The client states, "Who is confused? He said I should go, but I didn't. Is that weird?" Which response by the nurse would be best to clarify the client's
... [Show More] statement?
A. How did you feel before you talked to him?
B. When did you first notice yourself feeling confused?
C. Did he indicate to you exactly what he meant?
D. I don't understand. Can you explain in another way?
D
During the initial interview with a client, the nurse begins to feel uncomfortable and realizes the client's behavior and mannerisms remind the nurse of the nurse's abusive parent. The nurse concludes that the current situation represents which phenomenon?
A. Transference
B. Countertransference
C. Denial
D. Reaction formation
B
A client asks the nurse what to do about leaving the spouse. The nurse replies "Why are you having trouble making a decision? It's easy to see that you should file for divorce." The nurse manager overhearing the conversation would counsel this nurse because the nurse's response: (Select all that apply)
A. Restricts the client's opportunity for self-exploration & problem solving skills
B. Belittles the client & the client's indecisiveness
C. Challenges the client's belief system
D. Assumes that the client is incapable of reaching an independent decision
A,B,D
While communicating with a client, the nurse decides to provide the client with feedback. The primary reason for this is that giving appropriate feedback makes it possible for the nurse to:
A. Present advice
B. Explore feelings
C. Provide information
D. Explain behavior
C
The nurse assesses a client as being on the mental health end of the mental health/mental illness continuum. Which statement by the client best supports this assessment? (Select all that apply)
A. I am satisfied with my life and life choices
B. My family thinks that I am a good person
C. I'm an average person leading a normal average life.
D. I've always thought I should have been more sucessful
A,C
A newly admitted adult client says, "No, I don't want that medicine. I won't take it." The nurse says, "Take it. It's good medicine." The nurse then places the cup in front of the client's mouth and forcefully presses it against the client's lips. In counseling this nurse, what important legal principles can be applied to the nurse's action? (Select all that apply)
A. If a client does not object a second time, a nurse can administer the medication
B. If treatment is given without consent, legal charges of battery can be filed
C. Clients have the right to be treated in the least restrictive manner possible
D. Clients, unless declared legally incompetent, have the right to refuse medication
B,D
A client presents at a crisis clinic with reports of having crying spells and overwhelming feelings of loss. The client further relates that this extreme distress began one week ago when the client's parent developed an acute physical illness & died. The client speaks clearly and descriptively about the illness & death & verbalizes feelings readily. The nurse interprets that the client's behaviors suggest the client:
A. Has suffered irreversible psychological damage
B. Is a candidate for long-term psychotherapy
C. Is highly anxious and depressed
D. Is a good candidate for short-term, focused psychotherapy
D
A client has purposefully attempted to embarrass a nurse by making a sexually explicit comment. The best response by the nurse is to:
A. Clarify the intention of the client
B. Leave the situation altogether
C. Refuse to talk with the client any further
D. Continue to interact as if the comments did not cause embarrassment
A
An emergency psychiatric client presents with amnesia, hyperthermia, & unexplained loss of appetite. Accompanying family members state that the client suffered a head injury while falling from a ladder several days before. The nurse concludes that the client's symptoms are consistent with trauma to which area of the brain?
A. Thalamus
B. Hypothalamus
C. Cerebrum
D. Cerebellum
B
The nurse has explained to a client the biologic theories of depression. the nurse concludes that the teaching has been effective if the client says, "I now know that my depression may be caused from: (Select all that apply)
A. Excessive serotonin activity level in the CNS
B. Insufficient serotonin activity in the CNS
C. Excessive acetylcholine in the CNS.
D. Insufficient acetylcholine activity in the CNS
B,D
A client was quite upset the entire time she was pregnant and made it clear she did not want her unborn child. However, since the birth, she has become overly protective and refuses to let anyone else near the infant. Which ego defense mechanism does the nurse recognize in the client's behavior?
A. Denial
B. Projection
C. Reaction formation
D. Displacement
C
The client has an elective abortion. The nurse wishes to assist the client to manage post-abortion emotional responses. Which nursing approach is most appropriate?
A. Reassure the client that having an abortion was the best possible decision
B. Teach the client how to use effective methods of birth control
C. Encourage the client to express feelings of loss and grief
D. Suggest that the client rely on a higher power for spiritual support
C
A 63-year-old male client expresses feelings of hopelessness and helplessness about his spouse's illness and anticipated death. On which of the following issues should the nurse initially assist the client to focus?
A. The nature of the spouse's present illness
B. The client's response to past losses
C. The dying spouse's feelings about impending loss and death
D. The client's relationship with the spouse
A
The mental health nurse is conducting an assessment with a client who has a history of anxiety. The nurse concludes that the client's use of defense mechanisms is adaptive when the client remains psychologically and physically safe and the client:
A Experiences fewer direct manifestations of anxiety
B. Seeks social isolation to avoid stress
C. Displaces anxiety onto other persons or situations
D. Identifies the personal level of anxiety
A
The mental health client who experienced a brief psychotic reaction was treated as an inpatient for one week and then discharge to outpatient day hospital program for follow-up treatment. The nurse explains to the client's family that the outpatient treatment setting approach is based on the principle of providing which of the following?
A. Compliance with the Americans with disabilities act as it applies to mental health clients
B. Mental health care in the least restrictive setting possible
C. Community-based care for non-chronically ill mental health clients
D. Non-pharmacologic treatment modalities for mental health clients in outpatient settings
B
A nurse completing a cultural assessment of the client recognizes a personal tendency to engage in stereotyping in countertransference responses. The nurse should further recognize that these behaviors are likely to lead the nurse to do which of the following?
A. Anticipate the unmet needs of the individual client
B. Be open and honest while responding to the client's concerns
C. Fail to recognize unmet needs of the individual client
D. Facilitate the treatment process
C
In order to deal effectively with the spiritual needs of a client, what should be the nurse's initial strategy?
A. Refer the client to an appropriate clergy
B. Clarify own spiritual beliefs and values
C. Use a spiritual assessment tool
D. Discuss on religiosity with the client
B
During a team meeting, the nurse develops the outcomes of care for a depressed male client. Which of the following is the most appropriately stated outcome for the client within 3 days?
A. Feel less depressed
B. Reduce self-rating on a depression scale by 10%
C. State he has significantly more insight into his problems
D. Feel supported as he deals with grief issues
B
In older adult grieving the loss of a family member reports all of the following symptoms to the nurse. To plan appropriate nursing interventions, the nurse needs to determine which symptoms need to be addressed first. Put the following client symptoms in order from highest to lowest priority.
A. Occasional feelings of tightness in the chest
B. Expressed thoughts of being better off dead
C. Statements of guilt about a loved one's death
D. Morbid preoccupation with feelings of worthlessness
B,D,A,C
An elderly African-American woman is admitted for sepsis and pneumonia. She immediately calls for her minister to be at her bedside to pray with her. The nurse recognises this as a(n):
A. Indication that she feels she may die soon
B. Positive coping mechanism in the African-American culture
C. Indication that the client is lonely
D. Signal that the client does not trust the hospital staff
B
The client says, "I feel like I've been abandoned." The nurse who chooses to which communication technique might reply, "You feel alone...?"
A. Focusing
B. Summarizing
C. Reflecting
D. Restating
C
A new staff nurse asks the experienced psychiatric-mental health nurse to explain the primary purpose for which nurses use the DSM-IV-TR. The response should be:
A. Determine functional categories of physical disabilities of the client
B.Understand the clients psychiatric-mental health medical diagnosis
C. Define categories of nursing diagnoses for the client
D. Specify individualized outcomes for nursing care of the client
B [Show Less]