RNSG VNSG 1201-Chapter 08: Principles and Skills of Mental Health Care Morrison-Valfre: Foundations of Mental Health Care, 6th Edition

RNSG VNSG 1201-Chapter 08: Principles and Skills of Mental Health Care Morrison-Valfre: Foundations of Mental Health Care, 6th Edition MULTIPLE CHOICE 1. An adult female client becomes combative with the nurse during routine medication administration. What is the nurse’s primary responsibility in this situation? a. To ensure that the client takes her medications b. To ensure that the client is placed in physical restraints to protect the safety of the staff and other clients c. To ensure that chemical restraints are used in the future until the client displays more appropriate and compliant behavior d. To ensure that the client is kept safe while trying to protect staff safety and to reason with the client to try to de-escalate the combative behavior ANS: D The “Do no harm” principle of mental health care applies to this situation. Client and staff safety are imperative. Ensuring that the client takes her medications is not of greatest concern in this situation because this most likely would cause increased combativeness. Physical restraints and chemical restraints are not reasonable options in the care of this patient. PTS: 1 DIF: Cognitive Level: Application REF: p. 80 OBJ: 2 TOP: Do No Harm KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 2. A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action by the nurse is going to best promote development of a mutually trusting relationship? a. At the beginning of the shift, the nurse promises to play a game of cards with the client at some point during that day and does so before the end of the shift. b. The nurse promises to play a game of cards with the client on the following day. c. The nurse leads a group discussion with clients about ways to develop trust in a relationship. d. The nurse gives the client written information about the medications he is taking. ANS: A Developing mutual trust is one of the principles of mental health care. The nurse most likely would be able to carry out plans on a daily basis rather than trying to make plans for the next day. Making plans with the client is a very effective way to develop trust, as long as the plans can be carried out. Leading a group discussion and giving written information are helpful to clients but are not going to promote development of trust in the same way that making plans and carrying them out would do. PTS: 1 DIF: Cognitive Level: Application REF: p. 81 OBJ: 3 TOP: Develop Mutual Trust KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 3. An adult female client is exhibiting behavior that the nurse interprets as anger toward another client. What is the nurse’s best action? a. Continue to monitor the client’s behavior and document it as anger directed toward another client b. Talk with the client about the observations made, and ask whether she was displaying anger toward the other client c. Ask the other client if she felt that the client was angry at her d. Ask the client to write in a journal the emotions she was feeling at that time ANS: B Asking the client is an effective way of understanding the meaning of her behavior and is one of the principles of mental health care. Documentation of the nurse’s interpretations without clarification would not be appropriate, nor would involving another client by asking for her interpretation of the situation. Asking the client to write in a journal is fine, but not in this circumstance. PTS: 1 DIF: Cognitive Level: Application REF: p. 82 OBJ: 3 TOP: Explore Behaviors and Emotions KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity 4. A nurse and an adolescent female client develop a plan of care together that addresses the client’s difficult relationship with her parents. The client says that her parents just don’t understand her, and she is always getting privileges taken away for not doing things that she is supposed to do. What is the nurse’s best action? a. Talk with the client about how important it is that she carry through with actions that her parents feel are important b. Identify two priority responsibilities that are agreed upon between the client and her parents, and monitor her ability to comply with the plan for 1 week c. Discuss with the parents what responsibilities they feel are important, to determine what actions should be planned with the client d. Identify what the client feels are reasonable responsibilities ANS: B Responsibility is one of the principles of mental health care that should be fostered. It is important to work in conjunction with all involved parties to set a realistic goal and plan of action. Remaining options do not include all parties and do not set a realistic goal or plan. PTS: 1 DIF: Cognitive Level: Application REF: p. 82 OBJ: 3 TOP: Encourage Responsibility KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 5. __________ coping mechanisms are means of successfully solving a problem or reducing one’s stress level. a. Defensive b. Maladaptive c. Constructive d. Individual ANS: C Constructive, or adaptive, coping mechanisms are effective because they deal with the problem to attempt to solve it and in turn reduce stress. Defensive and maladaptive mechanisms do not deal with the problem effectively. Individual coping mechanisms may or may not be effective. PTS: 1 DIF: Cognitive Level