At what point should the nurse determine that a client is at risk for developing a mental illness

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1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the clients behaviors?
1. The clients behaviors demonstrate mental illness in the form of depression.
2. The clients behaviors are extensive, which indicates the presence of mental illness.
3. The clients behaviors are not congruent with cultural norms.
4. The clients behaviors demonstrate no functional impairment, indicating no mental illness.

ANS: 4
Rationale: The nurse should assess that the clients daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without significant impairment, the clients distress does not indicate a mental illness.

2. At what point should the nurse determine that a client is at risk for developing a mental illness?
1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.
2. When maladaptive responses to stress are coupled with interference in daily functioning.
3. When a client communicates significant distress.
4. When a client uses defense mechanisms as ego protection.

ANS: 2
Rationale: The nurse should determine that the client is at risk for mental illness when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental illness, daily functioning must be significantly impaired. The clients ability to communicate distress would be considered a positive attribute.

3. A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents?
1. Reactions to stress are relative rather than absolute; individual responses to stress vary.
2. It is abnormal for identical twins to react differently to similar stressors.
3. Identical twins should share the same temperament and respond similarly to stress.
4. Environmental influences to stress weigh more heavily than genetic influences.

ANS: 1
Rationale: The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress. Mental health is a state of being that is relative to the individual client. Environmental influences and temperament can affect stress reactions.

4. Which client should the nurse anticipate to be most receptive to psychiatric treatment?
1. A Jewish, female social worker.
2. A Baptist, homeless male.
3. A Catholic, black male.
4. A Protestant, Swedish business executive.

ANS: 1
Rationale: The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important as physical health. Women are also more likely to seek treatment for mental health problems than men.

5. A psychiatric nurse intern states, This clients use of defense mechanisms should be eliminated. Which is a correct evaluation of this nurses statement?
1. Defense mechanisms can be appropriate responses to stress and need not be eliminated.
2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

ANS: 1
Rationale: The nurse should determine that defense mechanisms can be appropriate during times of stress. The client with no defense mechanisms may have a lower tolerance for stress, thus leading to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills.

6. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, Im here for my heart, not my head problems. Which is the nurses best response?
1. Its just a routine part of our assessment. All clients are asked these same questions.
2. Why are you concerned about these types of questions?
3. Psychological factors, like excessive stress, have been found to affect medical conditions.
4. We can skip these questions, if you like. It isnt imperative that we complete this section.

ANS: 3
Rationale: The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. It is not appropriate to skip physiological and psychosocial questions, as this would lead to an inaccurate assessment.

7. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee?
1. The employee assertively confronts the boss.
2. The employee leaves the staff meeting to work out in the gym.
3. The employee criticizes a coworker.
4. The employee takes the boss out to lunch.

ANS: 3
Rationale: The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutral or less-threatening target.

8. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism?
1. Displacement
2. Projection
3. Reaction formation
4. Sublimation

ANS: 3
Rationale: The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Projection refers to the attribution of unacceptable feelings or behaviors to another person. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities.

9. Which nursing statement about the concept of neurosis is most accurate?
1. An individual experiencing neurosis is unaware that he or she is experiencing distress.
2. An individual experiencing neurosis feels helpless to change his or her situation.
3. An individual experiencing neurosis is aware of psychological causes of his or her behavior.
4. An individual experiencing neurosis has a loss of contact with reality.

ANS: 2
Rationale: The nurse should define the concept of neurosis with the following characteristics: The client feels helpless to change his or her situation, the client is aware that he or she is experiencing distress, the client is aware the behaviors are maladaptive, the client is unaware of the psychological causes of the distress, and the client experiences no loss of contact with reality.

10. Which nursing statement regarding the concept of psychosis is most accurate?
1. Individuals experiencing psychoses are aware that their behaviors are maladaptive.
2. Individuals experiencing psychoses experience little distress.
3. Individuals experiencing psychoses are aware of experiencing psychological problems.
4. Individuals experiencing psychoses are based in reality.

ANS: 2
Rationale: The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. The client with psychosis is unaware that his or her behavior is maladaptive or that he or she has a psychological problem.

11. When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the clients use of the defense mechanism of denial?
1. The client hides liquor bottles in a closet.
2. The client yells at her son for slouching in his chair.
3. The client burns dinner on purpose.
4. The client says to the spouse, I dont drink too much!

ANS: 4
Rationale: The clients statement I dont drink too much! alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.

12. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief?
1. If only we could have tried again, things might have worked out.
2. I am so mad that the children and I had to put up with him as long as we did.
3. Yes, it was a difficult relationship, but I think I have learned from the experience.
4. I still dont have any appetite and continue to lose weight.

ANS: 3
Rationale: The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life.

13. A nurse is performing a mental health assessment on an adult client. According to Maslows hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health?1. Maintaining a long-term, faithful, intimate relationship.2. Achieving a sense of self-confidence.3. Possessing a feeling of self-fulfillment and realizing full potential.4. Developing a sense of purpose and the ability to direct activities.

ANS: 3
Rationale: The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslows hierarchy of needs.

14. According to Maslows hierarchy of needs, which situation on an in-patient psychiatric unit would require priority intervention by a nurse?1. A client rudely complaining about limited visiting hours.2. A client exhibiting aggressive behavior toward another client.3. A client stating that no one cares.
4. A client verbalizing feelings of failure.

ANS: 2
Rationale: The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslows hierarchy of needs and must be fulfilled before other higher-level needs can be met. Clients who complain, have feelings of failure, or state that no one cares are struggling with higher-level needs such as the need for love and belonging or the need for self-esteem.

15. How would a nurse best complete the new DSM-5 definition of a mental disorder? A health condition characterized by significant dysfunction in an individuals cognitions, or behaviors that reflects a disturbance in the
1. psychosocial, biological, or developmental process underlying mental functioning.
2. psychological, cognitive, or developmental process underlying mental functioning.
3. psychological, biological, or developmental process underlying mental functioning.
4. psychological, biological, or psychosocial process underlying mental functioning.

ANS: 3
Rationale: A health condition characterized by significant dysfunction in an individuals cognitions, or behaviors that reflects a disturbance in the psychological, biological, or developmental process underlying mental functioning, is the new DSM 5 definition of a mental disorder.

16. A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.)
1. Fidgeting
2. Laughing inappropriately
3. Palpitations
4. Nail biting
5. Limited attention span

ANS: 1, 2, 4
Rationale: The nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with mental illness unless there is significant impairment in other areas of daily functioning. Other indicators of more serious anxiety are restlessness, difficulty concentrating, muscle tension, and sleep disturbance.

17. _______________________ is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.

ANS: Anxiety
Rationale: The definition of anxiety is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. Townsend considers this a core concept.

18. _______________________ is a subjective state of emotional, physical, and social responses to the loss of a valued entity.

ANS: Grief
Rationale: The definition of grief is a subjective state of emotional, physical, and social responses to the loss of a valued entity. Townsend considers this a core concept.

1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
1. Clarify personal attitudes, values, and beliefs.
2. Obtain thorough assessment data.
3. Determine the clients length of stay.
4. Establish personal goals for the interaction.

ANS: 1
Rationale: The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding ones own attitudes, values, and beliefs is called self-awareness.

2. If a client demonstrates transference toward a nurse, how should the nurse respond?
1. Promote safety and immediately terminate the relationship with the client.
2. Encourage the client to ignore these thoughts and feelings.
3. Immediately reassign the client to another staff member.
4. Help the client to clarify the meaning of the relationship, based on the present situation.

ANS: 4
Rationale: The nurse should respond to a clients transference by clarifying the meaning of the nurse-client relationship based on the present situation. Transference occurs when the client unconsciously displaces feelings about a person from the past toward the nurse. The nurse should assist the client in separating the past from the present.

3. What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
1. Acknowledge the clients actions and generate alternative behaviors.
2. Establish rapport and develop treatment goals.
3. Attempt to find alternative placement.
4. Explore how thoughts and feelings about this client may adversely impact nursing care.

ANS: 2
Rationale: The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client, based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship.

4. Which client action should a nurse expect during the working phase of the nurse-client relationship?
1. The client gains insight and incorporates alternative behaviors.
2. The client establishes rapport with the nurse and mutually develops treatment goals.
3. The client explores feelings related to reentering the community.
4. The client explores personal strengths and weaknesses that impact behavioral choices.

ANS: 1
Rationale: The nurse should expect that that the client will gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals.

5. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship?
1. I cant bear the thought of leaving here and failing.
2. I might have a hard time working with you, because you remind me of my mother.
3. I really dont want to talk any more about my childhood abuse.
4. Im not sure that I can count on you to protect my confidentiality.

ANS: 3
Rationale: The nurse should identify that the client statement, I really dont want to talk any more about my childhood abuse, reflects that the client is in the working phase of the nurse-client relationship. The working phase includes overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.

6. A mother who is notified that her child was killed in a tragic car accident states, I cant bear to go on with my life. Which nursing statement conveys empathy?
1. This situation is very sad, but time is a great healer.
2. You are sad, but you must be strong for your other children.
3. Once you cry it all out, things will seem so much better.
4. It must be horrible to lose a child, and Ill stay with you until your husband arrives.

ANS: 4
Rationale: The nurses response, It must be horrible to lose a child, and Ill stay with you until your husband arrives, conveys empathy to the client. Empathy is the ability to see the situation from the clients point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.

7. When an individual is two-faced, which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing?
1. Respect
2. Genuineness
3. Sympathy
4. Rapport

ANS: 2
Rationale: When an individual is two-faced, which means double-dealing or deceitful, the nurse should identify that genuineness is missing in the relationship. Genuineness refers to the nurses ability to be open and honest and maintain congruence between what is felt and what is communicated. When a nurse fails to bring genuineness to the relationship, trust cannot be established.

8. On which task should a nurse place priority during the working phase of relationship development?
1. Establishing a contract for intervention
2. Examining feelings about working with a particular client
3. Establishing a plan for continuing aftercare
4. Promoting the clients insight and perception of reality

ANS: 4
Rationale: The nurse should place priority on promoting the clients insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the pre-interaction phase. Establishing a plan for aftercare would occur in the termination phase.

9. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: My father spanked me often.
Nurse: Your father was a harsh disciplinarian.
1. Restatement
2. Offering general leads
3. Focusing
4. Accepting

ANS: 1
Rationale: The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. It allows the client to know whether the statement has been understood and provides an opportunity to continue.

10. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: When I am anxious, the only thing that calms me down is alcohol.
Nurse: Other than drinking, what alternatives have you explored to decrease anxiety?
1. Reflecting
2. Making observations
3. Formulating a plan of action
4. Giving recognition

ANS: 3
Rationale: The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking. The use of this technique may serve to prevent anger or anxiety from escalating.

11. The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a general lead?
1. Do you know why you are here?
2. Are you feeling depressed or anxious?
3. Yes, I see. Go on.
4. Can you order the specific events that led to your admission?

ANS: 3
Rationale: The nurses statement, Yes, I see. Go on, is an example of a general lead. Offering general leads encourages the client to continue sharing information.

12. A nurse says to a client, Things will look better tomorrow after a good nights sleep. This is an example of which communication technique?
1. The therapeutic technique of giving advice
2. The therapeutic technique of defending
3. The nontherapeutic technique of presenting reality
4. The nontherapeutic technique of giving reassurance

ANS: 4
Rationale: The nurses statement, Things will look better tomorrow after a good nights sleep, is an example of the nontherapeutic communication technique of giving reassurance. Giving reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the clients feelings.

13. A client diagnosed with post-traumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of broad openings?
1. What occurred prior to the rape, and when did you go to the emergency department?
2. What would you like to talk about?
3. I notice you seem uncomfortable discussing this.
4. How can we help you feel safe during your stay here?

ANS: 2
Rationale: The nurses statement, What would you like to talk about? is an example of the therapeutic communication technique of a broad opening. Using broad openings allows the client to take the initiative in introducing the topic and emphasizes the importance of the clients role in the interaction.

14. A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?
1. S
2. O
3. L
4. E
5. R

ANS: 2
Rationale: The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), observing and open posture (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

15. An instructor is correcting a nursing students clinical worksheet. Which instructor statement is the best example of effective feedback?
1. Why did you use the clients name on your clinical worksheet?
2. You were very careless to refer to your client by name on your clinical worksheet.
3. Surely you didnt do this deliberately, but you breeched confidentiality by using names.
4. It is disappointing that after being told youre still using client names on your worksheet.

ANS: 3
Rationale: The instructors statement, Surely you didnt do this deliberately, but you breeched confidentiality by using names, is an example of effective feedback. Feedback is method of communication for helping others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice.

16. What is a nurses purpose for providing appropriate feedback?
1. To give the client good advice
2. To advise the client on appropriate behaviors
3. To evaluate the clients behavior
4. To give the client critical information

ANS: 4
Rationale: The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

17. A client exhibiting dependent behaviors says, Do you think I should move from my parents house and get a job? Which nursing response is most appropriate?
1. It would be best to do that in order to increase independence.
2. Why would you want to leave a secure home?
3. Lets discuss and explore all of your options.
4. Im afraid you would feel very guilty leaving your parents.

ANS: 3
Rationale: The most appropriate response by the nurse is, Lets discuss and explore all of your options. In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

18. A mother rescues two of her four children from a house fire. In an emergency department, she cries, I should have gone back in to get them. I should have died, not them. What is the nurses best response?
1. The smoke was too thick. You couldnt have gone back in.
2. Youre experiencing feelings of guilt, because you werent able to save your children.
3. Focus on the fact that you could have lost all four of your children.
4. Its best if you try not to think about what happened. Try to move on.

ANS: 2
Rationale: The best response by the nurse is, Youre experiencing feelings of guilt, because you werent able to save your children. This response uses the therapeutic communication technique of restating what the client has said. This lets the client know whether an expressed statement has been understood or if clarification is necessary.

19. A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation?
1. Everyone diagnosed with OCD needs to control their ritualistic behaviors.
2. It is important for you to discontinue these ritualistic behaviors.
3. Why are you asking for help, if you wont participate in unit therapy?
4. Lets figure out a way for you to attend unit activities and still wash your hands.

ANS: 4
Rationale: The most appropriate statement by the nurse is, Lets figure out a way for you to attend unit activities and still wash your hands. This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship.

20. Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.)
1. Meeting the psychological needs of the nurse and the client
2. Ensuring therapeutic termination
3. Promoting client insight into problematic behavior
4. Collaborating to set appropriate goals
5. Meeting both the physical and psychological needs of the client

ANS: 2, 3, 4, 5
Rationale: The nurse-client therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. Meeting the nurses psychological needs should never be addressed within the nurse-client relationship.

21. Which of the following individuals are communicating a message? (Select all that apply.)
1. A mother spanking her son for playing with matches
2. A teenage boy isolating himself and playing loud music
3. A biker sporting an eagle tattoo on his biceps
4. A teenage girl writing, No one understands me
5. A father checking for new e-mail on a regular basis

ANS: 1, 2, 3, 4
Rationale: The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to80% of communication is nonverbal.

22. The term ________________________ implies special feelings on the part of both the client and the nurse, based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

ANS: rapport
Rationale: Rapport implies special feelings on the part of both the client and the nurse, based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude. Establishing rapport may be accomplished by discussing non-health-related topics.

23. ___________________ refers to a nurses behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurses past

ANS: Countertransference
Rationale: Countertransference refers to a nurses behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurses past or they may be generated in response to transference feelings on the part of the client

1. A jilted college student is admitted to a hospital following a suicide attempt and states, No one will ever love a loser like me. According to Eriksons theory of personality development, a nurse should recognize that this patient has a deficit in which developmental stage?1. Trust versus mistrust2. Initiative versus guilt3. Intimacy versus isolation4. Ego integrity versus despair

ANS: 3
Rationale: The nurse should recognize that the client who states, No one will ever love a loser like me has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort.

2. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed?1. Learning to count on others2. Learning to delay satisfaction3. Identifying oneself4. Developing skills in participation

ANS: 2
Rationale: The nurse should determine that this client has completed the learning to delay satisfaction stage of development, according to Peplaus interpersonal theory. This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others.

3. A 9-month-old child screams every time his mother leaves and will not tolerate anyone else changing his diaper. The nurse should determine that, according to Mahlers developmental theory, this childs development was arrested at which phase?1. The autistic phase2. The symbiotic phase3. The separation-individuation phase

ANS: 2
Rationale: The nurse should understand that this clients development was halted in the symbiotic phase of Mahlers developmental theory, which usually occurs between 1 and 5 months of age. The child has not entered into the separation-individuation phase of development, in which a child establishes the understanding of being separate from the mother.

4. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?1. Technical expert2. Resource person3. Surrogate4. Leader

ANS: 3
Rationale: The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate, according to Peplaus interpersonal theory. A surrogate serves as a substitute for another personin this case, the childs parent.

5. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept?
1. A possible genetic basis for the clients problems2. The structure and dynamics of the personality3. Behavioral responses to stressors4. Maladaptive cognitions

ANS: 2
Rationale: The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, the ego, and the superego.

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