Question 1

A client has received some bad news about a prognosis from the physician. When the nurse comes in with medications, the client states in an angry tone, "You're late; I was just about to call the hospital administrator to complain." The nurse is aware that the client received a disappointing prognosis and understands the behavior as displacement. The nurse is silent for a few moments to let the client collect some thoughts and control any feelings. Which response should the nurse make next?

Accepted Answer

Option B is the best response as it acknowledges the client's emotional state and shows empathy. It also allows the client to open up about their concerns and feelings related to the disappointing prognosis. Options A, C, and D are not appropriate responses as they either deflect from the client's emotional state or falsely attribute emotions to the client.

Question 2

A nurse is to assess a client's level of anxiety in order to determine how much of an anti-anxiety drug to administer prior to performing a painful dressing change for a deep tissue burn. Which question would give the nurse the most accurate assessment?

Accepted Answer

This question gives the client a specific scale to rate their anxiety, which allows for a more accurate assessment. The other options are too vague or unrelated to anxiety.

Question 3

A client who abuses alcohol states that the client drinks because the client's job is so stressful. Recognizing this as rationalization, the nurse makes a response to the client. The nurse would know treatment was effective when the client says which of the following?

Accepted Answer

The client recognizing that their drinking has gone beyond just coping with job stress indicates that they are beginning to take responsibility for their behavior and acknowledge their alcohol abuse as a problem. This is a positive step towards recovery and effective treatment. Options A, B, and D all involve denial and rationalization, indicating resistance to change and ineffective treatment.

Question 4

A child with asthma was admitted to the hospital during an attack. The mother says, "This is all my fault, if only I hadn't smoked when I was pregnant." Which response would be helpful to the mother?

Accepted Answer

Blaming oneself for a child's illness is a common response among parents, and it is important to provide gentle reassurance and accurate information to help alleviate those feelings. In this case, explaining that asthma is caused by a complex interaction of genetic and environmental factors can help the mother understand that her smoking during pregnancy may have contributed to the risk, but it is not the only cause of her child's asthma. It is important to avoid shaming or blaming the mother, as this can be counterproductive to helping her support her child's health.

Question 5

A teen comes to the school nurse to get help with anxiety about singing in front of the school. The teen states, "I just know everyone is going to laugh. What if I sing off-key?" What does the nurse recognize as the teen's source of anxiety?

Accepted Answer

The teen's fear that others will laugh and disapprove of their singing shows that they are anxious about anticipated disapproval by significant others.

Question 6

A female client comes to the nursing clinic for a routine physical. When asked how she has been doing, she reports that she has been feeling very low since her youngest child left to attend dental school. She indicates that she has told herself to "just get over it" and find something to do. She has been telling herself that feeling so low is foolish since she is happy her daughter got into a good school. Which coping methods does the nurse recognize in the client's statements?
Select all that apply.

Accepted Answer

The client is privately thinking it through by reflecting on her feelings and situation. She is also relying on self-discipline by telling herself to "just get over it" and find something to do.

Question 7

A community health nurse meets with a 15-year-old single mother to teach a tube-feeding technique to her infant. The teen's mother is present. The nurse notes that the young mother is hesitant to try the feeding technique and does not ask questions. During the feeding, the teen mother almost drops the feeding tube and is scolded by her mother for being clumsy. Based on this initial information, which nursing diagnosis is most appropriate?

Accepted Answer

The young mother's hesitance to try the feeding technique, lack of questions, and almost dropping the feeding tube along with being scolded by her mother indicate a situational low self-esteem related to lack of experience, criticism, and role uncertainty. There is no evidence of anxiety, impaired social interaction, or ineffective family coping in this scenario.

Question 8

A nurse is talking with the wife of a client who has terminal cancer. The wife is explaining what an ordeal it has been over the last six months. She states her diabetes is out of control and she feels tired and exhausted all the time. What risks does chronic stress present for the wife?
Select all that apply.

Accepted Answer

The answer of A nurse is talking with the wife...

Question 9

A client with Crohn's disease is seen in the nursing clinic following a recent flare-up. The client describes herself as married with no children and a hard-working elementary school teacher. Which questions asked by the nurse are an important part of this client's assessment?
Select all that apply.

Accepted Answer

The answer of A client with Crohn's disease is seen...

Question 10

A 22-year-old delivers a baby at home and calls the police who bring her to the psychiatric unit for an evaluation. The nurse learns that the mother is unwilling to accept the pregnancy and denies that she ever delivered a baby. The nurse continues to work with the client and establishes a trusting relationship. How should the nurse proceed in order to help the client?

Accepted Answer

Exploring the protective functions of the client's denial can help the nurse understand and support the client's coping mechanisms. This approach can provide opportunities to discuss the client's feelings and concerns about the situation, and work towards a resolution. Options B and C may be premature at this point and may not be helpful if the client is not ready to accept or acknowledge the reality of the situation. Option D may further reinforce the client's denial and hinder the therapeutic relationship.

Question 11

A nurse has been working with a client who witnessed a traumatic event and is now experiencing panic-level anxiety. The desired outcome is:

Accepted Answer

The desired outcome for a client experiencing panic-level anxiety after witnessing a traumatic event is for the anxiety to be maintained at a manageable level. Complete absence of anxiety may not be realistic or attainable immediately, and hoping for improvement in self-esteem may be a long-term goal that is not relevant to the immediate crisis at hand. The priority is to help the client cope with the anxiety in a way that does not interfere with daily functioning or cause further harm.

Question 12

A client who abuses alcohol was brought to the hospital as a police hold after a fight with his wife. When the client is sober, the nurse recognizes that the client is using a defensive behavior called rationalization. Which statement did the client make?

Accepted Answer

Rationalization is a defense mechanism in which the individual justifies their behavior with excuses or reasons that may seem logical but are not necessarily valid. Option D is an example of rationalization as the client is justifying his violence against his wife by blaming her for not leaving him alone.

Question 13

A client diagnosed with a brain tumor is considering whether or not to have surgery after the physician explains that possible responses might include stroke, facial paralysis, and other mobility-limiting events. A few hours after signing the consent form, the client anxiously calls the nurse to withdraw consent, and then reverses the decision again a few moments later. This behavior continues over the next several hours. How should the nurse understand what is going on with this client?

Accepted Answer

The client's behavior of withdrawing and then reversing consent indicates vacillation regarding the decision for surgery. This can be a common response when faced with a difficult decision such as surgery that may have significant risks and complications. The nurse should provide support and education to help the client make an informed and confident decision.

Question 14

A nurse is working with a student on the acute care psychiatric unit. The student asks the nurse why it is important to assess clients' values when there are many other more important issues to attend to. The nurse's reply should emphasize which of the following?

Accepted Answer

Assessing clients' values is important because health behaviors are strongly influenced by personal values. Understanding the values of the client can help the nurse provide individualized care that is more likely to be accepted and followed by the client. It can also help the nurse identify any potential conflicts between the client's values and the plan of care. It is not necessary to ensure that clients' values are congruent with the nurse's values, and while values regarding health may be common across many cultures, they are also highly individualized. Values do not form the scientific basis for health behaviors; rather, research on health behaviors is based on scientific studies.

Question 15

Epidemiological studies indicate that less than half of individuals with 3 or more mental disorders sought specialty mental health treatment. What factor may be contributing to this problem?

Accepted Answer

Lack of preventative outreach services may be contributing to the problem of less than half of individuals with 3 or more mental disorders seeking specialty mental health treatment. Without these services, individuals may not be aware of the resources available to them or may not be properly educated on preventative measures to maintain their mental health.

Question 16

A nurse is working at a health care clinic serving the needs of the homosexual community. A neighbor says the nurse must be brave because most of "those" people have AIDS. What would be the nurse's best response?

Accepted Answer

The nurse should challenge the neighbor's stereotype by acknowledging it and then asking to discuss the reality. This can help educate the neighbor and reduce discrimination. The other choices either downplay the significance of AIDS or avoid confronting the discrimination.

Question 17

The nurse is planning to incorporate principles of epidemiological psychiatry into her nursing practice. Which step should the nurse prioritize?

Accepted Answer

Identifying groups of people at high risk for specific psychiatric disorders is the first step in epidemiological psychiatry and is crucial in preventing and addressing the disorder. The other steps (assessing care-seeking patterns, predicting future needs, and evaluating the effect of preventive and therapeutic measures) require understanding the risk factors and populations affected by psychiatric disorders.

Question 18

Clients who experience sexual assault often experience increased rates of mental disorder. Which risk factor would apply to a client who had been sexually assaulted?

Accepted Answer

Social environment can be a significant risk factor for sexual assault. This includes factors such as living in an area with higher rates of crime or being surrounded by individuals who engage in risky behaviors. Additionally, social support, or lack thereof, can impact an individual's mental health outcomes after experiencing sexual assault.

Question 19

A nurse is meeting with a Cuban family in which the wife abuses alcohol. During the family assessment meeting, the nurse observes that the husband speaks for the wife and other family members when the nurse is directing questions towards them. The husband says, "I am responsible for my family." What cultural values should the nurse consider when planning care for this client?

Accepted Answer

CIn many cultures, including some Cuban families, the husband or male head of the household may take a leading role in making decisions for the family, including health care decisions (B). Additionally, the concept of familismo, a strong dedication to family and group welfare over individual needs, is prevalent in many Latino cultures, suggesting that health care decisions may involve the entire family (C).

Question 20

Wildfires have devastated large parts of a rural county. General health practitioners in the county have noticed an increase of clients presenting with stress-related disorders. Applying principles of psychiatric epidemiology, which of the following is true regarding the presentation of stress-related disorders following this traumatic event?

Accepted Answer

Awareness of care-seeking patterns is essential in order to address use of mental health services. While it is true that most people with mental disorders seek professional treatment (option D), and it is not true that individuals with chronic mental disorders do not seek treatment (option C), the most relevant information for addressing the increase of stress-related disorders in this particular situation is the need to be aware of care-seeking patterns in order to effectively address the use of mental health services.

Quiz 1: The Strength and Structure of Psychiatric Mental Health Nursing; Theoretical Basis for Psychiatric-Mental Health Nursing Practice and Process