Exam 1 Flashcards
1
Q
A nurse is reviewing the literature in preparation for a research study about eating disorders. The nurse wants to find out information about the total number of people with eating disorders occurring within a population of girls between the ages of 12 to 18 years. The nurse is not concerned about when the disorder had its onset for this population. Which epidemiological data would the nurse identify?
A
Prevalence
Prevalence refers to proportion of persons who HAVE A CONDITION AT OR DURING a particular time period.
Incidence refers to the proportion or rate of persons who DEVELOP A CONDITION DURING a particular time period.
2
Q
Difference between prevalence and incidence in an epidemiological study.
A
Prevalence refers to proportion of persons who HAVE A CONDITION AT OR DURING a particular time period.
Incidence refers to the proportion or rate of persons who DEVELOP A CONDITION DURING a particular time period.
3
Q
What statement would a nurse integrate into an education plan for a local community group about mental illness and mental disorders?
A
Clusters of behaviors, thoughts, and feelings define mental disorders.
4
Q
A client with a mental illness tells the nurse, “I’m just like what others say I am. I can never be normal.” The nurse interprets this statement as reflecting which of the following?
Manipulation
Label avoidance
Self-stigma
Public stigma
A
Self-stigma
5
Q
A client with depression participates in all areas of his treatment plan such that the client is managing the condition and living in a physically and emotionally healthy manner. The client’s status reflects which dimension of recovery?
A
Health
6
Q
A client has sought care for a prolonged history of depressed mood and has been diagnosed with major depression. The client is readily open to beginning pharmacologic treatment but is unwilling to attend a support group, despite easy geographic access and a flexible schedule. What explanation for the client’s behavior should the nurse explore?
- The client views depression as a purely psychosocial, rather than biologic, phenomenon.
- The client is uncomfortable with being labeled as mentally ill
- The client does not understand the relationship between the symptoms of depression and its diagnosis
- The client has an inaccurate understanding of the causes of depression.
A
The client is uncomfortable with being labeled as mentally ill.
7
Q
The nurse is caring for a group of clients in a primary care setting. When would the nurse determine a client is at greatest risk for developing a mental disorder?
- when emotional symptoms cause impaired daily functioning
- when a sad event causes emotional distress
- when coping strategies become difficult
- when emotional symptoms cause occasional stress
A
When emotional symptoms cause impaired daily functioning.
8
Q
Which of the following is accurate with regards to cultural syndromes?
A
They are specific disorders found in a particular locality.
9
Q
A family member of a client diagnosed with a mental illness asks the nurse, “What is mental illness, really?” Which information would the nurse most likely integrate into the response? Select all that apply.
- Mental illness can cause significant distress
- Mental illness is primarily due to social/cultural factors.
- Mental illness can interfere with a person’s ability to function.
- Individuals suffering from mental illness are usually able to cope effectively with daily life.
- Individuals suffering from mental illness may experience dissatisfaction with relationships and self.
A
- Mental illness can cause significant distress.
- Mental illness can interfere with a person’s ability to function.
- Individuals suffering from mental illness may experience dissatisfaction with relationships and self.
10
Q
A nurse is assessing a client who has come to the clinic for an evaluation. The nurse determines that the client is mentally healthy based on which finding? Select all that apply.
- Client talks readily about doing things with friends and family.
- Client describes actions used to appropriately cope with life stresses.
- Client verbalizes a realistic depiction of surroundings and events.
- Client reports moving from job to job to job over the years.
- Client identifies strengths and weaknesses in abilities.
A
- Client talks readily about doing things with friends and family.
- Client describes actions used to appropriately cope with life stresses.
- Client verbalizes a realistic depiction of surroundings and events.
- Client identifies strengths and weaknesses in abilities.
11
Q
A psychiatric-mental health nurse is developing a recovery-oriented plan of care for a client with obsessive-compulsive disorder. The nurse identifies interventions to strengthen the client’s social networks. The nurse is addressing which dimension to support recovery?
A
Community
12
Q
A nurse is teaching the family of a client with a mental illness who is receiving recovery-oriented treatment about this care. The nurse determines that the teaching was successful based on which statement made by the family?
A
Change is the underlying process involved with recovery.
13
Q
A psychiatric-mental health nurse working at a community mental health center is using epidemiological data to plan the development of programs for the population in the future. Based on the nurse’s knowledge associated with disease projections and the leading burden of disease, the nurse would work on developing programs for which condition?
- Depression
- Generalized anxiety disorder
- Schizophrenia
- Post traumatic stress syndrome
A
Depression
14
Q
The nurse would be more likely to witness uncontrolled weeping, anxiety attacks and somatization symptoms in which of the following clients?
- A client of Jewish heritage whose husband of several decades has recently died.
- A female, older adult client of Latin American descent.
A
Correct response:
A female, older adult client of Latin American descent
15
Q
One of the best ways to counteract the negative effects of stigma is to do what?
A
Have contact with the stigmatized group.
16
Q
A nurse is preparing a presentation about how mental health providers are often portrayed in the media, which leads to public stigma. Which of the following descriptors would the nurse most likely include?
- Group-oriented
- Caring
- Arrogant
A
Arrogant
17
Q
A nurse is performing an assessment on a client and notes the client has had five different jobs in the past 2 months, has a fifth-grade education, lacks health insurance, lives in a town with a high rate of violence, has a home with limited running water, and has limited family and friend support. Based on these findings, the nurse determines that the client is at risk for health problems. The nurse identifies which finding(s) as reflecting the social determinant domain of neighborhood and built environment? Select all that apply.
- fifth-grade education
- health insurance
- town violence
- housing situation
- support resources
A
- town violence
- housing situation
HealthyPeople2020 classifies neighborhood and built environment factors into these four categories:
- Access to Healthy Foods.
- Quality of Housing.
- Crime and Violence.
- Environmental Conditions
18
Q
Which of the following would be associated with stigma? Select all that apply.
- Individualization
- Disapproval
- Shunning
- Stereotyping
- Understanding
A
- Dispproval
- Shunning
- Stereotyping
19
Q
When describing wellness and mental disorders, which of the following factors would the nurse address as commonly interfering with the individual’s ability to achieve wellness? Select all that apply.
- Lack of education
- Medication compliance
- Employment issues
- Poverty
- Trauma
A
Poverty
Employment issues
Trauma
Lack of education
20
Q
A nursing instructor is teaching a class about stigma and using nonstigmatizing language. The instructor determines that the education was successful when the students state which of the following as an example?
- Hypochondriac
- Schizophrenic
- Bipolar client
- Client with major depression
A
Client with major depression
21
Q
According to the World Health Organization, by 2030, which mental illness is projected to be the leading burden of disease worldwide?
- schizophrenia
- substance use
- depression
- anxiety
A
Depression
22
Q
A nurse is conducting a presentation for a local community group about mental health and mental illness. One of the participants asks the nurse, “How do you know that a person is mentally healthy?” Which characteristic(s) would the nurse include when responding to the participant? Select all that apply.
- contributes to society
- adapts to changes
- is irresponsible
- functions in their role
- has erratic behaviors
A
- contributes to society
- adapts to changes
- functions in their role
23
Q
A nurse is giving a presentation about preventing mental illness to college freshmen. A student asks, “What does it mean to be mentally healthy?” Which of the following potential responses by the nurse is best?
- “Mental health is marked by productivity, fulfilling relationships, and adaptability.”
- “Mental health is defined as behavior accepted as normal by the major cultural group.”
- “Mental health is the absence of mental illness.”
- “Mental health is difficult to define and depends on cultural norms.”
A
“Mental health is marked by productivity, fulfilling relationships, and adaptability.”
24
Q
A nurse is collaborating with a team of researchers to determine the annual incidence of schizophrenia is the community. In order to calculate the incidence, the team must know:
- the prevalence of schizophrenia at the beginning of the year and the end of the year.
- the odds of developing schizophrenia in the year preceding the year that is being examined.
- the point prevalence on or near June 30.
- the length of time that each resident with schizophrenia has been living with his or her diagnosis.
A
The prevalence of schizophrenia at the beginning of the year and the end of the year.
25
In epidemiology, certain terms have specific meanings relative to what they measure. What represents the total number of people who have a disorder within a given population at a specified time, regardless of how long ago the disorder started?
- Prevalence
- Point prevalence
- Rate
- Incidence
Prevalence
26
After educating a group of nursing students about mental health and wellness, which statement by a group member indicates the need for additional education?
- A person cannot be healthy without being mentally healthy.
- Poverty and unemployment are common in individuals with mental health issues.
- Mental health problems have minimal effect on the process of wellness.
- A person can be mentally healthy but still have a mental disorder.
Mental health problems have minimal effect on the process of wellness.
27
A psychiatric-mental health nurse is collaborating with a client on ways to promote recovery. The client is diagnosed with a substance use problem. As part of the process, the person tells the nurse, “I want to be drug-free and show everyone that I can be a responsible person.” The nurse interprets this statement as reflecting which principle of recovery?
- Recovery is holistic.
- Recovery is based on respect.
- Recovery is person-driven.
- Recovery emerges from hope.
Recovery is person-driven.
28
Which of the following is accurate with regards to cultural syndromes?
- They are conditions that are highly researched and documented
- They are based on the person's ability to function overall.
- They are specific disorders found in a particular locality.
- They encompass nonrecurrent behavior.
- They are specific disorders found in a particular locality.
29
A psychiatric-mental health nurse is working with a client who has a mental health disorder on ways to develop self-determination and self-direction. The nurse is integrating which principle of recovery into the plan of care?
- Recovery emerges from hope.
- Recovery is holistic.
- Recovery is based on respect.
- Recovery is person-driven.
- Recovery is person-driven.
30
The nurse is teaching a group of community members about health, wellness, and living with mental illness. Which statement(s) made by a community member requires follow up by the nurse? Select all that apply.
- “One cannot have overall health without also being mentally healthy.”
- “One can improve overall wellness by improving physical health, but mental health is more difficult to improve.”
- “Overall wellness includes aspects of mental, emotional, and physical well-being.”
- “Overall health cannot exist if you also have a mental illness.”
- “Being well means you do not have disease, either physical or mental.”
- “One can improve overall wellness by improving physical health, but mental health is more difficult to improve.”
- “Overall health cannot exist if you also have a mental illness.”
- “Being well means you do not have disease, either physical or mental.”
31
A key element in the definition of mental illness is that ...
- The individual must need medications in order for the diagnosis to be of mental origin.
- The individual must have physiological symptoms that match with behaviors that are impaired.
- The individual must have difficulties in functioning that cause distress and/or impairment of some type.
- The individual must acknowledge that he or she is having difficulties in functioning.
- The individual must have difficulties in functioning that cause distress and/or impairment of some type.
32
What is acculturation?
Assimilation to a different culture, typically the dominant one.
33
What occurs when minority groups learn and adopt selective aspects of the dominant culture?
Acculturation
34
What is is most consistent with spirituality?
Feeling a connection to a higher power.
35
An adult client was born as a female gender but has a male gender identity. Which statement by the nurse demonstrates a therapeutic approach of respecting the client’s gender identity?
What pronouns do you go by?
36
A psychiatric-mental health nurse is caring for a client on the unit. What is the best approach to learn the client’s preferences regarding the use of eye contact, greeting, and physical distance when caring for the client?
Observe the patient in the initial interview.
37
The nurse is caring for an older adult whose spouse recently died. Which statement made by the client requires follow-up by the nurse?
- “My children think I should go to a grief support group.”
- "I haven't talked to my friends lately.:
I haven't talked to my friends lately.
The client is likely experiencing spiritual distress from the loss of a spouse. The nurse must be able to recognize that a client who has withdrawn socially may be experiencing spiritual distress.
38
What population is most risk for being unable to escape the spiral of poverty?
Homeless people.
39
What is acculturation?
When a person uses some of the aspects of the dominant culture in an effort to socialize and adapt to the new environment.
40
What is cultural identity?
A set of cultural beliefs one feels is standard behavior.
41
What is cultural idiom of distress?
Describes suffering among a group of people.
42
What are cultural explanations?
The perceived causes of the symptoms the group is displaying.
43
Is the following an accurate or inaccurate statement with regard to cultural competence and mental health?
Interventions need to work for various groups, not individuals.
Inaccurate
44
What is the most common method of suicide in rural areas, where the suicide rate is higher than in urban areas?
Firearms
Even though rural residents are less likely than urban residents to have mental health diagnoses or receive mental health care, the suicide rate is higher in the rural areas with firearms being the most commonly used method, over hanging, suffocation, or poisoning.
45
The nurse is taking care of a client from a culture different from the nurse's culture. How might the nurse best provide culturally competent care?
Find out as much as possible about a client's cultural values, beliefs, and health practices.
46
A nurse is completing the initial interview with a newly admitted client. What statement made by the nurse would be most appropriate to get to know the client better in the initial interview?
- “How would you like to be cared for?”
- “Have you been in a facility like this before?”
- “Would you like a tour of your room and the unit?”
- "You are welcome to ask any questions that you may have.”
How would you like to be cared for?
To provide care, the nurse must find out as much as possible about a client’s values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to them. The nurse’s question, “How would you like to be cared for?” is an accepting and nonjudgmental approach to inquire about the client’s preferences; therefore, it would be the most appropriate in the initial interview. The nurse’s questions, “Have you been in a facility like this before?”, and “Would you like a tour of your room and the unit?” could be asked after the client has been greeted appropriately and assessed. The nurse’s statement, “You are welcome to ask any questions that you may have” is generic and not client centered.
47
The nurse is caring for clients in a large metropolitan city outpatient clinic. Which cultural phenomenon will be assessed by the nurse that includes preference such as touch and eye contact?
- Communication
- Social organization
- Environmental control
- Biologic variations
Communication
Communication involves verbal and nonverbal communication such as touch and eye contact. Social organization refers to family structure and organization, religious values and beliefs, ethnicity, and culture. Environmental control refers to a client's ability to control the surroundings or direct factors in the environment. Biologic variations do not directly affect preferences around touch and eye contact.
48
A nurse is reviewing information about Taoism to gain a better understanding of a client. The nurse demonstrates an understanding of the information by identifying which of the following as behaviors leading to peace and contentment? Select all that apply.
Optimism
Aggressiveness
Humility
Calmness
Loyalty
Optimism
Humility
Calmness
According to Taoism, peace and contentment are found in the personal behaviors of optimism, passivity (not aggressiveness), humility and internal calmness. Loyalty to places and locations where one lives or works and purity and balance in physical and mental life are major motivators of personal conduct with Shintoism.
49
A nurse is reviewing information about mental health, mental illness, and suicide in rural cultures. What would the nurse identify as the most common method of suicide in this group?
Firearms
50
When describing wellness and mental disorders, which of the following factors would the nurse address as commonly interfering with the individual's ability to achieve wellness?
a. Poverty
b. Employment issues
c. Medication compliance
d. Trauma
e. Lack of education
Poverty
Employment issues
Trauma
Lack of education
51
A psychiatric-mental health nurse is providing recovery-oriented care for several clients with mental illness. When implementing this care, the nurse would assume which primary role?
a. Decision-maker
b. Partner
c. Leader
d. Educator
b Partner
In recovery-oriented care, the person with a mental health problem develops a partnership with a clinician to manage the illness, strengthen coping abilities, and build resilience for life's challenges. The nurse would not be the decision-maker or leader. Although the nurse may assume the role of an educator throughout the process, this would not be the primary role.
52
The nurse is teaching a group of community members about health, wellness, and living with mental illness. Which statement(s) made by a community member requires follow up by the nurse? Select all that apply.
a. “One cannot have overall health without also being mentally healthy.”
b. “Overall health cannot exist if you also have a mental illness.”
c. “Being well means you do not have disease, either physical or mental.”
d. “Overall wellness includes aspects of mental, emotional, and physical well-being.”
e. “One can improve overall wellness by improving physical health, but mental health is more difficult to improve.”
B, C, E.
A person cannot be healthy without being mentally healthy. However, it is possible to be mentally healthy and also have a mental or physical disorder. Improving both your physical and mental health may be challenging at times; however, mental health is not necessarily more difficult to improve.
53
The nurse is educating a client, who has been recently diagnosed with a mental illness, on aspects of wellness. Which dimension(s) of wellness should the nurse include? Select all that apply.
a. Social aspects
b. Financial stability
c. Physical abilities
d. Behavioral episodes
e. Intellectual ability to learn
f. Spiritual beliefs
A, B, C, E, F.
Wellness is being in good physical and mental health. There are eight dimensions of wellness. These are emotional, financial, social, spiritual, occupational, physical, intellectual, and environmental. Behavioral is not a dimension of wellness, although many mental illnesses include behavioral aspects. These eight dimensions of wellness should be including in teaching to the client.
54
A psychiatric-mental health nurse is conducting a program for a community group about the stigma faced by patients with mental illness. After teaching the group, the nurse determines that the program was successful when the group identifies which type? Select all that apply.
a. Private
b. Public
c. Self-stigma
d. Label avoidance
e. Community
b, c, d
Public stigma, self-stigma, and label avoidance are three types of stigma people with mental illnesses experience.
55
A nurse is caring for a client with a different ethnic and cultural background from the nurse. Which action(s) by the nurse will promote cultural competence? Select all that apply.
a. Provide interventions according to the culture.
b. Demonstrate genuine interest and respect for the client.
c. Conduct a thorough social and cultural assessment.
d. Do not assume that all individuals of a racial/ethnic group are the same.
e. Learn about the client's country of origin before assessing them.
B, D, E
Cultural competence in mental health includes learning about the client's country of origin before assessment; conducting a thorough social and cultural assessment; demonstrating genuine interest in and respect for the individual; educating clients about mental health issues, including available treatment, benefits of obtaining services, and contributions and abilities of individuals with a mental illness; not assuming all individuals of a racial or ethnic group are the same. Being quiet and a lack of eye contact may be culturally appropriate and may indicate shyness, not depression or another mental illness. Tailor interventions to the individual; one intervention does not work for everyone. Tailoring interventions to the culture is not a part of cultural competence.
56
The nurse is meeting with a client who changes topics and refuses to focus on a particular area. Which nurse behavior(s) indicate that the relationship is nontherapeutic? Select all that apply.
a) schedules longer meetings
b) schedules shorter meetings
c) encourages the client to stay on topic
d) assumes an aloof behavior during meetings
e) struggles to find common ground with the client
a, b, d, e
In a nontherapeutic relationship, both the nurse and client are frustrated and they will vary approaches with each other in an attempt to establish a meaningful relationship. The nurse may vary the length of the meetings–some may be longer or shorter than others. The nurse may alter demeanor during the meetings and may appear aloof. The nurse is struggling to find common ground with the client. Encouraging the client to stay on topic would be an action during the orientation, working, or termination phases of the therapeutic relationship.
57
Which question(s) should the nurse include when assessing a client who is noncompliant with prescribed psychopharmacologic medications? Select all that apply.
a. “Are you having trouble paying for your prescribed medications?”
b. “Are the side effects to your medications causing problems at work?”
c. “Are you confused about when you should take each of your medications?”
d. “Are you afraid that you will become addicted to your prescribed medication?
e. “Are you concerned about the stigma associated with taking the prescribed medications?”
b, c, d, e
Nonadherence is an issue with clients diagnosed with a mental health condition. Reasons for nonadherence with prescribed medication treatment include a stigma associated with taking medications for a mental health disorder. Side effects of the medication is a common reason for a client to stop taking prescribed medications. The client may have an improvement in symptoms and stops taking the medication thinking that it is no longer needed. The client may deny having a mental health condition that requires medication and will not take the drug as prescribed. Cost is not identified as a reason for not taking medications as prescribed for this scenario, as patient is getting medication.
58
A client with a mood disorder admits to frequently skipping doses of prescribed medications. On which area(s) would the nurse focus when assessing the reason for the client not adhering to medication therapy? Select all that apply.
a) cost
b) stigma
c) side effects
d) feeling better
e) denial of an illness
A, B, C, D, E
Common reasons for clients who are noncompliant to prescribed psychopharmacologic medications include the following: uncomfortable side effects and those that interfere with quality of life, such as work performance or intimate relationships; a lack of awareness or denial of illness; the associated stigma; the client begins to feel better; confusion about dosage or timing; difficulties in access to treatment; and a fear of substance use disorders. Based on this information, each of the questions from the nurse is appropriate when assessing a client who is nonadherent with the prescribed pharmacotherapy.
59
A client with a diagnosis of major depressive disorder is admitted to the psychiatric–mental health unit. During the admission interview, the client states “I wish I knew what was going on, everything is strange.” Which response(s) by the nurse demonstrates empathy? Select all that apply.
a. “You wish that you understood what was happening.”
b. “When you say everything, do you mean since you arrived at the hospital?”
c. “Everything is strange, and you wish you knew what was happening?”
d. “I am so sorry this is happening to you; it must be hard to not understand.”
e. “Can you clarify what you mean when you say that everything is strange?”
a, b, c, e
Several therapeutic communication techniques, such as reflection (“You wish that you understood what was happening”), restatement (“Everything is strange and you wish you knew what was happening?”), and clarification (“When you say everything, do you mean since you arrived at the hospital?” and “Can you clarify what you mean when you say that everything is strange?”), help the nurse send empathetic messages to the client. Sympathetic messages (“I am so sorry this is happening to you; it must be hard to not understand.”) are nontherapeutic.
60
The nurse is preparing to meet a new client. Which goal(s) would the nurse plan to achieve during the orientation phase of the nurse–client relationship? Select all that apply.
a. Explain the boundaries.
b. Identify problems to focus on.
c. Discuss the client’s expectations.
d. Explain the purpose of the relationship.
e. Listen to the client’s perception of problems.
a, c, d, e
The orientation phase begins when the nurse and client meet. During this phase, the nurse explains the boundaries of the relationship, discusses the client’s expectations, explains the purpose of the relationship, and listens to the client’s perception of problems. Identifying problems to focus on is an activity completed during the working phase of the nurse–client relationship.
61
A psychiatric-mental health nurse is creating a therapeutic interaction with a client. Which factor(s) is/are included in a therapeutic interaction with a client? Select all that apply.
a. limiting self-disclosure
b. active listening
c. silence
d. giving advice
e. validation
A, B, C, E
A therapeutic interaction with a client is different from a social interaction. In a therapeutic interaction, the nurse focuses on the client and client-related issues. Activities should have a definite purpose, and the conversation should focus only on the client. The nurse should not attempt to meet their own social or other needs during the interaction. Limiting self-disclosure, using active listening, selecting appropriate therapeutic techniques, using silence and validation, and using strength-based communication are important factors in a therapeutic interaction. Being nice toward the client is not necessarily therapeutic and is not a factor in a therapeutic interaction. Giving advice to the client is a block to communication and is not a factor in a therapeutic interaction.
62
A mental health nurse is working toward the avoidance of using nontherapeutic communication techniques when engaging with clients. Which technique(s) will the nurse most likely avoid using in order to use more therapeutic responses to clients? Select all that apply.
a. Silence
b. Voicing doubt
c. Agreeing
d. Challenging
e. Disapproving
f. Exploring
c, d, e
Silence is a therapeutic technique that involves the absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking. Voicing doubt is a therapeutic technique that involves expressing uncertainty about the reality of the client's perceptions. Agreeing is a nontherapeutic technique that involves indicating accord with the client. Agreeing indicates the client is "right" rather than "wrong" and there is no opportunity for the client to change their mind without being "wrong." Challenging is a nontherapeutic communication technique that involves demanding proof from the client, and this may cause the client to defend delusions or misperceptions more strongly than before. Disapproving is a nontherapeutic communication technique that involves judging the client's situation and behaviors. Exploring is a therapeutic technique that involves delving further into a subject or idea.
63
A new nurse is speaking to a client during a mental-health interview. Which technique(s) would indicate that the new nurse requires further teaching about therapeutic communication techniques? Select all the apply.
a. confronting the client
b. giving advice
c. agreeing with the client
d. providing reassurance
e. providing doubt
f. making observations
b, c, d
Techniques that inhibit communication are nontherapeutic for the client and include giving advice, agreeing with the client, challenging the client, providing reassurance, and disapproving of the client’s situation or behavior. Confronting the client, providing doubt, and making observations are therapeutic communication techniques that promote a therapeutic interaction.
64
The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply.
a. skips the last session
b. expresses anger towards the nurse and other clients
c. lists actions to move forward at the conclusion of the meeting
d. asks to keep in touch with the nurse after the relationship ends
e. identifies a resolved problem as a new one needing to be addressed
a, b, e
Ending the therapeutic relationship can produce anxiety in the client. The client may skip the last session to avoid ending the relationship. Expressing anger towards the nurse and other clients indicates that the client does not want the relationship to end. Identifying a resolved problem as a new problem is an action to keep the relationship going. Listing actions to move forward is a desired outcome at the conclusion of a therapeutic relationship. Asking to keep in touch with the nurse after the relationship ends is testing the boundaries but does not necessarily indicate that the client does not want the relationship to end.
65
A new nurse is conducting an admission interview and the client repeatedly uses the phrase “dirty whore” when talking about their spouse and children. Which action(s) by the nurse, if observed by the nurse manager, will require the nurse manager to intervene? Select all that apply.
a. asking another nurse to complete the interview
b. communicating distaste in the comment nonverbally
c. telling the client using the phrase may result in loss of privileges
d. asking the client to tell you the names of their spouse and children
e. maintaining a neutral facial expression
abc
The nurse–client relationship can be jeopardized if the new nurse finds the client’s behavior unacceptable or distasteful and allows those feelings to show by avoiding the client (by asking another nurse to complete the interview) or making verbal responses or facial expressions of annoyance or turning away from the client. Maintaining a neutral expression and asking the client to share the names of their spouse and children communicate active listening and promote insight into appropriate behaviors without communicating disapproval.
66
A new nurse is speaking to a client during a mental-health interview. Which technique(s) would indicate that the new nurse requires further teaching about therapeutic communication techniques? Select all the apply.
a. confronting the client
b. giving advice
c. agreeing with the client
d. providing reassurance
e. providing doubt
f. making observations
b, c, d
Techniques that inhibit communication are nontherapeutic for the client and include giving advice, agreeing with the client, challenging the client, providing reassurance, and disapproving of the client’s situation or behavior. Confronting the client, providing doubt, and making observations are therapeutic communication techniques that promote a therapeutic interaction.
67
Anhedonia
Anhedonia refers to the reduced ability to experience pleasure.
68
Echopraxia
Meaningless imitation of movements just made by another person, occurring as a symptom of mental conditions.
69
T/F: The Patient Self-Determination Act ensures that a person with a mental illness is not discriminated against in the workplace.
False. The Patient Self-Determination Act requires that agencies receiving Medicare and Medicaid reimbursement to inform patients at the time of admission of their right to be a central part of any and all health care decisions made about them or for them.
70
T/F: Involuntary commitment requires a court order.
True. Involuntary commitment is the confined hospitalization of a person without the person’s consent but with a court order.
Three common elements:
Mentally disordered
Dangerous to self or others
Unable to provide for basic needs
Provisions for emergency short-term hospitalization of 48 to 92 hours
71
List in order from least to most restrictive:
PRN medication offers
De-escalation techniques
Restraints
Seclusion room (open)
Time out
Locked seclusion
De-escalation techniques (From least)
PRN medication offers
Time out
Seclusion room (open)
Locked seclusion
Restraints (To most restrictive)
72
The following list requirements for what type of intervention?
Nutrition and toileting needs
Close observation (1 to 1)
Neuro/sensation/movement checks
Timely physician order
Most restrictive restraint method (restraints)
73
What is the Judgment that the client has harmed someone or is about to injure someone (safety is the key).
Duty to warn which is a breach in the confidentiality law.
74
What is using knowledge of science and incorporating art of caring to achieve maximal health care potential?
Beneficence
75
What is the fundamental right of self-determination?
Autonomy
76
Duty to treat all fairly
Justice
77
Duty to cause no harm
Nonmaleficence
78
Professionals authorized to make decisions for good of client
Paternalism
79
Duty to tell the truth
Veracity
80
Faithfulness to obligations and duties
Fidelity
81
Intense, emotional reaction to the loss of a loved one; biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation.
Grief
82
Process of healing and learning to cope with the loss that begins immediately after the loss and can last months or years.
Bereavement.
83
Frozen in chronic mourning (ex. Not being able to return to daily occupational or pleasurable activities).
Complicated bereavement
84
T/F: The disaster event marks the first phase of a disaster.
False, prewarning of the disaster is considered the first phase of a disaster. This is followed by the disaster event and finally recuperative efforts.
85
ABCs of nursing care
A—arousal, when present, the intervention goal is to decrease excitement by providing safety, comfort, and consolation
B—behavior, when abnormal or irrational behavior present, survivors should be assisted to function more effectively in the disaster
C—cognition, when cognitive disorientation occurs, reality testing and clear information should be provided
86
When applying the ABCs of psychological first aid, the nurse addresses which action with cognition?
A. Decreasing excitement
B. Providing for safety
C. Assisting to function more effectively
D. Providing reality testing
D.
When applying the “C” of the ABCs, the nurse would perform reality testing and provide clear information. Decreasing excitement occurs with “A,” arousal. Providing for safety and assisting the person to function more effectively occurs with “B,” behavior.
87
Which activity occurs during the orientation phase of the nurse–patient relationship?
A. Testing the relationship
B. Resolving the problem
C. Engaging in problem solving
D. Identifying problems
A.
During the orientation phase, the relationship is tested. Identifying the problems and engaging in problem solving occur during the working phase. The relationship terminates during the resolution phase.
88
Rapid speech with quick changes from one thought to another. Topic doesn’t remain the same. Common in bipolar disorder in manic phase or someone who is psychotic.
Flight of ideas
89
Thoughts are not organized and no connectivity. Trees to sky, to refrigerator, to television show.
Loose associations/derailment
90
Digressions on the way to an eventual conclusion to answer the questions. Go around the mulberry bush but do get to point.
Circumstantiality
91
Tangible, frequent digressions until the initial reason for discussion has been forgotten.
Incoherence
92
Seeing things that are not there, that we might not see.
Hallucinations
93
Fixed beliefs; accurate and false beliefs not corrected by reasoning.
Delusions
94
People are out to get them.
Persecutory delusions
95
Repeating same word.
Perseverating
96
With what condition do you not ever tell the patient that it’s unlikely that you’re seeing that. They literally see those things.
Hallucinations
97
When a patient is hearing voices, you should not what?
Not say you don’t hear them, you say, tell me more about those voices.
98
If they’re being told to hurt themselves or others or potentially unsafe, we want to know that. Don’t say we don’t hear them, ask how they make them feel.
Hallucinations
99
Which is mood and which is affect?
Sustained overall emotions that may be sustained for days or weeks or fluctuate during the day.
Capacity to vary outward emotions that fluctuate with thought content.
Mood: sustained overall emotions that may be sustained for days or weeks or fluctuate during the day.
Affect: Capacity to vary outward emotions that fluctuate with thought content.
100
Which is judgement and which is insight?
Awareness of own thoughts/feelings and ability to compare them with thoughts/feelings of others. Meaning of behavior i.e. having hallucinations and delusions does not mean I have a mental illness.
Ability to reach a logical decision and to choose a course of action after considering various possibilities.
Insight: Awareness of own thoughts/feelings and ability to compare them with thoughts/feelings of others. Meaning of behavior i.e. having hallucinations and delusions does not mean I have a mental illness.
Judgement: Ability to reach a logical decision and to choose a course of action after considering various possibilities.
101
Recovery-oriented nursing practice focuses on...
...collaborating with pt to help them be motivated to change.
102
Reinforce desired behaviors and extinguish undesired ones. Used for eating disorders, addictions, anger mgmt., impulse control, care of children.
Behavior modification
103
Patients rewarded for desired behaviors.
Token economy
104
Little evidence that what follows pt outside of treatment facility.
Little evidence that transfer of new behaviors from token economy follows pt outside of treatment facility.
105
The process of understanding one’s own beliefs, thoughts, motivations, biases, and limitations and recognizing how they affect others
Self-awareness
106
Which are biologic, psychological and social?
- Physical characteristics
- Psychological makeup; emotions, motivations, beliefs
- Cultural beliefs; patterns of communication
- Genetic makeup, chronic illness, or unobservable physical disability
- Traumatic experiences
- Sociocultural values
Biologic
- Physical characteristics
- Genetic makeup, chronic illness, or unobservable physical disability
Psychological
- Psychological makeup; emotions, motivations, beliefs
- Traumatic experiences
Social
- Sociocultural values
- Cultural beliefs; patterns of communication
107
What is the ongoing process of interaction in which meaning emerges and helps patient explain their perception and feelings?
Therapeutic communication
108
What are the following?
Acceptance
Confrontation
Voicing Doubt
Interpretation
Observation
Open-ended statements
Reflection
Restatement
Silence
Listening (active)
Validation
Clarification
Verbal therapeutic communication techniques.
109
Which of the following are nontherapeutic communication techniques (techniques that inhibit communication):
Interpretation
Advice/and personal opinions
Agreement
Reflection
Challenges
“Why” questions
Changing the subject matter
False Reassurance
Observation
Disapproval
Open-ended statements
Restatement
Silence
Advice/and personal opinions
Agreement
Challenges
False Reassurance
Disapproval
“Why” questions
Changing the subject matter
110
What part of the brain is involved in motor functions and association in both the learning and the programming of behavior or activities that are repetitive and, done over time, become automatic
Basal ganglia
111
Which parts of the brain do the following:
Stores information, especially emotions attached to memories
Relay-switching center of brain; relays all sensory information except smell
Basic human activities: sleep--rest patterns, body temperature, physical drives; secretes hormones; connected to pituitary gland
Hippocampus
Stores information, especially emotions attached to memories
Thalamus
Relay-switching center of brain; relays all sensory information except smell
Hypothalamus
Basic human activities: sleep--rest patterns, body temperature, physical drives; secretes hormones; connected to pituitary gland
112
Which structures are found in the cerebrum?
Hemispheres
Basal ganglia
Hippocampus
Amygdala
Hemispheres
113
Which neurotransmitter is the primary excitatory neurotransmitter
Greatest concentration in the peripheral nervous system
Possibly involved in higher intellectual functioning and memory
Acetylcholine
114
Which biogenic amines are synthesized from tyrosine, which from tryptophan?
Synthesized from tyrosine
Also referred to as catecholamines
Dopamine
Norepinephrine
Epinephrine
Synthesized from tryptophan
Serotonin
115
Which biogenic neurotransmitter is Excitatory and involved in Cognition
and Motor function?
Dopamine
116
Which excitatory bioamine neurotransmitter is responsible for
Mood states
Fight-or-flight
Sleep and wakefulness
Norepinephrine
117
Which biogenic amine neurotransmitter is involved in
Emotions
Cognition
Sensory perceptions
Sleep
Appetite
and is it excitatory or inhibitory?
Serotonin - excitatory
118
Amino acid neurotransmitters
Histamine (anticholinergic) and GABA (primary inhibitory)
119
What is the primary inhibitory amine neurotransmitter?
GABA
120
What is the primary inhibitory neurotransmitter that controls neuronal excitability through brain (example: controls or reduce anxiety)
GABA
121
What are neuropeptides involved in?
Pain (opiates category - endorphins)
122
Receptors have capacity to change.
Changes in sensitivity of receptors most commonly caused by...
- The effect of a drug on a receptor site
- Disease that affects the normal functioning of a receptor site
123
What do the following affect?
- The effect of a drug
- Disease that affects the normal functioning
Neurotransmitter receptor sites
124
T/F: Neurotransmitter receptors are static and not subject to change.
False.
Receptors exhibit receptor sensitivity indicating that they have the capacity to change. This change is most commonly caused by the effect of a drug on a receptor site or a disease that affects the normal functioning of a receptor site.
125
Four phases of drug treatment
Initiation
Stabilization
Maintenance
Discontinuation
126
Biologic basis of addiction is in what brain part?
Midbrain nuclei
