Foundations of Mental Health Care 4e by Morrison-Valfre-Test Bank

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Foundations of Mental Health Care 4e by Morrison-Valfre-Test Bank

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WITH ANSWERS
Foundations of Mental Health Care 4e by Morrison-Valfre-Test Bank

Morrison-Valfre: Foundations of Mental Health Care, 4th Edition

 

Test Bank

 

Chapter 2: Current Mental Health Care Systems

 

MULTIPLE CHOICE

 

  1. Because mental health care is not covered in Australia under the basic health plan, which citizens are more likely to receive mental health care?
a. Wealthy
b. Homeless
c. Disabled
d. Low-income

 

 

ANS:  A

Wealthy citizens, as well as those with private insurance, are more likely to receive mental health care in Australia because they are better able to afford the care than are homeless, disabled, or low-income citizens.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 10          OBJ:   1

TOP:   Mental Health Care in Australia      KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. What percentage of U.S. citizens have no health insurance?
a. 5%
b. 15%
c. 25%
d. 35%

 

 

ANS:  B

Approximately 15% of the U.S. population does not have health insurance, which amounts to almost 50 million people. The United States is the only wealthy, industrialized nation that does not have a universal health care system.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 10          OBJ:   1

TOP:   Mental Health Care in the United States

KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Mental health care is available under the universal health care system in Britain, which is funded primarily by:
a. Employers
b. Private donations
c. Small businesses
d. Tax revenues

 

 

ANS:  D

Tax revenues are the primary funding source for Britains universal health care system. All aspects of health care, except for eye care and limited dental care, are covered under the standard benefit package for citizens of Britain.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 10          OBJ:   1

TOP:   Mental Health Care in Britain         KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client is seen in a mental health clinic in the United States. The client is covered by an insurance plan that consists of a network of providers who accept discounted payments from the insurance company. The client is able to see specialists without a referral from the primary provider. Which type of plan does the client most likely have?
a. Point-of-service plan
b. Preferred provider organization (PPO)
c. Health maintenance organization (HMO)
d. Fee-for-service plan

 

 

ANS:  B

A PPO consists of a network of physicians, hospitals, and clinics that provide care for different organizations at a discount. With a PPO, the client is not required to have a referral to see a specialist. A point-of-service plan is similar to a PPO, with the main difference being that referrals are required for the client to see a specialist. An HMO has some similarities to a PPO; but the plan requires referrals for specialists, members have set fees for services, and mental health care is limited with some HMOs. A fee-for-service plan allows selection of any provider.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 10          OBJ:   1

TOP:   Mental Health Care in the United States

KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Because many individuals in the United States do not seek health care for mental illness until late into the illness, many end up being seen in:
a. Hospitals and nursing homes
b. Outpatient and community services
c. Emergency rooms and jails
d. Physicians offices

 

 

ANS:  C

Because many individuals do not seek treatment in time, symptoms escalate to the point that emergency room visits are required, and it is estimated that up to 1 million county jail admissions across the country are due to mental illness.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 11          OBJ:   2

TOP:   Care Settings                                   KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The concept of recidivism is prevalent among individuals with chronic psychiatric problems. Which is the most accurate description of this concept?
a. Relapse of symptoms of a clients mental health disease, resulting in frequent readmission to facilities
b. Coordination and cooperation between community mental health agencies and hospitals, resulting in continuity of care
c. Providing mental health care services to a client who lives on his own in his own home
d. Limited supervision in a community setting with emphasis on individual responsibility for care

 

 

ANS:  A

Recidivism occurs frequently as a result of fragmented care. Coordination and cooperation between mental health facilities and the hospital lead to lowering of recidivism rates. Outpatient mental health service consists of providing service to a client who lives on his own in his own home, and community-based mental health care involves limited supervision in a community setting with an emphasis on individual responsibility.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 11          OBJ:   2

TOP:   Outpatient Care                              KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The __________ model views clients holistically with the goal of creating a support system designed to encourage independence in the client with a mental health disorder.
a. Community support systems
b. Case management
c. Multidisciplinary health care team
d. Client population

 

 

ANS:  A

The community support systems (CSS) model works by coordinating social, medical, and psychiatric services. Case management refers to individual management of clients and takes into consideration psychosocial rehabilitation, consults, referrals, therapy, and crisis intervention. A multidisciplinary health care team is made up of all of the professionals who work within a mental health care system, and client population simply refers to individuals who may potentially seek mental health care.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 11          OBJ:   3

TOP:   Outpatient Care                              KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which type of community setting involves care for individuals with mental health issues in a protected and supervised environment within the community?
a. Psychiatric home care
b. Community mental health centers
c. Residential programs
d. Partial hospitalization

 

 

ANS:  C

A residential program involves care for individuals with mental health issues provided in a protected and supervised environment within the community. Psychiatric home care delivers mental health care to individuals within the home. Community mental health centers consist of programs such as crisis intervention centers, family counseling, and vocational and skills training. Partial hospitalization refers to day treatment centers.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 13          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The brother of a male mental health client is concerned because he works during the day and has no one to care for his brother, who requires almost constant supervision. He wants to keep his brother at home but is unsure of what resources are available in the community. What is the nurses best response?
a. Have you considered a residential group home?
b. Let me give you some information on a community day treatment center.
c. Psychiatric home care might be an option.
d. A community mental health center would be good for your brother.

 

 

ANS:  B

The needs expressed by the clients brother are best responded to by providing information on a community day treatment center. The other options do not address the need for constant supervision during the day, other than the possibility of a residential group home, and a residential group home does not meet the clients need to keep his brother home.

 

DIF:    Cognitive Level: Application          REF:   Page 13          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The home mental health nurse visits a female client to assess her ability to care for herself at home after discharge from an inpatient setting. Which component of the case management system does this demonstrate?
a. Consultation
b. Crisis intervention
c. Resource linkage
d. Psychosocial rehabilitation

 

 

ANS:  D

Psychosocial rehabilitation assists clients in gaining independence in activities of daily living to the best of their individual capabilities. Consultation refers to assistance obtained from specialists, such as a psychiatrist; crisis intervention refers to care provided during a crisis event; and resource linkage indicates referral to community resources.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 13          OBJ:   5

TOP:   Case Management Systems             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. A client with a severe, treatment-resistant mental illness has been assigned to an assertive community treatment (ACT) team. An ACT treatment strategy that helps to prevent recurrent hospitalizations for mental health reasons is to meet with the client in the community setting:
a. Once per week
b. Two to four times per week
c. Five to six times per week
d. Seven to eight times per week

 

 

ANS:  B

The continuous care team that meets with a client two to four times per week has been found to be effective in directing the clients treatment on a more continuous basis, resulting in greater stability for the client who is living in the community with the help of appropriate systems.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 14 | Page 15

OBJ:   5                    TOP:   Case Management Systems

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Which member of the multidisciplinary mental health care team is primarily responsible for evaluating the family of the client, as well as the environmental and social surroundings of the client, and plays a major role in the admission of new clients?
a. Psychiatric nurse
b. Clinical psychologist
c. Psychiatrist
d. Psychiatric social worker

 

 

ANS:  D

These are the primary responsibilities of the psychiatric social worker. The psychiatric nurses primary responsibilities include assisting with the clients activities of daily living and managing individual, family, and group psychotherapy. The clinical psychologist is involved in the planning of treatment and diagnostic processes, and the psychiatrist is the leader of the team.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 16          OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. It is estimated that approximately __________ of adults experience some form of mental or emotional disorder.
a. 11%
b. 19%
c. 27%
d. 35%

 

 

ANS:  B

It is difficult to obtain exact statistics on mental health disorders because many conditions remain undiagnosed and many affected individuals may become homeless or incarcerated.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 16          OBJ:   7

TOP:   Impact of Mental Illness                 KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A male client with a diagnosis of bipolar disorder is admitted to an inpatient unit during a severe manic episode. As a result of guidelines implemented by the Health Care Financing Administration in 1983, the clients Medicare will pay for his stay in this unit for:
a. The length of time necessary for his condition to be stabilized
b. Up to 6 months with appropriate documentation
c. A pre-determined length of time based on the diagnosis
d. 2 to 4 weeks

 

 

ANS:  C

Medicare payment guidelines are based on the diagnosis, which is classified under a diagnosis-related group (DRG), and specify a pre-determined payment for a particular diagnosis. This cost containment strategy has also been adopted by some private insurance companies. After the pre-determined time, the facility is responsible for additional costs incurred by the clients stay.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 17          OBJ:   1

TOP:   Economic Issues of Mental Illness KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A female client was given the diagnosis of schizophrenia and recently has lost her job. She tells the nurse that she has enough money for only two more house payments, and if she does not find a job, she fears she will become homeless. The nurse knows that this client falls in the group of nearly __________ of U.S. citizens who live below poverty level.
a. 1%
b. 6%
c. 12%
d. 25%

 

 

ANS:  C

Approximately 12% of Americans (or 33 million people) live below poverty level. Living in poverty often precipitates mental disorders, or mental disorders may occur while an individual is living in poverty. Both scenarios can cause an unbearable amount of stress.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 17          OBJ:   7

TOP:   Social Issues of Mental Illness        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of psychotherapeutic drugs is associated with:
a. Permanent psychotic states
b. Bipolar disorder
c. Generalized anxiety disorder
d. Obsessive-compulsive disorder

 

 

ANS:  A

Permanent psychotic states are occurring in mental health clients who combine their psychotherapeutic medications with the abuse of recreational drugs. As a result, the question of how to care for this population is a matter of growing concern. The combination of these two types of drugs is not commonly associated with bipolar disorder, generalized anxiety disorder, or obsessive-compulsive disorder.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 17          OBJ:   7

TOP:   Social Issues of Mental Illness        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client who is undergoing therapy for depression is divorced and has two children, ages 2 and 4. She has just enrolled in a local community college and is worried about providing food and clothes for her family while holding down a minimum wage job and devoting the time needed to be successful in school. The nurse determines that the best community resource for assisting this client to meet these needs is:
a. A shelter for victims of domestic violence
b. Women, Infants, and Children (WIC)
c. Family-planning agency
d. Family recreation center

 

 

ANS:  B

WIC gives assistance to low-income women and children up to the age of 5 who are at nutritional risk by providing foods to supplement the diet and information on healthy eating habits. This will lessen some of her financial burden while she is attending school. The other options do not address her situation because she has not voiced needs related to domestic violence or family planning, and a family recreation center will not meet her financial needs.

 

DIF:    Cognitive Level: Application          REF:   Page 12          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The home care nurse is providing care to an older adult client with a diagnosis of depression who is caring for his wife with Alzheimers disease. He states that he hardly has enough energy to cook and clean the house. The couple has no children, and no relatives live within a close distance. Which community agency would be of greatest benefit to this client?
a. A recreational club
b. An adult education program
c. A day care center for elderly
d. Meals on Wheels

 

 

ANS:  D

Caring for a loved one with Alzheimers is very demanding, as is dealing with the clients own depression. By providing food, Meals on Wheels would remove one responsibility for this client. A recreational club or an adult education program may be of assistance, but the priority need for this couple is food. A day care center for the elderly may be necessary in the future, but it is not a priority at this time.

 

DIF:    Cognitive Level: Application          REF:   Page 12          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A 9-year-old girl is given the diagnosis of depression. She has low self-esteem, does not enjoy group therapy, and does not show her emotions. The nurse has had difficulty establishing rapport with this client and decides to ask for assistance from another treatment team member. Which team member would best assist in this situation?
a. Psychiatric assistant
b. Dietitian
c. Occupational therapist
d. Expressive therapist

 

 

ANS:  D

Expressive therapists work well with children who have difficulty expressing their thoughts and feelings. Expressive therapists use creative methods that appeal to children. The dietitian would not be the best team member to meet the needs of the client at this time. The psychiatric assistant, or technician, assists the nurse with daily activities and in monitoring clients during leisure activities. The occupational therapist works primarily with rehabilitational therapy, such as socialization and vocational retraining.

 

DIF:    Cognitive Level: Application          REF:   Page 16          OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Nearly __________ of all countries in the world have no clear governmental policy that addresses mental health issues.
a. 7%
b. 26%
c. 50%
d. 75%

 

 

ANS:  C

In addition to nearly half of the countries in the world that have no policy on mental health issues, approximately one third have no program for coping with the increasing numbers of mental health disabilities.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 9            OBJ:   1

TOP:   Current Mental Health Care Systems

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. Which principles characterize mental health care in Canada? Select all that apply.
a. Portability
b. Universality
c. Accessibility
d. Comprehensiveness
e. Private insurance models
f. Public administration

 

 

ANS:  A, B, C, D, F

Portability refers to retaining services in the event of moving; universality means that everyone in the nation of Canada is covered; accessibility indicates that everyone has access to health care; comprehensiveness means that all necessary treatment is covered; and public administration reveals that the health care system is publicly run and accountable. Private insurance models are the type of insurance provided in the United States.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 9            OBJ:   1

TOP:   Mental Health Care in Canada        KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. In the United States, which factors determine whether a client requires inpatient rather than outpatient care? Select all that apply.
a. Severity of the illness
b. Level of dysfunction
c. Suitability of the setting for treating the problem
d. Anticipated diagnosis
e. Level of client cooperation
f. Ability to pay

 

 

ANS:  A, B, C, E, F

These options are the determining factors for inpatient mental health care. If a client meets the criteria, the diagnosis does not matter in the determination of whether the client requires inpatient or outpatient care.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 11          OBJ:   2

TOP:   Care Settings                                   KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Which client populations are at greater risk for the development of mental health disorders? Select all that apply.
a. Homeless
b. Clients infected with HIV or AIDS
c. Those in crisis
d. Nurses
e. Clients living in rural areas
f. Older adults
g. Psychiatrists
h. Children

 

 

ANS:  A, B, C, E, F, H

These individuals are considered to be at high risk for various reasons. Nurses and psychiatrists are not considered at high risk for developing mental health disorders.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 15 | Page 16

OBJ:   7                    TOP:   Client Populations

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

 

COMPLETION

 

  1. A __________ is a form of health insurance that delivers health care to clients enrolled in its plan. Clients pay a fixed price for care, as long as they receive services from a provider within the companys system.

 

ANS:

Health maintenance organization

Clients in a health maintenance organization (HMO) may or may not have a list of health care providers from which to choose (depending on their HMO company), and all require referrals for specialists.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 10          OBJ:   1

TOP:   Health Insurance                            KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The __________ therapist of the mental health team uses methods such as pet therapy and music therapy when working with clients and is responsible for providing leisure-time activities and for teaching inpatient clients useful ways to pass time.

 

ANS:

Recreational

These are the primary responsibilities of the recreational therapist, who has an advanced degree and specialized training in recreational therapy.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 16          OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

Morrison-Valfre: Foundations of Mental Health Care, 4th Edition

 

Test Bank

 

Chapter 10: Therapeutic Communication

 

MULTIPLE CHOICE

 

  1. A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Rueschs theory of communication, this unsuccessful interaction is called:
a. Disturbed communication
b. Nontherapeutic communication
c. Blocked communication
d. Therapeutic communication

 

 

ANS:  A

Ruesch called this type of interrupted communication disturbed communication. In addition to interference with receiving a message, as in the case of this client, the term applies to interference with the sending of messages, problems in language between people, insufficient information, and lack of the opportunity for feedback. Rueschs theory did not coin the term nontherapeutic or blocked communication, and this interaction would not be considered therapeutic.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 97          OBJ:   1

TOP:   Rueschs Theory                            KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. The theorist Eric Berne theorized that an individuals three ego states of parent, child, and adult make up ones:
a. Conscience
b. Personality
c. Thought processes
d. Ability to communicate

 

 

ANS:  B

The three ego states, according to Berne, make up an individuals personality. The parent ego focuses on rules and values, the child ego focuses on emotions and desires, and the focal point of the adult ego is previous observations. He did not address any of the other three options.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 97          OBJ:   1

TOP:   Transactional Analysis                   KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique?
a. I noticed that you pace the halls, and you have a tense look on your face. I sense that you are anxious about something.
b. Can you tell me more about how you feel when you are arguing with your daughter?
c. I would like to talk with you about your plan of care.
d. Tell me if I understand you correctly.

 

 

ANS:  A

Sharing perceptions lets the client know that you are listening and ensures that you understand what he or she is communicating. Asking the client to describe how he or she feels when arguing with his or her daughter describes focusing. Speaking to the client about the plan of care describes informing, and the nursing student is using clarification when asking whether he or she understands the client correctly.

 

DIF:    Cognitive Level: Application          REF:   Page 104        OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification?
a. You said that the fight you had with your wife caused you to start drinking again?
b. Lets discuss what made you feel the need to drink.
c. Could you tell me again when and what happened that you feel caused you to start drinking again?
d. Tell me what your childhood was like.

 

 

ANS:  C

Clarification helps to confirm feelings, ideas, and perceptions. The other options are examples of restating, focusing, and changing the topic.

 

DIF:    Cognitive Level: Application          REF:   Page 104        OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response?
a. Tell me more about the feelings you have regarding their relationship.
b. I think that you should tell them how you feel.
c. That seems like a childish feeling to have about their relationship.
d. Dont you think that you should be thankful that your daughter has a good relationship with her grandmother?

 

 

ANS:  D

Defensive, challenging statements such as this one will block communication with the client because she will feel that she needs to respond defensively and answer to the nurse for her feelings. The therapeutic communication response that includes a broad opening statement is used when the nurse asks the client to tell more about her feelings. When the nurse tells the client that she should tell the mother and daughter how she feels, it describes giving advice. The nurse uses the nontherapeutic technique of belittling the client when the nurse states that the clients feelings are childish.

 

DIF:    Cognitive Level: Application          REF:   Page 105        OBJ:   7

TOP:   Nontherapeutic Messages               KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just cant find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique?
a. I cant believe that you would want your daughter to grow up in this environment.
b. I understand your concern. Let me give you some information on our local council for domestic abuse.
c. Im sure it wont be that bad to be out on your own. I know you can do it.
d. I think you should not think about leaving and should just do it.

 

 

ANS:  C

This is an example of the nontherapeutic technique of falsely reassuring the client. It dismisses the clients concerns and does not support her. The nurse is showing disapproval in stating that she cant believe that the client would want her daughter to grow up in such an environment. The nurse gives an appropriate therapeutic statement when she acknowledges the clients concern and then provides the client with helpful information. The nurse is giving advice in offering her thoughts that the client should just leave.

 

DIF:    Cognitive Level: Application          REF:   Page 105        OBJ:   7

TOP:   Nontherapeutic Messages               KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse observes a male client who is sitting in a chair, staring out the window for a long time. The nurse asks the client whether he is okay. The client says that he is trying to talk himself into telling his wife about his gambling addiction and the money he has lost. He says that he is playing the scenario in his head and is thinking about how he wants to present the news to her and how she will respond. The clients behavior is an example of:
a. Hallucinations
b. Intrapersonal communication
c. Delusions
d. Interpersonal communication

 

 

ANS:  B

Intrapersonal communication is described as self-talk or self-dialogue, and it can serve as a very helpful mechanism of coping, as in this situation. Hallucinations would be occurring if the client in this situation were hearing voices. Delusions would be occurring if he had irrational thoughts that could not be reasoned with. Interpersonal communication describes the communication that will occur between the client and his wife.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 98          OBJ:   2

TOP:   Types of Communication               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client with severe depression is about to be discharged from an inpatient mental health unit. The clients highest level of education is 7th grade, and she reads at a 5th grade level. The nurse is giving her discharge instructions. Which instruction is most appropriate for this client?
a. Your MAOI should be taken once a day at the same time each day.
b. This is the medicine for your depression, and you will take it every morning after you get up.
c. Your MAOI should be taken q.d.
d. Your antidepressant should be taken in the morning or in the evening at the same time each day.

 

 

ANS:  B

Communicating with persons from different social classes must be considered in this situation. It is important not to talk down to clients with different educational backgrounds. The correct answer is stated clearly and can be followed easily as written instructions. Medical abbreviations, such as MAOI and qd, should not be used in this situation, and the term antidepressant also may be unclear to the client.

 

DIF:    Cognitive Level: Application          REF:   Page 99          OBJ:   8

TOP:   Factors that Influence Communication

KEY:  Nursing Process Step: Intervention MSC:  Client Needs: Psychosocial Integrity

 

  1. Therapeutic communication techniques support effective communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client?
a. Broad openings, restating, and advising
b. Clarification, focusing, and confrontation
c. Listening, silence, and reflection
d. Humor, informing, and reassuring

 

 

ANS:  C

The techniques of listening, silence, and reflection are all therapeutic. Advising, confronting, and reassuring are all examples of nontherapeutic techniques.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 104        OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client tells the nurse that he feels his depression is improving. The client has a flat affect and a monotone voice, has not combed his hair or shaved in a week, and has not participated in his group therapy sessions for 2 weeks. What is the nurses most accurate interpretation of this situation?
a. The clients true feelings of improvement in his depression were shared in his verbal communication
b. The clients nonverbal communication indicates that there is no improvement in his depression
c. The clients verbal communication and nonverbal communication convey the same message
d. Verbal communication is always the best indicator of how a person feels

 

 

ANS:  B

The clients nonverbal communication is conveying more than his verbal communication is conveying. Nonverbal communication often is more accurate than verbal communication because it is more difficult to control. Verbal communication can be controlled for the purpose of saying what the other person wants to hear, as is apparent in this situation. The clients verbal and nonverbal messages do not convey the same meaning in this situation, and verbal communication is not always the best indicator of a persons feelings.

 

DIF:    Cognitive Level: Application          REF:   Page 100        OBJ:   4

TOP:   Nonverbal Communication            KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. While the nurse is talking with a female client, the client becomes silent for several seconds. Which is the nurses best response?
a. To interpret this action as an indication that the client is finished with the conversation
b. To ask the client a question so the interaction can continue
c. To remain silent and be attentive to the clients nonverbal communication
d. To tell the client that help can be more effective if she shares her feelings

 

 

ANS:  C

This is an example of the therapeutic communication technique of silence. It allows the client time to collect her thoughts. Although most people want to talk away the silence, it is important for the caregiver to become comfortable with the effective technique of silence. The three incorrect options prevent silence from occurring.

 

DIF:    Cognitive Level: Application          REF:   Page 104        OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client who usually is very active in her therapy group tells the nurse that she really does not feel well today and would rather not attend the group therapy session.  Which is the nurses most appropriate response?
a. You dont feel like attending the group therapy today?
b. I will just stay with you for a while.
c. Its okay to skip a session every once in a while.
d. Why dont you want to attend group therapy?

 

 

ANS:  A

The nurse is restating what the client said, which verifies what the client communicated and lets the client know that the nurse listened and understood her. The client did not ask the nurse to sit with her, so this action is inappropriate. Telling the client that it is okay to skip a session is giving advice and is not conveying an understanding of what the client really said. Asking the client why she doesnt want to attend group therapy clearly conveys that the nurse did not listen to what the client communicated.

 

DIF:    Cognitive Level: Application          REF:   Page 104        OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client tells the nurse that she feels very depressed about her recent divorce. Which is the nurses best response?
a. I know exactly how you feel.
b. Most people experience depressed feelings after a divorce.
c. I know this must be difficult for you.
d. Look on the bright side. You will be glad you divorced him in a couple of years.

 

 

ANS:  C

This is an empathetic response that lets the client know that the nurse understood her and expresses compassion. The other options are nontherapeutic. Because no one can know exactly how someone feels, the nurses statement that she knows exactly how the client feels is belittling the client. The nurses statement that most people experience depression after divorce is generalizing the clients feelings. Telling the client that she will be glad of the divorce in the future dismisses the clients feelings as not important.

 

DIF:    Cognitive Level: Application          REF:   Page 104        OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should:
a. Sit with the client and encourage him to not verbalize
b. Do most of the talking
c. Discuss several different topics to keep the clients attention
d. Use simple, concrete language

 

 

ANS:  D

Because this client has been given the diagnosis of schizophrenia and frequently has auditory hallucinations, his perception of the communication must be considered. Use of simple, concrete language will assist the client in following the conversation without having to interpret what the nurse means during the interaction. Encouraging the client not to verbalize and doing most of the talking do not allow the client to express himself, and discussing several different topics will be confusing and may cause the client undue stress during the interaction.

 

DIF:    Cognitive Level: Application          REF:   Page 99 | Page 100

OBJ:   8                    TOP:   Verbal Communication

KEY:  Nursing Process Step: Intervention MSC:  Client Needs: Psychosocial Integrity

 

  1. When documenting in a clients mental health record, the nurse would be most accurate by:
a. Documenting exact words and phrases spoken by the client when appropriate
b. Using mental health terminology when documenting conversations
c. Waiting until the end of the shift to document activity for the day
d. Interpreting the clients feelings for documentation purposes

 

 

ANS:  A

Documenting exact words and phrases will more effectively communicate an accurate picture of the client to other mental health team members. Mental health terminology will not be used in the same context as the communication that occurred, which may lead to lack of true meaning, and some team members may not be familiar with the terms used. Waiting until the end of the shift to document will lead to forgetting pertinent information, and interpreting the clients feelings reveals the nurses own opinion.

 

DIF:    Cognitive Level: Application          REF:   Page 100        OBJ:   4

TOP:   Verbal Communication                  KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurses ability to interpret communication effectively in the mental health setting depends mostly on:
a. How well the client communicates
b. The nurses relationship with the client
c. The nurses understanding of mental health disorders
d. The nurses ability to listen to and observe the clients verbal and nonverbal messages

 

 

ANS:  D

Accurate interpretation of the clients communication cannot occur if the nurse does not listen to and observe the client. It is not dependent on how well the client communicates because the nurse has no control over the client. The nurses relationship with the client and understanding of mental health disorders are important but will not supersede good observation and listening.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 101        OBJ:   6

TOP:   Therapeutic Communication Skills KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which nurse response is the best example of the therapeutic principle of respect?
a. Im interested in what you have to say.
b. Describe how you are feeling for me.
c. I hear how worried you are about your future and can imagine how you feel.
d. You signed a contract stating that you would let me know when you have those thoughts.

 

 

ANS:  C

Although all of these responses are examples of therapeutic principles, this option best describes respect because it shows consideration and acceptance. The other options convey interest, the principle of concreteness, and honesty.

 

DIF:    Cognitive Level: Application          REF:   Page 102        OBJ:   6

TOP:   Therapeutic Communication Skills KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of:

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a. Permission
b. Respect
c. Interest