Nursing 2230 Mental Health Quiz 3 Chapters 12, 13, 14, 15, 20- Keiser University

Mental Health Quiz 3 Chapters 12, 13, 14, 15, 20 Chapter 12 Milieu Therapy - The Therapeutic Community 1. An angry client on an inpatient unit approaches a nurse, stating, Someone took my lunch! People need to respect others, and you need to do something about this now! The nurses response should be guided by which basic assumption of milieu therapy? A. Conflict should be avoided at all costs on inpatient psychiatric units. B. Conflict should be resolved by the nursing staff. C. Every interaction is an opportunity for therapeutic intervention. D. Conflict resolution should be addressed only during group therapy. The nurses response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve psychological health and functioning. 2. A client on an inpatient unit angrily states to a nurse, Peter is not cleaning up after himself in the community bathroom. You need to address this problem. Which is the appropriate nursing response? A. Ill talk to Peter and present your concerns. B. Why are you overreacting to this issue? C. You should bring this to the attention of your treatment team. D. I can see that you are angry. Lets discuss ways to approach Peter with your concerns. The most appropriate nursing response involves restating the clients feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills. 3. A newly admitted client asks, Why do we need a unit schedule? Im not going to these groups. Im here to get some rest. Which is the most appropriate nursing reply? A. Group therapy provides the opportunity to learn and practice new coping skills. B. Group therapy is mandatory. All clients must attend. C. Group therapy is optional. You can go if you find the topic helpful and interesting. D. Group therapy is an economical way of providing therapy to many clients concurrently. The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention. 4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? A. Peer pressure B. Structured programming C. Visitor restrictions D. Mandated activities The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups. 5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients bedside at the appropriate times. The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units; however, nurses must work with clients to foster independence and provide experiences that would foster increased self-esteem. 6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic? A. Dream analysis B. Creative cooking C. Paint by number D. Stress management The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a clients learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance. 7. What is the best rationale for including the clients family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors The nurse should include the clients family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment. 8. How does a democratic form of self-government in the milieu contribute to client therapy? A. By setting punishments for clients who violate the community rules B. By dealing with inappropriate behaviors as they occur C. By setting community expectations wherein all clients are treated on an equal basis D. By interacting with professional staff members to learn about therapeutic interventions A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input. 9. A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results? A. The psychiatrist B. The psychiatric social worker C. The clinical psychologist D. The clinical nurse specialist The nurse should consult with the clinical psychologist to review psychological testing results for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process. 10. In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the clients safety and physiological needs are met within the milieu. 11. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? Select all that apply. A. Respiratory therapist B. Occupational therapist C. Recreational therapist D. Social worker E. Mental health technician The typical interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, dietician, psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. Other disciplines may be included on the basis of resources available in a particular hospital setting and individual patient needs. 12. Which of the following are accurate descriptors of a therapeutic community? Select all that apply. A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists. In a therapeutic community the unit responsibilities are assigned according to client capability, and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills. Chapter 13 Crisis Intervention 1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance. 2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or inability to assume personal responsibility. 3. A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this clients crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6. The nurse should identify that a realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific, measurable, realistic, and contain a time frame. 4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations The priority nursing diagnosis for this client is Risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes on the basis of potential safety risk to the client and/or others. Nursing diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is determined to be potential. 5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. Are you currently thinking about harming yourself? B. Why do you want to harm yourself? C. Have you thought about the consequences of your actions? D. Who is your emergency contact person? The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should prioritize safety by assessing the client for thoughts of self-harm. 6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior. The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client and does not reinforce appropriate behavior. 7. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. Youve really been helpful. Can I count on you for continued support? B. I dont work out anymore. C. Im really glad I didnt go home. It would have been hard to come back. D. I carry mace when I jog. It makes me feel safe and secure. The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. 8. A despondent client, who has recently lost her husband of 30 years, tearfully states, Ill feel a lot better if I sell my house and move away. Which nursing reply is most appropriate? A. Im confident you know whats best for you. B. This may not be the best time for you to make such an important decision. C. Your children will be terribly disappointed. D. Tell me why you want to make this change. During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. The nurse should also assist the client in determining whether any changes are realistic and if timing of change is appropriate. This response encourages the client to think through what may be an impulsive decision. 9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers. The nurse should assess that tense facial expressions and body language may indicate that a clients anger is escalating. The nurse should conduct a thorough assessment of the clients past and current violent behaviors and develop interventions for de-escalation. 10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst is to process feelings and concerns related to the witnessed intervention. 11. Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? Select all that apply. A. Tell me what happened. B. What coping methods have you used, and did they work? C. Describe to me what your life was like before this happened. D. Lets focus on the current problem. E. Ill assist you in selecting functional coping strategies. In the assessment phase, the nurse should gather information regarding the precipitating stressor and the resulting crisis. Focusing on the current problem and selecting functional coping strategies are nursing interventions rather than assessments. 12. Which of the following are effective interventions that a nurse should utilize when caring for an inpatient client who expresses anger inappropriately? Select all that apply. A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. C. Use therapeutic touch to convey empathy. D. Set limits on the behavior. E. Teach the client to avoid I statements related to expression of feelings. The nurse should determine that when working with an inpatient client who expresses anger inappropriately, it is important to maintain a calm demeanor, clearly define the consequences, and set limits on the behavior. The use of therapeutic touch may not be appropriate and could escalate the clients anger. Chapter 14 Assertiveness Training 1. During a psychoeducational group on assertiveness training, a client asks, Why do we need to learn about this stuff? Which is the most appropriate nursing reply? A. Because your doctor requires you to attend this group. B. Being assertive is the ability to stand up for yourself while respecting the rights of others. C. Assertiveness training teaches you how to ask for what you want, when you want it. D. Assertive people place the needs and rights of others before their own. Assertiveness training assists people to maintain their own self-respect and meet their needs while respecting the rights of others. 2. Two clients are roommates on an inpatient psychiatric unit. At breakfast, client A, who had been missing her gold locket, notices client B wearing it. Which should a nurse recognize as a nonassertive or passive behavioral response from client A? A. Client A ignores the situation. B. Client A discusses the situation with her nurse and develops a plan of action. C. Client A immediately approaches client B and pulls the necklace off her neck. D. Client A offers to wash client Bs clothes and accidentally spills bleach in the water. By ignoring the situation, client A avoids conflict, denies her feelings, and does not assertively resolve the problem. This is an example of nonassertive behavior. 3. A client on an inpatient unit is angry with a peer. During lunch, when the peer is not looking, the client spits into his soup. How would the nurse document this interaction? A. Client is displaying assertive behaviors. B. Client is displaying aggressive behaviors. C. Client is displaying passive behaviors. D. Client is displaying passiveaggressive behaviors. This response is passiveaggressive. The clients anger is expressed indirectly by spitting in the soup when the peer is not looking. 4. A client continually waits more than an hour before being seen at the mental health clinic. The client approaches the nurse and states, When I have to wait for more than an hour to be seen, I feel like my time is not important. The nurse recognizes this as what type of behavior? A. Aggressive behavior B. Assertive behavior C. Passiveaggressive behavior D. Passive behavior This response is assertive. The client is openly expressing feelings and attempting to correct a stressful situation. 5. During an assertiveness training group, a client admits to aggressive behaviors. The client asks for suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply? A. Several techniques, including meditation and progressive muscle relaxation, appear helpful. B. Theres not much that can be done about aggressive behavior because of biological responses. C. Certain types of medications have been proven effective in promoting assertive communication. D. There are several techniques, including I statements, role playing, and thought stopping, that can help promote assertive behaviors and decrease aggressive behaviors. These techniques promote assertive behaviors and would help diminish aggressive responses. 6. During an assertiveness training group, a nurse suggests using I statements. The group questions the usefulness of this communication technique. Which explanation by the nurse is most appropriate? A. When I statements are used, opinions are communicated without blaming others. B. When I statements are used, anger is displaced by using indirect means. C. When I statements are used, responsibility for ones behavior is attributed to another. D. When I statements are used, eye contact is promoted. I statements clearly state ones feelings and needs without blaming or demeaning others. 7. While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example of an I statement. Which of the following statements is the best example of this assertive communication technique? A. I would like to know why you came home late without calling me. B. I hate it when you think you can just come home late without calling anyone to let them know where you are. C. I feel angry when you come home late without calling. D. I think you dont care about me, because if you did, youd call me if you were planning on coming home late. This response clearly states feelings about a situation without blaming another. 8. After vying for a nurse management position, nurse A is chosen over nurse B. When nurse manager A calls for staff meetings, nurse B is chronically late or absent. Nurse B is exhibiting which type of behavior? A. Passive B. Assertive C. Aggressive D. Passiveaggressive This response is passiveaggressive. The colleague is expressing anger indirectly by being late or absent from the meetings. 9. A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness? A. Disturbed personal identity B. Disturbed thought processes C. Defensive coping D. Impaired verbal communication Defensive coping reflects a self-protective pattern that defends against underlying perceived threats to positive self-regard. Clients who are utilizing defensive coping lack assertiveness skills. 10. Two clients get into a heated argument regarding TV program selections. The nurse turns off the TV and asks the clients to go to their rooms to cool off, after which they will discuss and attempt to resolve the problem. The nurses action is promoting which assertive technique? A. Defusing B. Clouding or fogging C. Responding as a broken record D. Shifting from content to process Defusing is a technique that delays further discussion with an angry individual until a calm demeanor has been achieved. In the situation presented, the nurse is allowing the clients to calm down prior to addressing their issues. 11. An emergency department nurse, who has worked 10 straight days, is pulled to the psychiatric unit. Which represents a passiveaggressive statement by the emergency department nurse? A. Get someone else to work 3 to 11! Ive been working 10 days straight, and I need a break! B. Okay. Ill do it, then purposefully leaves paperwork undone when leaving the unit at 11 p.m. C. I have worked 10 days straight, and I cannot work tonight. I will work for you tomorrow if you need me. D. Yes, Ill do it. Anything to keep peace with the hospital administration is a good thing. This response is passiveaggressive. The staff nurses anger is expressed indirectly. 12. Which best describes a nurses use of assertive behavior? A. When a nurse attempts to please others and apologizes for awkwardness in a new role B. When a nurse becomes defensive and angry when peers offer suggestions for improvement C. When a nurse has problems making decisions and has a tendency to procrastinate D. When a nurse is open and direct when asked by the nurse manager to complete assignments This is an assertive response. There is clear expression of needs and feelings. 13. Which is the most appropriate nursing reply when a client asks what the goal and benefit are of assertive skills training? A. It protects the client from others who express aggressive feelings. B. It gives reliable, expert information so that clients may correct faulty behaviors. C. It clarifies misperceptions that have caused clients to distort reality. D. It improves communication skills in order to improve interpersonal relationships. Assertiveness training helps to develop satisfying interpersonal relationships by teaching people how to communicate in a manner to meet their own needs while respecting the rights and needs of others. 14. An instructor is teaching about assertive rights. Which student statement indicates a need for further instruction? A. The right to be treated with respect is an assertive right. B. The right to say no without feeling guilty is an assertive right. C. The right to change your mind is an assertive right. D. The right to always put oneself first is an assertive right. This is not an assertive right. An assertive right is to consider others as well as yourself. This student statement indicates a need for further instruction. 15. One nurse confronts another and says, You are always so talkative in the meetings. I dont know why you cant stay quiet sometimes. Which reply by the other nurse reflects the technique of clouding/fogging? A. Youre right. I do speak up a lot. B. Sounds to me like youre agitated and we need to talk. What are you truly angry about? C. Are you offended that I speak up, or because my thoughts are in opposition to yours? D. I have the right to express my opinion. This response reflects the use of clouding/fogging. When clouding/fogging is used it concurs with the critics argument without becoming defensive and without agreeing to change. 16. A teenager gets a C in algebra. The mother angrily states, All you ever do is listen to music and text your friends. The teenager replies, What is it that youre really upset about, mom? Which response pattern is the teenager expressing? A. Clouding and fogging B. Shifting from content to process C. Delaying assertively D. Assuming responsibility for ones own statements This response reflects the use of shifting from content to process. The teenager is changing the focus of the communication from discussing the topic at hand to analyzing what is actually going on in the interaction. 17. The dean of nursing criticizes a faculty member about views on academic freedom. The faculty member states, Are you upset because I believe in academic freedom or because you dont? The faculty member is using which technique to promote assertive behavior? A. Standing up for ones basic human rights B. Delaying assertively C. Inquiring assertively D. Responding assertively with irony This response reflects the use of inquiring assertively. Inquiring assertively is an attempt to seek additional information about critical statements. 18. An aggressive nurse manager tells a staff nurse she has no business rallying staff to change the schedule. What would be an example of a technique that the staff nurse could use to stand up for her basic human rights? A. What is the real reason that you dont want the schedule changed? B. Sounds to me like youre threatened by this change. C. Are you upset because you dont want to redo the schedule? D. I have the right to express my opinion about the schedule. This response reflects the use of standing up for ones basic human rights. 19. A nursing supervisor is scheduling holiday hours. When the supervisor tells the staff nurse that she needs to work Christmas day, the staff nurse calmly states, I worked last Christmas and will not work this Christmas. When the supervisor says But I need you to work, the nurse repeats I worked last Christmas and will not work this Christmas. This is an example of which assertive behavior technique? A. Shifting from content to process B. Standing up for ones basic rights C. Responding as a broken record D. Defusing Responding as a broken record is an assertive behavior technique that consists of persistently repeating in a calm voice what is wanted. 20. A nurse has identified the following nursing diagnosis: ineffective communication R/T lack of assertiveness skills AEB inability to state needs. Which statement encourages the client to acknowledge the priority of this problem? A. Are you having thoughts of harming yourself or others? B. With whom are you least assertive? C. On a scale of 1 to 10, rank the importance of being assertive. D. When are you available to attend the assertiveness training class? This nursing statement encourages the client to objectively evaluate the priority of being assertive. It is important in patient-centered care for the client to prioritize his or her goals for treatment. 21. Which of the following are behavioral components of assertive communication? A. Listening B. You statements C. Closed posture D. Continuous direct eye contact One part of assertiveness communication and behavior is to listen and take time to understand what is being said before giving a response. 22. A client is experiencing high stress. The client states, My boss treats me like a doormat and thinks nothing of demanding frequent overtime. Which nursing intervention would be appropriate? A. To incorporate the family support system into the clients plan of care B. To teach thought-reframing techniques C. To encourage the client to seek other employment D. To teach the client how to use I statements The ability to use I statements is essential in assertive communication. The situation presented indicates that the client needs assertiveness training. 23. A nurse is caring for four clients. Which of the following clients should the nurse identify as likely to experience difficulty in being assertive? Select all that apply. A. A 20-year-old woman who is completing college homework assignments for several peers. B. A 69-year-old widow who is socially isolated C. A 17-year-old boy with conduct disorder D. A 45-year-old successful executive E. A 50-year-old diagnosed with narcissistic personality disorder The woman who is taking on the work of others in addition to her own may be having difficulty assertively saying no; the widow who is socially isolated may lack the necessary skills to communicate her needs; and the boy with a conduct disorder is likely to demonstrate aggressive behaviors. The business executive and an individual diagnosed with narcissistic personality disorder are the least likely to have difficulty being assertive. Chapter 15 Promoting Self-Esteem 1. A nurse is working in a nursing home. How best can this nurse foster self-esteem in the residents of this facility? A. Allowing them to remain in their rooms as much as they desire to maintain privacy B. Administering anti-anxiety medications as ordered C. Providing a sense of mastery over their environment by giving choices when appropriate D. Teaching assertiveness skills and self-esteem principles A sense of having some power and control over ones life enhances self-esteem. 2. A client shows a nurse a piece of artwork that took 3 days to create. How will this achievement improve the clients self-esteem? A. By providing a framework for assertive behavior B. By providing an expression of feelings and a sense of competence and pride C. By providing a positive perception of body image D. By providing appropriate boundaries for relationship establishment Creating the artwork provides expression of feelings and a sense of competence and pride. This will most likely have a positive effect on the clients self-esteem. 3. A nurse is running a group on self-esteem. A client asks, Where does self-esteem come from? Which is the most appropriate nursing reply? A. Many factors, over the life span, influence development and maintenance of self-esteem. B. Self-esteem is determined by factors outside of an individuals control. C. Self-esteem is established in childhood and remains relatively fixed throughout life. D. Genetics are the single largest contributor to an individuals self-esteem. Self-esteem refers to the degree of regard or respect that individuals have for themselves and is a measure of worth that they place on their abilities and judgments. Many factors influence the development of self-esteem over a persons life span. 4. In what way should a nurse expect a school-aged child to gain positive self-esteem, according to Eriksons psychosocial developmental stages? A. Through basic need fulfillment and environmental predictability B. Through exploration and experimentation, resulting in self-confidence in ability to perform C. Through positive reinforcement of creativity and recognition of performance D. Through receiving recognition when learning, competing, and performing successfully The school-aged child develops self-confidence by learning, competing, and performing successfully and receiving recognition from significant others, peers, and acquaintances. 5. The nurse is working with a 15-year-old client suffering from low self-esteem. According to Eriksons psychosocial developmental theory, which factor has most probably influenced this clients self-esteem? A. Regret over life choices B. Lack of personal concern for others C. Inconsistent, overly harsh, or absent parental discipline D. Parental labeling of the child as good regardless of their behavior. When there is inconsistent, overly harsh, or absent discipline in the home, it is difficult for a teenager to develop the independent sense of self needed to achieve a positive self-esteem. 6. On the basis of Eriksons theory, how should a nurse encourage a 40-year-old client to improve his or her selfesteem? A. Encourage the client to review life goals and accomplishments. B. Encourage the client to volunteer at a school, reading to underprivileged children. C. Encourage the client to form lasting intimate relationships. D. Encourage the client to seek recognition for task achievement. Making meaningful contributions to others is a way to meet the developmental task of the generativity versus stagnation (30 to 65 years) stage of Eriksons developmental theory. This action would promote a 40-year-old clients self-esteem. 7. Which is an appropriate initial nursing intervention for a client with chronic low self-esteem? A. Assessing the content of negative self-talk B. Administering anxiolytic medications C. Using reassurance and physical touch D. Using distraction techniques Self-negating verbalizations and internal self-talk undermine self-esteem. Assessing and then intervening to limit or eliminate these negative communications will help improve self-esteem. 8. A 30-year-old client diagnosed with depression has been exclusively cared for and financially subsidized by his mother since age 17. According to Eriksons theory, the nurse recognizes that the client has been unsuccessful in meeting which developmental task? A. Trust B. Initiative C. Intimacy D. Ego integrity The clients relationship with his mother has contributed to failing completion of the developmental task of intimacy in Eriksons stage of intimacy versus isolation (20 to 30 years). This has resulted in behaviors such as withdrawal, social isolation, aloneness, and the inability to form lasting relationships, leading to his diagnosis of depression. 9. A 40-year-old female client has never experienced an intimate relationship. A nursing student tells an instructor that this client remains in Eriksons developmental stage of intimacy versus isolation. What is the instructors most appropriate reply? A. Eriksons stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age. B. Eriksons stages of development are assessed by task achievement, not chronological age. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age. C. Eriksons stages of development are assessed by task achievement, not chronological age. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age. D. Eriksons stages of development are assessed by chronological age, not task achievement. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age. Eriksons stages of development are assessed by chronological age, not task achievement. This client is in Eriksons stage of generativity versus stagnation because she is 40 years old. The student has failed to recognize that even though the client did not successfully achieve the intimacy task of the intimacy versus isolation stage, the client must now be assessed at the age-appropriate developmental stage of generativity versus stagnation. 10. A home health nurse visits an 18-year-old client who lives with his mother. The client has been assessed as having low self-esteem. The nurse refers the client for individual counseling. During the next home visit, which assessed client behavior clearly indicates treatment success? A. The client wants to buy a dog but has not yet asked his mothers permission. B. The client asks his mother for permission to buy a dog. C. The client tells his mother he plans to buy a dog. D. The client buys a dog and hides it in the garage. When the client tells his mother he plans to buy a dog, he is making decisions and taking on responsibilities. This indicates an increase in self-confidence and therefore self-esteem. 11. A 40-year-old client lives with her parents. She has a high school diploma and works at a low-paying job. Her parents give her a weekly allowance to supplement her income. How should the nurse classify their clientparent boundaries? A. As loose B. As rigid C. As flexible D. As enmeshed The client and her parents are overly dependent. The parents control too many aspects of the clients life. Their boundaries are blurred so that it is hard for the client to differentiate her wants and needs from those of her parents. The clientparent boundaries are enmeshed. 12. A father tells his 5-year-old, Son, today instead of picking flowers in the outfield, lets try to catch a ball. The child subsequently pays attention and catches a ball. Which principle of building self-esteem has the father implemented? A. A sense of competence B. Unconditional love C. Realistic goals D. Reality orientation Low self-esteem can be the result of not being able to achieve established goals. The father has set for the child a realistic goal that the child accomplished. This should promote self-esteem. 13. A nursing instructor is teaching about self-concept. Which student statement indicates a need for further instruction? A. Self-concept is the thinking component of the self. B. Self-concept is a system of learned beliefs about self. C. Self-concept is the degree of regard that individuals have for themselves. D. Self-concept is the attitudes and opinions held true about personal existence. Self-esteem, not self-concept, is the degree of regard that individuals have for themselves. This student statement indicates a need for further teaching. 14. A client has continual problematic relationships and rejects others before possibly being rejected. The client states, I am afraid of failing in my job responsibilities. Which correctly written nursing diagnosis should be prioritized for this client? A. Poor self-esteem R/T negative self-image AEB fear of failure B. Altered thought processes R/T anxiety AEB delusions C. Role confusion R/T rejection and poor job productivity D. High risk for violence: self-directed R/T rejection of others Individuals with low self-esteem perceive themselves to be incompetent, unlovable, insecure, and unworthy. A correctly written actual nursing diagnosis must have a related to (R/T) and an evidenced by (AEB) statement. A risk for nursing diagnosis does not contain an AEB statement because the problem has not yet occurred. 15. A nurse is caring for a client who has recently undergone a radical prostatectomy. Which of the following should the nurse recognize as objective symptoms of low self-esteem? Select all that apply. A. Withdrawal from activities B. A decrease in self-care behaviors C. Poor eye contact D. Reports of pain E. Poor posture Withdrawal from activities, a decrease in self-care behaviors, eye contact, and poor posture are all common objective manifestations of low self-esteem. A report of pain should be evaluated as a physical issue before being attributed solely to low self esteem. 16. A 47-year-old mother of two has recently undergone a radical mastectomy. She refuses to see anyone and remains isolated and withdrawn. Which of the following may be relevant nursing diagnoses for this client? Select all that apply. A. Disturbed body image B. Situational low self-esteem C. Ineffective coping D. Altered thought processes E. Altered sensory perception The mastectomy is likely to disturb the clients body image. She is ineffectively coping by withdrawing. She may be experiencing negative feelings about herself related to her altered body image, which would result in low self-esteem. None of the symptoms presented indicate a problem with either altered thought or altered sensory perception. Chapter 20 Electroconvulsive Therapy 1. A nurse administers pure oxygen to a client during and after electroconvulsive therapy. What is the nurses rationale for this procedure? A. To prevent increased intracranial pressure resulting from anoxia B. To prevent hypotension, bradycardia, and bradypnea due to electrical stimulation C. To prevent anoxia due to medication-induced paralysis of respiratory muscles D. To prevent blocked airway resulting from seizure activity The nurse administers 100% oxygen during and after electroconvulsive therapy to prevent anoxia due to medication-induced paralysis of respiratory muscles. Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain. 2. Immediately after electroconvulsive therapy, in which position should a nurse place the client? A. On his or her side to prevent aspiration B. In semi-Fowlers position to promote oxygenation C. In Trendelenburgs position to promote blood flow to vital organs D. In prone position to prevent airway blockage The nurse should place a client who has received electroconvulsive therapy on his or her side to prevent aspiration. After the treatment, most clients will awaken within 10 to 15 minutes and will be confused and disoriented. Some clients will sleep for 1 to 2 hours. All clients require close observation following treatment. 3. A nursing instructor is teaching about electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. During ECT a state of euphoria is induced. B. ECT induces a grand mal seizure. C. During ECT a state of catatonia is induced. D. ECT induces a petit mal seizure. Electroconvulsive therapy is the induction of a grand mal seizure through the application of electrical current to the brain for the purpose of decreasing depression. 4. A chronically depressed and suicidal client is admitted to a psychiatric unit. The client is scheduled for electroconvulsive therapy (ECT). During the course of ECT, a nurse should recognize the continued need for which critical intervention? A. Suicide assessment must continue throughout the ECT course. B. Antidepressant medications are contraindicated throughout the ECT course. C. Discourage expressions of hopelessness throughout the ECT course. D. Encourage a high-caloric diet throughout the ECT course. ECT is an intervention for major depression that often includes suicidal ideations as a symptom. Continued suicide assessment is needed because mood improvement due to ECT may cause the client to act on suicidal ideations. 5. After undergoing two of nine electroconvulsive therapy (ECT) procedures, a client states, I cant even remember eating breakfast, so I want to stop the ECT. Which is the most appropriate nursing reply? A. After you begin the course of treatments, you must complete all of them. B. Youll need to talk with your doctor about what youre thinking. C. It is within your right to discontinue the treatments, but lets talk about your concerns. D. Memory loss is a rare side effect of the treatment. I dont think it should be a concern. The client has the right to terminate treatment. This nursing reply acknowledges this right but focuses on the clients concerns so that the nurse can provide needed information. 6. Immediately after an initial electroconvulsive therapy (ECT) procedure, a client states, Im not hungry and just want to stay in bed and sleep. On the basis of this information, which is the most appropriate nursing intervention? A. Allow the client to remain in bed. B. Encourage the client to join the milieu to promote socialization. C. Obtain a physicians order for parenteral nutrition. D. Involve the client in physical activities to stimulate circulation. Immediately after electroconvulsive therapy a nurse should monitor pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the client should remain in bed. 7. A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a clients electroconvulsive therapy (ECT) procedure. What is the rationale for administering this medication? A. Robinul decreases anxiety during the ECT procedure. B. Robinul induces an unconscious state to prevent pain during the ECT procedure. C. Robinul prevents severe muscle contractions during the ECT procedure. D. Robinul decreases secretions to prevent aspiration during the ECT procedure. Glycopyrrolate (Robinul) is the standard preoperative medication given prior to ECT procedures to decrease secretions and prevent aspiration. 8. A nursing instructor is teaching about the medications given prior to and during electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. Atropine (Atro-Pen) is administered to paralyze skeletal muscles during ECT. B. Succinylcholine chloride (Anectine) decreases secretions to prevent aspiration. C. Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious. D. Glycopyrrolate (Robinul) is given to prevent severe muscle contractions during seizure. In order to render a client unconscious during the ECT procedure, an anesthesiologist administers intravenously a short-acting anesthetic such as thiopental sodium (Pentothal). 9. A client scheduled for electroconvulsive therapy (ECT) at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. On the basis of this observation, which is the most appropriate nursing action? A. The nurse notifies the clients physician of the situation and cancels the ECT. B. The nurse removes the breakfast tray and assists the client to the ECT procedure room. C. The nurse allows the client to finish breakfast and reschedules ECT for 10:00 a.m. D. The nurse increases the clients fluid intake to facilitate the digestive process. A client who is scheduled for ECT procedures is given nothing by mouth (NPO) for a minimum of 6 to 8 hours before treatment. 10. A client who is learning about electroconvulsive therapy (ECT) asks a nurse, Isnt this treatment dangerous? Which is the most appropriate nursing reply? A. No, this treatment is side-effect free. B. There can be temporary paralysis, but full functioning returns within 3 hours of treatment. C. There are some risks, but a thorough examination will determine your candidacy for ECT. D. Transient ischemic attacks (TIAs) can occur but are rare. Clients are given medical clearance for ECT. This decreases the risk of injury from the treatment. 11. A client experienced bradycardia during electroconvulsive therapy (ECT). A nurse assigns a nursing diagnosis of decreased cardiac output R/T vagal stimulation occurring during ECT. Which outcome would the nurse expect the client to achieve? A. The client will verbalize an understanding of the need for moving slowly after treatment. B. The client will maintain an oxygen saturation level of 88% 1 hour after treatment. C. The client will continue adequate tissue perfusion 1 hour after treatment. D. The client will verbalize an understanding of common side effects of ECT. Vagal stimulation induced by ECT may cause a client to experience bradycardia. Adequate tissue perfusion would be a realistic expectation when normal cardiac output is restored. 12. A nursing student is observing an electroconvulsive therapy (ECT) procedure. The student notices a blood pressure cuff on the clients lower leg. The student questions the instructor about the cuff placement. Which is the most accurate instructor reply? A. The cuff has to be placed on the leg because both arms are used for intravenous fluids. B. The cuff functions to prevent succinylcholine from reaching the foot. C. The cuff position gives a more accurate blood pressure reading during the treatment. D. The cuff is placed on the leg so that arms can easily be restrained during seizure. A blood pressure cuff is placed on the lower leg and inflated above systolic pressure before injection of succinylcholine. This is to ensure that seizure activity can be observed and timed in this one limb that is unaffected by the paralytic agent. 13. A client states, My doctor has told me I am a candidate for electroconvulsive therapy (ECT). Where will the treatment take place, and how much time would this entail? Which is the most accurate nursing reply? A. Clients typically receive ECT in their hospital room, daily for 1 month. B. Clients typically undergo 6 to 12 ECT procedures, three times a week in an outpatient setting. C. Clients typically receive an unlimited number of treatments, in the hospital procedure room. D. Clients typically receive two to three treatments, in either an outpatient or inpatient setting. Most clients require an average of 6 to 12 ECT procedures, but some may require up to 20 procedures. Treatments are usually administered every other day, three times per week. Treatments are performed on either an inpatient or outpatient basis, depending on the need for client monitoring. 14. A client is scheduled for an initial electroconvulsive therapy (ECT) procedure. Which information should a nurse include when teaching about the potential side effects of this procedure? A. You may experience transient tangential thinking. B. You may experience some memory deficit surrounding the ECT. C. You may experience avolution for the remainder of the day. D. You may experience a higher risk for subsequent seizures. The most common side effect of ECT is temporary amnesia following the ECT procedure. 15. When scheduling electroconvulsive therapy (ECT), which client should the nurse prioritize? A. A client in bed in a fetal position who is experiencing active suicidal ideations B. A client with an irritable mood and exhibiting angry outbursts C. A client experiencing command hallucinations and delusions of reference D. A client experiencing manic episodes of bipolar disorder A client who is experiencing suicidal ideations is in need of an immediate intervention to prevent self-harm and must be prioritized when the nurse schedules ECT. 16. A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option? A. Because the client is extremely suicidal, ECT is an appropriate option. B. Because antidepressant medications have been ineffective, ECT is a good alternative. C. Because informed consent is required for ECT, cognitive deficits could preclude this option. D. Because of the clients cognitive deficits, a signed consent is waived. A client who is experiencing cognitive deficits cannot give informed consent, which is required prior to ECT. A court proceeding could determine the clients level of competency and, if necessary, the judge would appoint a guardian. 17. A nurse should recognize that electroconvulsive therapy (ECT) would potentially improve the symptoms of clients with which of the following diagnoses? Select all that apply. A. Major depressive disorder B. Bipolar I disorder: manic episode C. Schizoaffective disorder D. Obsessive-compulsive disorder E. Body dysmorphic disorder ECT has been shown to be effective in the treatment of severe depression, acute mania, and acute schizophrenia, particularly if it is accompanied by catatonic or affective (depression or mania) symptomatology. ECT has also been tried with other disorders, such as obsessive-compulsive disorder (OCD) and anxiety disorders, but little evidence exists to support its efficacy in the treatment of these conditions. 18. Which assessment results should a nurse evaluate and report in the process of clearing a client for electroconvulsive therapy (ECT)? Select all that apply. A. Electrocardiographic records B. Pulmonary function study results C. Electroencephalogram analysis D. Complete blood count values E. Urinalysis results A nurse should evaluate electrocardiographic records, pulmonary function study results, complete blood count, and urinalysis results and report any abnormalities to the clients physician. The client must be medically cleared prior to ECT. 19. During a course of 12 electroconvulsive therapy (ECT) procedures, an anxious client diagnosed with major depression refuses to bathe or attend group therapy. He reports some memory problems and says he has trouble figuring out what time of day it is. At this time, which of the following nursing diagnoses should be assigned to this client? Select all that apply. A. Anxiety R/T post-ECT confusion and memory loss B. Risk for injury R/T post-ECT confusion and memory loss C. Risk for activity intolerance R/T post-ECT confusion and memory loss D. Altered sensory perception R/T post-ECT confusion and memory loss E. Social isolation R/T post-ECT confusion and memory loss Because of the post-ECT thought alterations of confusion and memory loss, the client is anxious, is accident prone, and has socially isolated self. Altered sensory perception is related to psychotic thoughts of a sensory nature such as hallucinations, and because this client is diagnosed with major depression, not schizophrenia, altered sensory perception would not be anticipated. 20. Which of the following conditions would place a client at risk for injury during electroconvulsive therapy (ECT)? Select all that apply. A. Severe osteoporosis B. Acute and chronic pulmonary disorders C. Hypothyroidism D. Recent cardiovascular accident E. Prostatic hypertrophy Severe osteoporosis, acute and chronic pulmonary disorders, and a recent history of cardiovascular accident (CVA) can render clients at high risk for injury during electroconvulsive therapy. Quiz # 3 ATI Back Of Book CHAPTER 29 Crisis Management 1. A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job loss 2. A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply.) A. Lithium carbonate B. Paroxetine C. Risperidone D. Haloperidol E. Lorazepam