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1. The nurse is assessing the anxiety level of a young school-age child. The nurse encourages the child to express feelings through the use of toys in a play situation. The purpose for this approach to assessment is largely related to which of the following?
A) The child has cognitive impairment and has limited vocabulary skills.
B) The child has not been intellectually stimulated and can only express self through
C) Children may not have developed the language to fully describe their feelings.
D) Children will not express themselves openly unless instructed to do so by parents.
A clients age can influence how he or she expresses illness. A young child may lack the understanding and ability to describe his or her feelings, which may make management of the disorder more challenging. Nurses must be aware of the childs level of language and work to understand the experience as he or she describes it.
2. A nurse is teaching decision-making skills to a client with dependent personality disorder. According to Erikson, the likely cause of the client developing dependent personality is failure to meet the critical task of which developmental stage?
Failure to complete the critical task results in a negative outcome for that stage of development and impedes completion of future tasks. Tasks of trust versus mistrust include viewing the world as safe and reliable and viewing relationships as nurturing, stable, and dependable. In autonomy versus shame and doubt, children achieve a sense of control and free will. In initiative versus guilt, the child begins to develop a conscience, and learns to manage conflict and anxiety. Industry versus inferiority involves school-age children building confidence in their own abilities and taking pleasure in accomplishments.
3. Which one of the following statements is most accurate regarding the age at onset of a mental illness such as schizophrenia?
A) Persons who are diagnosed at a younger age will more likely have a poorer
B) Persons who are diagnosed at a younger age will more likely have a better
C) Age at diagnosis is not related to outcomes.
D) Younger clients have more experiences that will help them.
Persons who are diagnosed with schizophrenia at a younger age at onset have poorer outcomes, such as more negative signs and less effective coping skills, than do people with a later age at onset. A possible reason for this difference is that younger clients have not had experiences of successful independent living or the opportunity to work and be self-sufficient and have a less well-developed sense of personal identity than older clients.
4. Genetics have been shown to play which of the following roles in a persons mental and emotional health?
A) Several mental disorders appear to run in families.
B) Specific genes have been linked to certain mental disorders.
C) Biologic factors can be modified to change the influence on emotional health.
D) Psychiatric treatment is effective regardless of an individuals biologic influences.
Heredity and biologic factors are not under voluntary control. We cannot change these factors. Research has identified genetic links to several disorders. Although specific genetic links have not been identified for several mental disorders (e.g., bipolar disorder, major depression, and alcoholism), research has shown that these disorders tend to appear more frequently in families. Genetic makeup tremendously influences a persons response to illness and perhaps even to treatment.
5. Which one of the following statements about the roles that biologic makeup plays in a clients emotional responses is most accurate?
A) Biologic differences can affect a clients response to treatment with psychotropic
B) Biologic differences do not affect a clients response to treatment with
C) Heredity and biologic factors are under voluntary control.
D) Persons cannot change their health status and improve the ability to cope.
Biologic differences can affect a clients response to treatment with psychotropic drugs. Heredity and biologic factors are not under voluntary control. Persons can change their health status and improve their ability to cope.
6. Which of the following individual factors can a person modify to improve mental and emotional health? Select all that apply.
A) Serotonin deficiency
B) Lack of exercise
C) Poor nutrition
D) Type I diabetes
Ans: B, C, E Feedback:
Personal health practices, such as exercise, poor nutritional status, lack of sleep, or a chronic physical illness, can influence the clients response to illness. Unlike genetic factors, how a person lives and takes care of himself or herself can alter many of these factors. For this reason, nurses must assess the clients physical health even when the client is seeking help for mental health problems. Serotonin deficiency and type I diabetes are not under voluntary control.
7. The nurse is preparing to administer PRN medication to a client of a Japanese descent who is anxious. The prescription reads, iAlprazolam (Xanax) 0.25 to 1.0 mg PO PRN.i The best dose for the nurse to give initially is
A) 0.25 mg.
B) 0.5 mg.
C) 0.75 mg.
D) 1.0 mg.
Ans: A Feedback:
In general, nonwhites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. Persons of Asian descent often metabolize drugs more slowly, requiring lower doses to produce therapeutic effects.
8. A clients prognosis is said to be good due to a high degree of self-efficacy. Which of the following is evidence of a high degree of self-efficacy?
A) The client is self-motivated and asks for help when needed.
B) The client is able to resist illness when under stress.
C) The client responds well in stressful situations.
D) The client uses good problem-solving abilities.
Ans: A Feedback:
People with high self-efficacy set personal goals, are self-motivated, cope effectively with stress, and request support from others when needed. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problem- solving abilities and believing that one can cope with adverse or novel situations.
9. A client is actively involved in community service activities. The benefit of involvement in meaningful daily activities will most directly contribute to which of the following attributes?
Hardiness is the ability to resist illness when under stress. Hardiness has three components: commitmentoactive involvement in life activities; controloability to make appropriate decisions in life activities; and challengeoability to perceive change as beneficial rather than just stressful. Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problem- solving abilities and believing that one can cope with adverse or novel situations.
10. It is recorded in the clients chart that the family is resilient. The nurse concludes which of the following characteristics about the family life of this client? Select all that apply.
A) Family members are independent of one another.
B) Family members spend time together.
C) Family members engage in recreational activities together.
D) Family members share the same personal goals.
E) Family members allow individual members to develop unique daily routines.
Ans: B, C
Factors that are present in resilient families include positive outlook, spirituality, family member accord, flexibility, family communication, and support networks. Resilient families also spend time together, share recreational activities, and participate in family rituals and routines together. Personal goal setting reflects self-efficacy.
11. Spirituality is especially important in helping people cope primarily for which of the following reasons?
A) Spirituality helps people set personal goals.
B) Spirituality gives people meaningful daily activities in which to participate.
C) Spirituality provides a reliable support network.
D) Spirituality guides beliefs about the meaning of life events.
Spirituality involves the essence of a persons being and his or her beliefs about the meaning of life and the purpose for living. Spirituality is a genuine help to many adults with mental illness, serving as a primary coping device and a source of meaning and coherence in their lives. It may also help to provide a social network, but it serves primarily as a belief system. Personal goal setting is a demonstration of self-efficacy. Hardiness is enhanced through commitment to meaningful daily activities.
12. Which of the following statements about hope and symptoms of mental illness are true? Select all that apply.
A) Hope is not realistic and therefore is not related to mental well-being.
B) Persons having more hope experienced fewer actual symptoms.
C) Hope is a cause of mental illness.
D) There is not a significant relationship between hopelessness and increased
E) A possible way to help clients manage and decrease symptoms would be to
support the development of hope.
Ans: B, E
Persons having more hope experienced fewer actual symptoms. A significant relationship between hopelessness and increased symptoms was also demonstrated. This may indicate that one of the ways to help clients manage and decrease symptoms is having a wellness plan that includes a positive future outlook and support for the development of hope.
13. Which of the following personal characteristics influence a clients response to stressors? Select all that apply.
B) Sense of belonging
Ans: A, C, D, E, F Feedback:
Personal characteristics that influence a clients response to stressors include self- efficacy, spirituality, hardiness, resilience, and resourcefulness. Sense of belonging is an interpersonal factor that can influence a clients response to stressors.
14. Which of the following statements about spirituality are true? Select all that apply.
A) Many clients with mental disorders have disturbing religious delusions.
B) Religious activities have been shown to be linked with better health and a sense of
C) Spirituality only involves religion.
D) Hope and faith are two critical factors in psychiatric and physical rehabilitation.
E) Spirituality may include a relationship with the environment.
Ans: A, B, D, E
Many clients with mental disorders have disturbing religious delusions. Religious activities have been shown to be linked with better health and a sense of well-being. Spirituality involves the essence of a persons being and his or her beliefs about the meaning of life and the purpose for living. It may include belief in God or a higher power, the practice of religion, cultural beliefs and practices, and a relationship with the environment. Hope and faith are two critical factors in psychiatric and physical rehabilitation.
15. Individuals who grow up in iat-riski environments but are able to become productive, successful citizens are believed to possess which of the following characteristics?
C) Social skills
Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.
16. Which of the following factors would be the most influential in determining a clients response to a particular stressor?
A) The clients experience with stress
B) The clients perception of the stressor
C) Duration of the stressor
D) Severity of the stressor
Ans: B Feedback:
The client will respond to the stressor based on his or her appraisal (perception) of the stressor. Resilience is related to positive outlook. The clients experience with stress, the duration of the stressor, and the severity of the stressor would not be the most influential in determining a clients response to a stressor.
17. The client says to the nurse, iI know I can learn to cope with my family situation. By getting help here at the clinic, Ill be able to deal with them more effectively, and I wont be so stressed out all the time.i This client is demonstrating a high level of
Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. A person who believes that his or her behavior makes a difference is more likely to take action. Persons with high self-efficacy are self-motivated, get needed support, and cope effectively. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Sense of belonging is the clients place in the group, family, etc.
18. A client reports feeling like he belongs among his peers with whom he shares a group home. The nurse incorporates this sense of belonging when formulating discharge plans because the nurse understands which of the following?
A) Living with a peer group often increases anxiety.
B) Peers may alienate the client from daily living activities.
C) The client will likely feel needed by his peers.
D) Peer groups often do too much for each other causing dependency.
An increased sense of belonging is associated with decreased levels of anxiety. Persons with a sense of belonging are less alienated and isolated, have a sense of purpose, believe they are needed by others, and feel productive socially.
19. Which of the following situations would most likely provide social support to a client?
A) A friend who will share his or her perspective on an issue
B) The transportation service that provides access to daily rehabilitation services
C) Fellow teammates participating in a community softball league
D) The teacher assisting a client to obtain a GED
Social support is emotional sustenance that comes from friends, family members, and even health-care providers who help a person when a problem arises. It is different from social contact, which does not always provide emotional support. An example of social contact is the friendly talk that goes on at parties.
sense of belonging. self-efficacy.
20. A holistic plan of recovery would be especially important to a client from which of the following cultural groups?
A) American Indian
B) African American
C) Mexican American
D) Arab American
Ans: A Feedback:
The American Indians concept of health is holistic and wellness oriented. African Americans and Mexican Americans value feelings of well-being, ability to fulfill role expectations, and being free of pain or excess stress. Arab Americans view health as a gift of God manifested by eating well, meeting social obligations, being in a good mood, and having no stressors or pain.
21. A nurse and a client of Chinese heritage are collaborating on treatment goals. The nurse would document which of the following as the clients priority goal?
A) The client will be free of pain and excess stress.
B) The client will express a feeling of balance and harmony.
C) The client will be free of physical symptoms of illness.
D) The client will express gratefulness to God for recovery.
Ans: B Feedback:
Chinese and many other Asian cultures view health as a balance of body, mind, and spirit. Pain-free is a major focus of African American culture. Russians and Latino cultures focus largely on physical aspects of health. Arab cultures view health as a gift of God.
22. The nurse is preparing to conduct an admission assessment interview with a Mexican American client. During the interview, the nurse should respect the clients culture through which behavior?
A) Greet the client with a hug,
B) Encourage direct eye contact during questioning
C) Prohibiting the next of kin to remain present
D) Introduce self with a handshake
With Mexican Americans touch by strangers is not appreciated, but a handshake is polite and welcomed. Nonverbal communication generally avoids direct eye contact with authority figures. Socially, contact with families comes first.
23. A nurse is working with a Middle-Eastern client being treated for major depression. The client is expressing feelings of guilt for not being able to isnap out of it.i A therapeutic response by the nurse would be,
A) iYou have to keep trying to feel better.i
B) iWhat do you think could have caused your depression?i
C) iClinical depression is not something you have brought on yourself.i
D) iIt will take several weeks for your medicine to start to help you feel better.i
Arab Americans believe mental illness is something the person can control. Educating about the etiology reduces the guilt associated with having an illness. Suggesting the client keep trying or caused the depression in some way implies that the client is responsible for the illness. Informing about medication ignores the clients feelings of guilt.
24. Several family members arrive to visit an African American client. The nurse can best meet this clients need for socialization by providing the client and family which of the following?
A) Individual visits to provide the client with a calm environment
B) Group gatherings and open conversation
C) Inclusion of ritualistic health practices with the family present
D) A spiritual healer to remove the illness and protect the family
During illness, families are often a support system for the sick person. Families often feel comfortable demonstrating public affection such as hugging and touching one another. Conversation among family and friends may be animated and loud. Spiritual rituals are more prevalent in Native American cultures.
25. A Filipino client meets the nurse for the first time. The client simply smiles at the nurse when introduced. The nurse interprets this behavior as
A) a display of being shy and introverted.
B) a typical greeting for a Filipino client.
C) constricted verbal skills associated with the clients illness.
D) a sign that the client may be suspicious of the nurse.
Ans: B Feedback:
Smiles rather than handshakes are a common form of greeting in Pilipino culture. Filipino clients consider direct eye contact impolite, so there is little direct eye contact with authority figures such as nurses and physicians.
26. Females from which of the following cultures are most likely to be expected to move in with husbands family?
A) African Americans
B) Mexican Americans
C) South Asians
African Americans are more likely to have a nuclear family. Mexican Americans mostly live in nuclear families. South Asians expect the daughters to move in with the husbands family. Haitians may have an extended or a nuclear family.
27. Culture has the most influence on a persons health beliefs and practices. African Americans believe that the cause of mental illness occurs because of which of the following?
A) Lack of harmony of emotions
B) Supernatural causes
D) Lack of spiritual balance
African Americans believe that mental illness is caused by lack of spiritual balance. Chinese believe that mental illness is caused by lack of harmony of emotions. Haitians believe that mental illness is caused by supernatural causes. Cubans believe that mental illness is hereditary.
28. A client from which of the following cultural groups is likely to prefer closeness in personal space?
A) Arab Americans
D) African Americans
Arab Americans prefer closeness in personal space. Chinese keep respectful distance. Cubans have greatly varying preferences for personal space. African Americans respect privacy and use a respectful approach.
29. Direct eye contact is preferred by which of the following cultures?
A) Native Americans
Of these cultures, only Russians prefer direct eye contact. Native Americans communicate respect by avoiding eye contact. For Cambodians, eye contact is acceptable, but ipolitei women lower their eyes. For Chinese, eye contact is avoided with authority figures.
30. Beliefs about the causes of pain and illness vary among cultures. In the United States (Western culture), pain and illness are generally attributed to
A) economic class.
B) psychological influences.
C) physiologic causes.
D) sociocultural factors.
Ans: C Feedback:
Usually, Americans believe that pain and illness arise from physical causes. Two prevalent types of beliefs about what causes illness in non-Western cultures are natural and unnatural or personal. Unnatural or personal beliefs attribute the causes of illness to the active, purposeful intervention of an outside agent, spirit, or supernatural force or deity. The natural view is rooted in a belief that natural conditions or forces, such as cold, heat, wind, or dampness, are responsible for illness.
31. The nurse considers cultural variations pertaining to a clients nonverbal communication. Which of the following is the primary rationale for considering alternative meanings of nonverbal communication?
A) The nurse must become expert at interpreting the clients gestures.
B) Nonverbal signs indicative of certain mental illnesses transcend cultural differences.
C) Mental illnesses impair a clients ability to express nonverbal messages.
D) Nonverbal messages have different meanings in various cultures.
Ans: D Feedback:
The nurse should be aware that nonverbal communication has different meanings in various cultures. These differences are important to note because many people make inferences about a persons behavior. The nurse can never know all culturally relevant messages. All communication is culturally relative. Persons with mental illness are fully capable of nonverbal expression.
32. Which of the following cultural phenomena that should be assessed by the nurse includes preference such as touch and eye contact?
B) Social organization
C) Environmental control
D) Biologic variations
Ans: A Feedback:
Communication involves verbal and nonverbal communication. Social organization refers to family structure and organization, religious values and beliefs, ethnicity, and culture. Environmental control refers to a clients ability to control the surroundings or direct factors in the environment.
33. Which of the following questions best encourages the client to disclose information the nurse must assess to provide culturally competent care?
A) iHow do you want me to help you?i
B) iDo you want me to contact your preacher?i
C) iWhat special dietary preferences do you have?i
D) iWhich family members do you want to receive calls from?i
To provide culturally competent care, the nurse must find out as much as possible about a clients cultural values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to him or her. An open and objective approach to the client is essential. Clients will be more likely to share personal and cultural information if the nurse is genuinely interested in knowing and does not appear skeptical or judgmental. Assuming the client wants a preacher or has dietary preferences is assuming the clients values. Asking about preferred family members does little to assess the nature of family relationships.
34. The nurse is making a cultural assessment of a client. The most important data about a clients cultural beliefs are
A) objective data about the culture.
B) subjective data from the client.
C) subjective data from the family.
D) subjective data from society.
Ans: B Feedback:
The clients perception and description of cultural beliefs and values are most important.
35. How might the nurse best provide culturally competent care?
A) Behave as appropriate for the nurses culture.
B) Find out as much as possible about a clients cultural values, beliefs, and health
C) Know what to expect from many cultural groups.
D) Validate knowledge about culture through continuing education.
Each client is an individual; the nurse can never assume that any individual client will fit the general preferences of his or her culture.
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