Foundations of Mental Health Care 5th Ed By Michelle Morrison Valfre-Test Bank

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Foundations of Mental Health Care 5th Ed By Michelle Morrison Valfre-Test Bank

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WITH ANSWERS
Foundations of Mental Health Care 5th Ed By Michelle Morrison Valfre-Test Bank

Chapter 2: Current Mental Health Care Systems

Test Bank

 

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 on the basic health plan with no mental health care coverage.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 11              OBJ:   1

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

MSC:  Client Needs: Psychosocial Integrity

 

  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:   p. 11              OBJ:   1

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

MSC:  Client Needs: Psychosocial Integrity

 

  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:   p. 12              OBJ:   3

TOP:   Outpatient Care                              KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  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:   p. 14              OBJ:   5

TOP:   Case Management                          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 _____ per week.
a. Once
b. Two to four times
c. Five to six times
d. Seven to eight times

 

 

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:   p. 15              OBJ:   5

TOP:   Case Management                          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:   p. 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:   p. 17              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 predetermined 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 predetermined 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:   p. 18              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.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 18              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. 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:   p. 18              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 also 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. 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:   p. 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 care nurse is providing care to an older adult client with a diagnosis of depression who is caring for his wife who has 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 daycare center for elderly
d. Meals on Wheels

 

 

ANS:  D

By providing food, Meals on Wheels would remove one responsibility for this client. A recreational club or an adult education program might be beneficial, but the priority need for this couple is food. A daycare center for the elderly may be necessary in the future, but it is not a priority at this time.

 

DIF:    Cognitive Level: Application          REF:   p. 13              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 be the best choice to 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 rehabilitation therapy, such as socialization and vocational retraining.

 

DIF:    Cognitive Level: Application          REF:   p. 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:   p. 10              OBJ:   1

TOP:   Current Mental Health Care Systems

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

 

  1. A woman is admitted to an inpatient psychiatric unit after a suicide attempt by overdose. The primary rationale for her admission is to:
a. Have limited supervision by health care personnel.
b. Maintain responsibility for her own behavior.
c. Receive treatment in the least restrictive manner.
d. Provide her with a safe and secure environment.

 

 

ANS:  D

The most important advantage of inpatient psychiatric care is that it provides clients with a safe and secure environment where they can focus on and work with the problems that brought them there.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 11              OBJ:   2

TOP:   Inpatient Care                                           KEY:              Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client suffering from chronic mental illness often forgets to take her medication and needs to be reminded to take care of daily hygiene. She does not have family or other support persons living in the area. The care delivery provider facility that would be most beneficial for this client is:
a. Emergency departments
b. Residential program
c. Community mental health center
d. Psychiatric home care

 

 

ANS:  B

Residential programs offer a protected, supervised environment, which is what this client needs to be compliant. Emergency department care has stabilization and crisis as its focus, psychiatric home care works with clients and families in transition, and community mental health centers deal with crisis, counseling, and education.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 13              OBJ:   4

TOP:   Community Mental Health Care Delivery

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

 

  1. A 35-year-old client with a long history of schizophrenia who often forgets to take his medication is admitted to an inpatient unit after police found him threatening passengers on a bus. This is his fourth admission in 3 months. This frequent re-hospitalization is an example of:
a. Recidivism
b. Symptom exacerbation
c. Noncompliance
d. Rejection

 

 

ANS:  A

Unable to cope in the community setting, people with chronic psychiatric problems often return to institutions or use community services on a revolving-door basis. This behavior pattern is known as recidivism and means a relapse of a symptom, disease, or behavior. Recidivism is a major problem in mental health care.

 

DIF:    Cognitive Level: Application          REF:   p. 12              OBJ:   4

TOP:   Outpatient Care                              KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Arranging community resource linkages for a client and her children who are victims of domestic violence, which resource would be the most immediately appropriate community resource link for a client and her children who are victims of domestic violence?
a. Adult education program
b. Family recreation center
c. Mediation group
d. Womens shelter

 

 

ANS:  D

The womens domestic abuse shelter is the most appropriate resource for immediate safety needs of the family. While education programs, family recreation centers, and mediation groups also provide benefit to the family, they do not address the initial safety of the woman and her children.

 

DIF:    Cognitive Level: Application          REF:   p. 14              OBJ:   4

TOP:   Case Management: Resource Linkages

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:   p. 10              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:   p. 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:   p. 17              OBJ:   7

TOP:   Client Populations                          KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The case management for a client requiring community mental health services would include which of the following? (Select all that apply.)
a. Advocacy
b. Crisis intervention
c. Provision of referrals to a shelter
d. Administration of psychotropic medications
e. Developing a clients plan of care

 

 

ANS:  A, B, C

Case management is a system of interventions designed to support mentally ill clients living in the community. The major components of case management are psychosocial rehabilitation, consultation, resource linkage (referral), advocacy, therapy, and crisis intervention. Administration of medications is performed by an individual, not a system, and clients are involved in planning their care.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 14              OBJ:   5

TOP:   Case Management                          KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

COMPLETION

 

  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:   p. 16              OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

Chapter 10: Therapeutic Communication

Test Bank

 

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 _____ communication.
a. Disturbed
b. Nontherapeutic
c. Blocked
d. Therapeutic

 

 

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:   p. 104            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:   p. 104            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:   p. 105            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:   p. 105            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. Lets not talk about that right now.
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:   p. 113            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:   p. 111            OBJ:   7

TOP:   Nontherapeutic Messages               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:   p. 111            OBJ:   7

TOP:   Interacting Skills                             KEY:  Nursing Process Step: Assessment

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:   p. 111            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:   p. 111            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:   p. 107            OBJ:   8

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:   p. 110            OBJ:   6

TOP:   Therapeutic Communication          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:   p. 109            OBJ:   6

TOP:   Therapeutic Communication          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:
a. Permission
b. Respect
c. Interest
d. Protection

 

 

ANS:  D

A protective response such as, Lets look together again at what we have planned for you when you go home, will help the client feel more confident in her ability to do well once she is discharged. The other options are examples of therapeutic principles but do not address the needs of this client at this time.

 

DIF:    Cognitive Level: Application          REF:   p. 110            OBJ:   6

TOP:   Therapeutic Communication          KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A nurse has just graduated from nursing school and has been hired on a mental health unit. The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves:
a. Focusing
b. Parroting
c. Restating
d. Clarifying

 

 

ANS:  B

Parroting is the extreme form of the therapeutic communication skill of restating. It becomes very annoying to clients when the nurse continually repeats the clients statements in an attempt to show understanding of the clients message. The other options are therapeutic communication skills.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 113            OBJ:   7

TOP:   Nontherapeutic Messages               KEY:  Nursing Process Step: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating?
a. Aphasia
b. Dyslexia
c. Speech cluttering
d. Incongruent communications

 

 

ANS:  C

Rapid, confusing delivery of speech patterns is called speech cluttering and can result in the clients inability to focus on verbal communication as the main form of interaction. Aphasia refers to the inability to speak, dyslexia refers to mixing of letters when reading that sometimes results in mixing of syllables when speaking, and incongruent communications occur when verbal messages do not match nonverbal messages.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 112            OBJ:   8

TOP:   Problems with Communication       KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills?
a. Finishing the clients sentences to indicate listening
b. Not clarifying messages to avoid interrupting
c. Avoiding taking notes to detract from listening
d. Changing the environment to decrease distractions

 

 

ANS:  D

Effective listening improves the ability to meet client needs. Changing the environment to decrease distractions is a practice important to listening skills. Finishing client sentences, not clarifying messages, and avoiding taking notes are barriers to listening and may prevent the nurse from picking up hidden messages, which could minimizing minimize misunderstandings if perceived.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 110            OBJ:   7

TOP:   Problems with Communication       KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing.  This is an example of:
a. Echolalia
b. Circumstantiality
c. Neologism
d. Perseveration

 

 

ANS:  B

Circumstantiality is a speech pattern in which the client describes in too much detail and cannot be selective.  Echolalia is repeating the last word heard, neologism is the coining of new words or expressions and perseveration is the repeating of a single activity and the inability to shift from one topic to another.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 115            OBJ:   8

TOP:   Speech Patterns Associated with Psychiatric Problems

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

 

  1. The client tells the nurse that she believes there is no improvement in her manic episodes.  Her clothing matches, and her makeup is more subdued.  She sits quietly in the chair during the session.  What does this indicate?
a. Verbal communication takes priority.
b. Verbal communication is not congruent with nonverbal communication.
c. Nonverbal communication indicates the client is lying.
d. Nonverbal communication should take priority.

 

 

ANS:  B

Verbal and nonverbal communication sends and receives messages with every interaction.  Neither verbal nor nonverbal communication takes priority over the other.  In this case the verbal communication of the client that her episodes are not improving is belied by the obvious improvement in her dress and behavior (nonverbal communication).

 

DIF:    Cognitive Level: Knowledge          REF:   p. 107            OBJ:   8

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

MSC:  Client Needs: Psychosocial Integrity

 

  1. When the adolescent client is asked about the magazine she is reading, she responds, Its an article about my favorite movie star.  Did you see all the stars out last night? I used to be afraid of the dark at night.  Which speech pattern is this an example of?
a. Echolalia
b. Flight of ideas
c. Loose association
d. Neologism

 

 

ANS:  C

Loose association is a pattern in which the speaker shifts between loosely related topics such as movie star, stars in the sky at night, and darkness at night.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 115            OBJ:   8

TOP:   Speech Patterns Associated with Psychiatric Problems

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

 

MULTIPLE RESPONSE

 

  1. Which elements must be present for communication to occur? (Select all that apply.)
a. Feedback
b. Transmission
c. Sender
d. Clarification
e. Receiver
f. Focusing
g. Context

 

 

ANS:  A, B, C, E, G

Feedback, transmission, sender, receiver, and context are the five elements that must be in place for communication to occur. The sender transmits the message to the receiver, resulting in feedback between them. The context, or setting, is where the communication takes place. Clarification and focusing are types of therapeutic communication.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 105            OBJ:   3

TOP:   Process of Communication             KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which interventions assist the nurse to effectively communicate with clients fro

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