Nursing 2230 Mental Health Quiz 2 Chapters 6, 9, 10 - Keiser University

Nursing 2230 Mental Health Quiz 2 Chapters 6, 9, 10 Mental Health Quiz 2 Chapters 6, 9, 10 Chapter 6 Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing 1. An African American youth, growing up in an impoverished neighborhood, presents in the emergency department with bruises to his face, chest, and arms. He appears to be upset, is speaking in a dialect that is difficult for the nurse to understand, and is standing within 6 inches of the nurses personal space. What cultural consideration should a nurse identify as playing a role in this youths behavior? A. African Americans frequently speak in different tongues when they are upset. B. Most African Americans have learned to be aggressive when they have to see a health professional. C. African Americans tend to use dialects and invasion of personal space to intimidate others. D. Some African Americans speak in a dialect that is different from standard English and tend toward smaller personal space than that of the dominant culture. The nurse needs to recognize that a tendency toward smaller personal space and the use of dialects different from Standard English are cultural variables and dont necessarily imply aggressive or disrespectful behavior. 2. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of mental disorders? A. Dissociative disorders B. Neurocognitive disorders C. Stress-related disorders D. Schizophrenia spectrum disorders Northern European American values, such as punctuality, hard work, and acquisition of material possessions, may place this group at risk for stress-related disorders when individuals struggle to meet societal demands. 3. A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care? A. Northern European Americans B. Native Americans C. Latino Americans D. African Americans Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this groups educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices. 4. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture? A. Extremes of emotional expression prevent accurate assessment of this culture. B. Suspicion of Western civilization has resulted in minimal cultural research. C. The small size of this subpopulation makes research virtually impossible. D. The Asian American culture includes individuals from many different countries. The Asian American culture includes peoples and descendents from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes. 5. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this clients decision? A. Future orientation causes the client to devalue assertiveness skills. B. Decreased emotional expression makes it difficult to be assertive. C. Assertiveness techniques may not be aligned with the clients definition of the female role. D. Religious prohibitions prevent the clients participation in assertiveness training. The nurse should identify that the Latin American womans refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the male-dominated family. The father usually possesses the ultimate authority. 6. A Latino American man refuses to acknowledge responsibility for hitting his wife, stating instead, It’s the mans job to keep his wife in line. Which cultural belief may be associated with this clients behavior? A. Traditional Latino American families are male dominated with clear malefemale role distinctions. B. Religious tenets of Latino American culture support the use of violence within a marriage. C. Latino American families are female dominated and the mother possesses ultimate authority. D. Marriage dynamics are controlled by dominant females in Latin American families. Traditional Latino American families are male dominated with clear malefemale role distinctions and may impact the clients perception about whether or not striking his wife is physical abuse. The nurse should also recognize that cultural beliefs do no exempt one from adhering to state and federal laws with regard to assault and battery. 7. When working with clients of any culture, which action should a nurse avoid? A. Maintaining eye contact, based on cultural norms B. Assuming that all individuals who share a culture or ethnic group are similar C. Supporting the client in participating in cultural and spiritual rituals D. Using an interpreter to clarify communication The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals. 8. To effectively care for Asian American clients, a nurse should be aware of which cultural norm? A. Obesity and alcoholism are common problems. B. Older people maintain positions of authority within the culture. C. Milk is a staple in the Asian American diet. D. Asian Americans are likely to seek psychiatric help. To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. Milk is seldom consumed because a majority of Asian Americans are lactose intolerant. In the Asian culture, psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families. 9. A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? A. Assist the client in contacting a shaman of his choice. B. Explain to the client that voodoo medicine will not heal the ulcerated toe. C. Ask the client to explain what the shaman can do that the physician cannot. D. Inform the client that refusing treatment is a clients right. The most appropriate nursing intervention would be to facilitate meeting the clients need to have a shaman present. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients. 10. When planning care for a Latino American client, the nurse should be aware of which cultural influence that may impact access to health care? A. The root doctor may be the first contact made when illness is encountered. B. The yin and yang practitioner may be the first contact made when illness is encountered. C. The shaman may be the first contact made when illness is encountered. D. The curandero may be the first contact made when illness is encountered. The nurse should understand that some Latino Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs. 11. In what way should a nurse expect a traditional Asian American client to view mental illness? A. Mental illness relates to uncontrolled behaviors that bring shame to the family. B. Mental illness is a curse from God related to immoral behaviors. C. Mental illness is cured by home remedies based on superstitions. D. Mental illness is cured by hot and cold herbal remedies. The nurse should expect that traditional Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. It is often more acceptable for mental distress to be expressed as physical ailments. 12. Which cultural considerations should a nurse identify with Western European Americans? A. They are present-time oriented and perceive the future as Gods will. B. They value youth, and older adults are commonly placed in nursing homes. C. They are at high risk for alcoholism due to a genetic predisposition. D. They are future oriented and practice preventive health care. The nurse should identify that most Western European Americans are present oriented and perceive the future as Gods will. Older adults are held in positions of respect and are often cared for in the home instead of nursing homes. 13. A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group? A. Northern European Americans B. Asian Americans C. Native Americans D. Jewish Americans The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present. 14. During the first interview with a man from Syria who has just lost his son in a car accident, in sympathy for the mans loss, the female nurse reaches out and hugs him. Which is an accurate evaluation of the nurses action? A. The nurses action should be evaluated as unacceptable due to breech of cultural norms. B. The nurses action should be evaluated as empathetic, encouraging expression of feelings. C. The nurses action should be evaluated as the technique of offering self. D. The nurses action should be evaluated as inappropriate due to poor timing. The nurses action should be evaluated as unacceptable due to breech of cultural norms. During communication, Arab Americans stand close together, maintain steady eye contact, and may touch the others hand or shoulder but only between members of the same sex. 15. A nursing instructor is teaching about cultural characteristics. Which statement by the student indicates the need for further instruction? A. All cultures communicate freely within their group. B. All cultures embrace light therapeutic touch. C. All cultures view the importance of timeliness differently. D. All cultures display biological variations. Not all cultures embrace light therapeutic touch. In the Native American culture, if a hand is offered to another it may be accepted with a light touch; however, in the Asian culture, touching during communication has been historically considered unacceptable. This student statement indicates the need for further instruction. 16. A nurse is preparing to establish a therapeutic relationship with a grieving family from China. Which nursing intervention would be considered most appropriate? A. Touch each member lightly, as this enhances the communication process. B. Direct questions to the young males of the family, as they maintain positions of authority. C. Avoid direct eye contact, as it implies rudeness. D. Remain objective and empathetic, as Asians express feelings freely. In the Asian culture, eye contact is often avoided, as it connotes rudeness and lack of respect. 17. Which cultural group is correctly matched with the disease process for which this group is most susceptible? A. African Americans are susceptible to lactose intolerance. B. Western European Americans are susceptible to malaria. C. Arab Americans are susceptible to sickle cell disease. D. Jewish Americans are susceptible to thalassemia. A number of genetic diseases are more common in the Arab American population, including sickle cell disease, tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infestations, thalassemia, and cardiovascular disease. 18. When interviewing a client of a different culture, which of the following questions should a nurse consider asking? Select all that apply. A. Would using perfume products be acceptable? B. Who may be expected to be present during the client interview? C. Should communication patterns be modified to accommodate this client? D. How much eye contact should be made with the client? E. Would hand shaking be acceptable? When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability, since these are cultural variables. 19. A female nurse is caring for a traditional Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? Select all that apply. A. Limited touch is acceptable only between members of the same sex. B. Conversing individuals of this culture stand far apart and do not make eye contact. C. Devout Muslim men may not shake hands with women. D. The man is the head of the household and women take on a subordinate role. E. In traditional culture, men are responsible for the education of their children. When planning effective care for this client, the nurse should be aware that limited touch within this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subordinate to the man, who is the head of household. Conversing individuals of this culture stand close together and maintain eye contact. Arab American women are responsible for the education of the children. 20. Because of cultural characteristics, in which of the following cultural groups would a nurses assessment of mood and affect be most challenging? Select all that apply. A. Arab Americans B. Native Americans C. Latino Americans D. Western European Americans E. Asian Americans The nurse should expect that both Native Americans and Asian Americans might be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asian Americans may have a reserved public demeanor and may be perceived as shy or uninterested. Chapter 9 The Nursing Process in Psychiatric/Mental Health Nursing 1. Which data-gathering technique is employed during the assessment phase of the nursing process? A. Asking the client to rate mood after administering an antidepressant B. Asking the client to verbalize understanding of previously explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful The nurse should ask the client to describe any thoughts of self-harm during the assessment phase of the nursing process. Assessment involves collecting and analyzing data about the client that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. The other three options are employed during the evaluation phase of the nursing process. 2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client, including biopsychosocial aspects. C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations. The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. 3. Which nursing diagnosis should a nurse identify as being correctly formulated? A. Schizophrenia R/T biochemical alterations AEB altered thought B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance C. Depressed mood R/T multiple life stressors D. Developmental disability R/T early-onset schizophrenia AEB hallucinations The nurse should determine that the correctly written diagnosis would be Self-care deficit: hygiene R/T altered thought AEB disheveled appearance. The nursing diagnosis should describe the unhealthy response (inference), the contributing factors, and the data that support the inference. 4. Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days. The statement Client will initiate interaction with one peer during free time within 2 days is an example of a correctly formulated expected outcome. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. 5. Which statement regarding nursing interventions should a nurse identify as accurate? A. Nursing interventions are independent from the treatment teams goals. B. Nursing interventions are directed solely by written physician orders. C. Nursing interventions occur independently but in concert with overall treatment team goals. D. Nursing interventions are standardized by policies and procedures. The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the clients care. 6. Within the nurses scope of practice, which function is exclusive to the advance practice psychiatric nurse? A. Teaching about the side effects of neuroleptic medications B. Using psychotherapy to improve mental health status C. Using milieu therapy to structure a therapeutic environment D. Providing case management to coordinate continuity of health services The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. It is within the scope of practice of a registered psychiatric mental health nurse generalist to provide education, case management, and milieu therapy. 7. A nurse charts Verbalizes understanding of the side effects of Prozac. This is an example of which category of focused charting? A. Data B. Problem C. Action D. Response Verbalizes understanding of the side effects of Prozac is an example of the response category of focused charting. The response is a description of the clients reaction to any part of medical or nursing care. 8. The nurse should recognize which acronym as representing problem-oriented charting? A. SOAPIE B. SOLER C. DAR D. PQRST The acronym SOAPIE represents problem-oriented charting, which reflects the subjective, objective, assessment, plan, implementation, and evaluation format. This type of charting identifies nursing diagnoses (client problems) on a written plan of care with appropriate nursing interventions described for each. 9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? A. CIWA scale B. GGT C. MMSE D. CAPS scale The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdrawal from substances such as alcohol. The CAPS refers to the clinicianadministered PTSD scale and would be used to assess signs and symptoms of PTSD. The GGT test is used to assess gamma-glutamyl transferase levels, which may be an indication of alcoholism. 10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? A. Mood B. Perception C. Orientation D. Affect The nurse should ask the client to identify name, date, residential address, and situation to assess the clients orientation. Assessment of the clients orientation to reality is part of a mental status evaluation. 11. What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis. The purpose of gathering client information is to enable the nurse to make sound clinical nursing judgments and plan appropriate care. The nurse should complete a thorough assessment of the client, including information collected from the client, significant others, and health-care providers (consistent with HIPAA laws and the clients right to confidentiality). 12. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? A. Health teacher B. Case manager C. Milieu manager D. Psychotherapist The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. Health teaching involves promoting health and a safe environment. Case management is utilized to organize client care so that outcomes are achieved. Psychotherapy involves conducting individual, couples, group, and family counseling. 13. The following outcome was developed for a client: Client will list five personal strengths by the end of day 1. Which correctly written nursing diagnostic statement most likely generated the development of this outcome? A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements B. Self-care deficit R/T altered thought processes C. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 D. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day 1. Self-care deficit, disturbed body image, and risk for disturbed self-concept would generate specific outcomes in accordance with specific needs and goals. The self- care deficit and risk for disturbed self-concept nursing diagnoses are incorrectly written. 14. How should a nurse prioritize nursing diagnoses? A. By the established goal of care B. By the life-threatening potential C. By the physicians priority of care D. By the clients preference The nurse should prioritize nursing diagnoses related to life-threatening potential. Safety is always the nurses first priority. 15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this clients problem? A. The client will avoid daytime napping and attend all groups. B. The client will exercise, as needed, before bedtime. C. The client will sleep 7 uninterrupted hours by day four of hospitalization. D. The clients sleep habits will improve during hospitalization. The outcome The client will sleep 7 uninterrupted hours by day four of hospitalization is accurately written and an appropriate outcome to address the client problem of insomnia. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. 16. The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. B. The client has a history of four suicide attempts in adolescence. C. The client expresses hopelessness and helplessness and isolates self. D. The client has disorganized thought processes and delusional thinking. The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury due to confusion and potential for falls. History of suicide and hopelessness would lead to the development of nursing diagnosis of risk for suicide. Disorganized thoughts and delusional thinking would lead to the development of a nursing diagnosis of altered thought processes. 17. A student nurse asks an instructor which resource is best to use when developing nursing outcomes for clients. Which reply by the instructor most accurately answers the students question? A. Use the Nursing Interventions Classification (NIC), as a reference for nursing outcomes. B. Use the NANDA resource to identify appropriate outcomes. C. Use the Nursing Outcomes Classification (NOC), as a reference for nursing outcomes. D. Copy your standard outcomes from a nursing care plan textbook. NOC is a comprehensive, standardized classification of client outcomes developed to evaluate the effects of nursing interventions. NANDA is a resource for identifying approved nursing diagnoses. 18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this clients problem? A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion The nursing diagnosis altered sensory perception accurately reflects the clients symptoms of hearing things that others do not. A nursing diagnosis describes a clients condition and facilitates the prescription of interventions. Delusional thinking, confusion, and disorientation are problems associated with the nursing diagnosis of altered thought processes. 19. A nursing instructor is teaching students about the purpose of using the nursing process in the care of psychiatric patients. Which of the following statements by the student indicates that learning has occurred? A. The nursing process is a method for interviewing the patient in a systematic way. B. The nursing process is used to assist patients to adapt successfully to stressors within the environment. C. The nursing process is used to provide support for the psychiatric diagnosis. D. The nursing process is used primarily to minimize allegations of negligence. The nursing process is a method for nursing care delivery in which the patients unhealthy responses are identified and interventions are planned, which are designed to assist the patient to adapt more successfully in their environment. 20. A client is diagnosed with generalized anxiety disorder. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse? A. Assessing the clients level of anxiety B. Assessing and documenting the clients vital signs C. Assessing suicide risk D. Assessing availability of support systems Anxiety at a moderate or higher level will interfere with the learning process. 21. During the implementation phase of the nursing process, a nurse is teaching an adult depressed patient with a cochlear implant about medications. Which modification in the teaching plan would be the most appropriate for this client? A. Using repetition B. Speaking directly face-to-face C. Employing the use of sign language D. Providing large-print materials Speaking face-to-face is an appropriate way to teach individuals with alterations in hearing. 22. A client who has slept 6 hours the previous night reports this to the assigned psychiatric nurse. What should be the initial nursing action to address this situation? A. Provide warm milk and a backrub. B. Give a sleep medication. C. Hold a relaxation group before bedtime. D. Review the clients normal sleep pattern. In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the clients health or situation. In this situation the nurse must initially determine the clients normal sleep patterns in order to evaluate if a true problem exists. 23. An instructor overhears a student say, That family seems to disagree more than agree. The family seems to be dysfunctional. To further assess the familys situation, which would be an appropriate instructor reply? A. Families who disagree can be a challenge to the treatment team. B. You seem very critical of the family. Do you believe that you are unable to help them? C. Lets bring the family in for an educational session to improve their communication. D. What appears to trigger family disagreements? In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the clients health or situation. In this situation, prior to intervening with this family, the nurse needs further information about the cause of family conflicts. 24. Which nursing response would be appropriately used in the evaluation phase of the nursing process? A. If I were in your situation, I would not repeat a behavior that has caused problems. B. What do you think needs changing, and what do you want to do differently? C. What exactly will it take to carry out your plan, and what else do you need to do? D. It sounds like youre saying this new approach is working for you. In the evaluation phase of the nursing process, the nurse and the client evaluate progress toward attainment of the expected outcomes. 25. A client diagnosed with major depressive disorder states, Why should I keep trying to get a job? I mess up everything I do. Which correctly written nursing diagnosis best reflects the content and mood themes in this clients statement? A. Hopelessness R/T poor job performance B. Risk for impaired adjustment R/T inadequate social skills AEB isolation C. Altered role performance R/T the fear of failure AEB not seeking employment D. Chronic low self-esteem R/T major depressive disorder AEB self-hatred An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem; it doesnt yet exist. The clients statement indicates that role performance is altered because fear of failure prevents seeking employment. 26. During an intake interview, which question would assist the nurse in gathering data about the clients judgment? A. What brought you to the hospital? Do you know what day and season it is now? B. On a scale of 1 to 10, how would you rate your stress level? C. What does the phrase a rolling stone gathers no moss mean to you? D. If you found a stamped, addressed envelope in the street, what would you do? In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the clients health or situation. The nurse presents a situation that requires the client to make a judgment call and can assess appropriate judgment on the basis of the clients action choice. 27. An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals? A. What do you think needs to change about how you express anger? B. How did you feel after attending the anger management session? C. On a scale of 1 to 10, please rate your current level of anger. D. What bothers you about the actions of others when you get angry? In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client or to the situation. 28. The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview? A. Appears uncooperative. Exhibits characteristics of depression. B. Maintains poor eye contact throughout interview process. Unable to answer interview questions due to depression. C. States I dont need to be here when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission. D. Unwilling to respond openly during interview. Documentation occurs in the implementation phase of the nursing process. All charting entries to the clients legal record should be objective and based on assessed data. Implications and generalizations should be avoided. 29. A client is assigned the nursing diagnosis of impaired social interaction R/T sociocultural differences AEB client stating, Although Id like to, I dont join in because I dont speak the language so good. Which correctly written outcome addresses this clients problem? A. The client will collaborate with nursing staff to set specific goals by day 3. B. The client will participate in one group activity of choice by day 2. C. The client will express a desire to interact with others. D. The client will become increasingly independent by discharge. In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client need or to the situation. 30. The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. The triage nurse should expect which client to be admitted? A. The client who is experiencing tremors and has a need for medication adjustment B. The client who is experiencing anxiety and a sad mood after separation from spouse C. The client who is a single parent and hears voices stating, Kill your infant son. D. The client who argued with her boyfriend and inflicted a superficial cut on her arm In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the clients health or situation. These data are prioritized to meet client needs, with an emphasis on safety. 31. Which of the following nursing interventions fall within the standards of psychiatricmental health clinical nursing practice for a nurse generalist? Select all that apply. A. Assist clients to perform activities of daily living. B. Act as a consultant with other clinicians to provide services for clients and effect system change C. Encourage clients to discuss triggers for relapse D. Use prescriptive authority in accordance with state and federal laws E. Educate families about signs and symptoms of alcohol dependence and withdrawal Assisting clients to perform daily living activities, encouraging clients to discuss triggers, and educating families are nursing interventions that fall within the standards of psychiatric clinical nursing practice for a nurse generalist. Psychiatricmental health advanced practice registered nurses can consult with other clinicians and use prescriptive authority. 32. Which of the following are characteristics of accurately developed client outcomes? Select all that apply. A. Client outcomes are formulated by nurses independent from other team members. B. Client outcomes are not restricted by time frames. C. Client outcomes are specific and measurable. D. Client outcomes are realistically based on client capability. E. Client outcomes are formally approved by the psychiatrist. The nurse should identify that client outcomes should be specific, measurable, and realistically based on client capability. Outcomes should be derived from the diagnosis and should include a time estimate for attainment. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, client, and significant others. 33. After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? Select all that apply. A. Medical judgments related to the psychiatric disorder B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis D. Outcomes that will be targets for nursing interventions E. Statements of client problems of a functional nature A nursing diagnosis is a statement of a clients functional problem. An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem; it does not yet exist. Chapter 10 Therapeutic Groups 1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer. 2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit-setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members. 3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group. The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style. 4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed. 5. Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses association advertises for candidates for president. The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity. 6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yaloms curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others. 7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yaloms curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved. 8. During a group discussion, members freely interact with each other. Which member statement is an example of Yaloms curative group factor of imparting information? A. I found a Web site explaining the different types of brain tumors and their treatment. B. My brother also had a brain tumor and now is completely cured. C. I understand your fear and will be by your side during this time. D. My mother was also diagnosed with cancer of the brain. Yaloms curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by advice and suggestions given by other group members. 9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yaloms curative group factor of altruism? A. Ill give you the name of a friend that rents inexpensive rooms. B. The last time we helped a family, they got back on their feet and prospered. C. I can give you all of my baby clothes for your little one. D. I can appreciate your situation. I had to declare bankruptcy last year. Yaloms curative group factor of altruism occurs when group members provide assistance and support to each other, creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern. 10. During an inpatient educational group, a client shouts out, This information is worthless. Nothing you have said can help me. These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others. 11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader. The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group. 12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. Its hard for me to tell my story when Im not sure about the reactions of others. B. I think Joes Antabuse suggestion is a good one and might work for me. C. My situation is very complex, and I need professional, not peer, advice. D. I am really upset that you expect me to solve my own problems. The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change. 13. Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss. The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress. 14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. There is little research to support AAs effectiveness. B. Self-help groups used to be the treatment of choice, but their popularity is waning. C. These groups have no external regulation, so clients need to be cautious. D. Members themselves run the group, with leadership usually rotating among the members. The student indicates an understanding of self-help groups when stating, Members themselves run the group, with leadership usually rotating among the members. Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences. 15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement. 16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members. 17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group. 18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group. The nurse should determine that the clients absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses. 19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine. 20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. Psychodrama provides a safe setting in which to discuss painful issues. B. In psychodrama, the client is the protagonist. C. In psychodrama, the client observes actor interactions from the audience. D. Psychodrama facilitates resolution of interpersonal conflicts. The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist. 21. Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? Select all that apply. A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others. The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer. 22. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? Select all that apply. A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that rules established by the group do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development.