Psychiatric Mental Health Nursing 8th Edition Mohr - Test Bank

Import Settings: Base Settings: Brownstone Default Information Field: Chapter Information Field: Client Needs Information Field: Cognitive Level Information Field: Difficulty Information Field: Integrated Process Information Field: Objective Information Field: Page and Header Highest Answer Letter: D Multiple Keywords in Same Paragraph: No Chapter: Chapter 01: Introduction to Psychiatric-Mental Health Nursing Multiple Choice 1. 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? A) “Mental health is difficult to define and depends on cultural norms.” B) “Mental health is marked by productivity, fulfilling relationships, and adaptability.” C) “Mental health is characterized by the absence of mental illness.” D) “Mental health is the performance of behavior that is accepted as normal.” Ans: B Chapter: 01 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Teaching/Learning Objective: 01 Page and Header: 2, Mental Health Feedback: Mental health means the successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. 2. A 48-year-old independent, successful woman is recovering from a modified radical mastectomy. She states she was grateful that during the first few weeks after surgery her mother stayed with her and did “everything” for her. Which element of mental health does this reflect? A) Reality orientation B) Mastery of the environment C) Self-governance D) Tolerance of the unknown Ans: C Chapter: 01 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 2, Elements of and Influences on Mental Health Feedback: In self-governance, the person acts independently, dependently, or interdependently as the need arises without permanently losing his or her autonomy. Tolerance of the unknown means the person faces the uncertainty of life and the certainty of death with faith and hope. To master the environment, the person becomes competent, effective, and creative in interacting with and influencing his or her environment. Reality orientation involves differentiating fact from fantasy and behaving accordingly. 3. Why is the document Mental Health: A Report of the Surgeon General (1999) most significant? A) Because it states clearly that there are effective treatments for mental illness B) Because it allocates research money to psychiatric facilities C) Because it sets new guidelines for use of restraints D) Because it establishes reimbursement guidelines for third-party payers Ans: A Chapter: 01 Client Needs: A-1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 3, Mental Health as a National Priority Feedback: Mental Health: A Report of the Surgeon General addressed that mental health is fundamental to and necessary for a healthy life; mental disorders are real health conditions with enormous consequences for individuals, families, communities, and the nation; effective treatments for mental disorders are available; a range of treatment options is available for most mental disorders; and those with mental disorders or symptoms should seek treatment. 4. While a nurse is performing an admission assessment for a mental health client, the client states that all of his problems have been caused by his parents. The nurse knows that psychological factors that can influence mental health include which of the following? A) Neuroanatomy B) Emotional developmental level C) Values and beliefs D) Religion Ans: B Chapter: 01 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 3, Figure 1.2 Feedback: Psychological influences on mental health include interactions, intelligence quotient, self-concept, skills, creativity, and emotional developmental level. Neuroanatomy is a biological influence on mental health. Values, beliefs, and religion are sociocultural influences on mental health. 5. What is the primary purpose of the five-axis system used in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR)? A) To separate the various mental disorders into five related categories B) To give a comprehensive picture of client functioning C) To improve prognostic ability D) To provide a decision-making algorithm for pharmacologic treatment Ans: B Chapter: 01 Client Needs: A-1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 7, Five Axes of the DSM Feedback: The categorical classification of the DSM-IV-TR uses a five-axis system to give a comprehensive picture of the client's functioning. 6. One limitation of the DSM relates to diagnostic labels given to children. The most problematic issue caused by applying adult categories to children is which of the following? A) It prevents the proper treatment of childhood disorders. B) The criteria for diagnosis of a disorder are flexible for an adult, but not for children. C) Categories are based on manifestations of adult disorders, not research in children. D) The DSM was written before childhood psychological conditions were recognized. Ans: C Chapter: 01 Client Needs: A-1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 03 Page and Header: 8, Limitations and Criticisms of the DSM Feedback: The DSM diagnostic labels for children were derived from adult categories. The most problematic related issue is that the diagnoses are not based on a body of research on children—similar disorders may have different signs and symptoms for each age group. 7. Which of the following represents a problem complicating the treatment of people with mental illness? A) Insurers' reimbursement decisions B) Increased responsibility for care by state mental hospitals C) Overuse of the well-coordinated mental health care system D) Lack of effective treatments Ans: A Chapter: 01 Client Needs: A-1 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 10, Cost-Related Issues Feedback: A goal of behavioral health-managed care has been to reduce hospital admissions, which are the most expensive part of psychiatric care. Unfortunately, some managed care “gatekeepers” have denied or restricted access to needed services and therefore have added to the discouragement, distress, and even despair of clients and their families. 8. Julie, a 47-year-old woman, missed 1 week of work when she was hospitalized with bipolar disorder. She was placed on medication and was able to return to work. When asked about her absence, Julie informed coworkers that she was suffering from influenza. What is the most likely reason Julie lied about her illness? A) This is a sign that the medication is not effectively treating her illness. B) Fear of rejection, isolation, and discrimination based on her mental health diagnosis C) Due to workplace policies that encourage the firing of those with mental illnesses D) To avoid eliciting sympathy among her coworkers Ans: B Chapter: 01 Client Needs: C Cognitive Level: Evaluation Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 10, Stigma Feedback: Strong stigma still attaches to people who suffer from mental illness, largely related to public misunderstandings, misconceptions, and associated fears. At a personal level, people with mental illness must deal with painful rejection, isolation, and discrimination that erode self-assurance and can systematically undermine self-confidence. Stigma creates or reinforces interpersonal, financial, employment, and social barriers to accessing care. 9. A 22-year-old man with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client attended a prestigious art school and enjoyed many social and leisure activities. Of the following long-term goals for this client, which is consistent with an overarching recovery goal for all clients with mental disorders? A) The client will not injure himself. B) The client's symptoms will be reduced. C) The client will show interest in social and leisure activities. D) The client will resume pre-illness functioning. Ans: D Chapter: 01 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 04 Page and Header: 12, Beyond Response to Recovery Feedback: The aim now is for clients to recover or to experience a remission and be restored to pre-illness functioning in various domains, such as occupationally, socially, and educationally. 10. Which of the following approaches to care best reflects cultural competence? A) Always assign nurses of a specific ethnic background to clients with the same ethnic background. B) Learn the behaviors and values associated with people of specific ethnic backgrounds. C) Assess the culturally mediated beliefs of each client. D) Believe that people are more alike than they are different. Ans: C Chapter: 01 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 12, Culturally Competent Care Feedback: Culturally competent care means that care is provided in a manner acceptable to the person's cultural background, regardless of whether it is provided by a care provider from the same ethnic or minority group as the client. Health care professionals must be able to incorporate cultural factors including language, customs, beliefs, and traditions into plans of care. 11. The family advocacy movement and the National Alliance for the Mentally Ill (NAMI) have identified stages through which families progress when confronting the mental illness of a loved one. Which of the following accurately reflects the stages identified in the Family Advocacy Model? A) Dealing with a catastrophic event, learning to cope, moving into advocacy B) Learning acceptance, experiencing grief, developing advocacy C) Beginning recognition, denial, grief, acceptance, advocacy D) Learning to cope, understanding, advocating Ans: A Chapter: 01 Client Needs: C Cognitive Level: Comprehension Difficulty: Difficult Integrated Process: Nursing Process Objective: 05 Page and Header: 14, Table 1.2 and Table 1.3 Feedback: Initially, when dealing with the catastrophic event, the family is overwhelmed, confused, and lost. They then learn to cope and realize the illness is a reality. The family often expresses grief, fear, and sorrow over lost possibilities and the uncertain future. Finally, moving into advocacy is evidenced when family members develop empathy, acknowledge and own the situation, and focus anger and grief on empowerment. 12. According to research conducted by the National Alliance for the Mentally Ill (NAMI), the first event and stage of the Client Adaptation Model includes which of the following? A) Event: crisis, stage: recuperation B) Event: awakening, stage: recuperation C) Event: decision, stage: rebuilding D) Event: crisis, stage: recovery/discovery Ans: A Chapter: 01 Client Needs: C Cognitive Level: Knowledge Difficulty: Difficult Integrated Process: Nursing Process Objective: 05 Page and Header: 14, Table 1.3 Feedback: The first event and stage of the Client Adaptation Model are crisis and recuperation, the second event and stage are decision and rebuilding, and the final event and stage are awakening and recovery/discovery. 13. Which of the following interventions is appropriate for a psychiatric–mental health nurse at the basic level of practice? A) Promoting symptom management B) Managing psychotropic medications C) Conducting family therapy D) Interpreting laboratory tests Ans: A Chapter: 01 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 06 Page and Header: 15, Levels of Practice Feedback: Basic psychiatric–mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric–mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness. 14. An adolescent has a history of self-mutilation. The nurse questions the client about factors that the client believes to contribute to her behavior. The nurse's questioning reflects which principle? A) That every person deserves respect B) That all people share basic human needs C) That through the therapeutic use of self, nurses can help people adapt, change, and grow D) That all behavior is meaningful and can be understood from the person's perspective Ans: D Chapter: 01 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 04 Page and Header: 16, Guiding Principles Feedback: Psychiatric–mental health nursing is built on certain principles or beliefs about people and the care they deserve: Every person is worthy of dignity and respect; every person has the potential to change and grow; all people share basic human needs; all behavior is meaningful and can be understood from the person's perspective; people have the right to participate in decisions affecting their health and treatment. Through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. While all the above principles are followed, the nurse's questioning in the stem best reflects the principle that all behavior has meaning and can be understood from the person's perspective. 15. A 44-year-old client with a history of alcohol abuse and schizophrenia is being treated as an outpatient. He is living in a group home, has been stable for several months, is not abusing alcohol, and is not experiencing delusions or auditory hallucinations. Which of the following interventions most appropriately includes the client in decisions about his treatment? A) Suggest the client decide whether to take his medication, based on his symptoms. B) Include the client in developing a treatment plan in case he becomes acutely psychotic in the future. C) Agree with the client's suggestion that he terminate treatment and call if he experiences a relapse. D) Encourage the client to make a decision about living independently. Ans: B Chapter: 01 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 06 Page and Header: 16, The Role of the Psychiatric Nurse as a Team Member Feedback: The nurse is a member of an interdisciplinary team. The team also includes the client and his or her family. Collaboration implies that members work toward a common goal and share responsibility for the outcomes of care. 16. The legal system orders a client with antisocial personality disorder into treatment. He has a history of spousal abuse and multiple arrests and convictions for drug trafficking. Based on the history, the nurse decides to perform a quick assessment and give him information about the anger management classes he is mandated to attend. The nurse's brief visit and superficial intervention are which of the following? A) Appropriate, because clients with antisocial personality disorder resist treatment B) Appropriate, because the client is not in treatment willingly C) Inappropriate, because all people have the potential to change and grow D) Inappropriate, because the nurse did not address the client's history of drug abuse Ans: C Chapter: 01 Client Needs: A-1 Cognitive Level: Evaluation Difficulty: Moderate Integrated Process: Caring Objective: 04 Page and Header: 16, Guiding Principles Feedback: Psychiatric–mental health nursing is built on certain principles or beliefs about people and the care they deserve: Every person is worthy of dignity and respect; every person has the potential to change and grow; all people share basic human needs; all behavior is meaningful and can be understood from the person's perspective; people have the right to participate in decisions affecting their health and treatment; and through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. 17. What is the main tool at the nurse's disposal in treating clients with mental disorders? A) Psychotropic medications B) The therapeutic use of self C) Self-help groups D) Family education and therapy Ans: B Chapter: 01 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 06 Page and Header: 16, Guiding Principles Feedback: Through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. Medications and education will influence and enhance growth, but the therapeutic use of self is the nurse's primary tool. Self-help groups do not involve health care professionals. 18. An adult woman with a diagnosis of major depression has found that few of her peers and family members accurately understand the etiology of her health problem. Which of the following statements best describes the etiology of mental illnesses? A) Despite advances in neuroscience, the etiology of mental illnesses is largely unknown. B) Mental illnesses are the result of impaired coping skills and personality deficits. C) Each specific mental illness is linked to a particular gene defect. D) Mental illnesses result from a combination of genetic and environmental factors. Ans: D Chapter: 01 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 01 Page and Header: 7, Etiology Feedback: The roots of mental illness are a combination of biologic and environmental factors; however, it is inaccurate to think that any one gene is responsible for any mental disorder. Coping skills and personality affect the onset and course of mental illnesses but these factors are not solely, or even primarily, responsible for their etiology. 19. A male client with a history of depression and suicide attempts has established a psychiatric advanced directive specifying that he does not wish to be treated with psychotropic medications. The client has been admitted to the hospital following a suicide attempt and has been deemed an acute risk to his own safety. How will the individual's advanced directive affect his plan of care? A) The client will be treated with all appropriate interventions with the exception of medications. B) The client will be administered medications if they are determined to be essential to his care. C) The client will need to waive his advanced directive if he is to be successfully treated. D) The client will be administered medications without his knowledge. Ans: B Chapter: 01 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 14, Psychiatric Advanced Directives Feedback: Advanced directives are not meant to supersede care necessary to protect client safety. As such, the client may be treated with medications despite his advanced directive. Administering medications without the client's knowledge is never a preferred approach. 20. A psychiatric–mental health nurse has witnessed first-hand the high incidence and prevalence of depression in the American population, particularly among older adults. What phenomenon is known to complicate the diagnosis and treatment of depression in older adults? A) The disorder is often attributed to the aging process rather than treated aggressively. B) Depression results from organic brain changes that occur in both healthy and unhealthy adults. C) Older adults are frequently suspicious of psychiatry and of psychotropic medications. D) The disorder is often internalized by older adults, making accurate diagnosis challenging. Ans: A Chapter: 01 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 4, Incidence and Prevalence Feedback: Depression, a serious mental health problem for all age groups, is particularly challenging for older adults. Although 8% to 15% of them have depression, the condition often is undiagnosed and untreated for older clients because they, their families, or health care providers mistakenly confuse signs and symptoms with “normal aging.” This phenomenon is more significant than suspicion, internalization of symptoms or organic brain changes. Import Settings: Base Settings: Brownstone Default Information Field: Chapter Information Field: Client Needs Information Field: Cognitive Level Information Field: Difficulty Information Field: Integrated Process Information Field: Objective Information Field: Page and Header Highest Answer Letter: D Multiple Keywords in Same Paragraph: No Chapter: Chapter 03: Conceptual Frameworks and Theories Multiple Choice 1. A psychiatric–mental health nurse is aware of the importance of theories in the development and delivery of care. Which of the following is the best definition of a theory? A) A group of related concepts or ideas B) A person's or group's beliefs about how something happens or works C) A prediction about two or more concepts D) A researchable question related to health care Ans: B Chapter: 03 Client Needs: B Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 01 Page and Header: 42, Theories: Who Cares and So What? Feedback: A theory is a person's or group's beliefs about how something happens or works. Theories have different explanations to account for human behavior. They also promote interventions consistent with the tenets of their theories. 2. Which of the following explains why theories are important to psychiatric–mental health nursing? A) Theories provide more treatment options for clients. B) Theories add professionalism to health care. C) Theories simplify treatment decisions for most clients. D) Theories lead to the expansion of knowledge. Ans: D Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 01 Page and Header: 42, Theories: Who Cares and So What? Feedback: Theories lead to the collection of relevant empirical (factual) data or relations not yet observed, leading to the expansion of knowledge in a field. Theories also incorporate known empirical findings within a logically consistent and reasonably simple framework. They do not necessarily simplify treatment. Increased professionalism is not a central attribute of theories. 3. A client has been told by a psychologist that memories in his unconscious are contributing to his depression. This reasoning implies that the psychologist ascribes to what theory? A) Psychoanalytic theory B) Behavior theory C) Cognitive–behavioral theory D) The humanistic perspective Ans: A Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 44, General Principles Feedback: Central to psychoanalytic theory is the idea of the unconscious. A goal of psychoanalysis is to expand awareness of unconscious functioning and its relation to everyday living. The other listed theories do not prioritize the role of the unconscious to the same degree. 4. A client's current plan of care includes interventions that are rooted in the concepts of reinforcement. Which theory of human behavior is being prioritized during this client's care? A) Humanistic theory B) Sociocultural theory C) Behavioral theory D) Psychoanalytic theory Ans: C Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 47, Reinforcement Feedback: Behavior theory maintains that all human behavior is learned. Its major focus is on how environmental conditions result in the acquisition, modification, maintenance, and elimination of adaptive and maladaptive behaviors. Reinforcement is a central focus of behavioral theory. 5. A client and her therapist have been discussing the notion that her psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. This discussion is congruent with what theory? A) Humanistic theory B) Interpersonal theory C) Biophysiological theory D) Sociocultural theory Ans: A Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 51, Humanistic Theory Feedback: Humanistic theory recognizes the importance of learning and other psychological processes that traditionally have been the focus of research. With their positive view of human nature, humanists believe that psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. 6. During marital counseling, a man complains that his wife often “bombards” him with problems as soon as he settles down at home after work, which results in a prolonged argument. The wife admits that she does this but states she feels neglected and that her husband does not take the family problems seriously. She doesn't want her marriage to turn out like her parents' marriage. The wife admits that she sometimes provokes an argument in order to gain her husband's attention. How would a behaviorist most likely explain the wife's actions? A) She has repressed painful memories about her emotionally distant father and is working out her anger at the parent in the marital relationship. B) Her thoughts about her parents' unhappy marriage are a justification for her behavior. C) She has an underlying anxiety disorder. D) The long argument in which she and her husband participate positively reinforces her behavior. Ans: D Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 47, Reinforcement Feedback: Behavioral theory considers how reinforcement influences behavior. Through reinforcement, a person learns to perform a certain response (behavior) either to receive a reward or to avoid a punishment. The reward in this case is that the wife gets the needed attention from her husband even though it is in the form of an argument. A behaviorist would not likely emphasize the justifications for either person's behavior. 7. An adult man recalls that he was teased as a child about his inability to participate in sports. He began to avoid situations in which others might evaluate his behavior. He seeks treatment now because he is an accomplished musician but cannot perform for an audience. According to behavioral theory, his behavior is an example of which of the following concepts? A) Discrimination B) Modeling C) Generalization D) Shaping Ans: C Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 48, Generalization and Discrimination Feedback: Generalization happens when a conditioned response becomes associated with similar stimuli. For example, if a response such as a child's polite behavior (saying “please” or “thank you”) happens at home repeatedly, the child is very likely to display that behavior in circumstances outside the home given similar conditions. Some people who become frightened in specific social situations may begin to avoid similar situations and gradually develop social phobia, in which they avoid all social situations; this may account for this man's fear. 8. The nurse is working with a client who admits to having low self-esteem. The care team has determined that cognitive restructuring will likely enhance the client's self-esteem. Which of the following best describes the goals of this intervention? A) Avoid negative self-talk B) Replace negative self-talk with positive statements C) Change distorted thinking and the subsequent behaviors D) Use adaptive defense mechanisms Ans: C Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 03 Page and Header: 49, Rationale–Emotive Therapy Feedback: The goals of cognitive restructuring are for clients to monitor their maladaptive thoughts and beliefs, look for evidence supporting their beliefs, dispute their maladaptive self-statements, substitute adaptive thoughts, and thus change their patterns of distorted thinking and, consequently, their behavior. 9. A 55-year-old woman is being treated for narcissistic personality disorder. The therapist demonstrates caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory? A) Shaping B) Discrimination C) Modeling D) Conditioning Ans: C Chapter: 03 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 03 Page and Header: 48, Modeling and Shaping Feedback: Modeling involves demonstrating desired behavior patterns to a learner. Therapists model behaviors when they teach social skills, such as caring and appropriate regard for others. The therapist models regard for others with the expectation that the learner will copy that behavior. The caring behavior is then reinforced. Given sufficient practice of the caring behavior paired with its reinforcement, regard for others gradually becomes part of the client's behavioral inventory. 10. In a group therapy session, group members confront a 35-year-old woman about her abuse of prescription pain medications. The woman states that, because a physician has prescribed her medication, she is not a drug addict. The nurse identifies this as an example of which of the following defense mechanisms? A) Regression B) Projection C) Denial D) Sublimation Ans: C Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing Process Objective: 02 Page and Header: 45, Table 3.1 Feedback: Denial is refusing to recognize a reality that might be troublesome or traumatic. Regression refers to going back to an earlier and happier time of development. Projection is when a person refuses to recognize behavior in oneself and instead “projects” it or sees it in someone else. Sublimation means taking repressed feelings and transforming it into positive and constructive pursuits. 11. During an admission interview with an adult mental health client, the client begins to talk in a childish voice and says she'd like to be playing with her dolls. What defense mechanism is this client demonstrating? A) Regression B) Suppression C) Repression D) Projection Ans: A Chapter: 03 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 45, Table 3.1 Feedback: Regression refers to going back to an earlier and happier time of development. Suppression involves wishing to put something unpleasant out of awareness and voluntarily doing so. Repression involves involuntarily placing material of life experience out of the conscious. Projection is when a person refuses to recognize behavior in oneself and instead “projects” it or sees it in someone else. 12. The nurse is conducting a series of workshops on life skills for clients with mental illness. Which of the following is an example of operant conditioning that could be used to help the clients gain appropriate social skills? A) Provide rewards for small approximations of the desired behaviors B) Use positive reinforcement for all of the clients' behaviors C) Use punishment to show the consequences of unacceptable behavior D) Withdraw reinforcement when a client demonstrates undesirable behavior Ans: A Chapter: 03 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 03 Page and Header: 46, Conditioning Feedback: People respond to achieve something rewarding or to avoid something aversive. In operant conditioning, the response precedes the stimulus. Clients would learn that socially appropriate behavior leads to certain rewards from staff. Thus, they increase that behavior to subsequently increase those positive events. It would be unrealistic for the client to perform the behavior entirely before receiving any reward. Learning is more effective with the use of positive rewards rather than negative reinforcement or punishment. Positive reinforcement is ineffective if applied to all behavior, whether acceptable or unacceptable. 13. During a group session, the nurse therapist experiences frustration and anger related to a client's repeated efforts to redirect the conversation away from the other participants' needs and toward his own priorities. The nurse therapist's “blind spot” is an example of which of the following processes? A) Distorted cognition B) Countertransference C) Respondent conditioning D) Transference Ans: B Chapter: 03 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 44, General Principles Feedback: Countertransference refers to the feelings and thoughts that service providers have toward the client. In Countertransference, the provider may harbor certain images of the client that result in “blind spots,” which can be destructive or disruptive to the therapeutic process. Transference refers to feelings and thoughts that clients have toward the service provider. Respondent conditioning happens when a response and a stimulus become connected through repetition. Distorted cognitions are self-defeating thoughts that lead to self-defeating behaviors. 14. A parent is trying to teach her child appropriate social behavior by rewarding her child with praise. What type of reinforcement is this individual using? A) Operant reinforcement B) Respondent reinforcement C) Negative reinforcement D) Positive reinforcement Ans: D Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 47, Reinforcement Feedback: In both positive and negative reinforcement, the person is rewarded for an appropriate response. With positive reinforcement, the response happens by adding something to increase probability. Negative reinforcement involves the termination or removal of a consequence after a desired response to increase the probability of a behavior. Operant and respondent are terms used to describe conditioning, not reinforcement. 15. A client has begun a course of psychoanalysis. According to psychoanalytic theory, the client's notions of right and wrong are controlled by: A) The id B) The superego C) The ego D) Latency Ans: B Chapter: 03 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 44, General Principles Feedback: The superego is essentially what Freud thought of as conscience. The id, the original system of the personality, consists of everything psychological a person inherits at birth, including the instincts. The ego mediates between the id and the external world. The ego's function is to meet the needs of the id but in a way that ensures the person's well-being. 16. During a client's care conference, a psychiatrist states, “The client's psychopathology is the result of a physiologic condition involving a deviation within her central nervous system.” To what theory does this psychiatrist likely subscribe? A) Sociocultural theory B) Biophysiological theory C) Psychoanalytical theory D) Behavioral theory Ans: B Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 51, General Principles Feedback: The biophysiological perspective proposes that psychopathology results from a physiological condition, primarily a deviation within the central nervous system. The reasons for these deviations are multifaceted, involving a complex interplay of genetics, temperament, development, brain circuitry, molecular biology, and environment. 17. A teenage boy with a recent history of mental illness and legal problems states that he grew up in a poor and violent neighborhood. According to Cichetti's theoretical framework, what are these factors known as? A) Protective factors B) Proximal factors C) Risk factors D) Distal factors Ans: C Chapter: 03 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 54, Toward a Comprehensive, Multidisciplinary Understanding of Psychopathology Feedback: Risk factors are variables that impede development and cause hardship (eg, extreme poverty). Protective factors are variables that serve as buffers and have a helpful influence (eg, supportive family). 18. A therapist has integrated knowledge of a client's unique sociocultural history into the diagnosis and treatment of her mental illness. The therapist has demonstrated an awareness of: A) Demographic anthropology B) Sociocultural anthropology C) Koro anthropology D) Medical anthropology Ans: D Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 52, Sociocultural Theory Feedback: A rapidly growing discipline known as medical anthropology deals with the cross-cultural study of medical systems and the influence of ecological, biologic, and sociocultural factors on health and disease. 19. The nurse is assessing a client's socioeconomic and socioeconomic background and has learned that the client grew up in a violence-riddled neighborhood with few support services. Which system did the nurse assess? A) Microsystem B) Exosystem C) Macrosystem D) Otogenic Ans: B Chapter: 03 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 56, Community Characteristics (Exosystem) Feedback: The exosystem consists of community characteristics. The microsystem includes family characteristics. 20. A 22 year-old woman has been diagnosed with post-traumatic stress disorder (PTSD) following a military tour of duty. According to the stress–diathesis model, what variable should be considered in addition to the stressors that the woman faced during her service? A) The woman's possible hereditary predisposition to PTSD B) The incidence of PTSD among her peers who served alongside her C) The presence or absence of comorbid mental illnesses D) The influence of the woman's environment before and after her tour of duty Ans: A Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 52, The Stress–Diathesis Model Feedback: The stress–diathesis model, a popular variation of the biophysiological model, assumes that a disposition (or vulnerability) toward a certain disorder may result from a combination of genetics and early learning. In this model, the effects of life events cannot be understood without considering innate diatheses. These diatheses are prioritized over mental illness in her peers, the presence of comorbidities, or the woman's environment. 21. A rational–emotive therapy (RET) therapist has begun a course of therapy with an adult female client who has been diagnosed with obsessive-compulsive disorder (OCD). The therapist is likely to teach the client to: A) Manage her symptoms using the powers of mind control and “centering” B) Recognize the thinking patterns that precede her undesirable behaviors C) Impose moderate punishment on herself to block exacerbations of her symptoms D) Redefine the way that she expects herself to think and behave Ans: B Chapter: 03 Client Needs: C Cognitive Level: Evaluation Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 49, Rational–Emotive Theory Feedback: RET therapists teach clients to conduct a kind of functional analysis of their own behaviors in which they examine the antecedent condition, or the cognition that precedes behaviors and results in self-statements. This model does not use punishment, mind control, or a redefinition of behavior expectations. 22. Evan is a psychiatric–mental health nurse who has been providing inpatient care for Gordon, an adult male client, for several weeks. Which of the Gordon's recent statements would suggest the presence of transference? A) “You have to watch out for people with sticky fingers around here; my stuff's always disappearing.” B) “My meds are making things worse for me, not better.” C) “Most of the nurses here are great, but Evan doesn't have a clue what he's doing.” D) “I'm certain I'd be feeling better if was transferred to a different hospital.” Ans: C Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02 Page and Header: 44, General Principles Feedback: Transference refers to feelings and thoughts that clients have toward the nurse, psychiatrist, or other service provider. In this case, there is a negative image of the nurse in the client's mind. None of the other given statements refer to a specific individual. Import Settings: Base Settings: Brownstone Default Information Field: Chapter Information Field: Client Needs Information Field: Cognitive Level Information Field: Difficulty Information Field: Integrated Process Information Field: Objective Information Field: Page and Header Highest Answer Letter: D Multiple Keywords in Same Paragraph: No Chapter: Chapter 11: Therapeutic Relationships and Communication Multiple Choice 1. A nurse learns that a distant family friend has been admitted to the inpatient psychiatric unit where the nurse works. The nurse understands that it is not acceptable to discuss this with family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a central component of what element of the therapeutic relationship? A) Competence B) Sympathy C) Trust D) Autonomy Ans: C Chapter: 11 Client Needs: D-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 01 Page and Header: 184, Trust Feedback: An important component of trust is confidentiality. Mental health providers must reassure clients that they will not share the details of clients' lives outside the professional environment. 2. The nurse provides a new client with information about the antidepressant he has been prescribed and refers him to a community support group. What essential element of a therapeutic relationship is the nurse demonstrating? A) Empowerment B) Fidelity C) Professionalism D) Recovery Ans: C Chapter: 11 Client Needs: D-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 01 Page and Header: 184, Professionalism Feedback: When acting as a professional, the nurse must learn about clients' conditions, medications, and treatments in order to provide current information and accurate insight. The foci of the nurse–client relationship are problem solving and identifying community resources to fit specific needs. 3. During an assessment interview, a client frequently expresses concern about how her mental health problems will affect her grandmother. The client's grandmother, mother, and father attend a family session, during which the nurse frequently acknowledges the grandmother. In doing so, the nurse is demonstrating what? A) Confidentiality B) Empathy C) Trust D) Respect Ans: D Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 01 Page and Header: 184, Mutual Respect Feedback: Nurses must show respect for families who are doing the best they can to help their loved ones while also coping with their own, often challenging circumstances. 4. The parents of a teenage client meet with the nurse for the first family session following the client's recent suicide attempt. The nurse expresses empathy with the parents about the stress and worry they have felt over the client's condition. Which of the following reasons most likely explains the nurse's action? A) The nurse wishes to show respect for the family. B) The nurse wants to offset the mother's protective behaviors. C) The nurse wants to take the focus off the mother. D) The nurse is unable to create distance from the family. Ans: A Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Caring Objective: 01 Page and Header: 184, Mutual Respect Feedback: Nurses must show respect for families who are doing the best they can to help their loved ones while also coping with their own, often stressful circumstances. 5. An adult client has a history of severe psychological abuse by her mother, who has schizophrenia. The nurse plans to ask the client details about each incident of the abuse and how it has affected her sense of self-esteem. This is an example of what kind of intervention? A) Caring B) Excessive probing C) An opportunity to build trust D) A judgmental attitude Ans: B Chapter: 11 Client Needs: C Cognitive Level: Evaluation Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02 Page and Header: 189, Excessive Probing Feedback: Professionals have the right to ask any questions that they deem necessary. They should recognize, however, that the goal is to help clients cope with their current situation. Asking clients to relate painful details of their childhood or to recount the embarrassing circumstances leading to their hospitalization may place an unfair burden on them. Nurses must ask themselves whether their questions are designed to satisfy their own curiosity or to meet the client's current needs. 6. A male client was discharged from care several months ago after successful treatment for depression. Now, the client is back in the health care facility with severe depression, and all the former issues have returned. The nurse says to a coworker, “This is unbelievable; we're back at square one again. He should know better at this point.” The nurse's comments reflect what? A) Countertransference B) A judgmental attitude C) An acceptable level of frustration D) Her underlying concern for the client Ans: B Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 02 Page and Header: 187, Confronting Judgmental Attitudes Feedback: Judgmental attitudes and preconceptions deter the development of therapeutic relationships. Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, “Why doesn't this person just snap out of it, put his or her problems in perspective, or focus on something else?” 7. A nurse is conducting a life skills program for people who have mental illness. A young adult with schizophrenia asks the nurse to call her on the weekends so she has someone to talk to who really cares about her. Which of the following actions should the nurse take? A) Tell the client she will call once per week during office hours so that the client can practice phone skills B) Tell the client firmly that such a request is an inappropriate violation of their professional relationship C) Temporarily call the client once each weekend to build trust D) Tell the client to call the office answering service in case of an emergency Ans: A Chapter: 11 Client Needs: A-1 Cognitive Level: Application Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02 Page and Header: 188, Enhancing Self-Awareness Feedback: Nurses need to set limits with clients so that the boundaries of the relationship remain intact. Becoming overly involved with clients in inappropriate ways is evidence of a lack of self-awareness (making extra visits when time does not allow for them or calling clients when off duty). 8. A nurse therapist recently began meeting with a client in an effort to address some of the client's symptom-management strategies. Which of the following actions by the nurse or client represents the working phase of the therapeutic relationship? A) Setting goals B) Communicating interest in the client C) Identifying past ineffective behaviors D) Reviewing work that has been done Ans: C Chapter: 11 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 191, Working (Middle) Phase Feedback: In the working phase of the relationship, the client is involved actively in achieving goals set during the initial phase. The tasks of the working phase of the therapeutic relationship include identifying past behaviors that have been ineffective for coping with the focal problem; developing a plan of action, practicing implementing it, and evaluating its effectiveness; integrating a new self-concept, worldview, or attitude toward one's illness as a result of changes in behavior and circumstances; and increasing hopefulness for the future and ability to function independently. 9. During a therapy session, the nurse states, “So you're saying that you've tried many techniques for dealing with your anxiety but haven't felt any better?” This is an example of which of the following therapeutic communication techniques? A) Validating B) Paraphrasing C) Confirming D) Offering a broad opening Ans: B Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 194, Table 11.2 Feedback: Paraphrasing involves the nurse restating the client's message in his or her own words to verify accurate understanding of the client. 10. A client says to the nurse, “Nobody cares about anything I say; even you don't!” Which of the following responses is most therapeutic? A) “Why do you say I don't listen to you?” B) “It sounds like you're overreacting somewhat.” C) “It sounds like you're feeling ignored.” D) “I listen to you.” Ans: C Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 194, Table 11.2 Feedback: Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid “why” questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief. 11. A client tells you that she is afraid to quit her stressful job at a daycare center because she doesn't think she has any marketable skills. Which therapeutic communication technique would be helpful to use in this situation? A) Giving broad openings B) Offering a general lead C) Giving information D) Voicing doubt Ans: D Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 194, Table 11.2 Feedback: Voicing doubt is an effective way to promote the client to rethink a faulty belief. The dialogue does not likely require a general lead and the conversation has already opened. Information alone is not likely to counter the client's statement. 12. A hospitalized man discloses that he thought about suicide after a high-profile failure at his job. The nurse responds, “You have your family; you owe it to your kids to take care of yourself.” This is an example of which of the following? A) Moralizing B) Reality testing C) Clarifying D) Making stereotyped comments Ans: A Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 195, Table 11.3 Feedback: Moralizing can block patient disclosure because it imposes the nurse's views onto the client's situation, often causing the client to question if his or her feelings are unwarranted or inappropriate. 13. A client begins frankly discussing his harrowing history of abuse as a child. The nurse listens for some time and then changes the subject to address stress management techniques. What is the most likely motivation for the nurse's action? A) To make sure she understands other problem areas in the client's life B) To model social skills and communication skills for the client C) To help the client understand appropriate boundaries D) To reduce her own level of anxiety Ans: D Chapter: 11 Client Needs: C Cognitive Level: Evaluation Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 195, Table 11.3 Feedback: The nurse often changes the subject in efforts to avoid discussing a topic with which he or she feels uncomfortable. If the patient feels the need to bring up an issue, generally the nurse should resolve personal anxieties and facilitate patient exploration. 14. A client is speaking with the nurse about his difficult relationship with his father. He states, “He never showed me love or approval unless I was perfect.” Which of the following responses is a general lead that is most likely to encourage the client to continue elaborating? A) “Uh huh.” B) “You must feel rejected.” C) “Do you think he might have been trying to motivate you?” D) “I'm sure he loved you, though it sounds like he had trouble expressing it.” Ans: A Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 194, Table 11.2 Feedback: General leads are short comments used to prompt the client to continue along the same discussion. 15. Two nurses are preparing medications for the clients in a mental health facility. One nurse says, “I don't know why we bother. As soon as these people get out of here, they are going to go off their meds.” What is the nurse's statement an example of? A) Apathy B) Empathy C) Excessive probing D) Unconditional Regard Ans: A Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 02 Page and Header: 186, Caring Feedback: The opposite of caring is apathy, a sense of detachment and the belief that nothing one does makes any difference, which leads to a lack of concern about the problem or outcome. 16. A client relates that she has panic attacks and, during the attacks, rushes to the emergency department because she feels like she is dying. The nurse self-discloses that she has had panic attacks during which she also felt very fearful. How should this nurse's self-disclosure be best understood? A) Self-disclosure can help normalize the client's experience. B) Self-disclosure allows the client to see the nurse as a real human being. C) Self-disclosure can help the client feel like a friend. D) Self-disclosure should be detailed so the client does not feel unimportant or devalued. Ans: A Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 08 Page and Header: 198, Self-Disclosure Feedback: Nurses may use self-disclosure in the nurse–client relationship to comfort a client who is feeling frustrated and hopeless, enhance trust, decrease role distancing, facilitate the client's self-disclosure, convey support, or normalize the client's experience. 17. At the end of a 12-hour shift, Debbie overhears that Sam, a client she has cared for previously, is being readmitted to the mental health facility. She says to the charge nurse, “I better stay around for a couple of hours; I am the only one Sam will talk to.” This is a warning sign that the nurse is experiencing which of the following obstacles to establishing a therapeutic relationship? A) False reassurance B) Lack of self-awareness C) Excessive probing D) Partnership Ans: B Chapter: 11 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 188, Enhancing Self-Awareness Feedback: Warning signs that the nurse is experiencing a lack of self-awareness includes believing that you are the only person who can help a client—that is, having “rescue fantasies.” 18. The nurse therapist calls a client to reschedule their appointment for the following week. When the client arrives at the appointment, she is uncommunicative and avoids eye contact with the nurse. When asked how things have been going, she answers sharply, “Fine.” How should the nurse respond to this client's behavior? A) “You seem angry, and I understand that you have been depressed, but I feel like you are avoiding speaking to me. Can you explain why you're acting this way?” B) “You appear to be angry. Perhaps you are angry with me for rescheduling our appointment or something else has happened. Tell me more about what you are feeling.” C) “You seem angry. Let's talk more about how you're feeling” D) “I'm sorry I had to reschedule our appointment. It really couldn't be helped. Is that what's bothering you?” Ans: B Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 07 Page and Header: 197, Confrontation and Limit Setting Feedback: Confrontation is the skill of pointing out, in a caring way, the discrepancies between what clients say and do. This can be done using a three-step formula called a perception check: Describe the inconsistent or confusing behavior, offer at least two possible interpretations of that behavior, and ask for feedback. 19. The nurse is setting goals and beginning to plan interventions for a client who was recently admitted. In what phase of the therapeutic relationship is the nurse functioning? A) Introductory phase B) Working phase C) Middle phase D) Termination phase Ans: A Chapter: 11 Client Needs: C Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing Process Objective: 03 Page and Header: 189, Introductory Phase Feedback: During the introductory phase of the therapeutic relationship, the nurse discerns the focal problem, sets goals, and begins to plan interventions. 20. After spending 15 minutes talking with a client, the client walks away feeling defensive and discouraged. This is evidence that the communication was: A) In an improper environment B) Blocked by external noise C) Inaccurate D) Nontherapeutic Ans: D Chapter: 11 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 06 Page and Header: 199, Therapeutic Communication Feedback: Nontherapeutic communication develops when nurses respond in ways that cause clients to feel defensive, misunderstood, controlled, minimized, alienated, or discouraged from expressing thoughts and feelings. 21. A nurse is conducting an interview with a 34-year-old female client who is being admitted to the psychiatric–mental health facility. The nurse is surprised at the client's uncanny resemblance to a member of the nurse's own family and realizes that this may even be inhibiting communication with the client. Within the transactional communication model, this factor that is affecting communication is known as: A) Disturbance B) A confounding variable C) A distracter D) Noise Ans: D Chapter: 11 Client Needs: C Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Communication and Documentation Objective: 04 Page and Header: 193, Theoretical Framework and Communication Model Feedback: Within the transactional communication model, factors that disrupt communication are known as noise. Noise may be psychological, external, or physiological. 22. A psychiatric–mental health nurse will soon conduct an assessment of a client who has been brought to the emergency department. The nurse is aware of the importance of listening when establishing therapeutic communication. What is a characteristic of effective listening? A) Noticing all that the clients says and does B) Projecting an air of controlled authority C) Clarifying the client's statements at every opportunity D) Interjecting with your own experiences to create rapport Ans: A Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Communication and Documentation Objective: 05 Page and Header: 194, Listening Feedback: Listening, or focusing on all behaviors that clients express, is the foundation of therapeutic communication. It involves a deliberate focus on spoken and unspoken messages. 23. A nurse therapist is leading a meeting with a 16-year-old girl who has been diagnosed with anorexia nervosa as well as her mother and stepfather. The nurse quickly observes that the mother answers questions that the nurse poses to the daughter. How should the nurse proceed with the interview? A) Address a question to the stepfather in hope of changing the course of the meeting. B) Continue to pose questions to the daughter. C) Ask the mother questions directly about her daughter's condition. D) Ask the mother to temporarily leave the room. Ans: B Chapter: 11 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 09 Page and Header: 200, Families Feedback: Though it may later become necessary to addr