4: Families in which one mate is severely dysfunctional are called skewed families.

The other mate, who is usually aware of the dysfunction of the partner, assumes a passive, peacemaking, submissive stance to preserve the relationship. The couples relationship does not appear enmeshed, disengaged, or hostile.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Differentiate among schism, skew, enmeshment, and disengagement as problems of intimacy and control in families.

Question 5

Type: MCSA The nurse is working with a family in the process of a divorce. The parents are pressuring the children to decide which parent to live with after the divorce. The children are conflicted because they love both parents equally and want the family to stay together. This is an example of a: 1. Schismatic family.

2. Skewed family.

3. Hostile family.

4. Disengaged family.

Correct Answer: 1 Rationale 1: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Rationale 2: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Rationale 3: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Rationale 4: Families in which the children are forced to join one or the other camp of two warring spouses or adult caretakers are called schismatic families. The constant fighting in these families is most likely a defense against intimacy or closeness. The family does not appear skewed, disengaged, or hostile.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate among schism, skew, enmeshment, and disengagement as problems of intimacy and control in families.

Question 6 Type: MCSA A child with ADHD is referred to the nurse practitioner for family therapy. The father and mother are out of the country and have been out of touch for three months. The childs older sister has assumed the role of parenting her younger sibling. This is an example of a: 1. Disengaged family.

2. Enmeshed family.

3. Skewed family.

4. Schismatic family.

Correct Answer: 1 Rationale 1: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Rationale 2: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Rationale 3: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Rationale 4: In disengaged families, family members seem oblivious to the effects of their actions on one another. They are unresponsive and unconnected to each other. Structure, order, or authority in the family may be weak or nonexistent. In these families, a child often assumes the parental role. The family does not appear skewed, enmeshed or schismatic.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate among schism, skew, enmeshment, and disengagement as problems of intimacy and control in families.

Question 7 Type: MCSA The nursing student knows that involving families with the clients treatment is an important aspect of family nursing. Certain biases, such as believing families are responsible for the clients mental illness, prevents: 1. Social interaction and violates family rights.

2. Hope, support, and happiness.

3. Future episodes of negative client behavior.

4. Family identity and reduces negative perceptions.

Correct Answer: 1 Rationale 1: Assessing and intervening with the families of clients is an essential nursing role.

Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Rationale 2: Assessing and intervening with the families of clients is an essential nursing role.

Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Rationale 3: Assessing and intervening with the families of clients is an essential nursing role.

Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Rationale 4: Assessing and intervening with the families of clients is an essential nursing role.

Unfortunately, some mental health care professionals still have a bias against family involvement. This bias is a remnant of now-discredited theories that poor parenting and dysfunctional family interaction patterns give rise to mental illness. A related bias is the belief that if families cause schizophrenia, then the familys contact with the client should be limited for the clients sake. Besides violating family rights, this bias prevents social interaction with family members that might serve as a normalizing force by confronting clients with reality. These biases do not reduce negative perceptions, negative client behavior, or hope, support, and happiness.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Carry out a family assessment.

Question 8 Type: MCSA In order to obtain detailed information that gives insight into how a clients family may function, the nurse knows to ask: 1. What are your goals after discharge?

2. How often do you attend church?

3. What are your favorite foods?

4. Do you take your medicine at the same time every day?

Correct Answer: 2

Rationale 1: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Rationale 2: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Rationale 3: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Rationale 4: How actively the family pursues religious/spiritual activities is the sort of detailed information that will give insight into family functioning. Goals after discharge, favorite foods, and medication information are not related to family functioning.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Carry out a family assessment.

Question 9 Type: MCSA When collecting family interactional data, the nurse knows to ask: 1. How do the actions of your family worsen your symptoms of schizophrenia?

2. Since you have been in the hospital, who is taking care of your children?

3. How often do you shop for nutritional items for your family?

4. What do you buy when you shop at the local market?

Correct Answer: 2 Rationale 1: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Rationale 2: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Rationale 3: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Rationale 4: Family interactional data is probably the most complex data to obtain. It is important to determine family alliances and family supports. Information about shopping habits is not part of the interactional data. Implying that the family causes or affects the clients mental illness reflects the nurses bias.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Carry out a family assessment.

Question 10 Type: MCSA The nurse knows that because people with mental illness continue to be ostracized by mainstream society, families must cope with the burden of: 1. Dementia.

2. Shame.

3. Isolation.

4. Stigma.

Correct Answer: 4 Rationale 1: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Rationale 2: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Rationale 3: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the

household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Rationale 4: Family burden refers to the difficulties and responsibilities of family members who assume a caretaking function for relatives with psychiatric disability. Stigma is one example of family burden. Other family burdens reported most often are financial strain, violence in the household, reductions in the physical and mental health of family caregivers, disruption of family routines, worry about the future, the mental health system itself as a stressor, and feeling overwhelmed or unable to cope. Isolation is more of an issue for the person with mental illness than for the family. Dementia and shame are not considered family burdens.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Carry out a family assessment.

Question 11 Type: MCSA The family nurse therapist, in an effort to learn more details about family patterns and interactions over time, may use: 1. The psychiatrists progress notes.

2. Anecdotes from family and friends.

3. Police reports.

4. A genogram.

Correct Answer: 4 Rationale 1: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Rationale 2: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Rationale 3: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Rationale 4: From the study of families in detail, it becomes apparent that patterns are spread over generations. The timeline, or genogram, is highly effective as a visual representation of family patterns from one generation to the next. The other choices have not been proven effective in soliciting information about multigenerational patterns.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate the data obtained in a family assessment into the care plan for the client.

Question 12 Type: MCSA When developing a care plan for a client in family therapy, which of the following questions will provide the best information for planning appropriate interventions?

1. What kinds of activities does your family enjoy together?

2. Who is the primary caregiver in your family?

3. What is the most important problem that you want help with?

4. How often do you attend church together as a family?

Correct Answer: 3 Rationale 1: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Rationale 2: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Rationale 3: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Rationale 4: The best way to find out what families need from mental health professionals is to ask them directly. The other questions provide information during a family assessment, but do not solicit the familys opinion of what they think they need help with.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate the data obtained in a family assessment into the care plan for the client.

Question 13 Type: MCSA Which of the following interventions is not an appropriate strategy for the family therapist?

1. Openly disagree with one another when appropriate 2. Showing that anger and pain are not safe emotions to examine 3. Delineating family roles and functions 4. Openly discuss problems with one another Correct Answer: 2 Rationale 1: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Rationale 2: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Rationale 3: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The

other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Rationale 4: The family therapist should encourage examination of all emotions in a safe environment. There are no forbidden areas that cannot be examined during family therapy. The other interventions are all appropriate strategies for the family therapist to engage in during therapy.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate the data obtained in a family assessment into the care plan for the client.

Question 14 Type: MCSA Parents of adult clients with mental health disorders struggle to find a balance between emotional support and fostering independence. The nurse helps by: 1. Teaching the client and family about past mistakes.

2. Providing psychoeducation group therapy.

3. Providing interaction with family members.

4. Teaching the client to embrace the future.

Correct Answer: 2

Rationale 1: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Rationale 2: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Rationale 3: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Rationale 4: Family members can benefit from psychoeducation groups designed to help them cope with their loved ones illness. Family psychoeducation programs have emerged as a strongly supported evidence-based practice in the treatment of schizophrenia, bipolar disorder, depression, obsessive-compulsive disorder, and borderline personality disorder. Family psychoeducation has also been found to reduce psychotic relapse and rehospitalization and to improve client recovery and family well-being. The other answers may be results of psychoeducation group therapy.

Global Rationale: Cognitive Level: Analyzing

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Partner with clients and their families in recognizing when family interventions, referral to NAMI, or family therapy are appropriate.

Question 15 Type: MCSA Which of the following is a grassroots, self-help support organization of families, friends, and clients with severe mental illness?

1. National Institute of Mental Health (NIMH) 2. American Mental Health Association (AMHA) 3. A mental health clinic 4. National Alliance on Mental Illness (NAMI) Correct Answer: 4 Rationale 1: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Rationale 2: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Rationale 3: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Rationale 4: The National Alliance on Mental Illness (NAMI) is a grassroots, self-help, advocacy and support organization of families, consumers (a term used by NAMI to describe people diagnosed with and receiving treatment for severe mental illness), and friends of people with severe mental disorders. NAMI provides several services to families and consumers, including general information on mental disorders, psychiatric medications, and mental health policy positions; referral to state and local affiliates and support groups throughout the country; and support from trained volunteersconsumers and family memberswho know what its like to have a mental disorder or to have a family member with a mental disorder. The other agencies are not grassroots self-help organizations.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Partner with clients and their families in recognizing when family interventions, referral to NAMI, or family therapy are appropriate.

Question 16 Type: MCSA A client diagnosed with bipolar disorder is starting the first family therapy session. The nurse knows the clients children, aged 2 and 4, will: 1. Not be included in the therapy session.

2. Help the client acclimate to the mental health clinic.

3. Benefit from the therapy session.

4. Help the client understand the importance of getting well.

Correct Answer: 1 Rationale 1: Children 4 years of age and younger are often not included in ongoing family therapy sessions. They may misinterpret or be frightened by the dialogue. In addition, small children tend to be disruptive. The children are not expected to help the client.

Rationale 2: Children 4 years of age and younger are often not included in ongoing family therapy sessions. They may misinterpret or be frightened by the dialogue. In addition, small children tend to be disruptive. The children are not expected to help the client.

Rationale 3: Children 4 years of age and younger are often not included in ongoing family therapy sessions. They may misinterpret or be frightened by the dialogue. In addition, small children tend to be disruptive. The children are not expected to help the client.

Rationale 4: Children 4 years of age and younger are often not included in ongoing family therapy sessions. They may misinterpret or be frightened by the dialogue. In addition, small children tend to be disruptive. The children are not expected to help the client.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Design family psychoeducation activities to improve client recovery and family well-being.

Question 17 Type: MCSA In order to help improve the functioning of mental health clients and their families, nurses must: 1. Teach the client communication skills.

2. Help each member negotiate what they need within the family.

3. Decrease the clients stress by compromising the integrity of family interactions.

4. Normalize the familys experience.

Correct Answer: 2 Rationale 1: The negotiation phase of family therapy is begun by identifying what each member would like to change in the family. When each family member and the therapist have identified important goals, they begin negotiating a set of attainable goals that everyone is willing to work on. Some give-and-take among the family members is needed to achieve workable goals. At this

time, the family therapist, along with the family, may also identify the meanstasks, strategies, and so onthat will be used to reach the negotiated goals. Teaching the client communication skills may be one of the tasks the family identifies. Normalizing the familys experience may result from improvement of family functioning. It is nontherapeutic for the nurse to actively compromise the integrity of family interactions.

Rationale 2: The negotiation phase of family therapy is begun by identifying what each member would like to change in the family. When each family member and the therapist have identified important goals, they begin negotiating a set of attainable goals that everyone is willing to work on. Some give-and-take among the family members is needed to achieve workable goals. At this time, the family therapist, along with the family, may also identify the meanstasks, strategies, and so onthat will be used to reach the negotiated goals. Teaching the client communication skills may be one of the tasks the family identifies. Normalizing the familys experience may result from improvement of family functioning. It is nontherapeutic for the nurse to actively compromise the integrity of family interactions.

Rationale 3: The negotiation phase of family therapy is begun by identifying what each member would like to change in the family. When each family member and the therapist have identified important goals, they begin negotiating a set of attainable goals that everyone is willing to work on. Some give-and-take among the family members is needed to achieve workable goals. At this time, the family therapist, along with the family, may also identify the meanstasks, strategies, and so onthat will be used to reach the negotiated goals. Teaching the client communication skills may be one of the tasks the family identifies. Normalizing the familys experience may result from improvement of family functioning. It is nontherapeutic for the nurse to actively compromise the integrity of family interactions.

Rationale 4: The negotiation phase of family therapy is begun by identifying what each member would like to change in the family. When each family member and the therapist have identified important goals, they begin negotiating a set of attainable goals that everyone is willing to work on. Some give-and-take among the family members is needed to achieve workable goals. At this time, the family therapist, along with the family, may also identify the meanstasks, strategies, and so onthat will be used to reach the negotiated goals. Teaching the client communication skills may be one of the tasks the family identifies. Normalizing the familys experience may

result from improvement of family functioning. It is nontherapeutic for the nurse to actively compromise the integrity of family interactions.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Design family psychoeducation activities to improve client recovery and family well-being.

Question 18 Type: MCSA When instructing nursing students on therapy termination strategies for families and clients with mental health disorders, the nursing instructor teaches that effective family nursing strategies include: 1. Helping families achieve realistic goals.

2. Giving criticism in a calm voice.

3. Knowing effective communication skills.

4. Monitoring nonverbal communication.

Correct Answer: 1 Rationale 1: Family therapists use various criteria to determine when termination is appropriate.

Termination occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. Knowing effective communication skills, giving

criticism in a calm voice, and monitoring nonverbal communication may be included in the goals.

Rationale 2: Family therapists use various criteria to determine when termination is appropriate.

Termination occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. Knowing effective communication skills, giving criticism in a calm voice, and monitoring nonverbal communication may be included in the goals.

Rationale 3: Family therapists use various criteria to determine when termination is appropriate.

Termination occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. Knowing effective communication skills, giving criticism in a calm voice, and monitoring nonverbal communication may be included in the goals.

Rationale 4: Family therapists use various criteria to determine when termination is appropriate.

Termination occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. Knowing effective communication skills, giving criticism in a calm voice, and monitoring nonverbal communication may be included in the goals.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Design family psychoeducation activities to improve client recovery and family well-being.

Question 19

Type: MCSA Which of the following information should be included in psychoeducation with a family of a client recently diagnosed with a mental illness?

1. Most mental illnesses are inherited so the entire family should be tested for the same disorder.

2. Mental illness is extremely complex and it may take several years for the right treatment to be effective.

3. Most mental illnesses are caused by an imbalance of chemicals in the brain and can be treated with medications and therapy.

4. Earlier screening and diagnosis could have prevented the severity of symptoms and behavior problems.

Correct Answer: 3 Rationale 1: Families misunderstand mental illness to be a personal failing and are comforted by the fact that it has a biologic basis and can be treated with medications and therapy. There is no truth to the other statements.

Rationale 2: Families misunderstand mental illness to be a personal failing and are comforted by the fact that it has a biologic basis and can be treated with medications and therapy. There is no truth to the other statements.

Rationale 3: Families misunderstand mental illness to be a personal failing and are comforted by the fact that it has a biologic basis and can be treated with medications and therapy. There is no truth to the other statements.

Rationale 4: Families misunderstand mental illness to be a personal failing and are comforted by the fact that it has a biologic basis and can be treated with medications and therapy. There is no truth to the other statements.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Provide information about family therapy and support to clients and their families while they are engaged in family therapy.

Question 20 Type: MCSA Which of the following behaviors indicate that family therapy has been effective and can be terminated?

1. Family members are able to give feedback to others, telling them how they appear 2. Family members are able to identify faults and failures of others, telling them how to act better 3. Family members are able to give praise and criticism in equal measure 4. Family members are able to identify problems with communication Correct Answer: 1 Rationale 1: Termination in family therapy occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. The ability to give feedback to each other in a constructive manner is the sign of a healthy family. The ability to identify problems with communication is an early goal of therapy. Identifying faults and failures of others is not the focus of family therapy. Giving praise and criticism in equal measure is not a goal of family therapy and does not indicate the need for termination.

Rationale 2: Termination in family therapy occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. The ability to give feedback to each other in a constructive manner is the sign of a healthy family. The ability to identify problems with communication is an early goal of therapy. Identifying faults and failures

of others is not the focus of family therapy. Giving praise and criticism in equal measure is not a goal of family therapy and does not indicate the need for termination.

Rationale 3: Termination in family therapy occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. The ability to give feedback to each other in a constructive manner is the sign of a healthy family. The ability to identify problems with communication is an early goal of therapy. Identifying faults and failures of others is not the focus of family therapy. Giving praise and criticism in equal measure is not a goal of family therapy and does not indicate the need for termination.

Rationale 4: Termination in family therapy occurs in a flexible way, helping families achieve realistic goals, thus ending therapy with a feeling of accomplishment. The ability to give feedback to each other in a constructive manner is the sign of a healthy family. The ability to identify problems with communication is an early goal of therapy. Identifying faults and failures of others is not the focus of family therapy. Giving praise and criticism in equal measure is not a goal of family therapy and does not indicate the need for termination.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Provide information about family therapy and support to clients and their families while they are engaged in family therapy.

Question 21 Type: MCSA The mother of a young child diagnosed with conduct disorder asks the nurse to recommend a qualified nurse to provide family therapy. The nurse knows that:

1. Nurse family therapists should be clinical specialists or advanced practitioners in mental health nursing.

2. Nurses with a bachelors degree are qualified to provide family therapy if they are nationally certified in mental health nursing.

3. Nurses are not reimbursed by third party insurers to provide family therapy.

4. Nurses specializing in family therapy are expensive and it is difficult to get a timely appointment.

Correct Answer: 1 Rationale 1: Family therapists should be specially educated in the practice of family therapy and strongly committed to a belief in the importance of the family. Nurse family therapists should be clinical specialists or advanced practitioners prepared in graduate programs that provide both theory and supervised clinical practice in this specialized area. All other statements are false.

Rationale 2: Family therapists should be specially educated in the practice of family therapy and strongly committed to a belief in the importance of the family. Nurse family therapists should be clinical specialists or advanced practitioners prepared in graduate programs that provide both theory and supervised clinical practice in this specialized area. All other statements are false.

Rationale 3: Family therapists should be specially educated in the practice of family therapy and strongly committed to a belief in the importance of the family. Nurse family therapists should be clinical specialists or advanced practitioners prepared in graduate programs that provide both theory and supervised clinical practice in this specialized area. All other statements are false.

Rationale 4: Family therapists should be specially educated in the practice of family therapy and strongly committed to a belief in the importance of the family. Nurse family therapists should be clinical specialists or advanced practitioners prepared in graduate programs that provide both theory and supervised clinical practice in this specialized area. All other statements are false.

Chapter 13. Stabilization for Trauma and Dissociation

Question 1 Type: MCSA The nurse finds that the client with a somatoform disorder has physical symptoms, but there is no evidence of physiologic disease. The client may have decreased amounts of serotonin and endorphins, causing the client to experience an increased sensitivity to pain. This explanation of the clients symptoms is based in: 1. Communication theory.

2. Humanistic theory.

3. Biologic theory.

4. Genetic theory.

Correct Answer: 3 Rationale 1: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 2: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 3: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe

somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 4: Research has shown that brain abnormalities such as decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Communication theorists believe somatization is nonverbal body language intended to communicate a message to significant others. Humanistic theorists believe one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 2 Type: MCSA The client states, I was reared in a chaotic, alcoholic family situation. The nurse knows that the most useful theory for explaining the clients somatoform disorder would come from: 1. Humanistic theory.

2. Psychosocial theory.

3. Biologic theory.

4. Genetic theory.

Correct Answer: 2 Rationale 1: Psychosocial theorists believe that the client did not receive adequate nurturing.

Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 2: Psychosocial theorists believe that the client did not receive adequate nurturing.

Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 3: Psychosocial theorists believe that the client did not receive adequate nurturing.

Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Rationale 4: Psychosocial theorists believe that the client did not receive adequate nurturing.

Biologic theorists believe that decreased serotonin and endorphins may lead to altered pain perception. Genetic theorists believe that both genetic and environmental factors contribute to somatization disorders. Humanistic theorists believe that one must look at clients with somatoform disorders in the context of what is happening in the clients lives.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 3 Type: MCSA The nurse finds that the client with a pain disorder has been in a physically and verbally abusive relationship. The client feels guilty and fears a loss of love. According to psychoanalytic concepts, this is believed to be a(n): 1. Unconscious conflict from childhood that was reawakened in adulthood by a similar situation.

2. Environmental factor.

3. Stress related to relationships.

4. Brain abnormality.

Correct Answer: 1 Rationale 1: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Rationale 2: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Rationale 3: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Rationale 4: The psychosocial theory addresses the psychoanalytic concepts of a repressed affect that is transformed into pain. Brain abnormality as an explanation of the pain disorder reflects biologic theory. Stress related to relationships as an explanation of the pain disorder derives from a humanistic view. Environmental factors are a component of the genetic theory.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 4 Type: MCSA The nurse is presenting an in-service on dissociative disorder. The nurse knows that which of the following is most often used to explain the occurrence of dissociative disorder in psychiatric clients?

1. Psychosocial theories 2. Biological theories 3. Genetic theories 4. Physical theories Correct Answer: 1

Rationale 1: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Rationale 2: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Rationale 3: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Rationale 4: Although biologic and genetic factors are being studied as potential etiological factors, psychosocial theories are used most often to explain dissociative disorders.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe theories that aid in the understanding of dissociative, somatoform, and factitious disorders.

Question 5 Type: MCSA A client is being seen in the clinic for right-hand paresthesia that the client does not seem to be overly concerned about. The condition developed abruptly after being caught cheating on an exam by the teacher. The paresthesia also ended abruptly as well. Which symptom most clearly relates to la belle indiffrence?

1. Being caught cheating on the exam 2. Right-hand paresthesia

3. Lack of concern over the paresthesia 4. Paresthesia beginning and ending abruptly Correct Answer: 3 Rationale 1: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Rationale 2: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Rationale 3: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Rationale 4: La belle indiffrence describes a relative lack of concern over a physical problem like a paresthesia. La belle indiffrence does not refer to the nature of the physical problem or the course of the problem; therefore, the paresthesia itself and its abrupt onset and conclusion are not symptoms of la belle indiffrence. The client may or may not be concerned about being caught cheating on the exam, but that is not a physical problem.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 6 Type: MCSA The nurse would teach the adolescent with a conversion disorder what the person gets from having the disorder. This explanation would include a discussion of: 1. Preoccupation with the belief that the person has a serious disease without physical evidence.

2. Primary and secondary gains.

3. An overreaction by caregivers to the clients somatic complaints.

4. A pain cure.

Correct Answer: 2 Rationale 1: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a paindisordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Rationale 2: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a paindisordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Rationale 3: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a paindisordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Rationale 4: Primary and secondary gains are the two mechanisms thought to explain what a person gets from a conversion disorder. An overreaction by caregivers to the clients somatic complaints addresses somatization disorder. A pain cure would be discussed with a paindisordered person. Hypochondriasis is a persons preoccupation with the belief that the person has a serious disease without physical evidence.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 7 Type: MCSA A 24-year-old client with body dysmorphic disorder (BDD) tells the nurse that he plans to have a surgical procedure that will affect his appearance. The nurse understands that this plan is an effort to: 1. Suppress intrusive thoughts.

2. Deal with multiple physical complaints.

3. Treat associated depression.

4. Cure the imagined defect.

Correct Answer: 4 Rationale 1: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Rationale 2: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Rationale 3: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Rationale 4: Clients with BDD may use cosmetic surgery to cure the imagined defect. Cosmetic surgery does not treat associated depression, deal with multiple physical complaints, or suppress intrusive thoughts.

Global Rationale: Cognitive Level: Creating Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 8

Type: MCSA The client states that she has been ill and in pain since childhood. Her many symptoms are not caused intentionally, nor are they feigned. She has seen many doctors. Consistent with this clients disorder, the nurse believes the pain the client experiences is: 1. Fake.

2. Exaggerated.

3. Real.

4. For attention.

Correct Answer: 3 Rationale 1: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Rationale 2: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Rationale 3: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Rationale 4: This client has somatization disorder and is genuinely experiencing pain. It is not fake or for attention as with factitious disorders, or exaggerated.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 9 Type: MCSA The nurse is working with a client who is being admitted to the psychiatricmental health unit.

The client was missing for two weeks and returned home not knowing any time had passed.

Which of the following dissociative disorders has this client experienced?

1. Amnesia 2. Depersonalization disorder 3. Fugue 4. Dissociative identity disorder (DID) Correct Answer: 3 Rationale 1: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Rationale 2: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Rationale 3: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten

anything. When they return to their former consciousness, they do not remember the period of fugue.

Rationale 4: A person with dissociative fugue wanders, usually far from home and for days, perhaps even weeks or months, at a time. During this period, clients completely forget their past life and associations; but unlike people with amnesia, they are unaware of having forgotten anything. When they return to their former consciousness, they do not remember the period of fugue.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 10 Type: MCSA The nurse is caring for a client with a history of admissions to several hospitals over the last several years. Each hospitalization was for a different disorder in which there was no physical evidence. The medical record indicates the client is a pathological liar. Which of the following disorders does the client suffer from?

1. A somatoform disorder 2. Factitious disorder by proxy 3. Adult factitious disorder

4. Dissociative identity disorder Correct Answer: 3 Rationale 1: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Rationale 2: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Rationale 3: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Rationale 4: When the disorder is severe, chronic, and unremittinginvolving repeated hospitalizations, traveling between health care providers and health care facilities, and pathological lying of an intriguing and fantastic nature (termed pseudologica fantastica)it is often referred to as Munchausen syndrome or adult factitious disorder (AFD). Factitious

disorder by proxy sometimes called Munchausen by proxy syndrome(MBPS) occurs when parents or caregivers deliberately induce signs of an illness in another person, usually their own child. There is no evidence the client is suffering from dissociative identity disorder or a somatoform disorder.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast the biopsychosocial characteristics of various dissociative, somatoform, and factitious disorders.

Question 11 Type: MCSA The nurse is caring for a client with somatization disorder. When providing a report to the staff on the next shift, it is important for the nurse to relate the: 1. Amount of time the client talked about physical complaints.

2. Trigger for the clients worries.

3. Use of abdominal breathing at the first sign of anxiety.

4. The clients source of the original anxiety.

Correct Answer: 1 Rationale 1: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to

evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Rationale 2: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Rationale 3: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Rationale 4: Somatization disorder deals with physical problems that are found to have no organic basis. The amount of time the client talked about physical complaints is crucial to evaluate whether the client meets the goal of decreasing that time. The use of abdominal breathing at the first sign of anxiety, the clients source of the original anxiety, and the trigger for the clients worries are not priorities with somatization disorders.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 12

Type: MCSA An 18-year-old client who joined the military shortly after graduating from high school is admitted to the mental health unit for depression and suicidal ideation. He tells the nurse the military is not what he expected and he wants to go home. The nurse observes a variance in affect between his interaction with peers and staff. The nurse suspects: 1. Conversion disorder.

2. Factitious disorder.

3. Malingering.

4. Body dysmorphic disorder.

Correct Answer: 3 Rationale 1: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Rationale 2: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Rationale 3: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Rationale 4: Malingering describes a person deliberately faking symptoms; it is usually adopted to obtain a secondary gain. Factitious disorder describes a person assuming a sick role by intentionally producing or feigning illness. People with body dysmorphic disorder are preoccupied by an imagined defect. A person with a conversion disorder will report impaired physical function related to the expression of a psychologic conflict.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 13 Type: MCSA A client is certain she has cancer and peritonitis despite her doctors reassurance she does not.

She most likely is experiencing: 1. Malingering.

2. Conversion disorder.

3. Hypochondriasis.

4. Factitious disorder.

Correct Answer: 3

Rationale 1: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Rationale 2: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Rationale 3: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Rationale 4: This client is preoccupied with the belief she has a serious illness that is not medically present; this is hypochondriasis. Malingering describes a person deliberately faking symptoms and usually results in a secondary gain. Factitious disorder describes a person who assumes a sick role by intentionally producing or feigning illness. A person with conversion disorder will report impaired physical function related to the expression of a psychological conflict.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate among somatoform disorders, factitious disorders, and malingering.

Question 14 Type: MCSA The nurse cares for several clients with somatoform disorders, regularly reassessing their status.

The nurse is aware that it is: 1. Easy to be kind, nonjudgmental, and understanding.

2. Challenging because of the psychobiologic factors involved.

3. Best to include objective information only.

4. Best to include subjective information only.

Correct Answer: 2 Rationale 1: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 2: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 3: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Rationale 4: It can be difficult to assess the client because of the psychobiologic factors involved. It is not always easy to be kind, nonjudgmental, and understanding with this group of clients. Both objective and subjective information should be included in the assessment.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 15 Type: MCSA A client presents to the community clinic describing abdominal pain, refuses to complete informational forms, and dismisses the nurses assessment attempts while demanding to be seen immediately by a doctor. Which approach would be best for the nurse to use when assessing for somatoform disorders?

1. Realize client judgment is intact.

2. Avoid personalizing the behavior by recognizing that somatization is part of the illness.

3. Have sympathy for the psychopathology of the disorder.

4. Expect the client to respond appropriately to the nurses need to complete the assessment.

Correct Answer: 2 Rationale 1: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 2: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 3: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Rationale 4: The best approach is to avoid personalizing the behavior by recognizing that somatization is part of the illness. The nurse should have empathy, not sympathy for the psychopathology of the disorder. Given the self-absorption common to this disorder, it may be unrealistic to expect the client to respond appropriately to the nurses need to complete the assessment. With this disorder, client judgment is impaired.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 16 Type: MCMA

The nurse knows that performing an assessment on a client with dissociative disorder can be challenging. The nurse knows it is important to include which of the following in the assessment?

Standard Text: Select all that apply.

1. Memory 2. Identity 3. Consciousness 4. Clients spouse 5. Awareness of time Correct Answer: 1,2,3,5 Rationale 1: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 2: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 3: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 4: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Rationale 5: It can become extremely challenging when you begin to gather data on a client with dissociative symptoms. The major areas to focus on during assessment are identity, memory, and consciousness. Some other areas to assess are awareness of time, amount of unfinished tasks, goal setting, and inconsistent work attendance. There is no indication that the clients spouse would need to be included in the assessment of the client.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Perform a thorough and comprehensive assessment of clients with dissociative, somatoform, and factitious disorders.

Question 17 Type: MCMA The nurse is working with a client who has been diagnosed with a somatoform disorder. The nurse knows it is important to include which of the following interventions in the clients plan of care?

Standard Text: Select all that apply.

1. Encourage verbalization of feelings.

2. Encourage the client to write in a journal 3. Establish a weekly routine 4. Establish a trusting relationship.

5. Encourage the discussion of physical symptoms Correct Answer: 1,2,4 Rationale 1: Encourage verbalization of feelings: Verbalization is healthier than somatization.

Rationale 2: Encourage the client to write in a journal: Increases personal insight.

Rationale 3: Establish a weekly routine: A daily routine, not weekly, should be encouraged for this client as it will decrease the clients anxiety.

Rationale 4: Establish a trusting relationship: Promotes clients psychologic safety.

Rationale 5: Encourage the discussion of physical symptoms: The patient should be discouraged from discussing physical symptoms because it frees up time for problem-solving activities and decreases the reinforcement of secondary gain.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 18

Type: MCSA The nurse is caring for a client who has been diagnosed with dissociative disorder. The nurse knows that an appropriate intervention to promote effective role performance is to: 1. Encourage the client to have no contact with friends and family.

2. Ignore the clients other personalities.

3. Help the client alienate family members who do not believe the client is sick.

4. Include family members is therapy.

Correct Answer: 4 Rationale 1: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 2: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 3: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Rationale 4: It is important to work with the clients family in order to help everyone in the family unit to adjust to role performance alterations. Including family members in a therapeutic counseling relationship helps them learn new ways of dealing with the client. As stated earlier, considerable secondary gain is often associated with dissociative behavior: some clients may use the illness to escape responsibility and get special treatment. Families often need support in learning to avoid reinforcing dissociative behavior by acting as the source of secondary gain.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 19 Type: MCSA When working with clients with somatoform disorders, the nurse knows the priority intervention is to: 1. Encourage clients to participate in group therapy to receive feedback about the effect of their behavior on others.

2. Tone down clients characteristic extravagance.

3. Establish a trusting relationship.

4. Express respectful skepticism regarding clients oversimplifications and overdramatizations.

Correct Answer: 3

Rationale 1: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 2: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 3: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Rationale 4: A trusting relationship is essential to effective therapy. To tone down clients characteristic extravagance, express respectful skepticism regarding their oversimplifications and overdramatizations, and encourage participation in group therapy to receive feedback about the effect of their behavior on others are appropriate interventions, but they are not priorities.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate an understanding of therapeutic interventions for clients experiencing selected dissociative, somatoform, and factitious disorders into their plan of care.

Question 20 Type: MCSA

To intervene effectively with clients with somatoform disorders, it is essential that the nurse: 1. Help the client express a decreased degree of comfort regarding physical symptoms.

2. Encourage the clients expression of feelings symbolically through physical symptoms.

3. Address client anxiety at a later time.

4. Recognize and understand the clients self-perception as demonstrating an inability to cope.

Correct Answer: 4 Rationale 1: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 2: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 3: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Rationale 4: Recognize and understand the clients self-perception as an inability to cope and as part of the disorder. Do not encourage expression of feelings symbolically through physical symptoms. Client anxiety should be addressed at the present time, not at a later date. The client should express an increased degree of comfort regarding physical symptoms.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Analyze possible personal challenges to professional practice when caring for clients with dissociative, somatoform, and factitious disorders.

Question 21 Type: MCSA The nurse is caring for a 15-month-old who is admitted to the hospital for the fifth time in six months with severe diarrhea. The patients mother has been diagnosed with Munchausen by proxy syndrome (MBPS) as she has been giving her child large doses of laxatives to make the child sick. The nurse is having difficulty dealing with the situation. Which of the following is the best way for the nurse to proceed?

1. Confront the mother about making her child sick.

2. Seek clinical supervision to cope with situation.

3. Refuse to take care of the child and family.

4. Have as little contact with the mother as possible.

Correct Answer: 2 Rationale 1: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Rationale 2: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Rationale 3: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Rationale 4: It is difficult for health care providers to deal with situations in which a caregiver (usually a parent) deliberately injures the person under their care. In these situations, health care providers should seek clinical supervision or a consultant to help them to cope with their personal responses.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Basic Care and Comfort Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze possible personal challenges to professional practice when caring for clients with dissociative, somatoform, and factitious disorders.

Question 22 Type: MCSA A client is newly diagnosed with dissociative identity disorder. To support this client, who is struggling to accept the diagnosis, the nurse would: 1. Flood the client with stressful stimuli.

2. Actively listen to each identity state and provide support.

3. Assess for secondary gain to confront the client.

4. Discourage the use of psychometric tests.

Correct Answer: 2 Rationale 1: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Rationale 2: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Rationale 3: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Rationale 4: The most effective intervention would be to actively listen to each identity state and provide support. Discouraging the use of psychometric tests that might support the diagnosis, confronting with secondary gain issues, and flooding the client with stressful stimuli are not helpful interventions for this client.

Chapter 14. Dialectical Behavior Therapy for Complex Trauma MULTIPLE CHOICE 1. A nurse works with a patient diagnosed with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be included in the plan of care? a. Trigger flashbacks intentionally in order to help the patient learn to cope with them. b. Explain that the physical symptoms are related to the psychological state. c. Encourage repression of memories associated with the traumatic event.

d. Support numbing as a temporary way to manage intolerable feelings.

ANS: B Persons with posttraumatic stress disorder often experience somatic symptoms or sympathetic nervous system arousal that can be confusing and distressing. Explaining that these are the bodys responses to psychological trauma helps the patient understand how such symptoms are part of the illness and something that will respond to treatment. This decreases powerlessness over the symptoms and helps instill a sense of hope. It also helps the patient to understand how relaxation, breathing exercises, and imagery can be helpful in symptom reduction. The goal of treatment for posttraumatic stress disorder is to come to terms with the event so treatment efforts would not include repression of memories or numbing. Triggering flashbacks would increase patient distress.

2. Four teenagers died in an automobile accident. One week later, which behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who: a. visit their teenagers grave daily. b. return immediately to employment. c. discuss the accident within the family only. d. create a scholarship fund at their childs high school.

ANS: D Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest-risk situations for maladaptive grieving. The parents who create a scholarship fund are openly expressing their feelings and memorializing their child. The other parents in this question are isolating themselves and/or denying their feelings. Visiting the grave daily shows active continued mourning but is not as strongly indicative of resilience as the correct response.

3. After the sudden death of his wife, a man says, I cant live without hershe was my whole life.

Select the nurses most therapeutic reply.

a. Each day will get a little better. b. Her death is a terrible loss for you. c. Its important to recognize that she is no longer suffering. d. Your friends will help you cope with this change in your life.

ANS: B Adjustment disorders may be associated with grief. A statement that validates a bereaved persons loss is more helpful than false reassurances and clichs. It signifies understanding.

4. A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, If you had given him your undivided attention, he would still be alive. How should the nurse analyze this behavior? a. The comment suggests potential allegations of malpractice. b. In some cultures, grief is expressed solely through anger. c. Anger is an expected emotion in an adjustment disorder. d. The patient had ambivalent feelings about her husband.

ANS: C Symptoms of adjustment disorder run the gamut of all forms of distress including guilt, depression, and anger. Anger may protect the bereaved from facing the devastating reality of loss.

5. A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him, He would still be alive if you had given him your undivided attention. Select the nurses best intervention. a. Say to the wife, I understand you are feeling upset. I will stay with you until your family comes. b. Say to the wife, Your husbands heart was so severely damaged that it could no longer pump. c. Say to the wife, I will call the health care provider to discuss this matter with you.

d. Hold the wifes hand in silence until the family arrives.

ANS: A The nurse builds trust and shows compassion in the face of adjustment disorders. Therapeutic responses provide comfort. The nurse should show patience and tact while offering sympathy and warmth. The distracters are defensive, evasive, or placating.

6. A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the childs parents have adapted to their loss? The parents: a. visit their childs grave daily. b. maintain their childs room as the child left it 2 years ago. c. keep a place set for the dead child at the family dinner table. d. throw flowers on the lake at each anniversary date of the accident.

ANS: D Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest-risk situations for an adjustment disorder and maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the accident are openly expressing their feelings. The other behaviors are maladaptive because of isolating themselves and/or denying their feelings. After 2 years, the frequency of visiting the grave should have decreased.

7. A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurses most therapeutic response. a. Are you taking your medications the way they are prescribed? b. This loss is harder to accept because of your mental illness. Do you think you should be hospitalized? c. Im worried about how much you are crying. Your grief over your husbands death has gone on too long.

d. The unexpected death of your husband is very painful. Im glad you are able to talk about your feelings.

ANS: D The patient is expressing feelings related to the loss, and this is an expected and healthy behavior. This patient is at risk for a maladaptive response because of the history of a serious mental illness, but the nurses priority intervention is to form a therapeutic alliance and support the patients expression of feelings. Crying at 2 weeks after his death is expected and normal.

8. Which scenario demonstrates a dissociative fugue? a. After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing. b. A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them. c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of blackouts despite not drinking. d. A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller.

ANS: A The patient in a dissociative fugue state relocates and lacks recall of his life before the fugue began. Often fugue states follow traumatic experiences and sometimes involve assuming a new identity. Such persons at some point find themselves in their new surroundings, unable to recall who they are or how they got there. A feeling of detachment from ones body or from the external reality is an indication of depersonalization disorder. Losing track of several minutes when highly anxious is not an indication of a dissociative disorder and is common in states of elevated anxiety. Finding evidence of having bought clothes or gone to restaurants without any explanation for these is suggestive of dissociative identity disorder, particularly when periods are lost to the patient (blackouts). See relationship to audience response question.

9. The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is:

a. risk for self-harm.

c. memory impairment.

b. cognitive function.

d. condition of self-esteem.

ANS: A Assessments that relate to patient safety take priority. Patients with dissociative disorders may be at risk for suicide or self-mutilation, so the nurse must be alert for indicators of risk for selfinjury. The other options are important assessments but rank below safety. Treatment motivation, while an important consideration, is not necessarily a part of the nursing assessment.

10. A patient states, I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school. This scenario is most suggestive of which health problem? a. Acute stress disorder b. Dissociative amnesia c. Depersonalization disorder d. Disinhibited social engagement disorder ANS: C Depersonalization disorder involves a persistent or recurrent experience of feeling detached from and outside oneself. Although reality testing is intact, the experience causes significant impairment in social or occupational functioning and distress to the individual. Dissociative amnesia involves memory loss. Children with disinhibited social engagement disorder demonstrate no normal fear of strangers and are unusually willing to go off with strangers.

Individuals with ASD experience three or more dissociative symptoms associated with a traumatic event, such as a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization or dissociative amnesia. In the scenario, the patient experiences only one symptom.

11. The unlicensed assistive personnel (UAP) says to the nurse, That patient with amnesia looks fine, but when I talk to her, she seems vague. What should I be doing for her? Select the nurses best reply.

a. Spend as much time with her as you can and ask questions about her life. b. Use short, simple sentences and keep the environment calm and protective. c. Provide more information about her past to reduce the mysteries that are causing anxiety. d. Structure her time with activities to keep her busy, stimulated, and regaining concentration.

ANS: B Disruptions in ability to perform activities of daily living, confusion, and anxiety are often apparent in patients with amnesia. Offering simple directions to promote activities of daily living and reduce confusion helps increase feelings of safety and security. A calm, secure, predictable, protective environment is also helpful when a person is dealing with a great deal of uncertainty.

Recollection of memories should proceed at its own pace, and the patient should only gradually be given information about her past. Asking questions that require recall that the patient does not possess will only add frustration. Quiet, undemanding activities should be provided as the patient tolerates them and should be balanced with rest periods; the patients time should not be loaded with demanding or stimulating activities.

12. A patient diagnosed with depersonalization disorder tells the nurse, Its starting again. I feel as though Im going to float away. Which intervention would be most appropriate at this point? a. Notify the health care provider of this change in the patients behavior. b. Engage the patient in a physical activity such as exercise. c. Isolate the patient until the sensation has diminished. d. Administer a PRN dose of anti-anxiety medication.

ANS: B Helping the patient apply a grounding technique, such as exercise, assists the patient to interrupt the dissociative process. Medication can help reduce anxiety but does not directly interrupt the dissociative process. Isolation would allow the sensation to overpower the patient. It is not necessary to notify the health care provider.

13. A person runs from a crowded nightclub after a pyrotechnics show causes the building to catch fire. Which division of the autonomic nervous system will be stimulated in response to this experience? a. Limbic system

c. Sympathetic nervous system

b. Peripheral nervous system

d. Parasympathetic nervous system

ANS: C The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person would experience stress associated with the experience of being in danger. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system.

14. The gas pedal on a persons car stuck on a busy interstate highway, causing the car to accelerate rapidly. For 20 minutes, the car was very difficult to control. Afterward, this persons cortisol regulation was compromised. Which assessment finding would the nurse expect associated with the dysregulation of cortisol? a. Weight gain

c. Headache

b. Flashbacks

d. Diuresis

ANS: B Cortisol is a hormone released in response to stress. Severe dissociation or mindflight occurs for those who have suffered significant trauma. The episodic failure of dissociation causes intrusive symptoms such as flashbacks, thus dysregulating cortisol. The cortisol level may go up or down, so diuresis and/or weight gain may or may not occur. Answering this question correctly requires that the student apply prior learning regarding the effects of cortisol.

15. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with posttraumatic stress disorder (PTSD). The nurses highest priority is to screen this soldier for:

a. bipolar disorder.

c. depression.

b. schizophrenia.

d. dementia.

ANS: C Comorbidities for adults with PTSD include depression, anxiety disorders, sleep disorders, and dissociative disorders. Incidence of the disorders identified in the distracters is similar to the general population.

16. Two weeks ago, a soldier returned to the U.S. from active duty in a combat zone in Afghanistan. The soldier was diagnosed with posttraumatic stress disorder (PTSD). Which comment by the soldier requires the nurses immediate attention? a. Its good to be home. I missed my home, family, and friends. b. I saw my best friend get killed by a roadside bomb. I dont understand why it wasnt me. c. Sometimes I think I hear bombs exploding, but its just the noise of traffic in my hometown. d. I want to continue my education, but Im not sure how I will fit in with other college students.

ANS: B The correct response indicates the soldier is thinking about death and feeling survivors guilt.

These emotions may accompany suicidal ideation, which warrants the nurses follow-up assessment. Suicide is a high risk among military personnel diagnosed with posttraumatic stress disorder. One distracter indicates flashbacks, common with persons with PTSD, but not solely indicative that further problems exist. The other distracters are normal emotions associated with returning home and change.

17. A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). The soldier says, If theres a loud noise at night, I get under my bed because I think were getting bombed. What type of experience has the soldier described?

a. Illusion

c. Nightmare

b. Flashback

d. Auditory hallucination

ANS: B Flashbacks are dissociative reactions in which an individual feels or acts as if the traumatic event were recurring. Illusions are misinterpretations of stimuli, and although the experience is similar, it is better termed a flashback because of the diagnosis of PTSD. Auditory hallucinations have no external stimuli. Nightmares commonly accompany PTSD, but this experience was stimulated by an actual environmental sound.

18. A soldier returned 3 months ago from Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). Which social event would be most disturbing for this soldier? a. Halloween festival with neighborhood children b. Singing carols around a Christmas tree c. A family outing to the seashore d. Fireworks display on July 4th ANS: D The exploding noises associated with fireworks are likely to provoke exaggerated responses for this soldier. The distracters are not associated with offensive sounds.

19. A soldier served in combat zones in Iraq during 2010 and was deployed to Afghanistan in 2013. When is it most important for the nurse to screen for signs and symptoms of posttraumatic stress disorder (PTSD)? a. Immediately upon return to the U.S. from Afghanistan b. Before departing Afghanistan to return to the U.S. c. One year after returning from Afghanistan d. Screening should be on-going ANS: D

20. A soldier in a combat zone tells the nurse, I saw a child get blown up over a year ago, and I still keep seeing bits of flesh everywhere. I see something red, and the visions race back to my mind. Which phenomenon associated with posttraumatic stress disorder (PTSD) is the soldier describing? a. Reexperiencing

c. Avoidance

b. Hyperarousal

d. Psychosis

ANS: A Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events are often associated with PTSD. The soldier has described intrusive thoughts and visions associated with reexperiencing the traumatic event. This description does not indicate psychosis, hypervigilance, or avoidance.

21. A soldier who served in a combat zone returned to the U.S. The soldiers spouse complains to the nurse, We had planned to start a family, but now he wont talk about it. He wont even look at children. The spouse is describing which symptom associated with posttraumatic stress disorder (PTSD)? a. Reexperiencing

c. Avoidance

b. Hyperarousal

d. Psychosis

ANS: C Physiological reactions to reminders of the event that include persistent avoidance of stimuli associated with the trauma results in the individuals avoiding talking about the event or avoiding activities, people, or places that arouse memories of the trauma. Avoidance is exemplified by a sense of foreshortened future and estrangement. There is no evidence this soldier is having hyperarousal or reexperiencing war-related traumas. Psychosis is not evident.

22. A soldier returned home last year after deployment to a war zone. The soldiers spouse complains, We were going to start a family, but now he wont talk about it. He will not look at children. I wonder if were going to make it as a couple. Select the nurses best response.

a. Posttraumatic stress disorder often changes a persons sexual functioning. b. I encourage you to continue to participate in social activities where children are present. c. Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior. d. Posttraumatic stress disorder often strains relationships. Here are some community resources for help and support.

ANS: D Posttraumatic stress disorder precipitates changes that often lead to divorce. Its important to provide support to both the veteran and spouse. Confrontation will not be effective. While its important to provide information, on-going support will be more effective.

23. Which assessment finding best supports dissociative fugue? The patient states: a. I cannot recall why Im living in this town. b. I feel as if Im living in a fuzzy dream state. c. I feel like different parts of my body are at war. d. I feel very anxious and worried about my problems.

ANS: A The patient in a fugue state frequently relocates and assumes a new identity while not recalling previous identity or places previously inhabited. The distracters are more consistent with depersonalization disorder, generalized anxiety disorder, or dissociative identity disorder. See relationship to audience response question.

24. After major reconstructive surgery, a patients wounds dehisced. Extensive wound care was required for 6 months, causing the patient to miss work and social activities. Which pathophysiology would be expected for this patient? Dysfunction of the: a. pons.

c. hippocampus.

b. occipital lobe.

d. hypothalamus.

ANS: C The scenario presents chronic and potentially debilitating stress. If arousal continues unabated, neuronal changes occur that alter the neural circuitry of the prefrontal cortex, reducing the size the hippocampus so that memory is impaired.

25. Relaxation techniques help patients who have experienced major traumas because they: a. engage the parasympathetic nervous system. b. increase sympathetic stimulation. c. increase the metabolic rate. d. release hormones.

ANS: A In response to trauma, the sympathetic arousal symptoms of rapid heart rate and rapid respiration prepare the person for flight or fight responses. Afterward, the dorsal vagal response damps down the sympathetic nervous system. This is a parasympathetic response with the heart rate and respiration slowing down and decreasing the blood pressure. Relaxation techniques promote activity of the parasympathetic nervous system.

26. Select the correct etiology to complete this nursing diagnosis for a patient with dissociative identity disorder. Disturbed personal identity related to: a. obsessive fears of harming self or others. b. poor impulse control and lack of self-confidence. c. depressed mood secondary to nightmares and intrusive thoughts. d. cognitive distortions associated with unresolved childhood abuse issues.

ANS: D Nearly all patients with dissociative identity disorder have a history of childhood abuse or trauma. None of the other etiology statements is relevant. See relationship to audience response question.

MULTIPLE RESPONSE 1. A young adult says, I was sexually abused by my older brother. During those assaults, I went somewhere else in my mind. I dont remember the details. Now, I often feel numb or unreal in romantic relationships, so I just avoid them. Which disorders should the nurse suspect based on this history? Select all that apply. a. Acute stress disorder b. Depersonalization disorder c. Generalized anxiety disorder d. Posttraumatic stress disorder e. Reactive attachment disorder f. Disinhibited social engagement disorder ANS: A, B, D Acute stress disorder, depersonalization disorder, and posttraumatic stress disorder can involve dissociative elements, such as numbing, feeling unreal, and being amnesic for traumatic events.

All three disorders are also responses to acute stress or trauma, which has occurred here. The distracters are disorders not evident in this patients presentation. Generalized anxiety disorder involves extensive worrying that is disproportionate to the stressors or foci of the worrying.

Reactive attachment disorder and disinhibited social engagement disorder are problems of childhood.

2. A 10-year-old child was placed in a foster home after being removed from parental contact because of abuse. The child has apprehension, tremulousness, and impaired concentration. The foster parent also reports the child has an upset stomach, urinates frequently, and does not understand what has happened. What helpful measures should the nurse suggest to the foster parents? The nurse should recommend: (select all that apply) a. conveying empathy and acknowledging the childs distress. b. explaining and reinforcing reality to avoid distortions. c. using a calm manner and low, comforting voice.

d. avoiding repetition in what is said to the child. e. staying with the child until the anxiety decreases. f. minimizing opportunities for exercise and play.

ANS: A, B, C, E The childs symptoms and behavior suggest that he is exhibiting posttraumatic stress disorder.

Interventions appropriate for this level of anxiety include using a calm, reassuring tone, acknowledging the childs distress, repeating content as needed when there is impaired cognitive processing and memory, providing opportunities for comforting and normalizing play and physical activities, correcting any distortion of reality, and staying with the child to increase his sense of security.

3. The nurse interviewing a patient with suspected posttraumatic stress disorder should be alert to findings indicating the patient: (select all that apply) a. avoids people and places that arouse painful memories. b. experiences flashbacks or reexperiences the trauma. c. experiences symptoms suggestive of a heart attack. d. feels driven to repeat selected ritualistic behaviors. e. demonstrates hypervigilance or distrusts others. f. feels detached, estranged, or empty inside.

ANS: A, B, C, E, F These assessment findings are consistent with the symptoms of posttraumatic stress disorder.

Ritualistic behaviors are expected in obsessive-compulsive disorder.

4. Which experiences are most likely to precipitate posttraumatic stress disorder (PTSD)? Select all that apply. a. A young adult bungee jumped from a bridge with a best friend. b. An 8-year-old child watched an R-rated movie with both parents.

c. An adolescent was kidnapped and held for 2 years in the home of a sexual predator. d. A passenger was in a bus that overturned on a sharp curve and tumbled down an embankment. e. An adult was trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.

ANS: C, D, E PTSD usually occurs after a traumatic event that is outside the range of usual experience.

Examples are childhood physical abuse, torture/kidnap, military combat, sexual assault, and natural disasters, such as floods, tornados, earthquakes, tsunamis; human disasters, such as a bus or elevator accident; or crime-related events, such being taken hostage. The common element in these experiences is the individuals extraordinary helplessness or powerlessness in the face of such stressors. Bungee jumps by adolescents are part of the developmental task and might be frightening, but in an exhilarating way rather than a harmful way. A child may be disturbed by an R-rated movie, but the presence of the parents would modify the experience in a positive way.

Chapter 15. Psychopharmacotherapy and Psychotherapy Question 1 Type: MCMA Which of the following is part of the ongoing nursing assessments of the client on psychiatric medications?

Standard Text: Select all that apply.

1. How well the medication is managing the clients symptoms 2. The clients cultural belief system related to illness and medication 3. Whether the medication is causing side effects

4. The clients favorite activities 5. The clients readiness to learn Correct Answer: 1,2,3,5 Rationale 1: How well the medication is managing the clients symptoms. The nurse must assess how effective the medication is in terms of managing the symptoms of the clients illness.

Rationale 2: The clients cultural belief system related to illness and medication. A clients cultural belief system related to taking medications for behavioral symptoms may impact the clients willingness to take medications.

Rationale 3: Whether the medication is causing side effects. If a client is having a distressing side effect, the client may not adhere to the medication treatment regimen.

Rationale 4: The clients favorite activities. The clients favorite activities are not directly related to taking medications.

Rationale 5: The clients readiness to learn. Ongoing education is vital for adhering to medications and clients readiness to learn fluctuates throughout the course of the illness.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Assess the effectiveness of medications in psychiatricmental health settings.

Question 2

Type: MCSA Which of the following questions would the nurse ask a woman to assess for hyperprolactinemia as a side effect of an antipsychotic medication?

1. Are you having trouble sitting still?

2. Are you constipated?

3. Are you having any discharge from your breasts?

4. Do you have a dry mouth?

Correct Answer: 3 Rationale 1: Galactorrhea is a symptom of hyperprolactinemia. The inability to sit still could be a sign of akathisia. A dry mouth and constipation are often due to anticholinergic side effects.

Rationale 2: Galactorrhea is a symptom of hyperprolactinemia. The inability to sit still could be a sign of akathisia. A dry mouth and constipation are often due to anticholinergic side effects.

Rationale 3: Galactorrhea is a symptom of hyperprolactinemia. The inability to sit still could be a sign of akathisia. A dry mouth and constipation are often due to anticholinergic side effects.

Rationale 4: Galactorrhea is a symptom of hyperprolactinemia. The inability to sit still could be a sign of akathisia. A dry mouth and constipation are often due to anticholinergic side effects.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Assess the effectiveness of medications in psychiatricmental health settings.

Question 3 Type: MCSA Which of the following is a priority assessment for a child in the initial stages of antidepressant treatment?

1. School successes 2. Food preferences 3. Suicide assessment 4. Family functioning Correct Answer: 3 Rationale 1: Children, adolescents, and young adults are at risk for suicidal behaviors early in the treatment with antidepressants. Family functioning, school successes, and eating are important assessments, but not as important as assessing for lethality/suicidality.

Rationale 2: Children, adolescents, and young adults are at risk for suicidal behaviors early in the treatment with antidepressants. Family functioning, school successes, and eating are important assessments, but not as important as assessing for lethality/suicidality.

Rationale 3: Children, adolescents, and young adults are at risk for suicidal behaviors early in the treatment with antidepressants. Family functioning, school successes, and eating are important assessments, but not as important as assessing for lethality/suicidality.

Rationale 4: Children, adolescents, and young adults are at risk for suicidal behaviors early in the treatment with antidepressants. Family functioning, school successes, and eating are important assessments, but not as important as assessing for lethality/suicidality.

Global Rationale:

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Assess the effectiveness of medications in psychiatricmental health settings.

Question 4 Type: MCSA The nurse would be alert to assess for signs of lithium toxicity in a patient with which of the following lithium levels?

1. 1.5 mEq/l 2. 0.1 mEq/l 3. 0.5 mEq/l 4. 1.0 mEq/l Correct Answer: 1 Rationale 1: Significant side effects are often present in clients with a lithium level above 1.2 mEq/l.

Rationale 2: Significant side effects are often present in clients with a lithium level above 1.2 mEq/l.

Rationale 3: Significant side effects are often present in clients with a lithium level above 1.2 mEq/l.

Rationale 4: Significant side effects are often present in clients with a lithium level above 1.2 mEq/l.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Assess the effectiveness of medications in psychiatricmental health settings.

Question 5 Type: MCSA The nurse would assess which of the following as early signs of lithium poisoning?

1. Elevated blood pressure, paralysis, and impulsivity 2. Cardiac arrest, seizures, and change in level of consciousness 3. Vomiting, diarrhea, lethargy, and muscle twitching 4. Hallucinations, agitation, and anger Correct Answer: 3 Rationale 1: Vomiting, diarrhea, lethargy, and muscle twitching are early signs of lithium poisoning. Cardiac arrest, seizures, and change in level of consciousness are late and life threatening signs that could be avoided if the early signs are recognized. The combination of hallucinations, agitation, anger, elevated blood pressure, paralysis, and impulsivity are not early signs of lithium toxicity.

Rationale 2: Vomiting, diarrhea, lethargy, and muscle twitching are early signs of lithium poisoning. Cardiac arrest, seizures, and change in level of consciousness are late and life threatening signs that could be avoided if the early signs are recognized. The combination of hallucinations, agitation, anger, elevated blood pressure, paralysis, and impulsivity are not early signs of lithium toxicity.

Rationale 3: Vomiting, diarrhea, lethargy, and muscle twitching are early signs of lithium poisoning. Cardiac arrest, seizures, and change in level of consciousness are late and life threatening signs that could be avoided if the early signs are recognized. The combination of hallucinations, agitation, anger, elevated blood pressure, paralysis, and impulsivity are not early signs of lithium toxicity.

Rationale 4: Vomiting, diarrhea, lethargy, and muscle twitching are early signs of lithium poisoning. Cardiac arrest, seizures, and change in level of consciousness are late and life threatening signs that could be avoided if the early signs are recognized. The combination of hallucinations, agitation, anger, elevated blood pressure, paralysis, and impulsivity are not early signs of lithium toxicity.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Assess the effectiveness of medications in psychiatricmental health settings.

Question 6 Type: MCSA

Which of the following medications carries the highest risk of QTc prolongation and, therefore, the need to monitor cardiac side effects most carefully?

1. Thioridazine (Mellaril) 2. Risperidone (Risperdal) 3. Quetiapine (Seroquel) 4. Olanzapine (Zyprexa) Correct Answer: 1 Rationale 1: Thioridazine has an FDA black box warning to call attention to the risk of QTc prolongation. The other antipsychotics listed do not carry this warning.

Rationale 2: Thioridazine has an FDA black box warning to call attention to the risk of QTc prolongation. The other antipsychotics listed do not carry this warning.

Rationale 3: Thioridazine has an FDA black box warning to call attention to the risk of QTc prolongation. The other antipsychotics listed do not carry this warning.

Rationale 4: Thioridazine has an FDA black box warning to call attention to the risk of QTc prolongation. The other antipsychotics listed do not carry this warning.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Integrate an understanding of the positive and negative effects of psychiatric medications into pharmacological treatment.

Question 7 Type: MCSA Which of the following client behaviors would indicate a need for further intervention in the anxious patient on a benzodiazepine?

1. The client asking to be taken off the medication gradually 2. The client relying more on coping skills and taking less medication 3. The client inquiring about behavior methods for anxiety control 4. The client requesting a higher dose of drug to achieve the intended effect Correct Answer: 4 Rationale 1: Requesting higher doses of a benzodiazepine can be a sign of tolerance and addiction. The other responses are actually signs of relying less on the medication and more on coping strategies and are positive signs.

Rationale 2: Requesting higher doses of a benzodiazepine can be a sign of tolerance and addiction. The other responses are actually signs of relying less on the medication and more on coping strategies and are positive signs.

Rationale 3: Requesting higher doses of a benzodiazepine can be a sign of tolerance and addiction. The other responses are actually signs of relying less on the medication and more on coping strategies and are positive signs.

Rationale 4: Requesting higher doses of a benzodiazepine can be a sign of tolerance and addiction. The other responses are actually signs of relying less on the medication and more on coping strategies and are positive signs.

Global Rationale: Cognitive Level: Analyzing

Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Integrate an understanding of the positive and negative effects of psychiatric medications into pharmacological treatment.

Question 8 Type: MCSA The client received aripiprazole (Abilify) on admission to the inpatient unit with a diagnosis of schizophrenia, paranoid type. Which of the following would the nurse note as a sign that the aripiprazole is becoming effective?

1. The client paces in the hall and engages in solitary activities most of the day.

2. The client sleeps for shorter periods of time during the day.

3. The client establishes eye contact and remains in conversation with the nurse for longer periods.

4. The client eats only the food that is in its original container such as individual packages of crackers.

Correct Answer: 3 Rationale 1: Because suspiciousness is a central feature of paranoid delusions, efficacy is shown by the client demonstrating behaviors that suggest increasing trust in the nurse. Sleeping less during the day is not a sign that aripiprazole is alleviating psychotic symptoms. Engaging in solitary activities and eating prepackaged food are signs of paranoia.

Rationale 2: Because suspiciousness is a central feature of paranoid delusions, efficacy is shown by the client demonstrating behaviors that suggest increasing trust in the nurse. Sleeping less

during the day is not a sign that aripiprazole is alleviating psychotic symptoms. Engaging in solitary activities and eating prepackaged food are signs of paranoia.

Rationale 3: Because suspiciousness is a central feature of paranoid delusions, efficacy is shown by the client demonstrating behaviors that suggest increasing trust in the nurse. Sleeping less during the day is not a sign that aripiprazole is alleviating psychotic symptoms. Engaging in solitary activities and eating prepackaged food are signs of paranoia.

Rationale 4: Because suspiciousness is a central feature of paranoid delusions, efficacy is shown by the client demonstrating behaviors that suggest increasing trust in the nurse. Sleeping less during the day is not a sign that aripiprazole is alleviating psychotic symptoms. Engaging in solitary activities and eating prepackaged food are signs of paranoia.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Integrate an understanding of the positive and negative effects of psychiatric medications into pharmacological treatment.

Question 9 Type: MCSA Which of the following is an indication that the client understands the teaching related to buspirone (BuSpar)?

1. I will not drink grapefruit juice while taking this medication.

2. I should sleep though the night on this medication.

3. I should feel a relief of anxiety within a half hour.

4. I will not hear voices after being on this medication for two weeks.

Correct Answer: 1 Rationale 1: When taken with grapefruit juice, buspirone levels can be raised to nine times the normal level. Buspirone takes up to two weeks to show efficacy for anxiety control and is not a sedative. Buspirone is an antianxiety agent and does not impact auditory hallucinations.

Rationale 2: When taken with grapefruit juice, buspirone levels can be raised to nine times the normal level. Buspirone takes up to two weeks to show efficacy for anxiety control and is not a sedative. Buspirone is an antianxiety agent and does not impact auditory hallucinations.

Rationale 3: When taken with grapefruit juice, buspirone levels can be raised to nine times the normal level. Buspirone takes up to two weeks to show efficacy for anxiety control and is not a sedative. Buspirone is an antianxiety agent and does not impact auditory hallucinations.

Rationale 4: When taken with grapefruit juice, buspirone levels can be raised to nine times the normal level. Buspirone takes up to two weeks to show efficacy for anxiety control and is not a sedative. Buspirone is an antianxiety agent and does not impact auditory hallucinations.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Integrate an understanding of the positive and negative effects of psychiatric medications into pharmacological treatment.

Question 10

Type: MCSA Which of the following would indicate to the nurse that fluoxetine (Prozac) is effective for the client with major depressive disorder?

1. The client remained up all night discussing negative life situations with the nursing staff.

2. The client ate 100% of breakfast and lunch and ate 25% of the evening meal the past two days.

3. The client remained in the room reading and watching listening to music 90% of the day.

4. The client slept 60% of the night while remaining in bed from 11 p.m. to 5 a.m.

Correct Answer: 2 Rationale 1: An improvement in appetite is a sign of an improvement in a symptom of major depressive disorder. Ruminating on negative life events, not sleeping, and isolating are symptoms of depression and do not show an improvement from the medication.

Rationale 2: An improvement in appetite is a sign of an improvement in a symptom of major depressive disorder. Ruminating on negative life events, not sleeping, and isolating are symptoms of depression and do not show an improvement from the medication.

Rationale 3: An improvement in appetite is a sign of an improvement in a symptom of major depressive disorder. Ruminating on negative life events, not sleeping, and isolating are symptoms of depression and do not show an improvement from the medication.

Rationale 4: An improvement in appetite is a sign of an improvement in a symptom of major depressive disorder. Ruminating on negative life events, not sleeping, and isolating are symptoms of depression and do not show an improvement from the medication.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Integrate an understanding of the positive and negative effects of psychiatric medications into pharmacological treatment.

Question 11 Type: MCSA The nurse instructs the clients to take the medications that are prescribed because the psychiatrist knows what is best for the client. How would the nurses supervisor evaluate the effectiveness of the nurses teaching?

1. The nurse is demonstrating a paternalistic attitude that may contribute to client nonadherence.

2. Teaching the client to take all medications should help keep the client out of the hospital.

3. The nurse is helping the client develop trust in the psychiatrist.

4. The nurse is giving simple instructions that will be readily accepted by the client.

Correct Answer: 1 Rationale 1: In order to promote adherence, the nurse should partner with the client and the clients family. Telling the client that someone else knows what is best for the client is paternalistic and interferes with partnering with clients. Although the nurses statement is simple, it is not one that is readily accepted by clients. One develops trust through actions, not by telling someone to trust.

Rationale 2: In order to promote adherence, the nurse should partner with the client and the clients family. Telling the client that someone else knows what is best for the client is paternalistic and interferes with partnering with clients. Although the nurses statement is simple, it is not one that is readily accepted by clients. One develops trust through actions, not by telling someone to trust.

Rationale 3: In order to promote adherence, the nurse should partner with the client and the clients family. Telling the client that someone else knows what is best for the client is paternalistic and interferes with partnering with clients. Although the nurses statement is simple, it is not one that is readily accepted by clients. One develops trust through actions, not by telling someone to trust.

Rationale 4: In order to promote adherence, the nurse should partner with the client and the clients family. Telling the client that someone else knows what is best for the client is paternalistic and interferes with partnering with clients. Although the nurses statement is simple, it is not one that is readily accepted by clients. One develops trust through actions, not by telling someone to trust.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Incorporate the different perspectives clients have about pharmacology into treatment regimens.

Question 12 Type: MCSA The client tells the nurse that their spouse does not believe that medications are needed to improve depression. What nursing response would be most helpful in improving the clients medication adherence?

1. Suggest that the spouses views are not important 2. Ask the client to consider marriage counseling

3. Tell the client to ignore the spouse 4. Include the spouse in medication teaching Correct Answer: 4 Rationale 1: Lack of support from significant others can contribute to medication nonadherence.

Partnering with the family may help the family to be supportive. It is difficult to ignore ones spouse, and there is no evidence that marriage counseling is needed at this point. Usually the views of ones significant others are important.

Rationale 2: Lack of support from significant others can contribute to medication nonadherence.

Partnering with the family may help the family to be supportive. It is difficult to ignore ones spouse, and there is no evidence that marriage counseling is needed at this point. Usually the views of ones significant others are important.

Rationale 3: Lack of support from significant others can contribute to medication nonadherence.

Partnering with the family may help the family to be supportive. It is difficult to ignore ones spouse, and there is no evidence that marriage counseling is needed at this point. Usually the views of ones significant others are important.

Rationale 4: Lack of support from significant others can contribute to medication nonadherence.

Partnering with the family may help the family to be supportive. It is difficult to ignore ones spouse, and there is no evidence that marriage counseling is needed at this point. Usually the views of ones significant others are important.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate the different perspectives clients have about pharmacology into treatment regimens.

Question 13 Type: MCSA What is the primary rationale for the nurse asking a client on antidepressant medication about changes in sexual functioning?

1. Antidepressants used frequently contributes to sexual promiscuity and tragic regrets.

2. A side effect of antidepressants may be sexual dysfunction that contributes to nonadherence.

3. Cultural attitudes about sexual functioning may impact the effectiveness of the antidepressant medication.

4. A lack of libido is a symptom of depression that may interfere with the clients relationships.

Correct Answer: 2 Rationale 1: Sexual dysfunctions are frequent side effects of antidepressants and the client may be too embarrassed to initiate this discussion and quit taking the medication. Even though loss of libido may be a symptom of depression, it does not address the issue of the medication side effect. Cultural attitudes about sexual functioning are not directly related to the question.

Antidepressants do not frequently contribute to sexual promiscuity when given to a person with a depressive disorder.

Rationale 2: Sexual dysfunctions are frequent side effects of antidepressants and the client may be too embarrassed to initiate this discussion and quit taking the medication. Even though loss of libido may be a symptom of depression, it does not address the issue of the medication side effect. Cultural attitudes about sexual functioning are not directly related to the question.

Antidepressants do not frequently contribute to sexual promiscuity when given to a person with a depressive disorder.

Rationale 3: Sexual dysfunctions are frequent side effects of antidepressants and the client may be too embarrassed to initiate this discussion and quit taking the medication. Even though loss of libido may be a symptom of depression, it does not address the issue of the medication side effect. Cultural attitudes about sexual functioning are not directly related to the question.

Antidepressants do not frequently contribute to sexual promiscuity when given to a person with a depressive disorder.

Rationale 4: Sexual dysfunctions are frequent side effects of antidepressants and the client may be too embarrassed to initiate this discussion and quit taking the medication. Even though loss of libido may be a symptom of depression, it does not address the issue of the medication side effect. Cultural attitudes about sexual functioning are not directly related to the question.

Antidepressants do not frequently contribute to sexual promiscuity when given to a person with a depressive disorder.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate the different perspectives clients have about pharmacology into treatment regimens.

Question 14 Type: MCSA The nurse tells a psychotic client with alcohol dependence not to drink while taking the antipsychotic medication. How would the nurses supervisor evaluate this teaching statement?

1. There is no reason why the client cannot have one or two drinks per day.

2. It is not possible for a client with a psychotic disorder to be successful in staying sober.

3. It is a correct statement that should motivate the client to quit drinking.

4. Without treatment for the alcohol dependence, the client will be more likely to not take the medication.

Correct Answer: 4 Rationale 1: The alcohol dependence must be a part of the clients treatment plan or the client will likely not take the medication. Telling a client not to drink does not provide enough motivation to quit drinking. A person with alcohol dependence should not drink one or two drinks per day. It is possible for a client with a psychotic disorder to be successful at staying sober.

Rationale 2: The alcohol dependence must be a part of the clients treatment plan or the client will likely not take the medication. Telling a client not to drink does not provide enough motivation to quit drinking. A person with alcohol dependence should not drink one or two drinks per day. It is possible for a client with a psychotic disorder to be successful at staying sober.

Rationale 3: The alcohol dependence must be a part of the clients treatment plan or the client will likely not take the medication. Telling a client not to drink does not provide enough motivation to quit drinking. A person with alcohol dependence should not drink one or two drinks per day. It is possible for a client with a psychotic disorder to be successful at staying sober.

Rationale 4: The alcohol dependence must be a part of the clients treatment plan or the client will likely not take the medication. Telling a client not to drink does not provide enough motivation to quit drinking. A person with alcohol dependence should not drink one or two drinks per day. It is possible for a client with a psychotic disorder to be successful at staying sober.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Incorporate the different perspectives clients have about pharmacology into treatment regimens.

Question 15 Type: MCSA The nurse knows that the client did not adhere to a medication plan in the past due to severe side effects. What information would be most important to include in the clients teaching?

1. The need to monitor all body changes on a continuous basis 2. Hopefulness about managing side effects 3. Reassurance that side effects will not occur 4. A detailed explanation of all potential side effects Correct Answer: 2 Rationale 1: Side effects can be managed successfully and clients need to feel hopeful about their ability to work with the health care team in doing this. Although the client needs to know about potential side effects, the client should not be given only frightening information. Some side effects are a real possibility, and the nurse should not give false reassurance.

Rationale 2: Side effects can be managed successfully and clients need to feel hopeful about their ability to work with the health care team in doing this. Although the client needs to know about potential side effects, the client should not be given only frightening information. Some side effects are a real possibility, and the nurse should not give false reassurance.

Rationale 3: Side effects can be managed successfully and clients need to feel hopeful about their ability to work with the health care team in doing this. Although the client needs to know

about potential side effects, the client should not be given only frightening information. Some side effects are a real possibility, and the nurse should not give false reassurance.

Rationale 4: Side effects can be managed successfully and clients need to feel hopeful about their ability to work with the health care team in doing this. Although the client needs to know about potential side effects, the client should not be given only frightening information. Some side effects are a real possibility, and the nurse should not give false reassurance.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate the different perspectives clients have about pharmacology into treatment regimens.

Question 16 Type: MCSA A family member says to the nurse, I think my sister needs more medication because she says she cannot sit still and is moving her legs back and forth. The clients risperidone (Risperdal) was recently increased to 10 mg daily. What is the correct nursing response?

1. I will check with your sister because what you are describing sounds like a side effect called akathisia.

2. I will check to see what your sister has been prescribed because some clients get anxious when their medications are increased.

3. I will see if your sister has been prescribed a medication to counteract the dystonic reaction that she is having.

4. I will call the doctor and report that your sister is developing a tolerance to risperidone and the dose is not effective.

Correct Answer: 1 Rationale 1: Akathisia is the inability to sit still for more than a few minutes or the feeling of not being able to sit still. It is a side effect of antipsychotic medication that can be very distressing to the client. The nurse should assess the patient to determine if she has akathisia. It would not be typical for a client to get anxious just because the medications were increased. A dystonia would be an abnormal tonic muscle contraction. Risperidone is not addictive and clients do not develop tolerance to it.

Rationale 2: Akathisia is the inability to sit still for more than a few minutes or the feeling of not being able to sit still. It is a side effect of antipsychotic medication that can be very distressing to the client. The nurse should assess the patient to determine if she has akathisia. It would not be typical for a client to get anxious just because the medications were increased. A dystonia would be an abnormal tonic muscle contraction. Risperidone is not addictive and clients do not develop tolerance to it.

Rationale 3: Akathisia is the inability to sit still for more than a few minutes or the feeling of not being able to sit still. It is a side effect of antipsychotic medication that can be very distressing to the client. The nurse should assess the patient to determine if she has akathisia. It would not be typical for a client to get anxious just because the medications were increased. A dystonia would be an abnormal tonic muscle contraction. Risperidone is not addictive and clients do not develop tolerance to it.

Rationale 4: Akathisia is the inability to sit still for more than a few minutes or the feeling of not being able to sit still. It is a side effect of antipsychotic medication that can be very distressing to the client. The nurse should assess the patient to determine if she has akathisia. It would not be typical for a client to get anxious just because the medications were increased. A dystonia would be an abnormal tonic muscle contraction. Risperidone is not addictive and clients do not develop tolerance to it.

Global Rationale:

Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain acute extrapyramidal side effects to clients and families.

Question 17 Type: MCSA The nurse observes a client on an antipsychotic medication and notes a pill-rolling movement of the fingers and a tremor of the extremities. The nurse documents this as what type of side effect?

1. Drug-induced parkinsonism 2. Dystonia 3. Anticholinergic effect 4. Tardive dyskinesia Correct Answer: 1 Rationale 1: One form of EPSE is drug-induced parkinsonism characterized by tremors, rigidity, and pill-rolling movements of the fingers. Dystonia is an involuntary tonic muscle contraction.

Anticholinergic side effects include blurred vision, dry mouth, urinary retention, and constipation. Tardive dyskinesia is involuntary nonrhythmic movements of the mouth, face, etc.

Rationale 2: One form of EPSE is drug-induced parkinsonism characterized by tremors, rigidity, and pill-rolling movements of the fingers. Dystonia is an involuntary tonic muscle contraction.

Anticholinergic side effects include blurred vision, dry mouth, urinary retention, and constipation. Tardive dyskinesia is involuntary nonrhythmic movements of the mouth, face, etc.

Rationale 3: One form of EPSE is drug-induced parkinsonism characterized by tremors, rigidity, and pill-rolling movements of the fingers. Dystonia is an involuntary tonic muscle contraction.

Anticholinergic side effects include blurred vision, dry mouth, urinary retention, and constipation. Tardive dyskinesia is involuntary nonrhythmic movements of the mouth, face, etc.

Rationale 4: One form of EPSE is drug-induced parkinsonism characterized by tremors, rigidity, and pill-rolling movements of the fingers. Dystonia is an involuntary tonic muscle contraction.

Anticholinergic side effects include blurred vision, dry mouth, urinary retention, and constipation. Tardive dyskinesia is involuntary nonrhythmic movements of the mouth, face, etc.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain acute extrapyramidal side effects to clients and families.

Question 18 Type: MCSA The spouse of a client on an antipsychotic medication asks the nurse why they routinely assess the client for movements, especially around the mouth and extremities. What nursing response is correct?

1. Abnormal involuntary movements can be an irreversible side effect of antipsychotic medications.

2. Antipsychotic medications can lead to this type of dystonia.

3. Abnormal involuntary movements can be easily treated and less annoying to the client.

4. Movements around the mouth herald the approaching medication tolerance that the client is developing.

Correct Answer: 1 Rationale 1: The nurse is assessing for tardive dyskinesia, an arrhythmic, involuntary movement that can be irreversible if not detected early. Antipsychotic medications do not lead to tolerance.

Abnormal involuntary movements are not easily treated. Dystonia is a side effect characterized by muscle spasms.

Rationale 2: The nurse is assessing for tardive dyskinesia, an arrhythmic, involuntary movement that can be irreversible if not detected early. Antipsychotic medications do not lead to tolerance.

Abnormal involuntary movements are not easily treated. Dystonia is a side effect characterized by muscle spasms.

Rationale 3: The nurse is assessing for tardive dyskinesia, an arrhythmic, involuntary movement that can be irreversible if not detected early. Antipsychotic medications do not lead to tolerance.

Abnormal involuntary movements are not easily treated. Dystonia is a side effect characterized by muscle spasms.

Rationale 4: The nurse is assessing for tardive dyskinesia, an arrhythmic, involuntary movement that can be irreversible if not detected early. Antipsychotic medications do not lead to tolerance.

Abnormal involuntary movements are not easily treated. Dystonia is a side effect characterized by muscle spasms.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain acute extrapyramidal side effects to clients and families.

Question 19 Type: MCSA When in the course of treatment with an antipsychotic medication would the nurse be most likely to assess tardive dyskinesia?

1. Within 72 hours of initiation 2. After long-term use 3. Within 48 hours of initiation 4. After three or more weeks of treatment Correct Answer: 2 Rationale 1: Tardive dyskinesia has a late onset during the course of treatment with antipsychotic medications.

Rationale 2: Tardive dyskinesia has a late onset during the course of treatment with antipsychotic medications.

Rationale 3: Tardive dyskinesia has a late onset during the course of treatment with antipsychotic medications.

Rationale 4: Tardive dyskinesia has a late onset during the course of treatment with antipsychotic medications.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Question 20 Type: MCMA Which of the following are extrapyramidal side effects that the nurse would assess as symptoms of dystonia?

Standard Text: Select all that apply.

1. Decreased gastric motility and tachycardia 2. An inability to sit still 3. Forcing the back to arch and the neck to bend backward 4. Pulling the neck down into the shoulders 5. Spasms of the neck and back Correct Answer: 2,3,4,5 Rationale 1: Decreased gastric motility and tachycardia. Decreased gastric motility and tachycardia may occur with a dopamine-acetylcholine imbalance in the extrapyramidal system.

Rationale 2: An inability to sit still. An inability to sit still is akathisia.

Rationale 3: Forcing the back to arch and the neck to bend backward. Forcing the back to arch and the neck to bend backward are examples of dystonia.

Rationale 4: Pulling the neck down into the shoulders. Pulling the neck into the shoulders is a type of dystonia.

Rationale 5: Spasms of the neck and back. Spasms of the neck and back are examples of dystonia.

Global Rationale:

Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explain acute extrapyramidal side effects to clients and families.

Question 21 Type: MCSA The client is taking a medication to help cope with EPSEs but can not remember the name of the medication. The nurse would give the client information about which of the following medications that the client is receiving?

1. Risperidone (Risperdal) 2. Duloxetine (Cymbalta) 3. Loxapine (Loxitane) 4. Benztropine (Cogentin) Correct Answer: 4 Rationale 1: Benztropine is an antiparkinson drug used to help manage the EPSEs of antipsychotic medications. Risperidone and loxapine are antipsychotic medications. Duloxetine is an antidepressant medication.

Rationale 2: Benztropine is an antiparkinson drug used to help manage the EPSEs of antipsychotic medications. Risperidone and loxapine are antipsychotic medications. Duloxetine is an antidepressant medication.

Rationale 3: Benztropine is an antiparkinson drug used to help manage the EPSEs of antipsychotic medications. Risperidone and loxapine are antipsychotic medications. Duloxetine is an antidepressant medication.

Rationale 4: Benztropine is an antiparkinson drug used to help manage the EPSEs of antipsychotic medications. Risperidone and loxapine are antipsychotic medications. Duloxetine is an antidepressant medication.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast a plan of care for taking these medications for an indefinite period of time versus a six-month period of time.

Question 22 Type: MCSA The client reports difficulty remembering at home whether the client took the medication or just thought about taking the medication. Which of the following strategies would be most helpful for the nurse to suggest?

1. Obtaining and using a pill box 2. Wearing a rubber band to remember 3. Repeating the need to take the medications routinely 4. Putting the pill container near the breakfast table

Correct Answer: 1 Rationale 1: A pill box is the only method listed for which the patient can check the date and time to see whether or not the pill was taken.

Rationale 2: A pill box is the only method listed for which the patient can check the date and time to see whether or not the pill was taken.

Rationale 3: A pill box is the only method listed for which the patient can check the date and time to see whether or not the pill was taken.

Rationale 4: A pill box is the only method listed for which the patient can check the date and time to see whether or not the pill was taken.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast a plan of care for taking these medications for an indefinite period of time versus a six-month period of time.

Question 23 Type: MCSA The nurse should monitor for which of the following in the client taking venlafaxine (Effexor)?

1. Increased weight 2. Prolonged QTc interval 3. Increased blood pressure

4. Tardive dyskinesia Correct Answer: 3 Rationale 1: Sustained increased blood pressure has been noted in some clients, especially those on higher doses of venlafaxine. Weight, QTc intervals, and tardive dyskinesia are not typical side effects of venlafaxine.

Rationale 2: Sustained increased blood pressure has been noted in some clients, especially those on higher doses of venlafaxine. Weight, QTc intervals, and tardive dyskinesia are not typical side effects of venlafaxine.

Rationale 3: Sustained increased blood pressure has been noted in some clients, especially those on higher doses of venlafaxine. Weight, QTc intervals, and tardive dyskinesia are not typical side effects of venlafaxine.

Rationale 4: Sustained increased blood pressure has been noted in some clients, especially those on higher doses of venlafaxine. Weight, QTc intervals, and tardive dyskinesia are not typical side effects of venlafaxine.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast a plan of care for taking these medications for an indefinite period of time versus a six-month period of time.

Question 24 Type: MCSA

Which of the following laboratory studies are routinely done on patients taking second generation antipsychotic medications?

1. Hemoglobin and hematocrit 2. Renal functions 3. Thyroid functions 4. Serum glucose levels Correct Answer: 4 Rationale 1: Second generation antipsychotic medications have a risk of insulin resistance contributing to diabetes, so serum glucose levels are routinely monitored. Hemoglobin, thyroid function, and renal function are not typically affected by the second generation antipsychotic medications.

Rationale 2: Second generation antipsychotic medications have a risk of insulin resistance contributing to diabetes, so serum glucose levels are routinely monitored. Hemoglobin, thyroid function, and renal function are not typically affected by the second generation antipsychotic medications.

Rationale 3: Second generation antipsychotic medications have a risk of insulin resistance contributing to diabetes, so serum glucose levels are routinely monitored. Hemoglobin, thyroid function, and renal function are not typically affected by the second generation antipsychotic medications.

Rationale 4: Second generation antipsychotic medications have a risk of insulin resistance contributing to diabetes, so serum glucose levels are routinely monitored. Hemoglobin, thyroid function, and renal function are not typically affected by the second generation antipsychotic medications.

Global Rationale: Cognitive Level: Applying

Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast a plan of care for taking these medications for an indefinite period of time versus a six-month period of time.

Question 25 Type: MCSA The client has been taking fluvoxamine (Luvox) for years, has been symptom-free for one year, and is now considering taking a drug holiday. What nursing teaching is necessary?

1. The client should be symptom-free for at least two years before trying to go off the medication 2. The client should let the prescriber make these decisions and should not suggest this 3. A drug holiday should be avoided due to discontinuation symptoms 4. This is worth trying since the client has been symptom-free for a year Correct Answer: 3 Rationale 1: Fluvoxamine should be gradually tapered to avoid discontinuation symptoms. The client should discuss the drug holiday with the prescriber.

Rationale 2: Fluvoxamine should be gradually tapered to avoid discontinuation symptoms. The client should discuss the drug holiday with the prescriber.

Rationale 3: Fluvoxamine should be gradually tapered to avoid discontinuation symptoms. The client should discuss the drug holiday with the prescriber.

Rationale 4: Fluvoxamine should be gradually tapered to avoid discontinuation symptoms. The client should discuss the drug holiday with the prescriber.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast a plan of care for taking these medications for an indefinite period of time versus a six-month period of time.

Question 26 Type: MCSA A client exhibiting which of the following antipsychotic side effects would require the nurses immediate intervention?

1. Neuroleptic malignant syndrome 2. Drowsiness 3. Parkinsonism 4. Impotence Correct Answer: 1 Rationale 1: Neuroleptic malignant syndrome can be fatal. Parkinsonism, impotence, and drowsiness are not normally life-threatening conditions.

Rationale 2: Neuroleptic malignant syndrome can be fatal. Parkinsonism, impotence, and drowsiness are not normally life-threatening conditions.

Rationale 3: Neuroleptic malignant syndrome can be fatal. Parkinsonism, impotence, and drowsiness are not normally life-threatening conditions.

Rationale 4: Neuroleptic malignant syndrome can be fatal. Parkinsonism, impotence, and drowsiness are not normally life-threatening conditions.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate nursing interventions to address the major side effects associated with psychotropic medications.

Question 27 Type: MCSA Which of the following laboratory studies is performed because the client is taking lithium?

1. Hemoglobin 2. CBC 3. Liver function 4. Thyroid function Correct Answer: 4 Rationale 1: A thyroid goiter and hypothyroidism are side effects of lithium; therefore, thyroid function studies are performed periodically. Lithium is not metabolized in the liver and so does not require liver function studies. A CBC and hemoglobin are not needed because lithium does not frequently alter blood counts.

Rationale 2: A thyroid goiter and hypothyroidism are side effects of lithium; therefore, thyroid function studies are performed periodically. Lithium is not metabolized in the liver and so does not require liver function studies. A CBC and hemoglobin are not needed because lithium does not frequently alter blood counts.

Rationale 3: A thyroid goiter and hypothyroidism are side effects of lithium; therefore, thyroid function studies are performed periodically. Lithium is not metabolized in the liver and so does not require liver function studies. A CBC and hemoglobin are not needed because lithium does not frequently alter blood counts.

Rationale 4: A thyroid goiter and hypothyroidism are side effects of lithium; therefore, thyroid function studies are performed periodically. Lithium is not metabolized in the liver and so does not require liver function studies. A CBC and hemoglobin are not needed because lithium does not frequently alter blood counts.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate nursing interventions to address the major side effects associated with psychotropic medications.

Question 28 Type: MCSA Clients taking an MAOI should be taught to avoid completely which of the following foods?

1. White wines, cottage cheese, and ice cream 2. Steak, potatoes, and corn

3. Bread, apples, and hamburgers 4. Liver, sauerkraut, and yogurt Correct Answer: 4 Rationale 1: Clients taking MAOIs are taught to avoid foods containing tyramine, such as, liver, aged cheeses, red wines, sauerkraut, and yogurt. Additionally, caffeine, colas, chocolate, soy products, aged fish, and processed meats contain tyramine in high amounts. White wines, cottage cheese, ice cream, bread, apples, hamburgers, steak, potatoes, and corn are allowed.

Rationale 2: Clients taking MAOIs are taught to avoid foods containing tyramine, such as, liver, aged cheeses, red wines, sauerkraut, and yogurt. Additionally, caffeine, colas, chocolate, soy products, aged fish, and processed meats contain tyramine in high amounts. White wines, cottage cheese, ice cream, bread, apples, hamburgers, steak, potatoes, and corn are allowed.

Rationale 3: Clients taking MAOIs are taught to avoid foods containing tyramine, such as, liver, aged cheeses, red wines, sauerkraut, and yogurt. Additionally, caffeine, colas, chocolate, soy products, aged fish, and processed meats contain tyramine in high amounts. White wines, cottage cheese, ice cream, bread, apples, hamburgers, steak, potatoes, and corn are allowed.

Rationale 4: Clients taking MAOIs are taught to avoid foods containing tyramine, such as, liver, aged cheeses, red wines, sauerkraut, and yogurt. Additionally, caffeine, colas, chocolate, soy products, aged fish, and processed meats contain tyramine in high amounts. White wines, cottage cheese, ice cream, bread, apples, hamburgers, steak, potatoes, and corn are allowed.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Formulate nursing interventions to address the major side effects associated with psychotropic medications.

Question 29 Type: MCSA Because of the risk of postural hypotension, the client on clozapine (Clozaril) should be taught which of the following?

1. To wear sunscreen if going outdoors 2. To rise slowly from a lying position 3. To check for involuntary movements of the mouth 4. To have weekly blood work Correct Answer: 2 Rationale 1: Antipsychotic medications have a risk for postural hypotension that could lead to a fall if the client rises too quickly. Wearing a sunscreen is necessary due to photosensitivity, not hypotension. Blood work checks for agranulocytosis. Mouth movements are not caused by hypotension.

Rationale 2: Antipsychotic medications have a risk for postural hypotension that could lead to a fall if the client rises too quickly. Wearing a sunscreen is necessary due to photosensitivity, not hypotension. Blood work checks for agranulocytosis. Mouth movements are not caused by hypotension.

Rationale 3: Antipsychotic medications have a risk for postural hypotension that could lead to a fall if the client rises too quickly. Wearing a sunscreen is necessary due to photosensitivity, not hypotension. Blood work checks for agranulocytosis. Mouth movements are not caused by hypotension.

Rationale 4: Antipsychotic medications have a risk for postural hypotension that could lead to a fall if the client rises too quickly. Wearing a sunscreen is necessary due to photosensitivity, not

hypotension. Blood work checks for agranulocytosis. Mouth movements are not caused by hypotension.

Global Rationale: Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Formulate nursing interventions to address the major side effects associated with psychotropic medications.

Question 30 Type: MCSA Which of the following would indicate that the client needs more teaching related to coping with constipation as a side effect of antipsychotic medications?

1. I will regularly use enemas.

2. I will walk and stay active.

3. I will include fiber daily in my diet.

4. I will have an adequate intake of fluid.

Correct Answer: 1 Rationale 1: The client should not use enemas regularly as a way to deal with constipation.

Including fiber in the diet as well as adequate fluids are useful strategies to cope with constipation. Avoiding a sedentary lifestyle and being active help resolve constipation.

Rationale 2: The client should not use enemas regularly as a way to deal with constipation.

Including fiber in the diet as well as adequate fluids are useful strategies to cope with constipation. Avoiding a sedentary lifestyle and being active help resolve constipation.

Rationale 3: The client should not use enemas regularly as a way to deal with constipation.

Including fiber in the diet as well as adequate fluids are useful strategies to cope with constipation. Avoiding a sedentary lifestyle and being active help resolve constipation.

Rationale 4: The client should not use enemas regularly as a way to deal with constipation.

Including fiber in the diet as well as adequate fluids are useful strategies to cope with constipation. Avoiding a sedentary lifestyle and being active help resolve constipation.

Chapter 16. Psychotherapeutic Approaches for Addictions and Related Disorders MULTIPLE CHOICE 1. A patient diagnosed with alcoholism asks, How will Alcoholics Anonymous (AA) help me?

Select the nurses best response. a. The goal of AA is for members to learn controlled drinking with the support of a higher power. b. An individual is supported by peers while striving for abstinence one day at a time. c. You must make a commitment to permanently abstain from alcohol and other drugs. d. You will be assigned a sponsor who will plan your treatment program.

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

2. A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated.

The medical record shows these blood pressure and pulse readings at the times listed:

0200: 118/78 mm Hg and 72 beats/min 0400: 126/80 mm Hg and 76 beats/min 0600: 128/82 mm Hg and 72 beats/min 0800: 132/88 mm Hg and 80 beats/min 1000: 148/94 mm Hg and 96 beats/min What is the nurses priority action? a. Force fluids. b. Consult the health care provider. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.

ANS: B Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.

3. A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular

c. Neurologic

b. Respiratory

d. Hepatic

ANS: B Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority. See relationship to audience response question.

4. A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours.

The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, Bugs are crawling on my bed. Ive got to get out of here.

Select the most accurate assessment of this situation. The patient: a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. has symptoms of alcohol-withdrawal delirium. d. is having an acute psychosis.

ANS: C Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.

5. A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception

c. Ineffective denial

b. Ineffective coping

d. Risk for injury

ANS: D The patients clouded sensorium, sensory perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurses priority. The other diagnoses may apply but are not the priorities of care.

MSC: Client Needs: Safe, Effective Care Environment 6. A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n):

a. narcotic analgesic, such as hydromorphone (Dilaudid). b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). c. antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril). d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).

ANS: B Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

7. A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes

c. Keep the room dimly lit

b. One-on-one supervision

d. Force fluids

ANS: B One-on-one supervision is necessary to promote physical safety until sedation reduces the patients feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety.

A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

8. A patient diagnosed with an alcohol abuse disorder says, Drinking helps me cope with being a single parent. Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. Sooner or later, alcohol will kill you. Then what will happen to your children? b. I hear a lot of defensiveness in your voice. Do you really believe this? c. If you were coping so well, why were you hospitalized again? d. Tell me what happened the last time you drank.

ANS: D

The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurses frustration with the patient.

9. A patient asks for information about Alcoholics Anonymous. Select the nurses best response.

Alcoholics Anonymous is a: a. form of group therapy led by a psychiatrist. b. self-help group for which the goal is sobriety. c. group that learns about drinking from a group leader. d. network that advocates strong punishment for drunk drivers.

ANS: B Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable?

The patient: a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.

ANS: B A non-tolerant drinker would be in coma with a blood alcohol level of 500 mg%. The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patients body is tolerant. If disulfiram and alcohol are

ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

11. A patient admitted to an alcoholism rehabilitation program tells the nurse, Im actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening. The patient is using which defense mechanism? a. Denial

c. Introjection

b. Projection

d. Rationalization

ANS: A Minimizing ones drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for ones faults or problems. Rationalization involves making excuses. Introjectioninvolves incorporating a quality of another person or group into ones own personality.

12. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine (Parlodel)

c. Disulfiram (Antabuse)

b. Methadone (Dolophine)

d. Naltrexone (ReVia)

ANS: D Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

13. During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, After this treatment program, I think everything will be all right. Which remark by the nurse will be most helpful to the spouse? a. While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol.

b. It will be important for you to structure life to avoid as much stress as you can and provide social protection. c. Addiction is a lifelong disease of self-destruction. You will need to observe your spouses behavior carefully. d. It is good that you are supportive of your spouses sobriety and want to help maintain it.

ANS: A During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

14. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should: a. provide long-term care for the patient in a residential facility. b. withdraw the patient from cannabis, then treat the schizophrenia. c. consider each diagnosis primary and provide simultaneous treatment. d. first treat the schizophrenia, then establish goals for substance abuse treatment.

ANS: C Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

15. Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a. Empathetic, supportive

c. Cool, distant

b. Skeptical, guarded

d. Confrontational

ANS: A Support and empathy assist the patient to feel safe enough to start looking at problems.

Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.

16. Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe

c. Stimulating and colorful

b. Active and bright

d. Confrontational and challenging

ANS: A Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a bad trip.

17. When a patient first began using alcohol, two drinks produced relaxation and drowsiness.

After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. Pharmacokinetics of the alcohol have changed.

ANS: A Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

18. At a meeting for family members of alcoholics, a spouse says, I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work. The nurse assesses these comments as: a. codependence.

c. role reversal.

b. assertiveness.

d. homeostasis.

ANS: A Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario. See relationship to audience response question.

19. In the emergency department, a patients vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication. Select the priority outcome. a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patients breath sounds will be clear bilaterally and throughout lung fields.

ANS: B The correct short-term outcome is the only one that relates to the patients physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The patients respirations are slow and shallow, but there is no evidence of congestion.

20. Family members of an individual undergoing a residential alcohol rehabilitation program ask, How can we help? Select the nurses best response.

a. Alcoholism is a lifelong disease. Relapses are expected. b. Use search and destroy tactics to keep the home alcohol free. c. Its important that you visit your family member on a regular basis. d. Make your loved one responsible for the consequences of behavior.

ANS: D Often, the addicted individual has been enabled when others picked up the pieces for him or her.

The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.

21. Which goal for treatment of alcoholism should the nurse address first? a. Learn about addiction and recovery.

c. Develop a peer support system.

b. Develop alternate coping strategies.

d. Achieve physiologic stability.

ANS: D The individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treatment goals.

22. A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a. 1-week detoxification program

c. 12-step self-help program

b. Long-term outpatient therapy

d. Residential program

ANS: D Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, be self-reliant, and practice honesty. Residential programs are more effective for patients with antisocial tendencies than outpatient programs.

23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

ANS: A Overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

24. Symptoms of withdrawal from opioids for which the nurse should assess include: a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

ANS: B The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal.

Hyperthermia is likely to produce periods of diaphoresis. See relationship to audience response question. (Educators may alter this question to multiple answers if desired.)

25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes: a. cross-tolerance.

c. substance addiction.

b. substance abuse.

d. substance intoxication.

ANS: C Nicotine meets the criteria for a substance, the criterion for addiction is present, and withdrawal symptoms are noted with abstinence or reduction of dose. The scenario does not meet criteria for substance abuse, intoxication, or cross-tolerance.

26. Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech ANS: D Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use. (Educators may alter this question to multiple answers if desired.)

27. An adult in the emergency department states, Everything I see appears to be waving. I am outside my body looking at myself. I think Im losing my mind. Vital signs are slightly elevated.

The nurse should suspect: a. a schizophrenic episode.

c. opium intoxication.

b. hallucinogen ingestion.

d. cocaine overdose.

ANS: B The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about going crazy. Synesthesia is not common in schizophrenia.

CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. Phencyclidine (PCP) use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a. Substance Abuse and Mental Health Services Administration (SAMHSA) b. Institute of Medicine National Research Council (IOM) c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicine ANS: A The Substance Abuse and Mental Health Services Administration (SAMHSA) is the official resource for comprehensive information regarding addictions. The other resources have relevant information, but they are not as comprehensive.

29. A patient is thin, tense, jittery, and has dilated pupils. The patient says, My heart is pounding in my chest. I need help. The patient allows vital signs to be taken but then becomes suspicious and says, You could be trying to kill me. The patient refuses further examination. Abuse of which substance is most likely? a. PCP

c. Barbiturates

b. Heroin

d. Amphetamines

ANS: D The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.

30. Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will: a. state, I know I need long-term treatment. b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger.

d. develop a trusting relationship with one staff member.

ANS: A The key refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not give enough information to determine whether anger has been identified as a problem. A trusting relationship, while desirable, should have occurred earlier in treatment.

31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurses best first action? a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

ANS: C The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of ones own perspective.

Negative feelings may occur for the nurse; supervision is an important resource. The activities identified in the distracters occur after self-assessment.

MULTIPLE RESPONSE 1. A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy.

Patient teaching should include the need to: (select all that apply) a. avoid aged cheeses. b. avoid alcohol-based skin products. c. read labels of all liquid medications. d. wear sunscreen and avoid bright sunlight. e. maintain an adequate dietary intake of sodium.

f. avoid breathing fumes of paints, stains, and stripping compounds.

ANS: B, C, F The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.

2. The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply) a. rehearsing techniques to handle anticipated stressful situations. b. advising the patient to accept residential treatment if relapse occurs. c. assisting the patient to identify life skills needed for effective coping. d. advising isolating self from significant others until sobriety is established. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

ANS: A, C, E Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role-playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes. Residential treatment is not usually necessary after relapse.

Patients need the support of friends and family to establish and maintain sobriety.

3. A patient took a large quantity of bath salts. Priority nursing and medical measures include: (select all that apply) a. administration of naloxone (Narcan). b. vitamin B12 and folate supplements. c. restoring nutritional integrity.

d. management of heart rate. e. environmental safety.

ANS: D, E Care of patients who have taken bath salts is similar to those who have used other stimulants.

Tachycardia and chest pain are common when a patient has used bath salts. These problems are life-threatening and take priority. Patients who have used these substances commonly have bizarre behavior and/or paranoia; therefore, safety is a priority concern. Nutrition is not a priority in an overdose situation. Vitamin replacements and naloxone apply to other drugs of abuse.

4. A new patient beginning an alcoholism rehabilitation program says, Im just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening. Select the nurses most therapeutic responses. Select all that apply. a. I see, and use interested silence. b. I think you are drinking more than you report. c. Social drinkers have one or two drinks, once or twice a week. d. You describe drinking steadily throughout the day and evening. e. Your comments show denial of the seriousness of your problem.

ANS: C, D The correct answers give information, summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.

Chapter 17. Psychotherapy With Children Question 1 Type: MCMA

There are many roles involved in caring for clients in the specialized area of child psychiatry.

Which of the following diverse clinical functions includes the role of the nurse generalist working in child psychiatry?

Standard Text: Select all that apply.

1. Administer medication 2. Utilize knowledge and skills related to the mental health needs of clients 3. Prescribe psychotropic medications 4. Utilize knowledge related to the physical health needs of clients 5. Order diagnostic tests necessary to monitor effects of psychotropic medications Correct Answer: 1,2,4 Rationale 1: Administer medication. The nurse generalist working in child psychiatry will administer medications that require strict and systematic monitoring Rationale 2: Utilize knowledge and skills related to the mental health needs of clients. The nurse generalist working in child psychiatry will assess psychological symptoms.

Rationale 3: Prescribe psychotropic medications. Prescribing psychotropic medications is not within the scope of practice for a nurse generalist; these functions are performed by a physician or advanced practice nurse.

Rationale 4: Utilize knowledge related to the physical health needs of clients. The nurse generalist working in child psychiatry will assess physical symptoms.

Rationale 5: Order diagnostic tests necessary to monitor effects of psychotropic medications. Ordering diagnostic tests is not within the scope of practice for a nurse generalist; these functions are performed by a physician or advanced practice nurse.

Global Rationale:

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare the similarities and differences between generalist and specialist roles in child psychiatric nursing.

Question 2 Type: MCSA A nurse generalist and advanced practice nurse both work on the staff of an inpatient unit. The advanced practice nurse has a comprehensive role as a primary caregiver in child psychiatry.

Which of the following will be performed by the advanced practice nurse but not by the nurse generalist?

1. Explaining the treatment plan to a family 2. Performing admission assessments 3. Participating in discharge planning 4. Providing one-to-one counseling Correct Answer: 4 Rationale 1: Child psychiatricmental health nurses are involved in treatment, consultation, education, and medication supervision and are the mainstay of hospital treatment programs where they are responsible for daily treatment plans, ongoing one-to-one or group counseling, and management of the childs medication regimen. You will see advanced practice nurses as the primary caregivers for children with mental health problems, providing direct psychotherapy, working with the family, and managing the childs medications.

Rationale 2: Child psychiatricmental health nurses are involved in treatment, consultation, education, and medication supervision and are the mainstay of hospital treatment programs where they are responsible for daily treatment plans, ongoing one-to-one or group counseling, and management of the childs medication regimen. You will see advanced practice nurses as the primary caregivers for children with mental health problems, providing direct psychotherapy, working with the family, and managing the childs medications.

Rationale 3: Child psychiatricmental health nurses are involved in treatment, consultation, education, and medication supervision and are the mainstay of hospital treatment programs where they are responsible for daily treatment plans, ongoing one-to-one or group counseling, and management of the childs medication regimen. You will see advanced practice nurses as the primary caregivers for children with mental health problems, providing direct psychotherapy, working with the family, and managing the childs medications.

Rationale 4: Child psychiatricmental health nurses are involved in treatment, consultation, education, and medication supervision and are the mainstay of hospital treatment programs where they are responsible for daily treatment plans, ongoing one-to-one or group counseling, and management of the childs medication regimen. You will see advanced practice nurses as the primary caregivers for children with mental health problems, providing direct psychotherapy, working with the family, and managing the childs medications.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare the similarities and differences between generalist and specialist roles in child psychiatric nursing.

Question 3

Type: MCSA A growing role of the child psychiatricmental health nurse is: 1. Scrutinizing the public.

2. Promoting infant mental health.

3. Monitoring adult inpatient psychiatric clients.

4. Preventing mental health problems.

Correct Answer: 2 Rationale 1: A growing role for child psychiatricmental health nurses involves promotion of infant mental health in high-risk families in which the infants have medical complications or the parents have a history of mental illness or substance abuse. Monitoring adults and scrutinizing the public are not part of the child psychiatricmental health nurses role. Nurses can advocate for mental health issues, but they cannot prevent mental health problems.

Rationale 2: A growing role for child psychiatricmental health nurses involves promotion of infant mental health in high-risk families in which the infants have medical complications or the parents have a history of mental illness or substance abuse. Monitoring adults and scrutinizing the public are not part of the child psychiatricmental health nurses role. Nurses can advocate for mental health issues, but they cannot prevent mental health problems.

Rationale 3: A growing role for child psychiatricmental health nurses involves promotion of infant mental health in high-risk families in which the infants have medical complications or the parents have a history of mental illness or substance abuse. Monitoring adults and scrutinizing the public are not part of the child psychiatricmental health nurses role. Nurses can advocate for mental health issues, but they cannot prevent mental health problems.

Rationale 4: A growing role for child psychiatricmental health nurses involves promotion of infant mental health in high-risk families in which the infants have medical complications or the parents have a history of mental illness or substance abuse. Monitoring adults and scrutinizing

the public are not part of the child psychiatricmental health nurses role. Nurses can advocate for mental health issues, but they cannot prevent mental health problems.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare the similarities and differences between generalist and specialist roles in child psychiatric nursing.

Question 4 Type: MCSA When discussing indicators of emotionally disturbed children or children with disruptive behavior disorders with a group of student nurses, the psychiatric nurse states that one of the best indicators of emotionally disturbed children is that they have difficulty: 1. Seeking out peers.

2. Digesting a balanced diet.

3. Interpreting internal stimuli or external cues.

4. Following rules and norms of behavior.

Correct Answer: 4 Rationale 1: The central feature of a conduct disorder is repetitive and persistent behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Look for behaviors that show aggression toward people and animals, destruction of property,

deceitfulness or theft, or serious violations of parental or school rules. The ability to digest a balanced diet is not an indicator of an emotionally disturbed child. Children with a conduct disorder tend to find peers with similar issues. Interpreting internal stimuli or external cues is not related to conduct disorders.

Rationale 2: The central feature of a conduct disorder is repetitive and persistent behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Look for behaviors that show aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of parental or school rules. The ability to digest a balanced diet is not an indicator of an emotionally disturbed child. Children with a conduct disorder tend to find peers with similar issues. Interpreting internal stimuli or external cues is not related to conduct disorders.

Rationale 3: The central feature of a conduct disorder is repetitive and persistent behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Look for behaviors that show aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of parental or school rules. The ability to digest a balanced diet is not an indicator of an emotionally disturbed child. Children with a conduct disorder tend to find peers with similar issues. Interpreting internal stimuli or external cues is not related to conduct disorders.

Rationale 4: The central feature of a conduct disorder is repetitive and persistent behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Look for behaviors that show aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of parental or school rules. The ability to digest a balanced diet is not an indicator of an emotionally disturbed child. Children with a conduct disorder tend to find peers with similar issues. Interpreting internal stimuli or external cues is not related to conduct disorders.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Synthesize the key ideas in the biopsychosocial theories that help you understand the development of childhood psychiatric disorders.

Question 5 Type: MCSA The nurse observes an 8-year-old child regressing to behavior that is characteristic of a toddler when faced with new situations. The child has been in several foster care families over the past three years. Which of the following interventions is appropriate for this child?

1. Providing for unmet needs 2. Providing consistency and continuity of caregivers 3. Ignoring the regressive behavior 4. Ignoring the negative behavior and reinforcing the positive behavior Correct Answer: 2 Rationale 1: Defense mechanisms commonly employed by children are repression, reaction formation, and projection. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. Providing the child with consistency and continuity of caregivers will minimize situations that stimulate regression. The nurse will be able to evaluate the clients response to having consistency and continuity of caregivers. The nurse must recognize this behavior as a defense mechanism, and plan care that will strengthen the childs coping mechanisms. Providing for unmet needs is not specific or individualized and will be difficult to measure.

Rationale 2: Defense mechanisms commonly employed by children are repression, reaction formation, and projection. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. Providing the child with consistency

and continuity of caregivers will minimize situations that stimulate regression. The nurse will be able to evaluate the clients response to having consistency and continuity of caregivers. The nurse must recognize this behavior as a defense mechanism, and plan care that will strengthen the childs coping mechanisms. Providing for unmet needs is not specific or individualized and will be difficult to measure.

Rationale 3: Defense mechanisms commonly employed by children are repression, reaction formation, and projection. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. Providing the child with consistency and continuity of caregivers will minimize situations that stimulate regression. The nurse will be able to evaluate the clients response to having consistency and continuity of caregivers. The nurse must recognize this behavior as a defense mechanism, and plan care that will strengthen the childs coping mechanisms. Providing for unmet needs is not specific or individualized and will be difficult to measure.

Rationale 4: Defense mechanisms commonly employed by children are repression, reaction formation, and projection. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. Providing the child with consistency and continuity of caregivers will minimize situations that stimulate regression. The nurse will be able to evaluate the clients response to having consistency and continuity of caregivers. The nurse must recognize this behavior as a defense mechanism, and plan care that will strengthen the childs coping mechanisms. Providing for unmet needs is not specific or individualized and will be difficult to measure.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Synthesize the key ideas in the biopsychosocial theories that help you understand the development of childhood psychiatric disorders.

Question 6 Type: MCSA The parents of a premature infant are visiting their baby in the neonatal intensive care unit for the first time. The nurse observes the couple standing beside the incubator. Which of the following interventions will help facilitate the infants immediate mental health needs?

1. Notify the infants physician to come and talk with the parents 2. Facilitate stroking and touching their infant 3. Continue to observe their interactions to rule out a problem with bonding 4. Have them meet with other parents of premature infants Correct Answer: 2 Rationale 1: Helping the parents stroke and touch their infant is the first step in facilitating the attachment process, which is essential to developing a socioemotional bond. Having the parents meet with the physician or other parents of premature infants will be beneficial but will not help meet the infants immediate mental health needs. The nurse will need to observe the new familys interactions, but intervening to help the parents interact with their infant would be the priority action.

Rationale 2: Helping the parents stroke and touch their infant is the first step in facilitating the attachment process, which is essential to developing a socioemotional bond. Having the parents meet with the physician or other parents of premature infants will be beneficial but will not help meet the infants immediate mental health needs. The nurse will need to observe the new familys interactions, but intervening to help the parents interact with their infant would be the priority action.

Rationale 3: Helping the parents stroke and touch their infant is the first step in facilitating the attachment process, which is essential to developing a socioemotional bond. Having the parents meet with the physician or other parents of premature infants will be beneficial but will not help meet the infants immediate mental health needs. The nurse will need to observe the new familys interactions, but intervening to help the parents interact with their infant would be the priority action.

Rationale 4: Helping the parents stroke and touch their infant is the first step in facilitating the attachment process, which is essential to developing a socioemotional bond. Having the parents meet with the physician or other parents of premature infants will be beneficial but will not help meet the infants immediate mental health needs. The nurse will need to observe the new familys interactions, but intervening to help the parents interact with their infant would be the priority action.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Synthesize the key ideas in the biopsychosocial theories that help you understand the development of childhood psychiatric disorders.

Question 7 Type: MCSA The nurse is meeting for the first time with a child who was brought to the clinic with a mental health concern. When planning care for a child with a mental health problem, the nurse must understand both the childs mental health problems and the childs: 1. Previous hospitalizations.

2. Life experiences.

3. Physiological health problems.

4. Artistic ability.

Correct Answer: 2 Rationale 1: The nurse must understand the pathology involved in the childs mental health problems and the childs life experiences, as they may contribute to the childs problems as well as strengths. Physiological health problems, artistic abilities, and previous hospitalizations are components of the childs life experiences. These must be considered in order to develop interventions that are appropriate to the child.

Rationale 2: The nurse must understand the pathology involved in the childs mental health problems and the childs life experiences, as they may contribute to the childs problems as well as strengths. Physiological health problems, artistic abilities, and previous hospitalizations are components of the childs life experiences. These must be considered in order to develop interventions that are appropriate to the child.

Rationale 3: The nurse must understand the pathology involved in the childs mental health problems and the childs life experiences, as they may contribute to the childs problems as well as strengths. Physiological health problems, artistic abilities, and previous hospitalizations are components of the childs life experiences. These must be considered in order to develop interventions that are appropriate to the child.

Rationale 4: The nurse must understand the pathology involved in the childs mental health problems and the childs life experiences, as they may contribute to the childs problems as well as strengths. Physiological health problems, artistic abilities, and previous hospitalizations are components of the childs life experiences. These must be considered in order to develop interventions that are appropriate to the child.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Differentiate between the multicausal and interactive models of child mental illness.

Question 8 Type: MCSA The nurse providing case management to a child with a mental illness will collect data from the childs parents, teachers, and other health care providers in order to: 1. Complete a mental status exam.

2. Complete a comprehensive evaluation.

3. Collaborate with individuals that are significant to the child.

4. Complete a personality profile.

Correct Answer: 2 Rationale 1: A comprehensive evaluation includes collecting data from the various individuals, including the childs parents, teachers, and other health care providers. The comprehensive assessment is important in order to gain understanding into the variables that impact the childs mental health. Data for the mental status exam and personality profile is not gathered from parents, teachers, and other health care providers. The purpose for gathering the data is to complete the comprehensive assessment; collaboration may be a result of the process.

Rationale 2: A comprehensive evaluation includes collecting data from the various individuals, including the childs parents, teachers, and other health care providers. The comprehensive assessment is important in order to gain understanding into the variables that impact the childs mental health. Data for the mental status exam and personality profile is not gathered from

parents, teachers, and other health care providers. The purpose for gathering the data is to complete the comprehensive assessment; collaboration may be a result of the process.

Rationale 3: A comprehensive evaluation includes collecting data from the various individuals, including the childs parents, teachers, and other health care providers. The comprehensive assessment is important in order to gain understanding into the variables that impact the childs mental health. Data for the mental status exam and personality profile is not gathered from parents, teachers, and other health care providers. The purpose for gathering the data is to complete the comprehensive assessment; collaboration may be a result of the process.

Rationale 4: A comprehensive evaluation includes collecting data from the various individuals, including the childs parents, teachers, and other health care providers. The comprehensive assessment is important in order to gain understanding into the variables that impact the childs mental health. Data for the mental status exam and personality profile is not gathered from parents, teachers, and other health care providers. The purpose for gathering the data is to complete the comprehensive assessment; collaboration may be a result of the process.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate between the multicausal and interactive models of child mental illness.

Question 9 Type: MCSA

A nurse is describing the multicausal perspective of mental health and illness to the parents of a child recently diagnosed with a spectrum disorder. Which statement would the nurse utilize when describing this approach?

1. Exposure to drugs and alcohol has been associated with psychiatric disorders.

2. The feedback mechanism appears dysfunctional, creating neurotoxic effects on brain development and function.

3. The childs genetically determined attributes and life experiences interact to influence mental health outcomes.

4. Early psychological trauma may create deficits or abnormalities in brain structure.

Correct Answer: 3 Rationale 1: The childs genetically determined attributes and life experiences interacting to influence mental health outcomes explains the perspective of the multicausal model of mental health and illness. Discussing feedback mechanism dysfunction would provide a partial explanation of neuroendocrine reactivity. Discussing the effects of early psychological trauma on brain structure partially explains nervous system responsiveness. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses.

Rationale 2: The childs genetically determined attributes and life experiences interacting to influence mental health outcomes explains the perspective of the multicausal model of mental health and illness. Discussing feedback mechanism dysfunction would provide a partial explanation of neuroendocrine reactivity. Discussing the effects of early psychological trauma on brain structure partially explains nervous system responsiveness. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses.

Rationale 3: The childs genetically determined attributes and life experiences interacting to influence mental health outcomes explains the perspective of the multicausal model of mental health and illness. Discussing feedback mechanism dysfunction would provide a partial

explanation of neuroendocrine reactivity. Discussing the effects of early psychological trauma on brain structure partially explains nervous system responsiveness. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses.

Rationale 4: The childs genetically determined attributes and life experiences interacting to influence mental health outcomes explains the perspective of the multicausal model of mental health and illness. Discussing feedback mechanism dysfunction would provide a partial explanation of neuroendocrine reactivity. Discussing the effects of early psychological trauma on brain structure partially explains nervous system responsiveness. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Differentiate between the multicausal and interactive models of child mental illness.

Question 10 Type: MCSA A mother told the nurse she was appalled that the nurse would dare to ask if she took any drugs during her pregnancy. The nurse explains that the information is important in understanding the childs health because embryonic exposure to toxins during pregnancy is the major risk factor for: 1. Depression in preschoolers.

2. Lactose intolerance.

3. Mental retardation.

4. Mental illness.

Correct Answer: 3 Rationale 1: The major risk factor for retardation is the early alteration of embryonic development because of exposure to toxins in utero (maternal drug use, for example) or chromosomal changes (such as Down syndrome). Depression in preschoolers, mental illness, and lactose intolerance are not associated with maternal drug use.

Rationale 2: The major risk factor for retardation is the early alteration of embryonic development because of exposure to toxins in utero (maternal drug use, for example) or chromosomal changes (such as Down syndrome). Depression in preschoolers, mental illness, and lactose intolerance are not associated with maternal drug use.

Rationale 3: The major risk factor for retardation is the early alteration of embryonic development because of exposure to toxins in utero (maternal drug use, for example) or chromosomal changes (such as Down syndrome). Depression in preschoolers, mental illness, and lactose intolerance are not associated with maternal drug use.

Rationale 4: The major risk factor for retardation is the early alteration of embryonic development because of exposure to toxins in utero (maternal drug use, for example) or chromosomal changes (such as Down syndrome). Depression in preschoolers, mental illness, and lactose intolerance are not associated with maternal drug use.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of the potential risk factors for childhood mental illness into working with children in community settings Question 11 Type: MCSA A mother is concerned because her 6-year-old son stutters. She wants to know if she did anything during her pregnancy to cause this. Which of the following would be the best response?

The nurse should: 1. Assess for impaired thermoregulation during the postnatal period.

2. Assess for a family history of the disorder.

3. Verbalize the implied by asking, Are you saying you feel responsible for his problem?

4. Ask if the mother had preeclampsia during labor.

Correct Answer: 2 Rationale 1: The only known predisposing factor for the development of a communication disorder is a family history of the disorder. For stuttering, especially, family and twin studies provide strong evidence of a genetic factor in its etiology. Since family history is the only known predisposing factor, asking about impaired thermoregulation or preeclampsia is not relevant.

Questioning the mothers feelings does not address the cause of the stuttering.

Rationale 2: The only known predisposing factor for the development of a communication disorder is a family history of the disorder. For stuttering, especially, family and twin studies provide strong evidence of a genetic factor in its etiology. Since family history is the only known predisposing factor, asking about impaired thermoregulation or preeclampsia is not relevant.

Questioning the mothers feelings does not address the cause of the stuttering.

Rationale 3: The only known predisposing factor for the development of a communication disorder is a family history of the disorder. For stuttering, especially, family and twin studies provide strong evidence of a genetic factor in its etiology. Since family history is the only known

predisposing factor, asking about impaired thermoregulation or preeclampsia is not relevant.

Questioning the mothers feelings does not address the cause of the stuttering.

Rationale 4: The only known predisposing factor for the development of a communication disorder is a family history of the disorder. For stuttering, especially, family and twin studies provide strong evidence of a genetic factor in its etiology. Since family history is the only known predisposing factor, asking about impaired thermoregulation or preeclampsia is not relevant.

Questioning the mothers feelings does not address the cause of the stuttering.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Incorporate an understanding of the potential risk factors for childhood mental illness into working with children in community settings.

Question 12 Type: MCSA A 7-year-old child recently experienced the death of the familys pet dog, which was the childs constant companion. The child is at risk for: 1. A conduct disorder.

2. Elimination disorder.

3. Angoraphobia.

4. Separation anxiety disorder.

Correct Answer: 4 Rationale 1: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Rationale 2: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Rationale 3: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Rationale 4: Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful

life event such as the death of a pet. This childs dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Risk factors for conduct disorder are related to difficulties with parentchild interactions. Children with elimination problems may have psychosocial risk factors; however, the best response in this situation is to develop interactions to prevent separation anxiety disorder, which can be directly linked to the death of the childs companion. Angoraphobia is the fear of soft sweaters and rabbits and is not related to this situation.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: Incorporate an understanding of the potential risk factors for childhood mental illness into working with children in community settings.

Question 13 Type: MCSA A mother questions why it is important to list when her child sat up, began crawling, started walking, and was potty trained as she is bringing the toddler in because the child screams at night. The nurse explains to the mother that: 1. It is not normal for a young child to scream at night.

2. Children who scream at night have more difficulty with problem solving.

3. Children with mental disorders have difficulty with elimination at night.

4. A developmental history is part of assessing well-being of a child.

Correct Answer: 4 Rationale 1: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Rationale 2: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Rationale 3: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Rationale 4: The basics of an effective assessment include gathering cultural and developmental information, eliciting a history from the parents, and undertaking a clinical assessment of the child. These are developmental milestones. It is important to obtain information about the child to assist in identifying developmental progress. Night terrors are common in younger children and tend to happen when the child is in a deep sleep. The statements that children with mental disorders have difficulty with elimination at night and children who scream at night have more difficulty with problem-solving are incorrect.

Global Rationale:

Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Modify a care plan according to the signs and symptoms associated with common childrens psychiatric disorders.

Question 14 Type: MCSA Which of the following behaviors observed by the nurse will be important to disclose to the teacher of a child with a stereotypic movement disorder?

1. An episode of self-mutilation 2. Depression that results from feelings of inadequacy 3. Tendency to be hypoactive 4. Flexibility and ability to contribute to learning Correct Answer: 1 Rationale 1: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have

difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Rationale 2: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Rationale 3: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Rationale 4: Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, self-injurious behaviors such as head banging, and temper tantrums. This is important and relevant to discuss with the childs teacher who is a member of the treatment team. Problems with socialization and communication difficulties are also

common, evidenced by deficits in spontaneous, imaginative play. Stereotypic movement disorder involves repetitive nonfunctional motor behavior (i.e., hand waving, self-biting, body rocking, or head banging) that interferes with normal activity or risks self-inflicted bodily injury. The behavior lasts 4 weeks or longer. These behaviors are seemingly driven and protective measures are usually needed so that medical treatment will not be necessary. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The childs tendency would be toward hyperactivity rather than hypoactivity.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Modify a care plan according to the signs and symptoms associated with common childrens psychiatric disorders.

Question 15 Type: MCSA The school nurse is observing a young child who has episodes of rage toward peers during recess and at lunchtime. The advantage of conducting an assessment in this environment is: 1. This will assist in identifying the bullies who trigger the explosive episodes.

2. This provides an opportunity to collect data in the event that other children are injured and legal documentation is needed.

3. To provide data for the parents who are in denial about the problem.

4. This provides a picture of problems and strengths in a realistic context.

Correct Answer: 4 Rationale 1: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Rationale 2: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Rationale 3: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Rationale 4: Play has been described as the work of children. Observing the child interacting with peers during recess and lunchtime enables the nurse to observe the child during unstructured play, which is part of the mental status assessment. The nurse is not observing the child due to a potential lawsuit, to help identify bullies, or to provide data for the parents who are in denial, but as part of a nursing assessment.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Modify a care plan according to the signs and symptoms associated with common childrens psychiatric disorders.

Question 16 Type: MCSA The nurse is assessing a depressed child who was referred by the elementary school nurse. What is the best approach to use when assessing the childs socialization?

1. Tell me about the friends you enjoy being with.

2. So you spend a lot of time with your friends?

3. You seem like a person who would have a lot of friends.

4. How many friends do you have at school?

Correct Answer: 1 Rationale 1: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Rationale 2: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Rationale 3: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a

judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Rationale 4: The nurse is using therapeutic communication and encouraging the client to talk about a positive aspect of life. You seem like a person who would have a lot of friends, is a judgmental observation that may also be viewed as a stereotypical comment. The question How many friends do you have at school? can be perceived as probing and intrusive, which is nontherapeutic. So you spend a lot of time with your friends? invites a yes or no response and does not facilitate exploring the childs feelings about the friends.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Conduct an assessment of a child with a mental health problem.

Question 17 Type: MCSA The nurse is assessing a child diagnosed with conduct disorder. Which would be the most appropriate question to ask the parents?

1. Does your child have a history of cruelty to other people and animals?

2. Does your child unconsciously direct feelings and desires from other relationships toward others?

3. Does your child seem to be reassured by your presence?

4. Does your child readily seek out caregivers in times of stress?

Correct Answer: 1 Rationale 1: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Rationale 2: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Rationale 3: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Rationale 4: Characteristics of conduct disorder often manifest in behaviors that show aggression toward people and animals; these symptoms may appear as early as 5 or 6 years of age, but occur more typically in later childhood or early adolescence. Transference is a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. A child who feels secure will readily seek out caregivers in times of stress and is reassured by the caregivers presence.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Conduct an assessment of a child with a mental health problem.

Question 18 Type: MCSA When planning a new childrens mental health clinic, the nurse understands the importance of including a play area. Play and toys are used to assess children with suspected mental disorders because: 1. Children do not usually relate to adults.

2. Children express themselves through play.

3. Only toys that are developmentally appropriate and specific to the childs biological age are used.

4. Play enables the nurse to assess cognitive ability.

Correct Answer: 2 Rationale 1: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Rationale 2: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Rationale 3: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Rationale 4: A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the childs biological age.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Conduct an assessment of a child with a mental health problem.

Question 19 Type: MCSA The parents of a child with a spectrum disorder are asking the nurse about what kind of social expectations are realistic for their child. Which of the following is the overall outcome for a child diagnosed with a spectrum disorder?

1. To acknowledge the effects of ones own behavior on others 2. To function more effectively in social and emotional interactions 3. To stay on task 4. To acknowledge personal strengths Correct Answer: 2 Rationale 1: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity.

Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Rationale 2: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity.

Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Rationale 3: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity.

Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Rationale 4: Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity.

Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with children.

Question 20 Type: MCSA The school nurse recommends that the parents of a student seek help because the student is constantly in trouble and recently has set several small fires on school grounds. The nurse is concerned because the child is manifesting signs of: 1. Conduct disorder.

2. Depression.

3. Oppositional defiant disorder.

4. Attention deficit hyperactivity disorder.

Correct Answer: 1 Rationale 1: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Rationale 2: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Rationale 3: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder (ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Rationale 4: Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention deficit hyperactivity disorder

(ADHD) are the childs inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may show low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with children.

Question 21 Type: MCSA In working with a preschool-age child, which intervention would be considered as part of an effective plan for time-outs?

1. Identify in advance, situations that lead to anger 2. Explanations are not important to the child who is out of control 3. Length of time depends upon how long it takes the child to calm down 4. Incorporate a token economy Correct Answer: 3 Rationale 1: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral

interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Rationale 2: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Rationale 3: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Rationale 4: When children cannot behave in acceptable ways, they can take a time-out from the activity by sitting in a chair until they are able to pull themselves together. The use of behavioral interventions on inpatient units allows nursing staff to give continuous feedback to the children about the appropriateness of their behavior. As the child calms down, help the child see why the time-out was needed and what can be done differently next time. The goals are to have children learn what precedes episodes during which they lose control and learn ways to avoid the negative consequences of out-of-control behavior. Such behavior may or may not be anger-oriented. A token economy is not part of time-out planning.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with children.

Question 22 Type: MCSA The nurse works with both the child and parents to help the child develop interpersonal skills.

Which of the following general outcomes facilitates engaging the parents in the process?

1. Increasing knowledge of the childs psychopathology 2. Understanding the childs unique temperament and needs 3. Responding to separation anxiety 4. Administering PRN medications effectively Correct Answer: 2 Rationale 1: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Rationale 2: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Rationale 3: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Rationale 4: A general outcome is for the parents to develop a better understanding of the childs unique temperament and needs. The significance of this outcome is that as they work with the nurse to improve a childs interpersonal skills and become a more active social partner, the child should begin to engage the parents and respond in ways that reward their caregiving. Engaging the child in interpersonal skills will not facilitate the parents ability to perform the specific functions of administering PRN medications effectively, responding to separation anxiety, or understanding of the childs psychopathology.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with the parents of child clients.

Question 23 Type: MCSA The new stepfather of a child diagnosed with a conduct disorder wants to know the reason for including him in family therapy sessions. The nurse explains that the goal of family therapy is to: 1. Increase the probability that the childs mental health will improve.

2. Help the child relive past events and related feelings.

3. Provide an opportunity for the parents to interact with their child in a safe environment.

4. Speak for the child so the parents can become more aware of the childs potential.

Correct Answer: 1 Rationale 1: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Rationale 2: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving

of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Rationale 3: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Rationale 4: The goal of family therapy is to increase the likelihood that improvements in the childs mental health will occur. Involving step-parents in family therapy builds support in the home for these gains with consistent and sustained family patterns. The nurse uses modeling as an intervention to demonstrate specific ways of interacting with the child, to suggest approaches for the parents to try, to use positive interactions, and to speak for the child so the parents become more aware of the childs potential experience during caregiving. Abreaction, the reliving of past events and related feelings, is one of the purposes of play therapy. Providing a safe environment for interaction is another aspect of increasing the likelihood that improvements will occur. It is not a goal of family therapy for the nurse to speak for the child.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate various therapeutic approaches that child psychiatricmental health nurses might use in working with the parents of child clients.

Question 24 Type: MCSA A client, age 8, has just been prescribed pemoline (Cylert). The childs parents ask about the long-term effects of this medication. The nurse conducting patient teaching for the parents about this medication will include which of the following statements?

1. Photosensitivity is a problem with long-term use.

2. This is one of the drugs found to be safe for long-term use.

3. At the present time, there is limited information about this.

4. There seems to be a better outcome when the higher dose is given at bedtime.

Correct Answer: 3 Rationale 1: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Rationale 2: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Rationale 3: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Rationale 4: There is limited information on the long-term effects of stimulants or the impact of treatment when the child is on medication for 10 years or more. This medication is used to treat attention deficit disorder and should be given in the morning to prevent problems sleeping at night.

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast the various psychopharmacologic agents for children at each major developmental level.

Question 25 Type: MCMA The charge nurse is assigned a float nurse to help on the childrens unit. The nurse normally works with adults and says she feels out of place working with the children. In making the assignments, which of the following activities would the charge nurse NOT assign to the float nurse?

Standard Text: Select all that apply.

1. Administering daily medications 2. Administering PRN medications 3. Obtaining vital signs 4. Making rounds with the psychiatrist

5. Monitoring the children under close observation Correct Answer: 1,2,4,5 Rationale 1: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 2: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 3: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 4: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Rationale 5: This nurse is not familiar with the children in terms of their medications, dosages, and at-risk behaviors. The nurse should not be assigned to perform functions with a high potential for errors in judgment and safety with an unfamiliar population. These functions include administering medications (PRN or otherwise) and monitoring a group of children under close observation. Since the nurse is not familiar with the issues, needs, and progress of the children, making rounds with the psychiatrist may be counterproductive. In this instance, the nurse should be given some time to orient to the childrens unit.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare and contrast the various psychopharmacologic agents for children at each major developmental level.

Question 26 Type: MCSA The nurse administering a lithium carbonate (Lithobid) to a child with mental retardation monitors the child for which of the following therapeutic effects?

1. Weight loss 2. Decreased agitation 3. Weight gain 4. Elevated mood Correct Answer: 2

Rationale 1: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Rationale 2: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Rationale 3: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Rationale 4: Lithium carbonate (Lithobid) is the mood stabilizer used with children. Its primary use in clients with mental retardation is for severe aggression and agitation rather than for managing mania. A side effect of the medication is weight gain. Elevated mood and weight loss are not therapeutic effects of lithium carbonate (Lithobid).

Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast the various psychopharmacologic agents for children at each major developmental level.

Question 27 Type: MCSA

When caring for children in the mental health setting, nurses may become aware of unresolved issues about their own family. If left unaddressed, care for the child may be affected because: 1. This experience should not affect nurses.

2. There is an increased potential for regression.

3. This opportunity will help the nurses heal.

4. Nurses feelings may become activated.

Correct Answer: 4 Rationale 1: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Rationale 2: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Rationale 3: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Rationale 4: It is important that nurses working with children, particularly children with emotional problems, practice self-awareness. These experiences may activate feelings about ones own unresolved issues with the nurses family of origin or current family and may affect the ability to provide therapeutic care. If the feelings are activated, the nurse may have an opportunity to heal or may experience regression.

Global Rationale: Cognitive Level: Creating Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze your own attitudes and behavior toward child psychiatric clients and their parents.

Question 28 Type: MCSA A nurse caring for a child is concerned about remaining therapeutic when working with a child with anger management issues. Which of the following must the nurse avoid in order to remain therapeutic?

1. Examining personal feelings about the child 2. Reflecting back on a situation 3. Projecting his/her feelings onto the child 4. Sharing his/her concerns with peers and colleagues Correct Answer: 3 Rationale 1: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Rationale 2: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Rationale 3: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Rationale 4: Projecting is an ego defense mechanism whereby one places the undesirable behavior onto another. Projecting personal feelings onto the child who feels or acts in ways the nurse might have felt or acted affects the nurses ability to respond to the childs actual therapeutic needs. The other choices are acceptable behaviors.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze your own attitudes and behavior toward child psychiatric clients and their parents Question 29 Type: MCMA Self-awareness is an important aspect of nursing practice in any specialty. Which of the following questions would the nurse ask to build self-awareness when working with child psychiatric clients?

Standard Text: Select all that apply.

1. What dont I like about this child?

2. How can I use this opportunity to learn more about myself?

3. What am I learning about myself as I work with this child?

4. How do I avoid working with the parents?

Correct Answer: 1,2,3 Rationale 1: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Rationale 2: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Rationale 3: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Rationale 4: All of the questions apply to developing self-awareness except avoiding working with the parents; parents need to be involved in order for treatment to progress. Asking, What am I learning about myself as I work with this child? and What dont I like about this child? are necessary to help one examine thoughts and feelings which contribute to self-awareness. Asking, How can I use this opportunity to learn more about myself? is necessary for personal growth.

Chapter 18. Psychotherapy With Older Adults

Question 1 Type: MCSA A young nurse charted that a 70-year-old client was unable to perform ADLs due to old age.

What should the nursing supervisor do in response to this attitude?

1. Reassign the nurse to another unit with younger clients 2. Explain how aging does not prevent one from performing ADLs 3. Reprimand the nurse for charting opinions rather than facts 4. Suggest the young nurse encourage the client to be more independent Correct Answer: 2 Rationale 1: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 2: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 3: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting

opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Rationale 4: The nursing supervisor nurse should explain how aging does not prevent one from performing ADLs, thus, educating the young nurse regarding the differences between normal aging and problems associated with pathologic conditions. Reprimanding the nurse for charting opinions and reassigning the nurse to another unit does not dispel the myths about the aging process. Suggesting the nurse encourage the client to be more independent is not acting as an advocate for the needs of elders, nor does it address possible reasons for inability to perform activities of daily living.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Identify the age-related demographic projections that have implications for planning future mental health services for elders.

Question 2 Type: MCSA Which of the following statements should the nurse include in a presentation to the community regarding mental health care resources for elders?

1. Better pharmacological treatments have increased the normal life span of individuals afflicted with mental illness.

2. Medicare coverage will pay for most mental health services provided to elders.

3. Most elders require frequent hospitalization due to chronic illness and mental disability.

4. More long-term care facilities are admitting geropsychiatric clients.

Correct Answer: 1 Rationale 1: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 2: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 3: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Rationale 4: Individuals with schizophrenia, dementia, and mood disorders, once associated with decreased longevity, are living longer as a consequence of improved pharmacologic and other treatments. Medicare covers only a small portion of mental health services and many longterm care facilities do not admit identified geropsychiatric clients. Unless they can no longer drive or live alone, approximately 95% of elders are living independently and contentedly in

their own homes. Only 5% of the over-65 population are classified as frail elders and consume the majority of health care resources.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Identify the age-related demographic projections that have implications for planning future mental health services for elders.

Question 3 Type: MCSA Which of the following biopsychosocial theories of aging is the nurse using when taking a small group of older adults out in the community to a local restaurant for dinner and dancing?

1. Wear-and-tear theory 2. Activity theory 3. Nutritional theory 4. Environmental theory Correct Answer: 2 Rationale 1: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could

threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 2: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 3: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Rationale 4: Going to a local restaurant for a nice meal, dancing, and social interaction represents the concepts of activity theorythat remaining active contributes to mental health and satisfaction in late life. Nutritional theory focuses on the quality of ones diet to improve healthy aging, while environmental theory focuses on harmful substances and pollutants that could threaten health and cause undue stress. If the nurse was using nutritional and environmental theories, a healthy meal in a quiet, non-stressful environment would be planned. The wear-andtear theory emphasizes loss and decline in later life due to cellular degeneration caused by abuse and lack of care.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Discuss the major theories of aging and the ideas associated with each one.

Question 4 Type: MCMA The nurse is teaching a seminar for health professionals on the differences between the normal aging process and Alzheimers disease. Which of the following biopsychosocial theories of normal aging should be discussed regarding cellular changes?

Standard Text: Select all that apply.

1. Genetic theory 2. Immunology theory 3. Wear-and-tear theory 4. Environmental theory 5. Disengagement theory Correct Answer: 1,2,3 Rationale 1: Genetic theory: According to this theory, harmful genes activate in late life to stop cell growth and division; aging is programmed by genetic makeup.

Rationale 2: Immunology theory: Higher susceptibility to disease occurs as the bodys defensive ability declines with age, causing old irregular cells to be misidentified as foreign bodies and attacked by the body.

Rationale 3: Wear-and-tear theory: In this theory, cells eventually wear out with age; however, individual rates of cellular decline can be hastened by abuse and lack of care.

Rationale 4: Environmental theory: Various environmental substances such as pesticides, smog, and smoking can seriously harm health and cause cellular damage affecting ones ability to fight disease.

Rationale 5: Disengagement theory: Aging is an inevitable process in which older adults withdraw from social contacts and responsibilities. Psychosocial rather than cellular changes are responsible.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Discuss the major theories of aging and the ideas associated with each one.

Question 5 Type: MCSA The nurse is teaching staff at a long-term health care facility about depression in older adults.

Which comment by staff indicates to the nurse the need for further teaching?

1. Inability to organize and abstract information may indicate depression in older adults.

2. Depressed older adults may exhibit an excessive preoccupation with chronic constipation or pain.

3. Sadness or feeling blue are normal aspects of the aging process and are not a cause for concern.

4. Lack of interest or apathy may be a sign of depression in older adults.

Correct Answer: 3 Rationale 1: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 2: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 3: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Rationale 4: Depressed older adults may feel they are supposed to feel sad or blue as they age; however, these are not normal aspects of the aging process. Depression may be exhibited in older adults by a preoccupation with physical symptoms such as chronic pain or constipationcalled somatization. Loss of executive function such as the inability to sequence, organize, or abstract information as well as loss of interest and apathy may indicate depression in older adults.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 6 Type: MCSA The nurse suspects a 75-year-old male client with a recent diagnosis of cancer is contemplating suicide. Which one of the following cues indicates the highest suicide potential?

1. Yearly updating his will 2. Complaining of chronic pain 3. Vague statements about future funeral plans 4. Buying a hand revolver Correct Answer: 4 Rationale 1: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide.

Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 2: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide.

Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 3: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide.

Although discussing funeral plans, updating his will, and complaining of chronic pain are other

verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Rationale 4: Buying a hand revolver presents the highest suicide potential because it signals a degree of premeditation and planning with a highly lethal means for completing suicide.

Although discussing funeral plans, updating his will, and complaining of chronic pain are other verbal, behavioral, and situational cues for suicide, they can be expected in this situation and do not cause immediate concern.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 7 Type: MCMA The nurse suspects a 75-year-old male client is contemplating suicide. Which of the following factors place him at greater risk for suicide?

Standard Text: Select all that apply.

1. Being non-Hispanic Black 2. Frequent alcohol consumption 3. Being married

4. High socio-economic status 5. Having chronic pain caused by cancer Correct Answer: 2,3,5 Rationale 1: Being non-Hispanic Black. Non-Hispanic Blacks have the lowest suicide rate.

Non-Hispanic Whites have the highest suicide rates followed by Native Americans and Alaskan Natives.

Rationale 2: Frequent alcohol consumption. Alcohol abuse impairs decision making and increases the risk for suicide in any age.

Rationale 3: Being married. A close intimate relationship with a significant other decreases the risk for suicide. Widowed or divorced individuals are actually at greater risk.

Rationale 4: High socio-economic status. Financial stress due to lower socioeconomic status rather than higher income increases risk for suicide.

Rationale 5: Having chronic pain caused by cancer. A terminal illness such as cancer and chronic pain increase the risk for suicide in any age group.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 8

Type: MCSA During the nursing assessment of the older adult female client, the nurse finds the client believes others are poisoning her food. Which of the following psychiatric disorders would not be indicated?

1. Delirium 2. Adjustment disorder 3. Anxiety disorder 4. Dementia Correct Answer: 2 Rationale 1: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 2: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 3: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Rationale 4: Adjustment disorder is characterized by an anxious or depressed mood, physical complaints or withdrawal, but not delusions. Suspiciousness or persecutory delusions that people are poisoning or robbing them may be associated with depression, schizophrenia, anxiety, delirium, or dementia.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 9 Type: MCSA The wife of an older client is concerned that her husband has recently experienced memory lapses, is unusually aggressive and was involved in three traffic accidents in the past month. In planning a response, the nurse is guided by the knowledge that: 1. Further intervention is needed to prevent elder abuse of the wife.

2. Further assessment is needed to determine if alcohol abuse is possible.

3. These are normal responses to aging.

4. These are signs of depression or dementia.

Correct Answer: 2 Rationale 1: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 2: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 3: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Rationale 4: Alcohol abuse is often overlooked and untreated in older adults. Additionally, elders are more vulnerable to the effects of alcohol and are the largest consumers of OTC and prescribed medications. Aggressive behavior and memory lapses are not normal responses to aging and may be signs of depression or dementia; however, further assessment is needed before any diagnosis can be made. Elder abuse of the wife, although possible, is not apparent and the nurse should not assume intervention is necessary without further assessment.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 10

Type: MCSA The nurse is teaching a group of older adults about changes in sleep patterns due to the aging process. Which statement by older adults indicates understanding of the nurses teaching regarding the use of nonpharmacologic therapies for sleep?

1. We should avoid coffee, tea, or other fluids in the evening hours.

2. An herbal remedy such as melatonin can help us sleep better.

3. Taking long naps during the day will help us sleep better at night.

4. Taking a sleeping pill every night will improve our total sleep time.

Correct Answer: 1 Rationale 1: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 2: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 3: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Rationale 4: Avoiding caffeine products such as coffee or tea, or other substances such as alcohol or tobacco in the evening can help one to fall asleep faster and prevent awakenings

during the night. Taking long naps during the day will prevent the older adult from feeling tired and sleepy at bedtime. Sleeping aids and herbal remedies have not been shown to improve sleep quality and may lead to undesirable side effects in the older adult.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Differentiate the normal physical and psychosocial changes that accompany aging from mental disorders affecting elders.

Question 11 Type: MCSA When interviewing elders the psychiatric nurse is guided by the knowledge that: 1. Shame may inhibit the expression of feelings in elders.

2. Touch is inappropriate during the interview.

3. Family and staff members may provide inaccurate information.

4. Less time may be needed with elders than with other age groups.

Correct Answer: 1 Rationale 1: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no

reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 2: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 3: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Rationale 4: Shame and the fear of stigmatization may cause elders to be cautious and inhibit their ability to freely express feelings. More time may be needed with elders due to hearing loss, confusion, agitation, wandering, and communication problems. Information obtained from elders should also be validated with family and staff members to provide a complete picture; there is no reason to believe that these sources are inaccurate. Sitting close to the client and using touch when appropriate are helpful during individual interviews with elders due to possible sensory losses.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 12 Type: MCMA A thorough biopsychosocial assessment of elders includes: Standard Text: Select all that apply.

1. Spirituality 2. Social supports 3. Coping strategies 4. Sexuality 5. Early childhood interactions Correct Answer: 1,3,4 Rationale 1: Spirituality. Spiritual integrity is a basic human power that becomes especially important in later stages of life.

Rationale 2: Early childhood interactions. Early childhood interactions are more consistent with earlier psychological theories of mental disorder and are not needed.

Rationale 3: Coping strategies. Coping strategies are important data to collect from elders to obtain information regarding their reactions to stress.

Rationale 4: Sexuality. Sexuality is an important often overlooked area in elders and should be approached in a tactful, caring and nonjudgmental manner.

Rationale 5: Social supports. Interpersonal relationships and social networks of elders are important for optimal functioning especially with psychiatric disorders or confusion.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 13 Type: MCSA The nurse is assessing the social and financial status of an older adult. Which of the following questions would be appropriate to ask?

1. Do you have transportation to get to doctors appointments?

2. Do you have problems with your family taking advantage of you?

3. How often do you forget to pay your bills?

4. How much money do you get from social security?

Correct Answer: 1 Rationale 1: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family

members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 2: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 3: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Rationale 4: Transportation to doctor/nurse appointments or to the hospital is frequently an obstacle that older adults need help to overcome. Asking specific information regarding the amount of money a person has is an unnecessary invasion of privacy and may hinder the development of trust. Asking if the client forgets to pay bills or has problems with family members taking advantage of them are negative assumptions that can lead the older adult to suspect these events are occurring. Questions should be phrased in a non-judgmental, neutral tone.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 14 Type: MCSA Which of the following signs would lead the nurse to suspect elder abuse is occurring?

1. Leaving a competent elder at the doctors office to wait for an appointment 2. Leaving a confused elder at home alone 3. Complaints of a person poisoning their food or robbing them 4. Skin tears on the arms and hands Correct Answer: 2 Rationale 1: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Rationale 2: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Rationale 3: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Rationale 4: Leaving a confused elder unattended for long periods of time is a form of mistreatment. However, leaving a competent elder at the doctors office to await an appointment is not neglect or abandonment. Abrasions, sprains, and dislocations can be signs of coercion; however, most elders skin is very friable and skin tears are often the result of unintentionally hitting a sharp object. Suspiciousness or persecutory complaints may be a sign of dementia or delusions and should be further investigated if dementia or delusions are ruled out; but are not automatic signs of elder abuse.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 15 Type: MCSA An elderly client has presented to the clinic with multiple physical complaints. Biologic assessment information must be obtained before any physical illnesses can be ruled out. Which of the following objective measurements would be most helpful?

1. Electroencephalogram (EEG) 2. Standard diagnostic laboratory analyses 3. Lumbar puncture 4. Drug toxicology screening Correct Answer: 2 Rationale 1: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Rationale 2: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Rationale 3: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Rationale 4: Standard diagnostic laboratory analyses including: complete blood chemistry, electrolytes, glucose tolerance, CBC, urinalysis, thyroid levels, BUN, creatinine, and liver function tests would provide the most useful information regarding possible disease processes. A lumbar puncture, drug toxicology screening, and an EEG would not be performed unless standard diagnostic laboratory analyses revealed specific abnormalities warranting these tests.

Global Rationale:

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 16 Type: MCSA Which of the following nursing diagnoses would be most appropriate for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

1. Activity Intolerance 2. Ineffective Role Performance 3. Feeding Self-Care Deficit 4. Risk for Other-Directed Violence Correct Answer: 2 Rationale 1: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Rationale 2: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Rationale 3: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Rationale 4: The recent loss of his wife will almost certainly lead to ineffective role performance due to a change in social interaction and ability to manage on his own after 50 years of marriage. Social withdrawal, loneliness, and mental status changes can also occur due to lack of social stimulation. A risk for self-directed violence or suicide attempt would be a greater concern than violence directed toward others. A deficit in self-care activities and intolerance for activity are remote possibilities if the client loses interest in performing self care activities or withdraws completely.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 17 Type: MCSA Which of the following outcomes would be the most important for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

1. Ability to recognize behaviors that reduce feelings of hopelessness 2. Ability to focus on specific stimuli 3. Ability to acquire, organize, and use information 4. Ability to dress self and maintain own hygiene Correct Answer: 1 Rationale 1: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Rationale 2: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Rationale 3: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation;

therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Rationale 4: Depression, loneliness, and hopelessness are common reactions to loss; therefore, the ability to identify ways to reduce hopelessness would be the most important outcome for this client. Altered thought processes and self-care deficits would not be expected in this situation; therefore, the ability to process information or attend to stimuli would not be appropriate. Neither would the ability to dress or perform other self-care activities.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 18 Type: MCSA The nurse plans to implement health promotion activities at the local senior citizen center. Which one of the following strategies should the nurse include to meet the goal of promoting relaxation and restoring balance?

1. Pet therapy 2. Tai Chi exercises 3. Social support groups 4. Reality orientation

Correct Answer: 2 Rationale 1: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Rationale 2: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Rationale 3: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Rationale 4: Exercise and movement therapies such as Tai Chi can help induce relaxation, maintain flexibility, and restore balance in older clients. Pet therapy and social support groups are more commonly used with older adults who lack social supports or effective coping skills and do not restore balance. Older adults living in the community tend to have higher functional ability, greater social interaction, and cognitive abilities than older adults in long-term care facilities and are less likely to require reality orientation.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 19 Type: MCSA The nurse is planning teaching for a staff seminar regarding psychiatric medication administration. The nurses teaching should be guided by the knowledge that: 1. Sedation is a desirable side effect for older adults.

2. Falls and choking risk are increased by psychiatric medications.

3. Older adults are less prone to side effects than other age groups.

4. Standard adult dosages are well tolerated by older adults.

Correct Answer: 2 Rationale 1: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking.

Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 2: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking.

Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 3: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking.

Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Rationale 4: Psychiatric medications can cause extrapyramidal symptoms such as dystonias, akathisia, tremors, or pseudoparkinsonism, which can cause greater risk for falling or choking.

Older adults are more vulnerable to side effects and cannot tolerate standard adult dosages as well as other adults. Sedation is not a desirable side effect unless sleep is an issue because it can lead to falls, confusion, and decreased social interaction.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 20 Type: MCSA The nurses evaluation of the outcomes of care for an older adult mentally ill client should be guided by the knowledge that: 1. Cultural preferences that conflict with treatment goals take precedence.

2. Complete absence of psychiatric symptoms is the gold standard.

3. Clients values and preferences should be honored whenever possible.

4. Families and significant others are not routinely involved in this process.

Correct Answer: 3 Rationale 1: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 2: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 3: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Rationale 4: The clients values and preferences, particularly in later stages of life should be honored whenever possible to empower the client in the face of other losses. Some cultural preferences may directly conflict with treatment goals; therefore, risks should be weighed carefully before honoring those requests. The complete elimination of psychiatric symptoms is not realistic particularly with chronic mental illness. Families and significant others should always be invited to participate in evaluation of care.

Global Rationale: Cognitive Level: Applying

Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Synthesize the key components of a biopsychosocial assessment into the plan of care for an older client.

Question 21 Type: MCSA The nurse plans to increase self-esteem and reduce social isolation for residents living at the long-term care facility. Which one of the following strategies should the nurse include to meet these goals?

1. Reality orientation 2. Reminiscence therapy 3. Respite services 4. Restorative care Correct Answer: 2 Rationale 1: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments.

Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 2: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and

restorative care are geared toward restoring optimal function and compensating for impairments.

Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 3: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments.

Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Rationale 4: Reminiscence therapy is a useful intervention for improving self-esteem, increasing socialization and empowering older adults. Recalling past events, feelings, and thoughts can enhance pleasure, quality of life, and adaptation to present circumstances. Reality orientation and restorative care are geared toward restoring optimal function and compensating for impairments.

Respite services are an option in the community to provide temporary relief of burden for family caregivers.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 22 Type: MCSA

Which of the following behaviors would indicate that the nurses remotivation therapy group for long-term care residents was effective?

1. Orientation to time, place, and person 2. Active discussion of dating practices in teenage years 3. Active discussion of presidential candidates in the next election 4. Orientation to the long-term care surroundings Correct Answer: 3 Rationale 1: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 2: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 3: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Rationale 4: The goal of remotivation therapy is to stimulate interest in the environment and relationships with others. Discussion of presidential candidates represents awareness of current

events and interaction with others. Discussion of dating practices in teenage years does not indicate awareness in current events or the surrounding environment. Orientation to time, place, person, or the surroundings does not indicate an interest in relationships or socializing with others.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 23 Type: MCSA Which of the following outcomes would indicate successful reality orientation of an older adult client?

1. Ability to identify personal strengths 2. Ability to perform basic tasks and personal care activities 3. Ability to identify place and person 4. Ability to express faith and meaning in life Correct Answer: 3 Rationale 1: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then

person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 2: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 3: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Rationale 4: Reality orientation is successful when clients are able to use the part of their minds that are still intact. Orientation to time is the first ability that is lost followed by place, then person. Ability to perform basic tasks and personal care activities can occur without orientation to place or person. The ability to identify personal strengths or express faith and meaning in life are goals for remotivation or reminiscence therapy and not expected in reality orientation.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Develop treatment plans including reminiscence therapy, life review, reality orientation, and socialization enhancement for elders.

Question 24

Type: MCMA The nurse is a case manager for several older adults living in the community. Which of the following goals are relevant for community or home based nursing care?

Standard Text: Select all that apply.

1. Educate clients and caregivers about adult daycare programs 2. Diagnose and treat psychiatric illnesses 3. Coordinate supportive services to compensate for deficits 4. Encourage relocation to assisted living or skilled nursing facilities 5. Maintain safety and optimal functional independence Correct Answer: 1,3,5 Rationale 1: Educate clients and caregivers about adult daycare programs: Education about community-based programs such as adult daycare programs can provide respite for stressed and overwhelmed caregivers.

Rationale 2: Diagnose and treat psychiatric illnesses: Nurses need to monitor elders for signs of psychiatric illness and report them to the primary care physician, but nurses do not diagnose and treat unless they obtain advanced training and certification.

Rationale 3: Coordinate supportive services to compensate for deficits: When physical or mental deficits are present supportive services can help older adults stay in the home longer.

Rationale 4: Encourage relocation to assisted living or skilled nursing facilities: Delaying institutionalization is preferred by most elders and the nurse should support their desire to age in place unless the home environment becomes unsafe.

Rationale 5: Maintain safety and optimal functional independence: Safety and independence are key factors to remaining in the community.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 25 Type: MCMA Which of the following nursing interventions would be useful when caring for elders with behavioral disturbances who bite, hit, kick, or scream at caregivers during delivery of care?

Standard Text: Select all that apply.

1. Return at a later time to resume care when clients are calmer.

2. Order clients to stop biting, hitting, and screaming.

3. Continue the activity by restraining their hands and feet.

4. Allow clients to refuse bathing if no body odor is present.

5. Distract clients by encouraging them to sing with you.

Correct Answer: 1,4,5 Rationale 1: Return at a later time to resume care when clients are calmer. Research suggests that waiting and returning to resume care at a later time can be effective when dealing with resisting clients.

Rationale 2: Order clients to stop biting, hitting, and screaming. Ordering clients is ineffective. Talking and reasoning with them may be more effective.

Rationale 3: Continue the activity by restraining their hands and feet. Restraining the client unnecessarily is called battery and should only be used when someone is in imminent danger of harm.

Rationale 4: Allow clients to refuse bathing if no body odor is present. Dressing and bathing have few adverse health consequences and allow clients a form of control.

Rationale 5: Distract clients by encouraging them to sing with you. Research suggests that distracting clients with a social activity is helpful when dealing with resisting clients.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living to elders and their families into your plan of care.

Question 26 Type: MCSA The nurse case manager has become concerned that an older adult confused client is no longer safe at home due to wandering outside when the caregiver is not watching. Which of the following community-based programs would be most appropriate for referral?

1. Long-term care facilities 2. Assisted living communities

3. Senior citizen centers 4. Residential care facilities Correct Answer: 1 Rationale 1: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 2: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 3: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Rationale 4: Long-term care facilities are the only safe option listed for the client who is confused, wandering, and needs 24-hour supervision, seven days a week. Senior citizen centers do not have staff responsible for this type of care and assisted living and residential care facilities will only admit clients with minimal need for assistance.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 27 Type: MCSA The wife of a man with early stage Parkinsons disease expresses frustration and despair while caring for him at home because she is unable to leave him while she plays bridge with her friends twice a week. Which of the following community-based resources would be most appropriate in this situation?

1. Hospice care 2. Long-term care 3. Respite care 4. Restorative care Correct Answer: 3 Rationale 1: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 2: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 3: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if

the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Rationale 4: Respite care allows the client to continue living at home while providing temporary relief from excessive burdens placed on the primary caregiver. Hospice care is available only if the client has a terminal illness and is expected to die within six months. Restorative care would not provide the wife with support while she is away from home and 24-hour care provided by long-term care facilities is not required in the early stages of this disease.

Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate available community support programs such as adult day care, restorative programs, and assisted living for elders and their families into your plan of care.

Question 28 Type: MCSA A nurse is discussing the demanding and dependent behavior of an older, depressed female client with the treatment team. Which of the following comments indicates ageism?

1. She is demanding and dependent because she is lonely and not receiving enough attention from staff members.

2. She is feeling depressed and could benefit from counseling or an antidepressant.

3. She should be encouraged to attend more activities and do as much as possible by herself.

4. She should be encouraged to spend more time with people her own age instead of trying to look or act younger.

Correct Answer: 4 Rationale 1: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 2: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 3: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Rationale 4: Encouraging the client to spend time with people her own age instead of trying to look and act younger reflects ageisma bias against older people. Recognizing that demanding and dependent behaviors are symptomatic of depression and loneliness indicates an understanding that these behaviors are not a normal consequence of aging. Suggesting that the client could benefit from increased interaction, independence, and mental health intervention is implementing the role of an elder advocate.

Global Rationale:

Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Question 29 Type: MCSA Which of the following statements represents a myth about aging?

1. Advancing age does not condemn one to dependence and isolation.

2. Older adults do not benefit from supportive psychosocial services.

3. Senility and sadness are not inevitable outcomes with advancing age.

4. Aging itself is not a problem.

Correct Answer: 2 Rationale 1: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 2: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not

equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 3: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Rationale 4: A large proportion of healthy older adults, especially those who live alone, can and do benefit from supportive psychosocial services. Older adults are as responsive to mental health services as those of any other age group. Dependence, isolation, senility, and sadness do not equate with growing old. Chronic conditions may increase with age, but aging itself is not considered to be a problem.

Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze personal biases, feelings, and attitudes that may be experienced in professional practice when caring for elders who suffer from mental disorders.

Question 30 Type: MCSA Which of the following statements is true regarding financial roadblocks to mental health care services for people over the age of 65?

1. Medicare covers inpatient but not community mental health services.

2. Medicare Part D provides simple options for prescription coverage.

3. Medicare provides little coverage for long-term care services.

4. Medicare offers low copayments for most psychotropic medications.

Correct Answer: 3 Rationale 1: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 2: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 3: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Rationale 4: Medicare, the major form of health care financing for older adults, covers only a portion of the costs for long-term care needs. Medicare provides limited coverage of both inpatient and community mental health services. The Medicare Part D program provides options for older adults to minimize prescription costs but can be very difficult to understand. Expensive prescription plans and high co-payments are commonly seen with Medicare coverage causing increased psychosocial stressors for elders living on a fixed income.

Chapter 19. Reimbursement and Documentation 1. Which of the following does not refer to the process of adding written information to a health care record?

A. Recording B. Charting C. Data entry D. Documenting 2. Which of the following statements about documenting is not true?

A. Involves recording the interventions carried out to meet the patient's needs.

B. Done in a proper way, it reflect the nursing process.

C. Necessary to prove that nursing work was done.

D. Nursing documentation can be accepted in both verbal and written form 3. Which of the following are basic purposes for an accurate and complete written patient records? Select all that apply A. Sometimes used by government agencies to evaluate patient care B. It is a permanent record for accountability C. It is a legal record of care D. They are perfect sources for business and marketing E. Can be used for research, teaching and data collection 4. This is the main basis for cost reimbursement rates by government plans A. Critical pathway B. Minimum data sheet C. Diagnoses related groups D. Patient expense documentation

5. Which of the following statements are true regarding basic rules for documentation. Select all that apply.

A. Use direct quotes for objective assessments B. If a charting error is made, draw one line through the faulty information C. Chart only your own care even when someone else calls you for a late entry.

D. Chart after care is provided, as soon as possible, and as often as needed E. Sign each block of charting with full legal initials and title 6. Based upon the legal guidelines for documentation, which of the following corrective action is incorrect?

Discuss A. Never erase entries or use correction fluid. Never right with a pencil.

B. Do not record "physician made error".

C. Be certain that entry is factual even when opinions are used D. While logged into the computer, do not leave terminal unattended even during an emergency.

7. Which of the following statements about common forms of inadequate documentation should not be included?

A. Not charting correct time when events occurred B. Failing to record verbal orders or failing to have them signed

C. Documentation only in hand written format even when EMR is mandated D. Charting actions in advance to save time E. Documenting incorrect data 8. Which of the following practices could lead to malpractice? Select all that apply A. Charting interventions in advance to save time B. Documenting incorrect data C. Not charting the correct time when events took place

D. Deleting incorrect entries and crossing them out with a horizontal line.

E. Not recording verbal orders or not having them signed.

9. Charting that is divided into sections or blocks. Emphasis is placed on specific sections, or sheets of information. It also uses graphics and narrative charting A. Traditional Chart B. Problem-oriented medical record C. Standard form D. Kardex 10. Which of the following is a typical section of a traditional chart? Select all that apply Discuss A. Admission sheet and physician's orders B. Progress notes and nurse's admission information C. History and Physical Examination Data D. Medical Administration Record E. Care plan and nurse's notes 11. Which of the following is considered a traditional charting?

A. Narrative B. Problem Oriented Medical Record C. SOAPE D. DARE 12. What is the difference between Traditional and Problem Oriented medical Record charting?

A. Traditional uses an abbreviated story form. POMR uses an outline form B. Traditional uses SOAPE charting. Problems oriented medical record uses narrative charting C. Traditional uses blocks. POMR uses sections.

D. Traditional focuses on interventions. POMR focuses on interventions.

13. Which of the following are considered the principal sections of a problem-oriented medical record? Select all that apply.

A. Database B. Problem list C. Care plan D. Physical examination and diagnostic tests E. Referral form 14. Active, inactive potential and resolved problems that serve as the index for charting documentation A. Problem assessments B. Problem List C. Database D. Traditional Chart 15. Which insurance company will only reimburse 4 units per visit?

A. Aetna B. Medicare C. United D. Cigna 16. Which of the following insurance companies will reimburse for physical performance test (PPT)?

Discuss A. PC B. BCBS C. MVA

D. A & B E. All of the above 17. For Medicare, when must progress reports be completed?

A. 40 days or 15 visits, whichever comes first B. 30 days or 15 visits, whichever comes first C. 30 days or 10 visits, whichever comes first D. 40 days or 10 visits, whichever comes first 18. Aetna will only reimburse evaluations once every 180 days, even if it's a new injury.

A. True

B. False 19. A patient with Keystone HMO health insurance has been to the clinic for 20 visits. What is the total reimbursement the clinic will receive from insurance?

A. Only the deductible B. Only the co-pay and the capitated rate per patient per month.

C.$1,000 D. Nothing until the insurance company holds a manual review 20. A patient with Align insurance was injured at work. Which of the following statements is/are true?

A. The work ready script must be signed by the referring physician as soon as possible B. Authorization is not needed to perform FPN C. Align is not a third party administrator insurance D. There is reimbursement of 5 individual codes along with WH/WC E. A & C F. A, C & D

Chapter 20. Termination and Outcome Evaluation Question 1 Type: MCSA When does the psychiatrist decide to terminate treatment?

Global Rationale: Termination optimally occurs when coping and functioning have improved, symptoms are reduced, and the goals of treatment are met. Achievement of goals depends on the collaborative goals set with the patient at the outset of treatment and on the type of approach or model used. For example, supportive psychodynamic psychotherapy criteria for termination would include the strengthening of the ego, reversal of regression, and symptom improvement.

In contrast, more expressive psychoanalytic psychotherapy criteria for termination would involve the resolution of the transference neurosis, an acceptance of the futility of perfectionist strivings and childhood fantasies, a reduction in the intensity of core conflicts, and the development of a self-analytic capacity.

Question 2 Type: MCSA When does termination begin for cognitive behavioral therapy?

Global Rationale: For cognitive-behavioral psychotherapy, termination begins in the first session, and the expected duration is usually discussed at that time, when issues and goals for treatment are clarified. The therapist usually sets a specific number of sessions, sets a predetermined date to end, or informs the patient that the treatment will not go longer than a few weeks or months without specifying an exact date.

Question 3 Type: MCSA What does the Self Analytic Capacity reflect in psychotherapy?

Global Rationale:

Self-analytic capacity means that the person has learned to be reflective and to become his/her own therapist. The advanced practice psychiatric nurse (APPN) can usually detect that this has been achieved by what the patient says and does. For example, the person may say, “I thought about what you would say when I was in that situation” or “I had a whole conversation in my head with you before I talked to him.”

These kinds of statements reflect the patient’s internalization of the therapist’s reflective function.

Sometimes, nothing is said, but the person’s functioning has greatly improved, and it is obvious to the therapist from what the person says about how s/he has handled various situations that a newfound ability to self-reflect or self-soothe is operating.

Question 4 Type: MCSA What are the major goals in the interpersonal psychotherapy (IPT)?

Global Rationale: In interpersonal psychotherapy (IPT), major goals of treatment relate to resolution of interpersonal problems in the “here and now.” To that end, alternative strategies for interpersonal relationships are identified, new relational patterns are practiced, and old ways of relating are grieved. Once the patient is successfully implementing the new ways of being, goals of therapy are met. Termination begins as early as the middle phase of treatment and is embedded in the work of that phase, working with the sadness about the loss of the relationship with the therapist and addressing issues of relapse prevention. As with CBT, there is a finite number of sessions delineated (16), and this provides incentive for the person to do the work within a circumscribed parameters of the treatment. The therapy does not really end at the last session in that the work continues with the person working independently.

Question 4 Type: MCSA What are some ways a therapist decides on how to terminate?

Global Rationale: From a psychodynamic viewpoint, all requests from the patient to terminate should be explored.

Often, the patient’s desire to end treatment is thought to reflect resistance. Gabbard (2004) states that underlying motives should always be explored with these questions in mind: Is the patient anxious and afraid and running from something? Angry at the therapist? Enacting a flight into health? Discouraged about the therapy? Feeling judged by the therapist? If the goals of treatment have not been met, it is likely that anxiety is underlying the wish to terminate. The person may

not be aware of any underlying reason other than the stated “I am fine now.” For example, one patient who had been in treatment for depression and had difficulty in sustaining long-term relationships came only for several sessions and then unexpectedly announced that this would be her last session because she was feeling much better. The therapist was quite surprised because during the previous session, the patient had talked about how sad she had felt as a little girl about her mother’s absence in her life due to her alcoholism. This issue of loss seemed to permeate all relationships and situations, and the therapist had been moved by the previous session. The therapist gently explored whether the patient felt that her goals of being able to sustain a longterm relationship and trust someone were already met. As the session unfolded, the therapist wondered aloud whether her desire to leave now was based on some of the sad feelings she had expressed during the last session. Tearfully, the patient realized that she was fleeing as she was beginning to feel vulnerable in therapy. After this was expressed, she was able to stay and continue to work in ongoing psychotherapy.