Chapter 3(FREE) My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 3

Question 1

Type: MCSA

A nurse has completed orientation to a locked psychiatric unit. Which statement best demonstrates that the nurse is prepared to fulfill the professional role?

1. I took a course in self-defense so I can take care of myself.

2. I will ask for support from colleagues when I need it.

3. I know there is a fine line between the clients and the staff.

4. I can maintain proper distance by engaging in therapeutic interventions.

Correct Answer: 2

Rationale 1: Asking for support indicates that the nurse recognizes the emotional challenges of working on a locked psychiatric unit, has engaged in self-reflection, and realizes the value of sharing perceptions, feelings, and concerns with professional colleagues in order to fulfill professional responsibilities. Thinking that one would need a course in self-defense reflects the self-view that the nurses personal integration is threatened by the environment of the locked unit. Believing that there is a fine line between the clients and staff reveals the nurse has difficulty separating his or her own identity from the clients. Believing that engaging in therapeutic interventions will maintain boundaries indicates a hierarchical perspective of helping others and that the nurse inherently knows how clients should act or feel.

Rationale 2: Asking for support indicates that the nurse recognizes the emotional challenges of working on a locked psychiatric unit, has engaged in self-reflection, and realizes the value of sharing perceptions, feelings, and concerns with professional colleagues in order to fulfill professional responsibilities. Thinking that one would need a course in self-defense reflects the self-view that the nurses personal integration is threatened by the environment of the locked unit. Believing that there is a fine line between the clients and staff reveals the nurse has difficulty separating his or her own identity from the clients. Believing that engaging in therapeutic interventions will maintain boundaries indicates a hierarchical perspective of helping others and that the nurse inherently knows how clients should act or feel.

Rationale 3: Asking for support indicates that the nurse recognizes the emotional challenges of working on a locked psychiatric unit, has engaged in self-reflection, and realizes the value of sharing perceptions, feelings, and concerns with professional colleagues in order to fulfill professional responsibilities. Thinking that one would need a course in self-defense reflects the self-view that the nurses personal integration is threatened by the environment of the locked unit. Believing that there is a fine line between the clients and staff reveals the nurse has difficulty separating his or her own identity from the clients. Believing that engaging in therapeutic interventions will maintain boundaries indicates a hierarchical perspective of helping others and that the nurse inherently knows how clients should act or feel.

Rationale 4: Asking for support indicates that the nurse recognizes the emotional challenges of working on a locked psychiatric unit, has engaged in self-reflection, and realizes the value of sharing perceptions, feelings, and concerns with professional colleagues in order to fulfill professional responsibilities. Thinking that one would need a course in self-defense reflects the self-view that the nurses personal integration is threatened by the environment of the locked unit. Believing that there is a fine line between the clients and staff reveals the nurse has difficulty separating his or her own identity from the clients. Believing that engaging in therapeutic interventions will maintain boundaries indicates a hierarchical perspective of helping others and that the nurse inherently knows how clients should act or feel.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain how self-knowledge and self-reflection are important to psychiatricmental health nurses.

Question 2

Type: MCSA

The nurse receives the shift report on a newly admitted client with a history of drug abuse and prostitution. Prior to hospitalization, the clients parental rights were terminated. Which of the following actions best demonstrates the nurses ability to enhance self-knowledge?

1. The nurse will examine his or her own feelings with regard to this client.

2. The nurse will ignore the challenge to his or her self-view.

3. The nurse will ask for guidance from the charge nurse.

4. The nurse will review the current literature pertaining to drug addiction.

Correct Answer: 1

Rationale 1: Examining ones own feelings regarding a client who engages in behaviors that are outside the nurses behavior norms promotes self-awareness and acceptance of deviance, which then allows the nurse to respond with compassion and maintain empathy when meeting the client for the first time. Asking for guidance or reviewing the literature before examining ones feelings indicates that the nurse is unaware or uncomfortable with feelings and relies on others for guidance. Ignoring how ones self-view might be challenged by a patient situation indicates the nurse is not able to confront how the diversity of client behaviors or experiences impacts the quality and nature of the nurses relationships with others.

Rationale 2: Examining ones own feelings regarding a client who engages in behaviors that are outside the nurses behavior norms promotes self-awareness and acceptance of deviance, which then allows the nurse to respond with compassion and maintain empathy when meeting the client for the first time. Asking for guidance or reviewing the literature before examining ones feelings indicates that the nurse is unaware or uncomfortable with feelings and relies on others for guidance. Ignoring how ones self-view might be challenged by a patient situation indicates the nurse is not able to confront how the diversity of client behaviors or experiences impacts the quality and nature of the nurses relationships with others.

Rationale 3: Examining ones own feelings regarding a client who engages in behaviors that are outside the nurses behavior norms promotes self-awareness and acceptance of deviance, which then allows the nurse to respond with compassion and maintain empathy when meeting the client for the first time. Asking for guidance or reviewing the literature before examining ones feelings indicates that the nurse is unaware or uncomfortable with feelings and relies on others for guidance. Ignoring how ones self-view might be challenged by a patient situation indicates the nurse is not able to confront how the diversity of client behaviors or experiences impacts the quality and nature of the nurses relationships with others.

Rationale 4: Examining ones own feelings regarding a client who engages in behaviors that are outside the nurses behavior norms promotes self-awareness and acceptance of deviance, which then allows the nurse to respond with compassion and maintain empathy when meeting the client for the first time. Asking for guidance or reviewing the literature before examining ones feelings indicates that the nurse is unaware or uncomfortable with feelings and relies on others for guidance. Ignoring how ones self-view might be challenged by a patient situation indicates the nurse is not able to confront how the diversity of client behaviors or experiences impacts the quality and nature of the nurses relationships with others.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explain how self-knowledge and self-reflection are important to psychiatricmental health nurses.

Question 3

Type: MCSA

The nurse has just received a report on a new client admitted for depression. The client has severe cerebral palsy, communicates only with a computer, and is quadriplegic. Which of the following statements best demonstrates that the nurse has the ability to respond to this client?

1. I will read the record and talk with the physician to understand the clients disabilities.

2. It is important to interview the clients family before I meet the client.

3. This assignment may be a challenge for me and I will need to be aware of my feelings and any potential fears related to caring for this client.

4. The first thing I will do is thoroughly assess the clients needs and abilities.

Correct Answer: 3

Rationale 1: Acknowledging that caring for the client may be a challenge is the correct answer. Self-awareness of ones feelings and potential emotional responses to a situation is essential to develop empathy. The nurse recognizes that before meeting any client, it is important to recognize ones feelings and clarify beliefs and attitudes, especially when receiving medical information that might be unusual or even frightening. Assessing the clients needs and abilities and interviewing the family may be helpful in caring for this client, but will not necessarily enhance the nurses self-awareness. Reading the record and talking with the physician demonstrates that the nurse has difficulty confronting feelings and will rely on others for guidance.

Rationale 2: Acknowledging that caring for the client may be a challenge is the correct answer. Self-awareness of ones feelings and potential emotional responses to a situation is essential to develop empathy. The nurse recognizes that before meeting any client, it is important to recognize ones feelings and clarify beliefs and attitudes, especially when receiving medical information that might be unusual or even frightening. Assessing the clients needs and abilities and interviewing the family may be helpful in caring for this client, but will not necessarily enhance the nurses self-awareness. Reading the record and talking with the physician demonstrates that the nurse has difficulty confronting feelings and will rely on others for guidance.

Rationale 3: Acknowledging that caring for the client may be a challenge is the correct answer. Self-awareness of ones feelings and potential emotional responses to a situation is essential to develop empathy. The nurse recognizes that before meeting any client, it is important to recognize ones feelings and clarify beliefs and attitudes, especially when receiving medical information that might be unusual or even frightening. Assessing the clients needs and abilities and interviewing the family may be helpful in caring for this client, but will not necessarily enhance the nurses self-awareness. Reading the record and talking with the physician demonstrates that the nurse has difficulty confronting feelings and will rely on others for guidance.

Rationale 4: Acknowledging that caring for the client may be a challenge is the correct answer. Self-awareness of ones feelings and potential emotional responses to a situation is essential to develop empathy. The nurse recognizes that before meeting any client, it is important to recognize ones feelings and clarify beliefs and attitudes, especially when receiving medical information that might be unusual or even frightening. Assessing the clients needs and abilities and interviewing the family may be helpful in caring for this client, but will not necessarily enhance the nurses self-awareness. Reading the record and talking with the physician demonstrates that the nurse has difficulty confronting feelings and will rely on others for guidance.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explain how self-knowledge and self-reflection are important to psychiatricmental health nurses.

Question 4

Type: MCSA

The nurse educator is teaching a group of students about psychiatricmental health nursing concepts. Which intervention best demonstrates practicing with the concept known as detached concern?

1. Sharing personal beliefs and opinions in order to enhance connection with the client

2. Providing a critical perspective of the clients feelings

3. Setting rigid boundaries to separate the nurses experience from the clients

4. Sitting quietly with a client who is sobbing uncontrollably

Correct Answer: 4

Rationale 1: Sitting with a client who is experiencing a difficult emotion means the nurse is comfortable with people who may not be able to control their feelings and can separate the clients experiences and feelings from the nurses self-view. Sharing personal beliefs with clients indicates the nurse cannot separate the nurses identity from the clients identity. Setting rigid boundaries indicates the nurses identity is threatened by the clients behaviors. Providing a critical perspective of a clients feelings invalidates the clients experience and interferes with a therapeutic relationship.

Rationale 2: Sitting with a client who is experiencing a difficult emotion means the nurse is comfortable with people who may not be able to control their feelings and can separate the clients experiences and feelings from the nurses self-view. Sharing personal beliefs with clients indicates the nurse cannot separate the nurses identity from the clients identity. Setting rigid boundaries indicates the nurses identity is threatened by the clients behaviors. Providing a critical perspective of a clients feelings invalidates the clients experience and interferes with a therapeutic relationship.

Rationale 3: Sitting with a client who is experiencing a difficult emotion means the nurse is comfortable with people who may not be able to control their feelings and can separate the clients experiences and feelings from the nurses self-view. Sharing personal beliefs with clients indicates the nurse cannot separate the nurses identity from the clients identity. Setting rigid boundaries indicates the nurses identity is threatened by the clients behaviors. Providing a critical perspective of a clients feelings invalidates the clients experience and interferes with a therapeutic relationship.

Rationale 4: Sitting with a client who is experiencing a difficult emotion means the nurse is comfortable with people who may not be able to control their feelings and can separate the clients experiences and feelings from the nurses self-view. Sharing personal beliefs with clients indicates the nurse cannot separate the nurses identity from the clients identity. Setting rigid boundaries indicates the nurses identity is threatened by the clients behaviors. Providing a critical perspective of a clients feelings invalidates the clients experience and interferes with a therapeutic relationship.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the concept of personal integration and how it relates to psychiatricmental health nursing practice.

Question 5

Type: MCSA

A client approaches the nurse grimacing, talking in a whisper, and waving his arms. Which of the following actions best demonstrates the nurses ability to develop a therapeutic relationship?

1. Greet the client by name to demonstrate caring.

2. Assist the client to leave the area to prevent distress to others.

3. Ignore the client to convey disapproval of the behavior.

4. Confront the client about the behavior to encourage insight.

Correct Answer: 1

Rationale 1: Greeting the client by name conveys that the nurse accepts the clients uniqueness without pre-judging the clients behavior. Ignoring the client is disrespectful and communicates indifference. Assisting the client to leave demonstrates that the nurse is uncomfortable facing behavior that is outside the social norm. Confronting the client indicates that the nurse has preconceived ideas of what is normal behavior for the client.

Rationale 2: Greeting the client by name conveys that the nurse accepts the clients uniqueness without pre-judging the clients behavior. Ignoring the client is disrespectful and communicates indifference. Assisting the client to leave demonstrates that the nurse is uncomfortable facing behavior that is outside the social norm. Confronting the client indicates that the nurse has preconceived ideas of what is normal behavior for the client.

Rationale 3: Greeting the client by name conveys that the nurse accepts the clients uniqueness without pre-judging the clients behavior. Ignoring the client is disrespectful and communicates indifference. Assisting the client to leave demonstrates that the nurse is uncomfortable facing behavior that is outside the social norm. Confronting the client indicates that the nurse has preconceived ideas of what is normal behavior for the client.

Rationale 4: Greeting the client by name conveys that the nurse accepts the clients uniqueness without pre-judging the clients behavior. Ignoring the client is disrespectful and communicates indifference. Assisting the client to leave demonstrates that the nurse is uncomfortable facing behavior that is outside the social norm. Confronting the client indicates that the nurse has preconceived ideas of what is normal behavior for the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the concept of personal integration and how it relates to psychiatricmental health nursing practice.

Question 6

Type: MCSA

The client says to the nurse, Its my right to refuse medications. Which statement best reflects the nurses ability to create a mutual understanding?

1. Refusing your medications is your right, but it wont get you out of here.

2. Can you tell me why youre so angry that you will refuse your medications?

3. Can you tell me what concerns you have about medications?

4. If you refuse your medications, you will just get sick again.

Correct Answer: 3

Rationale 1: Asking the client to clarify concerns about medications shows that the nurse recognizes the clients goals may be different from the nurses. Telling the client that refusing medications will result in getting ill or prevent discharge conveys that the nurse is threatened by the clients assertiveness. Interpreting that the client is angry suggests that the nurse is making assumptions about the clients refusal, rather than operating on the facts.

Rationale 2: Asking the client to clarify concerns about medications shows that the nurse recognizes the clients goals may be different from the nurses. Telling the client that refusing medications will result in getting ill or prevent discharge conveys that the nurse is threatened by the clients assertiveness. Interpreting that the client is angry suggests that the nurse is making assumptions about the clients refusal, rather than operating on the facts.

Rationale 3: Asking the client to clarify concerns about medications shows that the nurse recognizes the clients goals may be different from the nurses. Telling the client that refusing medications will result in getting ill or prevent discharge conveys that the nurse is threatened by the clients assertiveness. Interpreting that the client is angry suggests that the nurse is making assumptions about the clients refusal, rather than operating on the facts.

Rationale 4: Asking the client to clarify concerns about medications shows that the nurse recognizes the clients goals may be different from the nurses. Telling the client that refusing medications will result in getting ill or prevent discharge conveys that the nurse is threatened by the clients assertiveness. Interpreting that the client is angry suggests that the nurse is making assumptions about the clients refusal, rather than operating on the facts.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Discuss the concept of personal integration and how it relates to psychiatricmental health nursing practice.

Question 7

Type: MCSA

A client comes to the nurses station yelling, I have to call the FBI. The bombs are set to destroy Washington, D.C. at 1:00 p.m. Please help me. It will be your fault if I dont call. Which intervention best demonstrates the nurses sensitivity?

1. Assist the client to become aware that this is a delusional belief.

2. Listen carefully for the underlying emotion expressed by the clients request.

3. Share your concerns that the clients request is unreasonable.

4. Switch the topic of conversation to defuse the clients underlying agitation.

Correct Answer: 2

Rationale 1: Listening for the tone underlying the clients request, rather than responding to the actual request, demonstrates the nurses sincerity and non-defensive approach to the client. Switching topics breaks down communication. Believing the clients request is unreasonable or identifying the belief as delusional invalidates the clients feelings and reflects insensitivity to the clients concern.

Rationale 2: Listening for the tone underlying the clients request, rather than responding to the actual request, demonstrates the nurses sincerity and non-defensive approach to the client. Switching topics breaks down communication. Believing the clients request is unreasonable or identifying the belief as delusional invalidates the clients feelings and reflects insensitivity to the clients concern.

Rationale 3: Listening for the tone underlying the clients request, rather than responding to the actual request, demonstrates the nurses sincerity and non-defensive approach to the client. Switching topics breaks down communication. Believing the clients request is unreasonable or identifying the belief as delusional invalidates the clients feelings and reflects insensitivity to the clients concern.

Rationale 4: Listening for the tone underlying the clients request, rather than responding to the actual request, demonstrates the nurses sincerity and non-defensive approach to the client. Switching topics breaks down communication. Believing the clients request is unreasonable or identifying the belief as delusional invalidates the clients feelings and reflects insensitivity to the clients concern.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 8

Type: MCSA

The nurse is caring for a client with depression. Which nursing intervention best demonstrates the nurses availability to the client?

1. Let the client know that time heals all sorrow.

2. Provide privacy when interviewing the client.

3. Be honest with the client about medication effects.

4. Assist the client with the activities of daily living.

Correct Answer: 4

Rationale 1: Assisting the client with activities of daily living demonstrates that the nurse is available to the client to help with basic human needs. Providing privacy is important, but shows respect for the client, not availability. Telling the client that time heals invalidates the clients experience. Being honest with the client about medications demonstrates respect for the client, not availability.

Rationale 2: Assisting the client with activities of daily living demonstrates that the nurse is available to the client to help with basic human needs. Providing privacy is important, but shows respect for the client, not availability. Telling the client that time heals invalidates the clients experience. Being honest with the client about medications demonstrates respect for the client, not availability.

Rationale 3: Assisting the client with activities of daily living demonstrates that the nurse is available to the client to help with basic human needs. Providing privacy is important, but shows respect for the client, not availability. Telling the client that time heals invalidates the clients experience. Being honest with the client about medications demonstrates respect for the client, not availability.

Rationale 4: Assisting the client with activities of daily living demonstrates that the nurse is available to the client to help with basic human needs. Providing privacy is important, but shows respect for the client, not availability. Telling the client that time heals invalidates the clients experience. Being honest with the client about medications demonstrates respect for the client, not availability.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 9

Type: MCSA

The nurse finds the client crying in the room. The client states, Im so sad and lonely. Im sitting here crying like a baby. Which of the following responses best reflects the nurses sensitivity toward the client?

1. Why dont you come to the dayroom to be with others?

2. Are you feeling embarrassed because you are crying?

3. Dont worry about crying. I think you are a fine person.

4. Its a gray, rainy day. A lot of clients are feeling sad.

Correct Answer: 2

Rationale 1: Asking the client about feeling embarrassed demonstrates the nurse is trying to understand the clients perspective and is showing genuine interest and concern. Telling the client not to worry or suggesting the client be with other clients invalidates the clients experience. Attributing the clients tears to the weather makes an assumption that discounts and invalidates the clients feelings.

Rationale 2: Asking the client about feeling embarrassed demonstrates the nurse is trying to understand the clients perspective and is showing genuine interest and concern. Telling the client not to worry or suggesting the client be with other clients invalidates the clients experience. Attributing the clients tears to the weather makes an assumption that discounts and invalidates the clients feelings.

Rationale 3: Asking the client about feeling embarrassed demonstrates the nurse is trying to understand the clients perspective and is showing genuine interest and concern. Telling the client not to worry or suggesting the client be with other clients invalidates the clients experience. Attributing the clients tears to the weather makes an assumption that discounts and invalidates the clients feelings.

Rationale 4: Asking the client about feeling embarrassed demonstrates the nurse is trying to understand the clients perspective and is showing genuine interest and concern. Telling the client not to worry or suggesting the client be with other clients invalidates the clients experience. Attributing the clients tears to the weather makes an assumption that discounts and invalidates the clients feelings.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 10

Type: MCSA

The nurse is caring for a client who repeatedly talks about the role of spirituality in curing depression. Which approach best demonstrates the nurses acceptance of the client?

1. Listen to the client in a supportive manner.

2. Share opinions regarding the role of spirituality in daily life.

3. Encourage the client to consider other curative factors.

4. Ignore the clients focus on spirituality.

Correct Answer: 1

Rationale 1: Listening to the client in a supportive manner demonstrates that the nurse is refraining from judging the clients position and is willing to listen in order to understand the clients views. Ignoring the clients viewpoint conveys rejection of the client. Encouraging the client to consider other factors disregards the clients communication. Sharing opinions is not a therapeutic use of self.

Rationale 2: Listening to the client in a supportive manner demonstrates that the nurse is refraining from judging the clients position and is willing to listen in order to understand the clients views. Ignoring the clients viewpoint conveys rejection of the client. Encouraging the client to consider other factors disregards the clients communication. Sharing opinions is not a therapeutic use of self.

Rationale 3: Listening to the client in a supportive manner demonstrates that the nurse is refraining from judging the clients position and is willing to listen in order to understand the clients views. Ignoring the clients viewpoint conveys rejection of the client. Encouraging the client to consider other factors disregards the clients communication. Sharing opinions is not a therapeutic use of self.

Rationale 4: Listening to the client in a supportive manner demonstrates that the nurse is refraining from judging the clients position and is willing to listen in order to understand the clients views. Ignoring the clients viewpoint conveys rejection of the client. Encouraging the client to consider other factors disregards the clients communication. Sharing opinions is not a therapeutic use of self.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 11

Type: MCSA

The nurse is seeking supervision regarding the use of self-disclosure with a client who has anxiety. Which response by the nurse most accurately reflects an understanding of the therapeutic use of self-disclosure?

1. There are really few circumstances in which it is appropriate for nurses to use self-disclosure with clients.

2. Nurses who disclose personal information must first undergo psychotherapy to prevent over-disclosure.

3. I can use self-disclosure with any client as long as it doesnt take the focus away from the client.

4. I will first ask myself whether what I am going to disclose meets the clients needs or just my own needs.

Correct Answer: 4

Rationale 1: Asking oneself whether the goal of the self-disclosure is to meet the clients need or the nurses need demonstrates that the nurse realizes it is important to determine the purpose and goal for the self-disclosure before sharing personal information with the client. Although the wisdom of self-disclosure has been the subject of much debate, there are studies that support the judicious use of self-disclosure. Before using self-disclosure with a client, the nurse must consider not only if it will take the focus away from the client, but also the context of the therapeutic relationship and give attention to the timing, appropriateness, and degree. Seeking supervision when using self-disclosure is appropriate for any nurse; however, one does not need to have undergone personal psychotherapy to understand the judicious use of self-disclosure.

Rationale 2: Asking oneself whether the goal of the self-disclosure is to meet the clients need or the nurses need demonstrates that the nurse realizes it is important to determine the purpose and goal for the self-disclosure before sharing personal information with the client. Although the wisdom of self-disclosure has been the subject of much debate, there are studies that support the judicious use of self-disclosure. Before using self-disclosure with a client, the nurse must consider not only if it will take the focus away from the client, but also the context of the therapeutic relationship and give attention to the timing, appropriateness, and degree. Seeking supervision when using self-disclosure is appropriate for any nurse; however, one does not need to have undergone personal psychotherapy to understand the judicious use of self-disclosure.

Rationale 3: Asking oneself whether the goal of the self-disclosure is to meet the clients need or the nurses need demonstrates that the nurse realizes it is important to determine the purpose and goal for the self-disclosure before sharing personal information with the client. Although the wisdom of self-disclosure has been the subject of much debate, there are studies that support the judicious use of self-disclosure. Before using self-disclosure with a client, the nurse must consider not only if it will take the focus away from the client, but also the context of the therapeutic relationship and give attention to the timing, appropriateness, and degree. Seeking supervision when using self-disclosure is appropriate for any nurse; however, one does not need to have undergone personal psychotherapy to understand the judicious use of self-disclosure.

Rationale 4: Asking oneself whether the goal of the self-disclosure is to meet the clients need or the nurses need demonstrates that the nurse realizes it is important to determine the purpose and goal for the self-disclosure before sharing personal information with the client. Although the wisdom of self-disclosure has been the subject of much debate, there are studies that support the judicious use of self-disclosure. Before using self-disclosure with a client, the nurse must consider not only if it will take the focus away from the client, but also the context of the therapeutic relationship and give attention to the timing, appropriateness, and degree. Seeking supervision when using self-disclosure is appropriate for any nurse; however, one does not need to have undergone personal psychotherapy to understand the judicious use of self-disclosure.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 12

Type: MCSA

The charge nurse is reviewing the care plans for the clients on the unit. In several care plans, the nurse has noted that the words noncompliant and manipulative have been used to describe those clients with severe mental illness. The nurse plans on discussing this with the staff at the next unit meeting. Which of the following responses will demonstrate the charge nurses personal accountability to the staff?

1. If you use these terms regularly, you will need to reassess your reasons for working in psychiatric settings.

2. Does the use of these terms reflect an underlying level of stress on the unit that I should be aware of?

3. While these terms might be accurate, they are not appropriate to use in a care plan.

4. How might these terms reflect negativity and stigma towards persons with mental illness?

Correct Answer: 4

Rationale 1: By asking the staff about the impact of these terms, the charge nurse is providing feedback to the staff and asking them to engage in critical thinking to improve the quality of care. Telling the staff that the terms are not appropriate to use or that by using them the staff need to reassess their reasons for working on the unit does not promote dialog or enhance problem solving. Assuming the reason for the use of the terms before engaging in a dialog with the staff closes off communication and does not enhance problem solving or feedback.

Rationale 2: By asking the staff about the impact of these terms, the charge nurse is providing feedback to the staff and asking them to engage in critical thinking to improve the quality of care. Telling the staff that the terms are not appropriate to use or that by using them the staff need to reassess their reasons for working on the unit does not promote dialog or enhance problem solving. Assuming the reason for the use of the terms before engaging in a dialog with the staff closes off communication and does not enhance problem solving or feedback.

Rationale 3: By asking the staff about the impact of these terms, the charge nurse is providing feedback to the staff and asking them to engage in critical thinking to improve the quality of care. Telling the staff that the terms are not appropriate to use or that by using them the staff need to reassess their reasons for working on the unit does not promote dialog or enhance problem solving. Assuming the reason for the use of the terms before engaging in a dialog with the staff closes off communication and does not enhance problem solving or feedback.

Rationale 4: By asking the staff about the impact of these terms, the charge nurse is providing feedback to the staff and asking them to engage in critical thinking to improve the quality of care. Telling the staff that the terms are not appropriate to use or that by using them the staff need to reassess their reasons for working on the unit does not promote dialog or enhance problem solving. Assuming the reason for the use of the terms before engaging in a dialog with the staff closes off communication and does not enhance problem solving or feedback.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 13

Type: MCSA

A nurse is working with a client who was admitted for treatment of bipolar disorder. The client asks the nurse if it is OK to pray for recovery. Which response best conveys the nurses ability to be a spiritual activist for the client?

1. Clients in psychiatric hospitals often experience spiritual crises that require prayer.

2. Its acceptable for clients to pray in the hospital chapel.

3. Spiritual practices, such as praying, can nurture ones spirit and enhance healing.

4. Its not advisable to focus only on prayer as a means to recovery.

Correct Answer: 3

Rationale 1: Acknowledging that a clients spiritual practices may assist in recovery acknowledges that practice of a religious or spiritual ritual is a reflection of the clients connection to faith. Telling the client that it is acceptable to pray in the hospital chapel ignores the clients question about the meaning of prayer. Suggesting that it is not advisable to focus only on prayer invalidates the clients spiritual needs. Generalizing about clients experiencing spiritual crises because of their hospitalization minimizes the importance of the clients search for meaning.

Rationale 2: Acknowledging that a clients spiritual practices may assist in recovery acknowledges that practice of a religious or spiritual ritual is a reflection of the clients connection to faith. Telling the client that it is acceptable to pray in the hospital chapel ignores the clients question about the meaning of prayer. Suggesting that it is not advisable to focus only on prayer invalidates the clients spiritual needs. Generalizing about clients experiencing spiritual crises because of their hospitalization minimizes the importance of the clients search for meaning.

Rationale 3: Acknowledging that a clients spiritual practices may assist in recovery acknowledges that practice of a religious or spiritual ritual is a reflection of the clients connection to faith. Telling the client that it is acceptable to pray in the hospital chapel ignores the clients question about the meaning of prayer. Suggesting that it is not advisable to focus only on prayer invalidates the clients spiritual needs. Generalizing about clients experiencing spiritual crises because of their hospitalization minimizes the importance of the clients search for meaning.

Rationale 4: Acknowledging that a clients spiritual practices may assist in recovery acknowledges that practice of a religious or spiritual ritual is a reflection of the clients connection to faith. Telling the client that it is acceptable to pray in the hospital chapel ignores the clients question about the meaning of prayer. Suggesting that it is not advisable to focus only on prayer invalidates the clients spiritual needs. Generalizing about clients experiencing spiritual crises because of their hospitalization minimizes the importance of the clients search for meaning.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the qualities that enable psychiatricmental health nurses to practice the use of self artfully in therapeutic relationships.

Question 14

Type: MCSA

The nurse is writing a care plan for a client with schizophrenia. Which of the following interventions demonstrates that the nurse is working from the Medical model?

1. The nurse will ask the client to identify responsible ways to manage delusional material.

2. The client will learn about the therapeutic effects of medications.

3. The nurse will teach the client appropriate social behaviors in group and one-on-one interactions.

4. The client will learn techniques that will interrupt hallucinations.

Correct Answer: 2

Rationale 1: The nurse who provides teaching to the client about medications is operating from the model that schizophrenia is a neurobiological disorder over which the client has no control, but can take responsibility for the symptoms by learning about medications. The nurse who teaches the client techniques to interrupt hallucinations operates from the model that the client is not to be blamed for the hallucinations but can take steps to manage the symptoms. The nurse who believes that teaching the client appropriate social behaviors is operating from the model that the client is responsible for inappropriate social behaviors and needs assistance from the nurse to solve this issue. The nurse who believes that asking the client to identify responsible ways to manage delusional material is operating from the model that the clients cause their own problems and are responsible for developing solutions.

Rationale 2: The nurse who provides teaching to the client about medications is operating from the model that schizophrenia is a neurobiological disorder over which the client has no control, but can take responsibility for the symptoms by learning about medications. The nurse who teaches the client techniques to interrupt hallucinations operates from the model that the client is not to be blamed for the hallucinations but can take steps to manage the symptoms. The nurse who believes that teaching the client appropriate social behaviors is operating from the model that the client is responsible for inappropriate social behaviors and needs assistance from the nurse to solve this issue. The nurse who believes that asking the client to identify responsible ways to manage delusional material is operating from the model that the clients cause their own problems and are responsible for developing solutions.

Rationale 3: The nurse who provides teaching to the client about medications is operating from the model that schizophrenia is a neurobiological disorder over which the client has no control, but can take responsibility for the symptoms by learning about medications. The nurse who teaches the client techniques to interrupt hallucinations operates from the model that the client is not to be blamed for the hallucinations but can take steps to manage the symptoms. The nurse who believes that teaching the client appropriate social behaviors is operating from the model that the client is responsible for inappropriate social behaviors and needs assistance from the nurse to solve this issue. The nurse who believes that asking the client to identify responsible ways to manage delusional material is operating from the model that the clients cause their own problems and are responsible for developing solutions.

Rationale 4: The nurse who provides teaching to the client about medications is operating from the model that schizophrenia is a neurobiological disorder over which the client has no control, but can take responsibility for the symptoms by learning about medications. The nurse who teaches the client techniques to interrupt hallucinations operates from the model that the client is not to be blamed for the hallucinations but can take steps to manage the symptoms. The nurse who believes that teaching the client appropriate social behaviors is operating from the model that the client is responsible for inappropriate social behaviors and needs assistance from the nurse to solve this issue. The nurse who believes that asking the client to identify responsible ways to manage delusional material is operating from the model that the clients cause their own problems and are responsible for developing solutions.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Provide examples of how the concepts of blame and control affect artful therapeutic practice.

Question 15

Type: MCSA

The nurse is working with a client who becomes upset and tells the nurse, Ive decided to give up on finishing my bachelors degree. Which response best reflects the nurses belief that the client is able to find the solution to this concern?

1. You dont need to make a decision about this right now.

2. It is probably too much for you to handle right now.

3. If you put your mind to it, you could finish the program.

4. It sounds like you feel it is too much for you to finish now.

Correct Answer: 4

Rationale 1: Reflecting back to the client what the nurse has heard is a therapeutic technique that facilitates the clients ability to problem-solve. Telling the client that it is probably too much or that the client does not need to make a decision assumes that the nurse knows what the client needs without taking time to explore the clients feelings. Telling the client that success depends on putting ones mind to it suggests that the client is to blame for the decision to give up.

Rationale 2: Reflecting back to the client what the nurse has heard is a therapeutic technique that facilitates the clients ability to problem-solve. Telling the client that it is probably too much or that the client does not need to make a decision assumes that the nurse knows what the client needs without taking time to explore the clients feelings. Telling the client that success depends on putting ones mind to it suggests that the client is to blame for the decision to give up.

Rationale 3: Reflecting back to the client what the nurse has heard is a therapeutic technique that facilitates the clients ability to problem-solve. Telling the client that it is probably too much or that the client does not need to make a decision assumes that the nurse knows what the client needs without taking time to explore the clients feelings. Telling the client that success depends on putting ones mind to it suggests that the client is to blame for the decision to give up.

Rationale 4: Reflecting back to the client what the nurse has heard is a therapeutic technique that facilitates the clients ability to problem-solve. Telling the client that it is probably too much or that the client does not need to make a decision assumes that the nurse knows what the client needs without taking time to explore the clients feelings. Telling the client that success depends on putting ones mind to it suggests that the client is to blame for the decision to give up.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Provide examples of how the concepts of blame and control affect artful therapeutic practice.

Question 16

Type: MCSA

The nurse is caring for a client with depression who is withdrawn. Which of the following statements suggests that the nurse is able to challenge his or her dogmatic beliefs?

1. I understand that clients with depression have anger turned inward.

2. I realize that if clients would just change their negative thoughts, they wouldnt be depressed.

3. I realize that clients with depression are not just avoiding their problems.

4. I understand that if clients would just develop strong interests, they wouldnt be depressed.

Correct Answer: 3

Rationale 1: The nurse who realizes clients with depression are not just avoiding their problems has been challenged to change their beliefs as the result of caring for clients with depression. Continuing to hold beliefs that clients remain depressed because of negative thoughts, anger turned inward, or a lack of strong interests demonstrates that the nurse is unable or unwilling to form new ideas and research about mental illness in order to fit his or her preconceived notion of depression.

Rationale 2: The nurse who realizes clients with depression are not just avoiding their problems has been challenged to change their beliefs as the result of caring for clients with depression. Continuing to hold beliefs that clients remain depressed because of negative thoughts, anger turned inward, or a lack of strong interests demonstrates that the nurse is unable or unwilling to form new ideas and research about mental illness in order to fit his or her preconceived notion of depression.

Rationale 3: The nurse who realizes clients with depression are not just avoiding their problems has been challenged to change their beliefs as the result of caring for clients with depression. Continuing to hold beliefs that clients remain depressed because of negative thoughts, anger turned inward, or a lack of strong interests demonstrates that the nurse is unable or unwilling to form new ideas and research about mental illness in order to fit his or her preconceived notion of depression.

Rationale 4: The nurse who realizes clients with depression are not just avoiding their problems has been challenged to change their beliefs as the result of caring for clients with depression. Continuing to hold beliefs that clients remain depressed because of negative thoughts, anger turned inward, or a lack of strong interests demonstrates that the nurse is unable or unwilling to form new ideas and research about mental illness in order to fit his or her preconceived notion of depression.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Provide examples of how the concepts of blame and control affect artful therapeutic practice.

Question 17

Type: MCSA

A nurse is taking a class on providing culturally competent care for clients with severe mental illnesses. Which response best reflects the nurses self-awareness of the sociocultural factors influencing his or her beliefs?

1. When I was growing up, my parents believed that mental illnesses were the work of evil spirits.

2. All that I need to understand about the culture of mental illness is available on the Internet.

3. My father was a psychiatrist, so I am very knowledgeable about how to work with mental illnesses.

4. I have been through therapy, so I know what to expect from clients with mental illnesses.

Correct Answer: 1

Rationale 1: The nurse who acknowledges what parents or significant others have said about mental illness recognizes that ones heritage has an impact on ones beliefs and can influence ones practice. Stating that a parents occupation makes one knowledgeable about mental illnesses suggests arrogance on the part of the nurse and does not invite self-reflection. Believing that one can learn about cultural differences through popular media does not promote self-awareness or critical thinking. Stating that because of therapy one understands the culture of those with mental illness suggests that psychotherapy is the only way to gain awareness of sociocultural differences.

Rationale 2: The nurse who acknowledges what parents or significant others have said about mental illness recognizes that ones heritage has an impact on ones beliefs and can influence ones practice. Stating that a parents occupation makes one knowledgeable about mental illnesses suggests arrogance on the part of the nurse and does not invite self-reflection. Believing that one can learn about cultural differences through popular media does not promote self-awareness or critical thinking. Stating that because of therapy one understands the culture of those with mental illness suggests that psychotherapy is the only way to gain awareness of sociocultural differences.

Rationale 3: The nurse who acknowledges what parents or significant others have said about mental illness recognizes that ones heritage has an impact on ones beliefs and can influence ones practice. Stating that a parents occupation makes one knowledgeable about mental illnesses suggests arrogance on the part of the nurse and does not invite self-reflection. Believing that one can learn about cultural differences through popular media does not promote self-awareness or critical thinking. Stating that because of therapy one understands the culture of those with mental illness suggests that psychotherapy is the only way to gain awareness of sociocultural differences.

Rationale 4: The nurse who acknowledges what parents or significant others have said about mental illness recognizes that ones heritage has an impact on ones beliefs and can influence ones practice. Stating that a parents occupation makes one knowledgeable about mental illnesses suggests arrogance on the part of the nurse and does not invite self-reflection. Believing that one can learn about cultural differences through popular media does not promote self-awareness or critical thinking. Stating that because of therapy one understands the culture of those with mental illness suggests that psychotherapy is the only way to gain awareness of sociocultural differences.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice.

Question 18

Type: MCSA

The nurse is admitting a client who is from Kenya to the psychiatric unit. Which of the following actions will demonstrate cultural competence?

1. Arrange for an interpreter to assist.

2. Ask a family member to stay during the assessment interview.

3. Follow the admission assessment form.

4. Talk with the client to determine fluency in English.

Correct Answer: 4

Rationale 1: In planning culturally competent care, the nurse must not make assumptions regarding a clients language preference and/or cultural needs. The nurse does not follow a predetermined plan for assessing clients, but instead takes the time to determine client needs based on the clients responses. Arranging for an interpreter or asking a family member to stay makes a predetermined assumption about the clients cultural needs or issues before a thorough assessment is done. While following an admission assessment form may assist the nurse in the process of admitting the client, assessing the clients cultural preferences requires time and creativity to which a predetermined assessment form may not lend itself.

Rationale 2: In planning culturally competent care, the nurse must not make assumptions regarding a clients language preference and/or cultural needs. The nurse does not follow a predetermined plan for assessing clients, but instead takes the time to determine client needs based on the clients responses. Arranging for an interpreter or asking a family member to stay makes a predetermined assumption about the clients cultural needs or issues before a thorough assessment is done. While following an admission assessment form may assist the nurse in the process of admitting the client, assessing the clients cultural preferences requires time and creativity to which a predetermined assessment form may not lend itself.

Rationale 3: In planning culturally competent care, the nurse must not make assumptions regarding a clients language preference and/or cultural needs. The nurse does not follow a predetermined plan for assessing clients, but instead takes the time to determine client needs based on the clients responses. Arranging for an interpreter or asking a family member to stay makes a predetermined assumption about the clients cultural needs or issues before a thorough assessment is done. While following an admission assessment form may assist the nurse in the process of admitting the client, assessing the clients cultural preferences requires time and creativity to which a predetermined assessment form may not lend itself.

Rationale 4: In planning culturally competent care, the nurse must not make assumptions regarding a clients language preference and/or cultural needs. The nurse does not follow a predetermined plan for assessing clients, but instead takes the time to determine client needs based on the clients responses. Arranging for an interpreter or asking a family member to stay makes a predetermined assumption about the clients cultural needs or issues before a thorough assessment is done. While following an admission assessment form may assist the nurse in the process of admitting the client, assessing the clients cultural preferences requires time and creativity to which a predetermined assessment form may not lend itself.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice.

Question 19

Type: MCSA

The nurse is planning care for an Asian client who is Buddhist. Which of the following actions is most important for the nurse to take to provide culturally relevant mental health care?

1. Explain western medical ideas to assist cultural adaptation.

2. Develop a thorough understanding of Buddhist religion.

3. Seek clarification of this clients health beliefs.

4. Use standard nursing interventions for this client.

Correct Answer: 3

Rationale 1: Seeking clarification of this clients health beliefs demonstrates that the nurse recognizes that a clients cultural beliefs can affect the clients response to treatment. Although developing a thorough understanding of Buddhist religion will assist the nurse in providing culturally competent care, it is not always possible to do so before encountering a client who is Buddhist. Explaining western medical ideas or using standard nursing interventions will not assist the nurse in delivering culturally competent care.

Rationale 2: Seeking clarification of this clients health beliefs demonstrates that the nurse recognizes that a clients cultural beliefs can affect the clients response to treatment. Although developing a thorough understanding of Buddhist religion will assist the nurse in providing culturally competent care, it is not always possible to do so before encountering a client who is Buddhist. Explaining western medical ideas or using standard nursing interventions will not assist the nurse in delivering culturally competent care.

Rationale 3: Seeking clarification of this clients health beliefs demonstrates that the nurse recognizes that a clients cultural beliefs can affect the clients response to treatment. Although developing a thorough understanding of Buddhist religion will assist the nurse in providing culturally competent care, it is not always possible to do so before encountering a client who is Buddhist. Explaining western medical ideas or using standard nursing interventions will not assist the nurse in delivering culturally competent care.

Rationale 4: Seeking clarification of this clients health beliefs demonstrates that the nurse recognizes that a clients cultural beliefs can affect the clients response to treatment. Although developing a thorough understanding of Buddhist religion will assist the nurse in providing culturally competent care, it is not always possible to do so before encountering a client who is Buddhist. Explaining western medical ideas or using standard nursing interventions will not assist the nurse in delivering culturally competent care.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice.

Question 20

Type: MCSA

The nurse is interviewing a Native American client who acknowledges seeing spirits. Which of the following actions will be most important for the nurse to take to assist in assessing this clients symptoms?

1. Carefully question the clients family to prevent aggravating this symptom.

2. Observe the clients behavior to determine how the client expresses this symptom.

3. Consult the physician regarding how best to evaluate this symptom.

4. Obtain a profile of the clients cultural norms on which to interpret this symptom.

Correct Answer: 4

Rationale 1: Nurses who are culturally competent assess symptoms in light of clients cultural norms by obtaining a cultural profile. Consulting the physician will not assist in assessing and interpreting this symptom based on the clients cultural norms. Questioning the clients family may provide additional assessment data for a cultural profile but does not impact the degree to which the client experiences the symptoms. Observing a clients behavior will provide assessment data, but not cultural data on which to interpret the symptoms.

Rationale 2: Nurses who are culturally competent assess symptoms in light of clients cultural norms by obtaining a cultural profile. Consulting the physician will not assist in assessing and interpreting this symptom based on the clients cultural norms. Questioning the clients family may provide additional assessment data for a cultural profile but does not impact the degree to which the client experiences the symptoms. Observing a clients behavior will provide assessment data, but not cultural data on which to interpret the symptoms.

Rationale 3: Nurses who are culturally competent assess symptoms in light of clients cultural norms by obtaining a cultural profile. Consulting the physician will not assist in assessing and interpreting this symptom based on the clients cultural norms. Questioning the clients family may provide additional assessment data for a cultural profile but does not impact the degree to which the client experiences the symptoms. Observing a clients behavior will provide assessment data, but not cultural data on which to interpret the symptoms.

Rationale 4: Nurses who are culturally competent assess symptoms in light of clients cultural norms by obtaining a cultural profile. Consulting the physician will not assist in assessing and interpreting this symptom based on the clients cultural norms. Questioning the clients family may provide additional assessment data for a cultural profile but does not impact the degree to which the client experiences the symptoms. Observing a clients behavior will provide assessment data, but not cultural data on which to interpret the symptoms.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice.

Question 21

Type: MCSA

A female client has made the decision to leave her husband, who abuses alcohol. She states she is very depressed. Which of the following statements best demonstrates the nurses empathy?

1. I know you are feeling very depressed right now. I felt the same way when I left my husband. From my experience, you are doing the right thing.

2. I can understand that you are feeling depressed right now. It must have been a very difficult decision to make. Ill sit here with you for a while.

3. I am very sorry you are going through this difficult time. I wish things could be different.

4. It is sad thing to break up a marriage. Its a shame that it didnt work out for you.

Correct Answer: 2

Rationale 1: Conveying an understanding of the clients feelings, acknowledging the difficulty of the decision, and offering to sit with her conveys the nurses ability to respond to and understand the experience of the client on her terms. Self-disclosure of the nurses experience to validate the clients experience does not convey empathy and may overwhelm the client. Saying you are sorry and wishing things could be different conveys sympathy, not empathy. Saying that it is a sad situation and that it is a shame it did not work out invalidates the clients experience and shuts down expression of feelings.

Rationale 2: Conveying an understanding of the clients feelings, acknowledging the difficulty of the decision, and offering to sit with her conveys the nurses ability to respond to and understand the experience of the client on her terms. Self-disclosure of the nurses experience to validate the clients experience does not convey empathy and may overwhelm the client. Saying you are sorry and wishing things could be different conveys sympathy, not empathy. Saying that it is a sad situation and that it is a shame it did not work out invalidates the clients experience and shuts down expression of feelings.

Rationale 3: Conveying an understanding of the clients feelings, acknowledging the difficulty of the decision, and offering to sit with her conveys the nurses ability to respond to and understand the experience of the client on her terms. Self-disclosure of the nurses experience to validate the clients experience does not convey empathy and may overwhelm the client. Saying you are sorry and wishing things could be different conveys sympathy, not empathy. Saying that it is a sad situation and that it is a shame it did not work out invalidates the clients experience and shuts down expression of feelings.

Rationale 4: Conveying an understanding of the clients feelings, acknowledging the difficulty of the decision, and offering to sit with her conveys the nurses ability to respond to and understand the experience of the client on her terms. Self-disclosure of the nurses experience to validate the clients experience does not convey empathy and may overwhelm the client. Saying you are sorry and wishing things could be different conveys sympathy, not empathy. Saying that it is a sad situation and that it is a shame it did not work out invalidates the clients experience and shuts down expression of feelings.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Demonstrate empathy in psychiatricmental health clinical practice.

Question 22

Type: MCSA

An adolescent who is pregnant asks the nurse on the psychiatric unit, Do you think I should give my baby up for adoption? Which of the following responses best reflects the nurses empathy?

1. Why would you want to give the baby up for adoption?

2. What do you feel would be the best thing for you to do?

3. It seems you will feel guilty if you gave your baby away.

4. It would probably be best for you and the baby.

Correct Answer: 2

Rationale 1: Asking a question that helps the client focus on her feelings conveys the nurses willingness to be with the client and understand the clients inner experience. Telling the client what would be best is giving advice. Asking the client why she would give up the baby does not convey the nurses interest in the clients experience and limits therapeutic communication. Telling the client that she will feel guilty assumes an understanding of the clients feelings before the nurse has taken the time to explore the clients experience.

Rationale 2: Asking a question that helps the client focus on her feelings conveys the nurses willingness to be with the client and understand the clients inner experience. Telling the client what would be best is giving advice. Asking the client why she would give up the baby does not convey the nurses interest in the clients experience and limits therapeutic communication. Telling the client that she will feel guilty assumes an understanding of the clients feelings before the nurse has taken the time to explore the clients experience.

Rationale 3: Asking a question that helps the client focus on her feelings conveys the nurses willingness to be with the client and understand the clients inner experience. Telling the client what would be best is giving advice. Asking the client why she would give up the baby does not convey the nurses interest in the clients experience and limits therapeutic communication. Telling the client that she will feel guilty assumes an understanding of the clients feelings before the nurse has taken the time to explore the clients experience.

Rationale 4: Asking a question that helps the client focus on her feelings conveys the nurses willingness to be with the client and understand the clients inner experience. Telling the client what would be best is giving advice. Asking the client why she would give up the baby does not convey the nurses interest in the clients experience and limits therapeutic communication. Telling the client that she will feel guilty assumes an understanding of the clients feelings before the nurse has taken the time to explore the clients experience.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Demonstrate empathy in psychiatricmental health clinical practice.

Question 23

Type: MCSA

A woman has been living in a shelter with her children after escaping her abusive husband. Her move-out date is getting closer. She states, Im afraid to leave here. Im afraid for my safety and the safety of my children. Which response by the nurse most accurately conveys empathy?

1. Even though you are scared, its the policy that you have to leave. Its unfortunate, but theres nothing I can do.

2. We learned your husband has moved out of state. I dont think you have anything to worry about now.

3. This is a difficult and scary transition. Lets work on developing a plan to keep you and your family safe.

4. Youve had a month to come up with a plan for keeping you and your family safe. Lets review your options.

Correct Answer: 3

Rationale 1: By responding to the clients feelings and offering assistance, the nurse demonstrates an understanding of the clients need for safety and security. Acknowledging the clients fear and then changing the focus to policy invalidates the clients experience. Telling the client that she has already had a month to work on a plan and offering to review the options conveys a judgmental attitude toward the client. Telling the client not to worry because her husband has left the state offers false reassurance and negates the clients feelings.

Rationale 2: By responding to the clients feelings and offering assistance, the nurse demonstrates an understanding of the clients need for safety and security. Acknowledging the clients fear and then changing the focus to policy invalidates the clients experience. Telling the client that she has already had a month to work on a plan and offering to review the options conveys a judgmental attitude toward the client. Telling the client not to worry because her husband has left the state offers false reassurance and negates the clients feelings.

Rationale 3: By responding to the clients feelings and offering assistance, the nurse demonstrates an understanding of the clients need for safety and security. Acknowledging the clients fear and then changing the focus to policy invalidates the clients experience. Telling the client that she has already had a month to work on a plan and offering to review the options conveys a judgmental attitude toward the client. Telling the client not to worry because her husband has left the state offers false reassurance and negates the clients feelings.

Rationale 4: By responding to the clients feelings and offering assistance, the nurse demonstrates an understanding of the clients need for safety and security. Acknowledging the clients fear and then changing the focus to policy invalidates the clients experience. Telling the client that she has already had a month to work on a plan and offering to review the options conveys a judgmental attitude toward the client. Telling the client not to worry because her husband has left the state offers false reassurance and negates the clients feelings.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Demonstrate empathy in psychiatricmental health clinical practice.

Question 24

Type: MCSA

The nurse is planning care for a client who has been withdrawn and isolated for the last three days. Which action will best demonstrate the nurses empathy for this client?

1. Encourage the clients attendance and participation in groups.

2. Focus on the clients strengths to enhance self-esteem.

3. Explore the clients feelings of anger related to powerlessness.

4. Approach the client regularly and spend time with the client.

Correct Answer: 4

Rationale 1: The nurse who acknowledges and focuses on being with a withdrawn client demonstrates a willingness to understand the experience of the client on his or her terms. Focusing on the clients strengths conveys respect and hope. Exploring feelings related to powerlessness makes the assumption that the nurse already knows the clients inner experience. Encouraging attendance and participation in groups does not respond to the clients feelings or experience.

Rationale 2: The nurse who acknowledges and focuses on being with a withdrawn client demonstrates a willingness to understand the experience of the client on his or her terms. Focusing on the clients strengths conveys respect and hope. Exploring feelings related to powerlessness makes the assumption that the nurse already knows the clients inner experience. Encouraging attendance and participation in groups does not respond to the clients feelings or experience.

Rationale 3: The nurse who acknowledges and focuses on being with a withdrawn client demonstrates a willingness to understand the experience of the client on his or her terms. Focusing on the clients strengths conveys respect and hope. Exploring feelings related to powerlessness makes the assumption that the nurse already knows the clients inner experience. Encouraging attendance and participation in groups does not respond to the clients feelings or experience.

Rationale 4: The nurse who acknowledges and focuses on being with a withdrawn client demonstrates a willingness to understand the experience of the client on his or her terms. Focusing on the clients strengths conveys respect and hope. Exploring feelings related to powerlessness makes the assumption that the nurse already knows the clients inner experience. Encouraging attendance and participation in groups does not respond to the clients feelings or experience.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Demonstrate empathy in psychiatricmental health clinical practice.

Question 25

Type: MCSA

The nurse is caring for a newly admitted client who has not showered in several days and emits an offensive odor. Which of the following actions best conveys respect for the client?

1. Assess the clients abilities and needs related to performing self-care.

2. Be honest with the client about how his or her appearance affects others.

3. Explain unit expectations regarding activities of daily living to the client.

4. Ignore the clients body odor to minimize causing humiliation.

Correct Answer: 1

Rationale 1: The nurse conveys respect for the clients ability to be in control by first assessing strengths, as well as areas that require assistance. Explaining unit expectations, or being honest with the client before assessment, does not promote dignity and communicates possible rejection of the client by the nurse. Ignoring the clients body odor reflects the nurses own discomfort when caring for clients who are struggling to meet their basic needs.

Rationale 2: The nurse conveys respect for the clients ability to be in control by first assessing strengths, as well as areas that require assistance. Explaining unit expectations, or being honest with the client before assessment, does not promote dignity and communicates possible rejection of the client by the nurse. Ignoring the clients body odor reflects the nurses own discomfort when caring for clients who are struggling to meet their basic needs.

Rationale 3: The nurse conveys respect for the clients ability to be in control by first assessing strengths, as well as areas that require assistance. Explaining unit expectations, or being honest with the client before assessment, does not promote dignity and communicates possible rejection of the client by the nurse. Ignoring the clients body odor reflects the nurses own discomfort when caring for clients who are struggling to meet their basic needs.

Rationale 4: The nurse conveys respect for the clients ability to be in control by first assessing strengths, as well as areas that require assistance. Explaining unit expectations, or being honest with the client before assessment, does not promote dignity and communicates possible rejection of the client by the nurse. Ignoring the clients body odor reflects the nurses own discomfort when caring for clients who are struggling to meet their basic needs.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Maintain a respectful attitude toward clients, their families, and colleagues.

Question 26

Type: MCSA

A family member caring for a relative with dementia complains of exhaustion. Which of the following responses best conveys respect for this family members situation?

1. It sounds like your home situation is too demanding. What about seeking individual therapy to cope with your issues?

2. I experienced the same thing with my mother. What about getting a housekeeper?

3. Caring for a person with dementia is too much for one person. You should place your relative in a nursing home.

4. It sounds like you are overwhelmed. You may benefit from respite care services.

Correct Answer: 4

Rationale 1: The nurse shows respect for the client and situation by validating feelings and suggesting an option that will support the clients needs. Self-disclosure of the nurses experience and suggesting a housekeeper takes the focus away from the clients experience. Although acknowledging that caring for a person with dementia is too much for one person can validate the clients experience, suggesting a nursing home conveys the nurses personal opinion rather than offering an option that will support the clients needs. Commenting that the home situation is demanding and suggesting therapy makes an inaccurate assumption of the clients experience and needs and again offers the nurses personal opinion.

Rationale 2: The nurse shows respect for the client and situation by validating feelings and suggesting an option that will support the clients needs. Self-disclosure of the nurses experience and suggesting a housekeeper takes the focus away from the clients experience. Although acknowledging that caring for a person with dementia is too much for one person can validate the clients experience, suggesting a nursing home conveys the nurses personal opinion rather than offering an option that will support the clients needs. Commenting that the home situation is demanding and suggesting therapy makes an inaccurate assumption of the clients experience and needs and again offers the nurses personal opinion.

Rationale 3: The nurse shows respect for the client and situation by validating feelings and suggesting an option that will support the clients needs. Self-disclosure of the nurses experience and suggesting a housekeeper takes the focus away from the clients experience. Although acknowledging that caring for a person with dementia is too much for one person can validate the clients experience, suggesting a nursing home conveys the nurses personal opinion rather than offering an option that will support the clients needs. Commenting that the home situation is demanding and suggesting therapy makes an inaccurate assumption of the clients experience and needs and again offers the nurses personal opinion.

Rationale 4: The nurse shows respect for the client and situation by validating feelings and suggesting an option that will support the clients needs. Self-disclosure of the nurses experience and suggesting a housekeeper takes the focus away from the clients experience. Although acknowledging that caring for a person with dementia is too much for one person can validate the clients experience, suggesting a nursing home conveys the nurses personal opinion rather than offering an option that will support the clients needs. Commenting that the home situation is demanding and suggesting therapy makes an inaccurate assumption of the clients experience and needs and again offers the nurses personal opinion.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Maintain a respectful attitude toward clients, their families, and colleagues.

Question 27

Type: MCSA

During a staff meeting, a nurse makes the following remark about the clients on the unit, These clients are just trying to avoid the problems of life. They just need to go out and work. Which of the following responses best demonstrates the charge nurses respectful attitude toward this nurse?

1. I agree that most clients are just avoiding life, but our mission is to provide care.

2. It is not our responsibility to determine whether clients have problems or not.

3. You seem to be having trouble accepting the fact that clients can lose emotional control of their lives. Why dont we talk about this as a group?

4. When you say that our clients are just avoiding life problems, it sounds like you are frustrated by the needs our clients express. Am I hearing you correctly?

Correct Answer: 4

Rationale 1: Restating what the nurse has said and asking if that is a correct understanding allows the charge nurse to maintain a respectful attitude by taking the time and energy to listen to and understand the colleagues experience. Suggesting that the nurse has trouble with clients who lose control and asking to talk about it as a group makes an assumption and threatens the nurses self-esteem. Stating that it is not a responsibility of the staff to determine whether clients have problems fails to address the nurses concerns. Agreeing with the nurses opinion does not demonstrate honesty or integrity when addressing difficult issues with colleagues.

Rationale 2: Restating what the nurse has said and asking if that is a correct understanding allows the charge nurse to maintain a respectful attitude by taking the time and energy to listen to and understand the colleagues experience. Suggesting that the nurse has trouble with clients who lose control and asking to talk about it as a group makes an assumption and threatens the nurses self-esteem. Stating that it is not a responsibility of the staff to determine whether clients have problems fails to address the nurses concerns. Agreeing with the nurses opinion does not demonstrate honesty or integrity when addressing difficult issues with colleagues.

Rationale 3: Restating what the nurse has said and asking if that is a correct understanding allows the charge nurse to maintain a respectful attitude by taking the time and energy to listen to and understand the colleagues experience. Suggesting that the nurse has trouble with clients who lose control and asking to talk about it as a group makes an assumption and threatens the nurses self-esteem. Stating that it is not a responsibility of the staff to determine whether clients have problems fails to address the nurses concerns. Agreeing with the nurses opinion does not demonstrate honesty or integrity when addressing difficult issues with colleagues.

Rationale 4: Restating what the nurse has said and asking if that is a correct understanding allows the charge nurse to maintain a respectful attitude by taking the time and energy to listen to and understand the colleagues experience. Suggesting that the nurse has trouble with clients who lose control and asking to talk about it as a group makes an assumption and threatens the nurses self-esteem. Stating that it is not a responsibility of the staff to determine whether clients have problems fails to address the nurses concerns. Agreeing with the nurses opinion does not demonstrate honesty or integrity when addressing difficult issues with colleagues.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Maintain a respectful attitude toward clients, their families, and colleagues.

Question 28

Type: MCSA

The nurse has just taken a continuing education class on assertive communication techniques. Which response best demonstrates that the nurse understands assertive behavior?

1. No, I cannot work for you on Sunday.

2. Yes, they always ignore staff requests.

3. It would be selfish to ask for time off.

4. I will demand a change in my schedule.

Correct Answer: 1

Rationale 1: The nurse who is assertive knows that one has the right to refuse a request without feeling guilty. Demanding a change demonstrates aggressive behavior. Stating it would be selfish demonstrates nonassertive behavior. Stating that they always ignore requests reflects aggressive behavior.

Rationale 2: The nurse who is assertive knows that one has the right to refuse a request without feeling guilty. Demanding a change demonstrates aggressive behavior. Stating it would be selfish demonstrates nonassertive behavior. Stating that they always ignore requests reflects aggressive behavior.

Rationale 3: The nurse who is assertive knows that one has the right to refuse a request without feeling guilty. Demanding a change demonstrates aggressive behavior. Stating it would be selfish demonstrates nonassertive behavior. Stating that they always ignore requests reflects aggressive behavior.

Rationale 4: The nurse who is assertive knows that one has the right to refuse a request without feeling guilty. Demanding a change demonstrates aggressive behavior. Stating it would be selfish demonstrates nonassertive behavior. Stating that they always ignore requests reflects aggressive behavior.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Demonstrate a commitment to practicing self-care and connecting with self and others.

Question 29

Type: MCSA

A nurse is seeking consultation on strategies to cope with the potential for burnout while working on a psychiatric unit. Which of the following strategies demonstrates the nurses ability to reduce the occurrence of burnout?

1. Focus on paperwork when the stress of listening to the clients becomes too much.

2. Pursue personal needs for social interactions during days off.

3. Take breaks often to relieve internal stress signals.

4. Maintain an accurate awareness of each clients needs throughout inpatient stays.

Correct Answer: 2

Rationale 1: Nurses who recognize that personal needs are an integral part of professional practice will be able to maintain concern and feeling for their clients. Maintaining an accurate awareness of client needs is not realistic and implies that the nurse can provide perfect care. Nurses who focus on paperwork tend to cope with stress by distancing themselves from the clients. Taking frequent breaks is an attempt to escape from ones stress rather than attend to it.

Rationale 2: Nurses who recognize that personal needs are an integral part of professional practice will be able to maintain concern and feeling for their clients. Maintaining an accurate awareness of client needs is not realistic and implies that the nurse can provide perfect care. Nurses who focus on paperwork tend to cope with stress by distancing themselves from the clients. Taking frequent breaks is an attempt to escape from ones stress rather than attend to it.

Rationale 3: Nurses who recognize that personal needs are an integral part of professional practice will be able to maintain concern and feeling for their clients. Maintaining an accurate awareness of client needs is not realistic and implies that the nurse can provide perfect care. Nurses who focus on paperwork tend to cope with stress by distancing themselves from the clients. Taking frequent breaks is an attempt to escape from ones stress rather than attend to it.

Rationale 4: Nurses who recognize that personal needs are an integral part of professional practice will be able to maintain concern and feeling for their clients. Maintaining an accurate awareness of client needs is not realistic and implies that the nurse can provide perfect care. Nurses who focus on paperwork tend to cope with stress by distancing themselves from the clients. Taking frequent breaks is an attempt to escape from ones stress rather than attend to it.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Demonstrate a commitment to practicing self-care and connecting with self and others.

Question 30

Type: MCSA

The charge nurse has just given a presentation about the importance of practicing self-care. Which of the following staff behaviors will the nurse find concerning?

1. Giving feedback to a fellow staff member about derogatory comments

2. Requesting to be alone during break time

3. Calling the unit on days off to inquire about clients progress

4. Verbalizing feelings about a clients situation

Correct Answer: 3

Rationale 1: A nurse who feels compelled to check on clients during sanctioned time away is unable to leave concerns about the clients at work and cannot assimilate the experiences of working with troubled clients. Requesting to be alone during break time demonstrates the nurses need for self-care after responding to the needs of clients. Providing feedback to another staff member demonstrates accountability for the quality of care and confronts demeaning language. Verbalizing ones feelings enhances self-awareness of difficult emotions and allows for constructive feedback and new perspectives.

Rationale 2: A nurse who feels compelled to check on clients during sanctioned time away is unable to leave concerns about the clients at work and cannot assimilate the experiences of working with troubled clients. Requesting to be alone during break time demonstrates the nurses need for self-care after responding to the needs of clients. Providing feedback to another staff member demonstrates accountability for the quality of care and confronts demeaning language. Verbalizing ones feelings enhances self-awareness of difficult emotions and allows for constructive feedback and new perspectives.

Rationale 3: A nurse who feels compelled to check on clients during sanctioned time away is unable to leave concerns about the clients at work and cannot assimilate the experiences of working with troubled clients. Requesting to be alone during break time demonstrates the nurses need for self-care after responding to the needs of clients. Providing feedback to another staff member demonstrates accountability for the quality of care and confronts demeaning language. Verbalizing ones feelings enhances self-awareness of difficult emotions and allows for constructive feedback and new perspectives.

Rationale 4: A nurse who feels compelled to check on clients during sanctioned time away is unable to leave concerns about the clients at work and cannot assimilate the experiences of working with troubled clients. Requesting to be alone during break time demonstrates the nurses need for self-care after responding to the needs of clients. Providing feedback to another staff member demonstrates accountability for the quality of care and confronts demeaning language. Verbalizing ones feelings enhances self-awareness of difficult emotions and allows for constructive feedback and new perspectives.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Demonstrate a commitment to practicing self-care and connecting with self and others.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

()Copyright 2012 by Pearson Education, Inc.

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