Mental Health EVOLVE FOUNDATIONS AND MODES OF CARE QUESTIONS AND ANSWERS (UPDATED)

Mental Health EVOLVE FOUNDATIONS AND MODES OF CARE QUESTIONS 1. A primary gain is always the reduction of anxiety. Gaining benefits from others is related to a secondary gain. Fulfillment of unconscious desires is unrelated to primary gains. Control of unacceptable impulses is unrelated to primary gains. 2. Mental healthy person SATA One who accepts aging One who engages available strengths One who sustains positive relationships 3. A mother and her three young children arrive at the mental health clinic. The woman says that she is seeking help in leaving her husband. She reports that he has been beating her for years but just started hitting the children. What is the best initial action by the nurse? A: Arranging for a staff member to watch the children so the mother and nurse can talk. 4. A nurse counseling a client on the inpatient psychiatric unit responds to a statement made by the client by stating, "I'm confused about exactly what is upsetting you. Would you go over that again, please?" What is the nurse using? A: Clarifying R: Clarifying is an attempt to better understand the message intended by the client. It is utilized to gain a clearer understanding of what another person has stated. Structuring is an attempt to create order and thereby allow a client to become aware of problems. Confronting examines a discrepancy between what a person is saying and what a person does. It requires careful attention to nonverbal communication, as well as the discrepancies between the nonverbal and verbal messages. Paraphrasing allows the speaker to share how one person perceives and hears another's information. The nurse is not paraphrasing, but instead is attempting to better understand the client. 5. Deaths that are perceived as preventable cause more guilt for the mourners and therefore increase the intensity and duration of the grieving process. Perceiving a death as preventable will not necessarily result in a pathological reaction, but it will usually make it harder to understand and accept the death. 6. A nurse working in a crisis center understands that a crisis can best be defined as what? A: A threat to equilibrium R: Caplan's theory states that a crisis is an internal disturbance caused by a stressful event that alters the usual way of coping with a threat to the self; this temporarily disturbs the equilibrium of the person involved 7. What does a psychiatric nurse identify as the primary purpose of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)? A: Provide a classification of types of mental disorders and guidelines to aid in making a diagnosis. R: The prime purpose of the DSM-5 is to serve the clinician as a guide in identifying a client’s mental health or psychiatric diagnosis. Although the DSM-5 is useful in facilitating communication, the teaching of psychopathology, and the collection of accurate public health statistics, none of these are the primary purpose of this publication. 8. A client who is to be discharged from an inpatient mental health facility is referred to a mental health daycare center in the community. What should the nurse identify as the primary reason for this referral? A: MAINTAINING GAINS ACHIEVED DURING HOSPITALIZATION R: The daycare center provides the client with a therapeutic setting for a few hours each day during the transitional stage between hospital and total discharge. The goal is to maintain and enhance progress made during inpatient treatment. Daycare treatment may improve social skills or allow the client to get out of the house for a few hours, but neither is its primary purpose. Avoiding direct confrontation with the community may help during the transition stage, but it is not the primary goal of daycare. 9. What can the nurse do to help and older adult successfully complete erikson major task of this stage? A: DEVELOP A SENSE OF SATISFACTION WHEN CONSIDERING PAST ACHIEVEMENTS. R: Feeling a sense of satisfaction when considering past achievements allows the client to accept what life is or was and helps prevent feelings of despair. Investing creative energies in promoting social welfare is the major task of middle adulthood (30 to 65 years). Developing deep, lasting relationships with other people or institutions is the major task of the young adult (20 to 30 years). Feeling a need to make up for past failings is a negative resolution of the major task of the older adult. 10. POWERELESSNESS Anger is a common feeling when people do not have control over decisions that affect them. There is no information to indicate that the client is feeling hopeless, indecisive, or worthless. 11. An inpatient therapy group on a psychiatric unit has as its goal helping clients participate in life more fully by gaining insight and changing behavior. The nurse leader can best help the group achieve this goal by using a leadership style that is what? A: DEMOCRATIC AND GUIDING R: A democratic and guiding leader stimulates and directs the group to assist it in developing its maximal potential by facilitating and balancing the group's forces. An autocratic and directing leader makes most of the decisions and controls the group, thereby limiting group growth potential. A laissez-faire, observing leader allows group members to take over the group; if there are no members with leadership skills, little is gained from the group. A passive and nonconfrontational leader does not provide adequate leadership to make the group effective. 2 12. Priority outcome in the planning of care for a client in crisis? A: RESTORING THE CLIENTS PSYCHOLOGICAL EQUILIBRIUM R: Crisis intervention is short-term therapy with the major outcome of restoring the client to the precrisis state. Referring the client for occupational therapy is not an outcome, but an action to help achieve an outcome; it is not part of crisis intervention. Scheduling the client for follow-up counseling is not an outcome, but rather an intervention that may be necessary if psychological equilibrium cannot be restored. Having the client gain insight into the problem is not always necessary for a client to be able to function effectively. 13. What should a nurse consider about the past experiences of clients who have immigrated to this country? A: IT IS IMPORTANT THAT THEIR VALUES BE ASSESESD FIRST R: Past experiences are important and must be recognized because they help set the individual's values throughout life. Past experiences will not affect inherited traits. Past experiences play an important role in an individual's life. Nothing establishes how an individual responds forever; new experiences continue to influence future responses. 14. Personality disorders are identified in the DSM-V in clusters. How should the nurse describe the behaviors of an individual with a cluster A personality disorder? A: ODD AND ECCENTRIC R: Cluster A includes paranoid, schizoid, and schizotypal personality disorders. These clients are odd and eccentric and use strange speech, are angry, and have impaired relationships. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. These clients are anxious, fearful, tense, and rigid. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. These clients are dramatic, erratic, labile, impulsive, hostile, and manipulative. 15. A nurse is conducting a therapy group whose objectives are to assist the members to gain insight and to change behavior so they are able to participate in life in a more satisfying manner. What leadership style will best help the nurse achieve these objectives? A: DEMOCRATIC, GUIDING R: A democratic, guiding type of leader stimulates, directs, and assists the group to develop its maximum potential by facilitating and balancing group forces. A hierarchal, directing type of leader makes most of the decisions and controls the group, thus limiting group growth potential. An autocratic, controlling type of leader makes most of the decisions and controls the group, thus limiting group growth potential. A laissez-faire, observing type of leader allows group members to take over the group; if the group has no leader or leaders, little is gained from the group. 16. A client in the mental health clinic who has been seeing a therapist for more than 6 months begins to talk and act like a therapist who is analyzing coworkers. What defense mechanism does the nurse identify? A: INTROJECTION R: Introjection is treating something outside the self as if it is actually inside the self; it is unconsciously incorporating the wishes, values, and attitudes of another as if they were one’s own. Undoing is taking some action to counteract or make up for a wrongdoing. Projection is 3 attributing to another person or group one’s own unacceptable attitudes or characteristics. Intellectualization is using logical explanations without feelings or an affective component. 17. A situational crisis involves an unanticipated loss that is apparent to others. Examples include loss of a job, death of a loved one, and a change in health status such as an amputation. A subjective (internal) crisis threatens a person's well-being but is not obvious to others. Examples of subjective crises include aging, lack of independence, and loss of faith. An adventitious crisis involves natural (e.g., hurricane, tsunami) or man-made (e.g., arson, terrorist attack) traumatic events. These crises often involve numerous losses. A maturational crisis occurs in response to stress as a person experiences a predictable change. Examples of maturational crises include adolescence, marriage, parenthood, and retirement. 18. A crisis occurs when usual methods of coping are no longer effective and the individual is so overwhelmed that emotional distress and cognitive impairment result. A crisis is precipitated by a known acute situation, not by a situation that comes and goes. Feelings of uneasiness, tension, and irritability are associated with anxiety. However, feelings associated with a crisis cause such severe disequilibrium that the individual is unable to concentrate or function. A: NOTHING I TRY WORKS, EVERYTHING JUST KEEPS GETTING WORSE 19.The nurse is scheduled to be the co-leader of a therapy group being formed in the mental health clinic. When planning for the first meeting, it is of primary importance that the nurse consider what? A: NEEDS OF THE CLIENT BEING INCLUDED R: When planning a group, the nurse must ensure that clients have similar needs to promote relationships and interactions; diverse needs do not foster group process. Although important, the number of clients is not a primary consideration. Behavior and needs, rather than diagnoses, are of primary importance. The socioeconomic status of the clients in the group has little effect on group process 20. A client is presented with the treatment option of electroconvulsive therapy (ECT). After discussion with staff members, the client requests that a family member be called to help make the decision about this treatment. What ethical principle does the nurse consider when supporting the client’s request? A:AUTONOMY Autonomy is the ethical principle of respecting the independence and right to self-determination of others. In this situation the nurse focuses on helping the client make a choice. Justice is the ethical principle that requires all people to be treated fairly, regardless of sex, age, religion, diagnosis, marital status, or socioeconomic level. Veracity is the ethical principle that requires truthfulness. Beneficence is the duty to do good and promote the welfare of others. 21. Clients who have experienced childhood sexual abuse will have difficulty being aware of their personal boundaries and maintaining appropriate boundaries for themselves and others. Clients who have experienced childhood sexual abuse tend to have decreased, not increased, libidos. Phobic behavior, the irrational fear of an object or situation, is not necessarily a concern that the nurse should have for this client more than for other clients. Clients who have experienced childhood sexual abuse can exhibit aggressive behavior, but it does not directly address the identification of inappropriate touching. 4 A: BOUNDARY VIOLATIONS 22. If a client drinks two drinks per day every day with no negative consequences, the client is considered a daily drinker. If a client drinks over two drinks per day every day, the client has a potential for future problems. This person does not meet the criteria for any substance abuse or dependence diagnosis because there is no evidence of tolerance or other signs of substance dependence and no negative sequelae. There is no functional alcoholic diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. 23. All behavior has meaning; before planning intervention, the nurse must try to understand what the behavior means to the client. Ignoring behavior does little to alter it and may even cause further acting out. Isolation may increase anxiety and precipitate more acting-out behavior. The nurse cannot explain the meaning of the client's behavior; only the client can. A: SEEK TO UNDERSTAND WHAT THE BEHAVIOR 24.A married woman is brought to the emergency department of a local hospital. Her eyes are swollen shut, and she has a bruise on her neck. She reports that she is being beaten by her husband. How does the nurse expect the husband to behave when he arrives at the emergency department? A: CHARMING R: Abusers are often extremely charming to mask their abusive tendencies and convince the abused mate and others that change is possible. After an abusive episode there is often a "honeymoon" period because the tensions of the abuser have been released. Abusers mask their fears by becoming angry and aggressive. Abusers are not confused; they are manipulative of others. Abusers are rarely indifferent; they tend to be opinionated and demanding. 25. Which psychotherapeutic theory uses hypnosis, dream interpretation, and free association as methods to release repressed feelings? A: PSYCOANALYTIC MODEL R: The psychoanalytic model studies the unconscious and uses the strategies of hypnosis, dream interpretation, and free association to encourage the release of repressed feelings. The behaviorist model holds that the self and mental symptoms are learned behaviors that persist because they are consciously rewarding to the individual; this model deals with behaviors on a conscious level of awareness. The psychobiologic model views emotional and behavioral disturbances as stemming from a physical disease; abnormal behavior is directly attributed to a disease process. This model deals with behaviors on a conscious level of awareness. The social-interpersonal model affirms that crucial social processes are involved in the development and resolution of disturbed behavior; this model deals with behavior on a conscious level of awareness. 26. Individuals with borderline personality disorder are impulsive and have difficulty identifying and respecting boundaries in relation to others. Exploration of this topic in a meaningful manner can be done only after an ongoing relationship has been established. Feeling victimized is a frequent theme among clients with this disorder; however, they rarely have the insight to initiate discussion 5 of these feelings and usually show resistance when the topic is broached. An individual with a borderline personality disorder may not be able to spend this length of time having a meaningful discussion with the nurse; usually they are too impulsive to engage in consistent work until a therapeutic relationship has been established. 27. What is a goal for a client who has difficulty with verbal communication precipitated by psychologic barriers? A: THE CLIENT WILL INTERACT WITH OTHER PEOPLE IN THE ENVIROMENT R: Interacting with other people in the environment is appropriate and measurable. Being free of injury is not related to the client's problem; the priority for this client is to facilitate interaction with others. Actingout behavior is not inherent in the situation. 28.A nurse understands that value clarification is a technique useful in therapeutic communication because initially it helps clients do what? A: BECOME AWARE OF THEIR PERSONAL VALUES R: Value clarification is a technique that reveals individuals' values so the individuals become more aware of them and their effect on others. Gaining information, making correct health decisions, and altering value systems to make them more socially acceptable are not outcomes of value clarification. 29. The wife of a client who is dying tells the nurse that although she wants to visit her husband daily, she can visit only twice a week because she works and has to take care of the house and their cat and dog. What defense mechanism does the nurse conclude that the client’s wife is using? A: RATIONALIZATION R: Rationalization is offering a socially acceptable or logical explanation to justify an unacceptable feeling or behavior. Projection is the denial of emotionally unacceptable feelings and the attribution of the traits to another person. Sublimation is the substitution of a socially acceptable behavior for an unacceptable feeling or drive. Compensation is making up for a perceived deficiency by emphasizing another feature perceived as an asset. 30.During group therapy, the working phase usually begins when the group displays what? A: COHESIVENESS 6 R: When the group becomes united (cohesive), the clients can feel accepted, valued, and part of the group; this is the optimal time for the working phase to begin. Confrontation, imitative behavior, and corrective recapitulation all occur later in the working phase of group process, not in the beginning. 31. A terminally ill client is moving gradually toward resolution of feelings about impending death. In a plan of care based on Elisabeth Kübler-Ross' research, the nurse should use nonverbal interventions after having assessed that the client is in which stage? A: ACCEPTANCE STAGE R: When acceptance is reached, the individual is beginning to withdraw from life; communication is simple, concise, and most often nonverbal. Kübler-Ross' research has shown that at this stage, verbal communication is typically less important and touch and presence are most important. The client has moved past the anger, denial, and bargaining stages. 32. The self is often the most important tool available to the nurse to help a client cope; to be therapeutic, the nurse must be present, actively listening, and attentive. The environment is important, but it is not the most basic tool. The nurse first must use the self before the helping process can begin. The client's intellect is not generally a therapeutic tool used by the nurse. 33. A nurse is assessing a client for the use of defense mechanisms. In the presence of which defense mechanism does the client express emotional conflicts through motor, sensory, or somatic disabilities? A: CONVERSION R: The defense mechanism is called conversion because the individual reduces emotional anxiety to a physical disability. Projection occurs when people assign their own unacceptable thoughts and feelings to others. With dissociation there is separation of certain mental processes from consciousness as though they belonged to another; a dissociative reaction is expressed as amnesia, fugue, multiple personality, aimless running, depersonalization, sleepwalking, and other behaviors. Compensation is a mechanism used to make up for a lack in one area by emphasizing capabilities in another. 34. A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? A: DISPLACEMENT R: Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on those who are less threatening. Repression is the unintentional putting out of the mind unacceptable or troubling thoughts, desires, or experiences. Transference is a mechanism by which affects or emotional tones are shifted from one individual to another; it is unrelated to child abuse. Manipulation is a mechanism by which individuals attempt to manage, control, or use others to suit their own purpose or to gain an advantage; it is unrelated to child abuse 35. A client in the mental health clinic who has concerns about getting married says to the nurse, "I guess I'd better get married. All the plans are made and paid for, and the invitations have all been mailed." What defense mechanism is the client using? A: RATIONALIZATION R: In rationalization, seemingly logical reasons are used to justify behaviors or feelings that are unacceptable or painful. This is not introjection because the client has not assumed the feelings of another. This is not identification because the client has not attempted to emulate another person. This is not compensation because the client is not counterbalancing deficiencies in one area by excelling in another area. 36. What is the most appropriate long-term goal for a client experiencing dysfunctional grieving after the death of a spouse? A: RESUMING PREVIOUSLY ENJOYED ACTIVITIES 7 R: Resuming previously enjoyed activities is realistic, specific, and measurable; it relates to the client’s acceptance of a new reason for being. Eating at least two meals a day with another person may be an unrealistic goal. There are no data to indicate that the client is thinking negatively about others. Relocating to a state in which other family members reside may be an unrealistic goal, or the client may not want to do this. 37. A female nurse has been caring for a depressed 75-year-old woman who reminds her of her grandmother. The nurse spends extra time with her every day and brings her home-baked cookies. What does the nurse's behavior reflect? A: COUNTERTRANSFERENCE R: With countertransference the professional provider of care exhibits an emotional reaction to a client based on a previous relationship or on unconscious needs or conflicts. 38. A client has been unable to function since her husband asked for a divorce 2 weeks ago. She is brought to the crisis intervention center by a friend. What type of crisis is this situation? A: SITUATIONAL R: Situational crises involve an unanticipated loss, such as a divorce, that is threatening to the client. Social crises involve multiple losses, such as those occurring during major disasters. Maturational crises occur in response to stress experienced as one struggles with developmental tasks. Developmental (maturational) crisis are associated with developmental tasks; divorce is not a developmental task. 39. As the nurse is discussing psychiatric care with an older adult client, the client says, "When I was growing up I was taught to accept my lot in life and not complain. I'm proud of the fact that despite my issues I can still function independently. I don't want to be just put away." The nurse understands that the factors that influence the client's mental health are examples of what? A: ATTITUDES AND BELIEFS R: Some attitudes and beliefs include reluctance by older people to seek help because of pride in their independence, stoic acceptance of difficulty, unawareness of resources, and fear of being "put away." Although the client mentions "being put away", that is an attitude. The client is not talking about all the resources that might be available. Anxiety is defined as an unpleasant and unwarranted feeling of apprehension. The client does not mention any cultural or ethnic issues, just his or her own feelings. 8 40. An executive busy at work receives a phone call from a friend relating bad news. The executive makes a conscious effort to put this information out of mind and continues to work at the task at hand. The next day executive remembers that the friend telephoned but is unable to recall the message. Which defense mechanism does this behavior represent? A: SUPPRESSION R: Suppression is the voluntary exclusion from awareness of anxiety-producing feelings, ideas, and situations. In regression, a person returns to an earlier and more comfortable developmental level. Passive aggression is the use of behaviors such as passivity, procrastination, and inefficiency that negatively affect others. Reaction formation is a conscious behavior that is the opposite of an unconscious feeling. 41. A mother and her 5-year-old daughter have been referred to a child advocacy center for a forensic pediatric sexual examination. Before the child is examined or interviewed, the mother gives a detailed history, relaying her suspicion that the child's maternal grandfather sexually assaulted her. As the interview progresses, the mother suddenly says, "My father sexually molested me when I was a child, but I try not to think about it." What defense mechanism does the nurse recognize that the mother's statement demonstrates? A: SUPPRESSION R: Suppression is voluntary refusal to admit an unacceptable idea or behavior. Introjection is the unconscious incorporation of wishes, values, and attitudes of others as if they were one's own. Passive-aggressive behavior is the expression of anger and hostility toward others in an indirect and nonassertive way. Reaction formation is the exact opposite of an unconscious feeling. 42.One afternoon the nurse on the unit overhears a young female client having an argument with her boyfriend. A while later the client complains to the nurse that dinner is always late and the meals are terrible. The nurse identifies the defense mechanism that the client is using as what? A: DISPLACEMENT R: Displacement reduces anxiety by transferring the emotions associated with an object or person to another emotionally safer object or person. Projection is the attempt to deal with unacceptable feelings by attributing them to another. Dissociation is an attempt to detach emotional involvement or the self from an interaction or the environment. Intellectualization is the use of facts or other logical reasoning rather than feelings to deal with the emotional effect of a problem. 9 43. A resident in a nursing home recently immigrated to the United States (Canada) from Italy. How does the nurse plan to provide emotional support? A: BY OFFERING CHOICES CONSISTENT WITH THE CLIENTS HERITAGE R: Adherence to a plan of care is enhanced by the nurse's providing choices consistent with the client's cultural beliefs and practices. The nurse's cultural or personal beliefs and biases should not influence or interfere with the implementation of appropriate care. Helping the client adjust to American culture is not the priority at this time; care should be adapted to the client's needs and culture. The person's cultural practices should not be addressed unless they are detrimental to the person's health. 44. A nurse is considering Erikson’s stages of psychosocial development while caring for a client. Which behavior is consistent with a problem involving trust versus mistrust? A: WOMAN WHOSE PARENTS WERE CHRONIC ALCOHOLICS AND WHO HAS PROBLEMS MAKING FRIENDS. R: Trust is learned in infancy. Being parented by individuals who were not able to consistently meet the client’s basic physiologic and safety needs is likely to result in an inability to engage in healthy interpersonal relationships as an adult. The response of the client in an abusive relationship is based not on events that occurred during infancy but rather on events in adulthood. The responses of the clients with paranoid schizophrenia and borderline personality disorder are symptoms of a psychiatric disorder rather than of an event that occurred during infancy. 45. After a nurse works with an adolescent with anorexia nervosa for 1 week, the adolescent becomes hostile and says to the nurse, "You're just like my mother. I hate you." What concept does the client's statement reflect? A: TRANSFERENCE R: Transference occurs when a client unconsciously assigns to the therapist feelings and attitudes originally associated with another important person in the client's life. This client's statement reflects a lack of insight. Universality is the sense that one is not alone in any situation. Identification is a defense mechanism that eases anxiety. The person takes on characteristics of someone who is viewed as admirable. 10 46. The emergency department nurse is conducting an interview and assisting with the physical examination of a female sexual assault victim. What is most important for the nurse to document on this client’s record? A: STATEMENTS BY THE CLIENT ABOUT THE SEXUAL ASSAULT AND THE RAPIST R: Statements by the client about the sexual assault and the rapist eliminate the nurse’s subjectivity from the report. Observations about the client’s reaction to male staff members is unrelated to the sexual assault itself and are subjective. Eliciting information about the client’s previous knowledge of the rapist is not the responsibility of the nurse. A summary statement about the client’s description of the sexual assault and the rapist may invite subjectivity. 47. While assessing an older adult in the emergency department the nurse notes that the client is upset. The nurse asks what is wrong, and the client describes the current situation and then offers information that goes further and further off the topic. What pattern of communication does this conversation reflect? A: TANGENTIAL THINGKING R: In tangential thinking the person never answers the question or returns to the central point of the conversation. It often is seen in people with dementia. Perseveration is the repetitive expression of a single idea in response to different questions; it is found most often in clients with cognitive impairments and those experiencing catatonia. Thought blocking is a sudden stoppage of the spontaneous flow of speaking for no apparent external reason; it is seen most often in clients who are experiencing auditory hallucinations. Overcompensation, also known as reaction formation, is a defense mechanism, not a pattern of communication. 48. Stages of Grieving 1. DENIAL 2. ANGER 11 3. BARGAINING 4. DEPRESSION 5. ACCEPTANCE 49.Confabulation- IMAGINATION IS USED TO FILL IN MEMORY GAPS. 50. Which of the following interventions will assist in creating and maintaining a therapeutic environment on an acute care mental health unit? Select all that apply. 1. REORIENTING CLIENTS TO THE RULES OF THE UNIT WHENEVER NECESSARY 2. PROVIDING A POSTED SHCEDULE OF UNIT ACTIVITIES 3. MONITORING EACH CLIENT FOR THE POTENTIAL OF AGGRESSIVE BEHAVIOR 4. ENCOURAGING THE CLIENTS TO TAKE AN ACITVE RILE IN PLANNING THE UNTS ACTIVITIES. 51. In an attempt to remain objective and support a client during a crisis, the nurse uses imagination and determination to project the self into the client's emotions. What is this technique known as? A: EMPATHY R: Empathy is the projection of self into another's emotions to share the emotions and the other's state of mind; this technique helps the nurse understand the meaning and significance of the experience to the client. Sympathy is a shared expression of sorrow over a real or imagined loss. Projection is an unconscious defense mechanism, not a therapeutic technique. Acceptance does not require the nurse to project the self into the client's emotions; rather, it involves accepting the client and the emotions. 12 52.The nurse teaches a client methods of coping with anger. The nurse concludes that the client has learned the most effective method when the client states that the client will do what when angry? A: TALK ABOUT ANGER R: Talking about angry feelings is better than acting them out; this response indicates that the client has learned a positive coping method. Although taking a long jog or going to the basement to scream may help, it is an isolated activity that does not permit sharing of feelings and may not always be possible. Concentrating on what made the client angry may result in an escalation of angry feelings. 53. Before discharge of an anxious client, the nurse should teach the family that anxiety can be recognized as what? A: A PATTERN OF EMOTIONAL AND BEHAVIOR RESPONSES TO STRESS. R: Anxiety is a human response consisting of both physical and emotional changes that everyone experiences when faced with stressful situations. Anxiety is experienced to a greater or lesser degree by every person. The fear may be related to a specific aspect of the environment rather than the total environment. Anxiety does not operate from the conscious level. 54. After an automobile collision involving a fatality and a subsequent arrest for speeding, a client has amnesia regarding the events surrounding the accident. Which defense mechanism is being used by the client? A: REPRESSION R: Repression is coping with overwhelming emotions by blocking awareness or memory of the stressful event. Projection is attributing one's own unacceptable feelings and thoughts to others. Suppression is consciously keeping unacceptable feelings and thoughts out of awareness. Rationalization is the attempt to mask unacceptable feelings or behaviors by providing excuses and explanations. 55.A client experiencing a tremendously stressful situation says, "My baby was diagnosed with terminal cancer 2 months ago. I'm either crying or walking around like I'm in a dream. I can't believe this is happening. What did we do to deserve something so horrible? The doctors can transplant almost every human organ, but they can't stop my baby from dying. I'm so angry. Most days I just want to take my child and run away." The nurse determines that the client is mainly expressing what? A: ANTICIPATORY GRIEF R: Anticipatory grief is an intellectual and emotional response to a potential loss. Signs include a sense of disbelief and numbness. Emotions swing from sadness to anger. Individuals express the desire to avoid the situation by running away and an intense feeling of anger toward the medical community for failing to save their loved one. Anger, denial, and avoidance are each a single part of the client's reaction. 56.A 17-year-old client is found to have anorexia nervosa. The psychiatrist, in conjunction with the client and the parents, decides to institute a 13 behavior modification program. What does the nurse recall is a major component of behavior modification? A: REWARDING POSITIVE BEHAVIOR R: In behavior modification [1] [2] [3], positive behavior is reinforced, and negative behavior is not reinforced or punished. Reducing the number or complexity of necessary restrictions, deconditioning the fear of weight gain, and reducing the number of anxietyproducing situations may all be part of the program, but none is a major component. 57. A 65-year-old man is admitted to the hospital with a history of depression. The client, who speaks little English and has had few outside interests since retiring, says, "I feel useless and unneeded." The nurse concludes that the client is in which Erikson's developmental stage? A: INTEGRITY VS DESPAIR R: Integrity versus despair is the task of the older adult; the client has difficulty accepting what life is and was, resulting in feelings of despair and disgust. Initiative versus guilt is the task of the preschool-aged child. Intimacy versus isolation is the task of the young adult. Identity versus role confusion is the task of the adolescent. 58. A nurse working on a mental health unit is caring for several clients who are at risk for suicide. Which client is at the greatest risk for successful suicide? A: OLDER SINGLE MAN JUST FOUND TO HAVE PANCREATIC CANCER R: Older single men with chronic health problems are at the highest risk of suicide. This is because men have fewer social supports than women do. (Men are less social then women in general.) Less social support at times of stress can increase the risk of suicide. Also, chronic health problems can lead to learned helplessness, which can lead to depression. People who are acutely psychotic as a group are at higher risk for suicide, but they do not have the suicide rate of older single adult men with chronic health problems. An adolescent who was recently sexually abused, although severely traumatized, does not have the risk of suicide of an older single man with chronic health problems. Dysfunctional grieving is prolonged grieving that is characterized by greater disability and dysfunctional patterns of behavior. Although people with complicated dysfunctional grieving may be at risk for self-directed violence, they do not have the suicide risk of older single men with chronic health problems. 59. A client who retired a year ago tells the nurse in the community health center, "I don’t have any hobbies or interests, and since I retired I feel useless and unneeded." According to Erikson’s developmental theory, with which developmental conflict is the client faced? A: INTEGRITY VS DESPAIR R: Integrity versus despair is the task of the older adult; this client has not adapted to triumphs and disappointments, so there is no acceptance of what life is and was; this results in feelings of despair and disgust. Initiative versus guilt is the task of the preschool period. Intimacy versus isolation is the task of the young adult. Identity versus role confusion is the task of the adolescent. 60. Which statement best explains the focus of a therapeutic milieu management? 14 A: MILIEU MANAGEMENT CREATES AN ENVIROMENT THAT SUPPORTS THE CLIENTS THERAPEUTIC CARE R: The focus of a therapeutic milieu is the creation and maintenance of an environment that supports and benefits a client toward achieving therapeutic goals. That management of a therapeutic milieu is a nursing responsibility, the nurse-client relationship is dependent upon therapeutic milieu management, and creating a therapeutic milieu requires a proactive approach on the part of the nurse are true, but these statements do not best explain the focus of the management of the milieu. 61. A young mother of three children, all born 1 year apart, has been hospitalized after trying to hang herself. The client is being treated with milieu therapy. The nurse understands that this therapeutic modality consists of what? A: PROVIDING A SUPPORTIVE ENVIROMENT TO BENEFIT THE CLIENT R: Any aspect of the treatment environment can be used to benefit the client in milieu therapy. Individual and family therapy are separate treatment modalities, not part of milieu therapy. Using positive reinforcement to reduce guilt is part of behavioral modification, not milieu therapy. Uncovering unconscious conflicts and fantasies is part of psychoanalytical, not milieu, therapy. 62. A nurse on the psychiatric unit is assigned to work with a male client who appears reclusive and distrustful of everyone. How can the nurse help the client develop trust? A: BY BEING PROMPT FOR THEIR SCHEDULED MEETINGS R: Being prompt for their scheduled meetings helps the client feel important because the nurse remembers their meetings and is on time. The client is distrustful of others and will probably not believe a sincere declaration of caring about the client's feelings; caring is best demonstrated through behavior. Handing the client medication and not watching to see whether it is swallowed is not only an unsafe practice, but could make the client feel that the nurse does not care enough to stay. Feelings should never be ignored; instead, they should be accepted as important to the client. 63. The nurse is admitting a confused 80-year-old client to the mental health unit. Which is one factor associated with the aging process? A: SLOWING OF RESPONSES R: Neurologic responses are slowed because of reduced sensory-receptor sensitivity. Excluding pathologic processes, the personality will be consistent with that of earlier years. There is no loss of intellectual ability unless there is a pathologic problem. Short-term, not long-term, memory is reduced because of a shortened attention span, delayed transmission of information to the brain, and perceptual deficits. 64. A nurse is caring for an adult client who immigrated to this country 5 years ago. What does the nurse know about the past experiences of clients who have immigrated to this country? A: THEY ARE IMPORTANT IN ASSESMENT OF THEIR VALUES R: Past experiences are important and must be recognized because they set the parameters for the individual's enduring values throughout life. Past experiences do not 15 affect inherited traits. Past experiences play an important role in an individual's life. Nothing establishes how an individual responds over a lifetime; new experiences continue to influence future responses 65. A newly immigrated older Chinese adult is brought to a mental health clinic when family members become concerned that their parent is depressed. In an attempt to conduct a culturally competent assessment interview, the nurse asks certain questions. Which questions does the nurse ask? SATA A: WHAT BROUGHT YOU HERE FOR TREATMENT TODAY? WHAT DO YOU BELIEVE IS THE CAUSE OF YOUR DEPRESSION? DOES RELIGION HAVE A ROLE IN YOUR PERCEPTION OF HEALHT AND WELLENESS HAVE YOU EVER SOUGHT TREATMENT FOR A MENTAL HEALTH PROBLEM BEFORE? 66. A community health nurse is counseling an adolescent with bulimia nervosa. For which type of treatment should the nurse refer the client? A: COGNITIVE BEHAVIORAL THERAPHY R: Research indicates that cognitive-behavioral therapy is most effective in the treatment of bulimia nervosa. Although rational-emotive behavioral therapy and supportive group therapy may both be helpful, neither is the most effective therapy for clients with bulimia nervosa. Although many nurses use an eclectic model when conducting psychotherapy, the crisis model is not an effective therapy for clients with bulimia nervosa. 67. On which principle should the nurse’s role be based in the maintenance or promotion of the health of older adults? A: THERE IS A STRONG CORRELATION BETWEEN SUCCESFUL RETIREMENT AND GOOD HEALTH R: Individuals who can reflect on life and accept it for what it was and who are able to adjust and enjoy the changes retirement brings are less likely to experience health problems, especially stress-related health problems. Most emotionally healthy older adults do not focus on death. The changes of aging are usually not reversible. Dependency often is more threatening to this age group. 68. An older retired client is visiting the clinic for a regularly scheduled checkup. The client tells the nurse about the great life he has lived and the activities that he enjoys at the senior center. According to Erikson, what developmental conflict has been resolved by this client? A: INTEGRITY VERUS DESPAIR R: The tasks of older individuals are ego integrity, satisfaction with life, and acceptance of the future versus despair, remorse, and fear of the future. Trust versus mistrust is the conflict associated with infancy. Generativity versus self-absorption is the conflict associated with later adulthood. Autonomy versus shame and doubt is the conflict associated with early childhood. 69. A young client who has become a mother for the first time is showing signs of being anxious about her new parenting role. With the nurse’s encouragement, she joins the new mothers’ support group at the local YMCA. What kind of prevention does this activity reflect? 16 A: PRIMARY PREVENTION R: Primary prevention is directed toward health promotion and prevention of problems. Tertiary prevention is focused on rehabilitation and the reduction of residual effects of illness. Secondary prevention is related to early detection and treatment of problems. There is no category of prevention called therapeutic prevention. 70. What is the most appropriate intervention for the nurse to implement after finding a disturbed client in bed in the fetal position? A: SITITNG DOWN IN A CHAIR BY THE CLIENTS AND SAYING, “IM HERE TO SPEND TIME WITH YOU”. R: "I'm here to spend time with you" accepts the client at the client's current level and allows the client to set the pace of the relationship. Touching the client may be misinterpreted and may precipitate an aggressive response. Going to the client and saying, "I'll be waiting for you in the community room, so please get up and join me," asks the client to reach out to the nurse; in the therapeutic relationship, the nurse must reach out to the client. Even if the client is too withdrawn to respond, the nurse's physical presence can be reassuring, so leaving the client alone is not the most appropriate choice. 71. TODDLERS- AUTONOMY 72. A nurse understands that when a client is a member of a different ethnic community it is important to do what? A: OFFER A THERAPEUTIC REGIMEN COMPATIBLE WITH THE LIFESYTLE OF THE FAMILY R: The client cannot be expected to accept or even respond to a plan that is incompatible with the family’s lifestyle. The family should not have to adjust to the nurse’s biases; the nurse must self-identify biases and ensure that they do not interfere with nursing care. There is no evidence that misconceptions will occur. All individuals respond differently to situations. 73. A nurse is performing a mental status assessment. What is being assessed when the nurse notes that the client is cooperative? A: ATTITUDE 17 R Attitude relates to the approach or manner of the client during the interaction with the interviewer (e.g., cooperative, resistive, friendly, ingratiating). Mood is a feeling state reported by the client (e.g., sad, depressed, angry, anxious, happy). Affect is a person's mood, feelings, or tone, observable as an outward manifestation; it may be referred to as inappropriate, flat, or blunted. Perception is how a person views and interprets a situation; a perception may or may not be based in reality. 74. A nurse on the psychiatric unit is planning a discharge conference with a client and the client's family. What is the priority nursing action that should be included in the discharge plan? A: EXPLORING WHAT HAS BEEN LEARNED FROM THIS HOSPITALIZATION R: Evaluation and termination are the foci of a discharge planning conference; it is important for the nurse to assist the family in viewing the hospitalization as a learning experience. A more complete family history should have been obtained before the discharge conference, during which evaluation and future planning are the foci. Teaching the client about the medication to be taken and discussing new issues that could be worked on at home should have been done before the discharge conference, during which evaluation and future planning are the foci. 75. A client tells the nurse in the mental health clinic that the practitioner said that the cornerstone of therapy used in the clinic is cognitive therapy. The client asks what this therapy entails. What concept should the nurse explain as the basis of cognitive therapy? A: NEGATIVE THOUGHTS CAN PRECIPITATE ANXIETY R: Cognitive behavioral therapy (CBT) is a highly structured psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative inaccurate thoughts and changing the rewards for behaviors. Cognitive therapy seeks to discover underlying thoughts that lead to feelings of depression and anxiety; also, it teaches the client to replace these thoughts with more positive, realistic thinking. The response, "Unconscious feelings influence actions," reflects a psychoanalytical approach to treatment. The response, "People can act their way into a new way of thinking," reflects a behavioral approach to treatment. The response, "Maladaptive behaviors will continue as long as they are reinforced," reflects a behavioral approach to treatment. 18 76. An adolescent client seeks help at a crisis intervention clinic. The client says, "I dropped out of college because the instructors were dumb. I tried waiting on tables but got fired. The boss said I was nasty to the customers. They were the nasty ones. If people were nicer, I wouldn't be in this mess." With the application of crisis theory, this client's stressful events can be seen as what? A: SITUATIONAL AND MATURATIONAL R: The data presented indicate developmentally related struggles and specific situations that are extremely stressful, resulting in the adolescent's use of projection as a defense. Multiple stresses can produce a crisis situation for the individual when past coping mechanisms are ineffective. It is not the experience but the individual's response to the experience that determines a crisis. A crisis is not an age-related problem; a crisis results when the individual's past coping mechanisms are no longer effective for managing a present stressful situation. The individual's inability to cope indicates a crisis. 77. A nurse recalls that the focus of environmental (milieu) therapy is to do what? A: MANIPULATE THE CLIENTS ENVIROMENT TO BRING OUT POSITIVE CHANGES IN BEHAVIOR R: Environmental (milieu) therapy is aimed at having everything in the client's surroundings geared toward helping the client. Role play is not a necessary ingredient of any type of therapy. Neither natural treatments nor medications are a necessary part of environmental therapy. Clients are strongly encouraged to be involved in various types of activitie 78. A nurse develops a relationship with a client who has bipolar disorder with episodes of mania. The nurse concludes that their therapeutic interaction has entered the working stage when the client does what? A; EXPLORES THE EFFECT OF BIPOLAR BEHAVIOR ON THE FAMILY R: Acknowledging and exploring issues is part of the working phase of a therapeutic relationship. Formulating the purpose or goals of the therapeutic relationship is part of the orientation or introductory phase. The orientation or introductory phase of a therapeutic relationship involves tension and anxiety within an uncertain situation. Ambivalence is not an uncommon feeling. Having the client share the family history is a part of the orientation or introductory phase of a therapeutic relationship. 79. The practitioner prescribes a tricyclic antidepressant medication to ease a suicidal client's depression. What factor should the nurse consider when initiating treatment with this type of medication? A: THERE MAY NOT BE A NOTICEABLE IMPROVEMENT FOR 2 TO 3 WEEKS R: These drugs do not produce an immediate effect; nursing measures must continue to decrease the risk of suicide. Avoiding aged cheese is a precaution taken with monoamine 19 oxidase (MAO) inhibitors. Giving the medicine with milk is unnecessary. Blood specimens are not necessary; toxicity is not as prevalent a problem with tricyclic antidepressants as it is with medications such as lithium. 80. A nurse is interviewing an 8-year-old girl who has been admitted to the pediatric unit. Which statement by the child needs to be explored? A: THOSE BOYS ARE SO CUTE. I HOPE THEIR ROOM IS NEXT TO MINE R: An 8-year-old child should be more concerned with same-gender relationships. A child who demonstrates a strong attraction to opposite-gender relations should be questioned further to explore the possibility of sexual abuse. A statement such as "Wow! This place has bright colors" is not unusual because 8-year-old children are usually attracted to colorful environments. A statement such as "Is my mother allowed to visit me tonight?" or "I'm scared about being here. Can you stay with me awhile?" is not unusual because 8-year-old children will want the support of a trusted person when experiencing stress. 81. Erikson sequence of achievments 1. INDUSTRY VS INFERIORITY (SCHOOL-AGE CHILD 6-12 YR) 2. IDENTITY VS ROLE CONFUSION (ADOLOSCENCE) 3. INTIMACY VS ISOLATION (YOUNG ADULTHOOD) 4. GENERATIVITY VS STAGNATION (ADULTHOOD) 5. INTEGRITY VS DESPAIR ( LATE YR – 65 YR – DEATH) 82. A nurse concludes that a client is using displacement. Which behavior has the nurse identified? A: DIRECTING PENT-UP EMOTIONS AT SOMEONE OTHER THANT THE PRIMARY SOURCE. R: When acting out against the primary source of anxiety creates even further anxiety or danger, the individual may use displacement to express feelings toward a "safer" person or object. Ignoring unpleasant aspects of reality is an example of denial. Resisting any demands made by others reflects an inability to mature and accept responsibility. Using imaginative activity to escape reality is fantasy. 83. An unmarried pregnant adolescent who is attending a crisis intervention group has decided to continue the pregnancy and keep the baby. What is the crisis intervention nurse's primary responsibility now? A: PROVIDE INFORMATUON ABOUT WHERE THE CLIENT WILL BE ABLE TO GET ASSISTANCE R: The crisis center nurse's main responsibility is to assist the client in using the problem-solving process; the client should be helped to explore alternative solutions and be given information regarding other agencies, facilities, and services. Although the client's decision should be supported, praising the client is a judgmental response. Exploring other problems that the client may be experiencing is not part of the immediate intervention during the crisis; the client may be encouraged to seek help later for other problems. Making an appointment for the client to visit a prenatal clinic is an option for which the client must take primary responsibility. 84. A brief mental assessment includes appearance, behavior, judgment, orientation, recent memory, affect, and cognition 20 A: CURRENT BEHAVIOR, COGNITIVE FUNCTION AND ORIENTATION 85. At times a client's anxiety level is so high that it blocks attempts at communication and the nurse is unsure of what is being said. To clarify understanding, the nurse says, "Let's see whether we both mean the same thing." What technique is this an example of? A: SEEKING CONSENSUAL VALIDATION R: Seeking consensual validation is a technique that prevents misunderstanding so the client and the nurse can work toward a common goal in the therapeutic relationship. Reflecting feelings, making observations, and trying to place events in sequence do not provide for clarification or understanding. 86. What is an initial client objective in relation to anger management? A: TAKING RESPONSIBILITY FOR THE HOSTILE BEHAVIOR R: Before progress can be made in treating anger, the client needs to take responsibility for the behavior. As long as the client blames others, there will be no motivation to change. The client may express remorse but continue to blame others and not feel the need for change. Developing alternative methods to release feelings is a worthwhile goal that is more appropriate later in therapy; it is not an initial goal. The client's own behavior needs to change; it is not appropriate in this situation to teach others to change. 87. Which statement demonstrates that a psychiatric nurse has fostered the most therapeutic nurse–client relationship? A: MY CLIENTS AND I ARE PARTNERS IN THE PLANNING THAT HELPS MEET THEIR PHYSICAL AND MENTAL HEALHT NEEDS R: Today's nurse–client relationship is one that demonstrates the nurse's clinical competence while recognizing the client's right to self-determination in decisions affecting both physical and mental health. Although the development of a true therapeutic relationship is a goal, when that is not achievable because of the client's mental health status, appropriate nursing care is still achievable. Although the demonstration of mutual respect and caring are basic elements, other factors also have an impact on the formation of a therapeutic nurse–client partnership. A truly therapeutic nurse–client relationship provides satisfaction for both nurse and client; that may not be achievable because of the client's mental health status. The nursing process can still provide care that strives to meet client outcomes that are reflective of their potential for both physical and mental wellness. 21 88. The parents of an adolescent who engages in selfinjurious cutting behavior ask the nurse why their child selfmutilates. What should the nurse give as the reason for the cutting? A: WAY TO MANAGE OVERWHELMING FEELINGS R: Self-injurious behavior is used to soothe or override painful feelings. Recent studies do not link cutting to suicidal thinking. Cutting behavior is often hidden from others; it is not attention-seeking behavior. 89. A nurse is assisting with an electroconvulsive therapy (ECT) treatment. The healthcare provider administers the electrical shock, and a seizure of 60 seconds’ duration results. Place in priority order the nursing actions that should be taken after the seizure ends. SEQUENCE 1. ENSURING AN OPEN AIRWAY 2. CHECKING THE VS 3. ORIENTING THE CLIENT TO PLACE AND TIME 4. ASSESING THE CLIENT FOR PRESENCE OF SHORT TERM MEMORY LOSS 5. PROVIDING NOURISHMENT BECAUSE THE CLIENT HAS BEEN ON NPO STATUS. 90. The staff members’ observations can help identify those clients who are ready to cope with outside stress and those who are not. Attendance at a ball game will not help clients adjust to community stressors or return to reality under controlled conditions. There is nothing to indicate that any of these clients needed to broaden their cultural experiences. 91. What must the nurse understand about breaks with reality such as those experienced by clients with schizophrenia? A: CLIENTS BELIEVE THAT WHAT THEY FEEL THAT THEYA RE EXPERIENCING IS REAL R: Failure to accept the client and the client's fears is a barrier to effective communication. Today mental health therapy is directed toward returning the client to the community as 22 rapidly as possible. Electroconvulsive therapy is not the treatment of choice for clients with schizophrenia. Family cooperation is helpful but not an absolute necessity. 92. Incidences of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation? A: REPRESSION R: Repression is a coping mechanism in which unacceptable feelings are kept out of conscious awareness; later, under stress or anxiety, thoughts or feelings surface and come into one's conscious awareness. Isolation is the separation of a thought from a feeling tone. Regression is the use of an unconscious coping mechanism through which a person avoids anxiety by returning to an earlier, more satisfying, or comfortable time in life. Introjection is the integration of the beliefs and values of another into one's own ego structure 93. When a person who wishes to be athletic is uncoordinated but also successful in a musical career, what defense mechanism might this be related to? A: COMPENSATION Compensation is replacing a weak area or trait with a more desirable one. Sublimation is rechanneling unacceptable desires and drives into those that are socially acceptable. Transference is the unconscious tendency to assign to others in the current environment feelings and attitudes associated with another person. Rationalization is the use of justification to make tolerable certain feelings, behaviors, and motives. 94. A nurse is working with a client who has emotional problems. During what stage of the therapeutic nurse–client relationship does the nurse anticipate that most of the client's problem solving will occur? A: WORKING STAGE R: During the working stage, goals are met, problems are resolved, and changes in behavior occur. There is no such thing as the planning stage in the nurse–client relationship; this is a step in the nursing process. During the orientation stage, trust is the primary focus, goals and contracts are set, and problems are identified. The termination stage is focused on accomplishments, reinforces new behaviors, and closes the relationship. 95. A nurse is teaching a group of recently hired staff members about conscious and unconscious defense mechanisms that are used to defend the self against anxiety. What is an example of a conscious defense mechanism that the nurse should include? A: SUPPRESSION R: Suppression is a conscious measure used as a defense against anxiety; the affected person intentionally avoids thinking about disturbing problems, wishes, feelings, or experiences. Undoing is an unconscious defense mechanism; it is the use of words or behavior to make amends symbolically for unacceptable thoughts, feelings, or actions. Projection is an unconscious defense mechanism; it is the false attribution to others of one's own unacceptable impulses, feelings, attitudes, or thoughts. Intellectualization is an unconscious defense mechanism; it is the use of thinking, ideas, or intellect to avoid emotionally charged feelings. 96. In the normal process of human development, individuals strive to maintain, protect, and enhance personal ego (or self) integrity. Which psychosocial response should the nurse expect a client to use to accomplish personal preservation of ego integrity? 23 A: DEFENSE MECHANISMS R: When the individual experiences a threat to self-esteem, anxiety increases and defense mechanisms are used to protect the ego (or self). Affective reactions are mood disorders. Severe withdrawal patterns and ritualistic behaviors are maladaptive ways of coping with stress and not an aspect of the developmental process 97. 24 25 26 New sets 1. An older adult tells the nurse, "I regret so many of the choices I’ve made during my life." Which of Erikson’s developmental conflicts has the client probably failed to accomplish? A: EGO INTEGRITY VS DESPAIR 2. A nurse is counseling a client who has had an angry episode that subsided after several minutes. What is the most important short-term objective for the client? A: TALKING ABOUT SITUATIONS THAT CAUSE ANGRY OUTBURTS. R: Talking about situations that precipitate anger is the first step in helping a client to cope with his or her feelings. 3. Electroconvulsive theaphy- VOID JUST BEFORE THE PROCEDURE 4. ECT- clinical depression for those who do not respond well to a trial of psychothropci medications or who are severely depressed that immediate intervention is needed. 5. What should the nurse's approach be when when working with clients who use manipulative, socially acting-out behaviors? A: SINCERE, CAUTIOS, AND CONSISTENT 6. A registered nurse (RN) in charge of a mental health unit has two additional staff members: a licensed practical nurse (LPN) and a nursing assistant (NA). The unit has 20 clients, with one client on constant observation for acute suicidality. What should the nurse in charge do when making the daily assignments? A: PROVIDE CLIENT CARE AND ADMINISTRATIVE DUTIES AND ASSIGN THE LPB TO ADMIN. MEDICATIONS AND THE NA TO MAINTAIN CONSTANT OBSERVATION OF THE SUICIDAL CLIENT 7. Cohesion- USE THE PHRASE OUR GROUP DURING DISCUSSIONS 8. A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a primary healthcare provider prescribes an antipsychotic medication for these clients? A: MANAGE SYMPTOMS OF PSYCHOSIS 9. While supervising the LPN’s technique with medication administration, the nurse manager sees the LPN beginning to dispense an incorrect dose. How should the nurse manager respond initially? A: BY QUESTIONING THE DOSAGE IN THE HOPE THAT THE LPN WILL IDENTIFY THE ERROR 10. RN legally permitted to perform in a mental health hospital  HEALTH PROMOTION  CASE MANAGEMENT  TREATING HUMAN RESPONSES 11. Speaking in monotone- ISOLATION 27 12. Client experiencing a crisis which NS responsible- SYMPHATETIC ns 13. How should a nurse expect a client's anxiety to be manifested physiologically? A: INCREASED BLOOD GLUCOSE LEVEL R: the flight or fight response 14. Defense mechanism of alcoholism- projection and rationalization 15. When having a conversation with a nurse, an older client states, "I’ve lived a good life. I don’t want to die, but I accept it as a part of life." What developmental stage, according to Erikson, has the client completed? A: INTEGRITY 16. A client's hands are raw and bloody from a ritual involving frequent hand washing. Which defense mechanism does the nurse identify? A: UNDOING 17. Helping client cope with crisis The sooner a client