NSG3450/ NSG 3450 Exam 2 (NEW 2026/ 2027 Update) Nursing Practice – Mental Health Guide| Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Galen

NSG3450/ NSG 3450 Exam 2 (NEW 2026/ 2027 Update) Nursing Practice – Mental Health Guide| Questions & Answers| Grade A| 100% Correct (Verified Solutions)- Galen Q. Which statement made by the nurse demonstrates the best understanding of nonverbal communication? a. "the pt.'s verbal and nonverbal communication is often different." b. "when my pt. responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response." c. "is a pt. is slumped in the chair, I can be ire he's angry or depressed." d. "it's easier to understand verbal communication than nonverbal communication." ANSWER B. "when my pt. responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response." Q. Which nursing statement is an example of reflection? a. "I think this feeling will pass." b. "so you are saying that life has no meaning." c. "I'm not sure I understand what you mean." d. "you look sad." ANSWER D. "you look sad." Q. When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient? a. change of shift report b. admission interviews c. one-to-one conversations with pt.'s d. conversations with pt. families ANSWER A. change of shift report Q. What principle about nurse-patient communication should guide a nurse's fear about "saying the wrong thing" to a patient? a. Pt.'s tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation b. the pt. is more interested in talking to you than listening to what you have to say and so is not likely to be offended c. considering the pt.'s history, there is little chance that the comment will do any actual harm d. most people with a mental illness have by necessity developed a high tolerance of forgiveness ANSWER A. Pt.'s tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation Q. During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply: a. auditory b. visual c. written d. tactile e. olfactory ANSWER a, b, d, e (auditory, visual, tactile, olfactory) Q. You have been working closely with a pt. for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the filling responses would most likely be therapeutic? a. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." b. "You say that you look forward to the meeting, but you appear anxious or unhappy." c. "I notice that you frowned and avoided eye contact just not. Don't you feel well." d. "I get the impression you don't really want to see you psychiatrist-- can you tell me why?" ANSWER A. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." Q. Which student behavior is consistent with therapeutic communication? a. offering your opinion when asked to convey support. b. summarizing the essence of the pt.'s comments in your own words. c. interrupting periods of silence before they become awkward for the pt. d. telling the pt. he did well when you approve of his statements or actions. ANSWER B. summarizing the essence of the pt.'s comments in your own words. Q. James is a 42 y/o pt. with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night, demons came to my rook and tried to rape me." Which response would be most therapeutic? a. "There are no such things as demons. What you saw were hallucinations." b. "It is not possible for anyone to enter your room at night. You are safe here." c. "You seem very upset. Please tell me more about what you experienced last night." d. "That must have been very frightening, but we'll check on you at night and you'll be safe." ANSWER C. "You seem very upset. Please tell me more about what you experienced last night." Q. Therapeutic communication is the foundation of a patient-centered interview. which of the following techniques is not considered therapeutic? a. restating b. encouraging description of perception c. summarizing d. asking "why" questions ANSWER D. asking "why" questions Q. Carolina is surprised when her pt. does not show for a regularly scheduled appointment. When contacted, the pt.s states, "I don't need to come see you anymore. I have found a therapy app on my phone that I love." How should Carolina response tot his news? a. "that sounds exciting, would you be willing to visit and show me the app?" b. "at this time, there is no real evidence that the app can replace our therapy." c. "I am not sure that is a good idea right now, we are so close to progress." d. "Why would you this the tis a better option than meeting with me?" ANSWER A. "that sounds exciting, would you be willing to visit and show me the app?" Q. Phases of Group development: Orientation phase ANSWER Leader establishes an atmosphere of respect, confidentiality and trust and describes the purpose of the group. Members are encouraged to get to know one another through their own introductions. Q. Phases of Group development: Working phase ANSWER Leader to encourage focus on problem solving consistent with the purpose of the group. It is important for the leader to guide and support conflict resolution Q. Phases of Group development: Termination phase Leader ensures each member summarizes personal accomplishments, shares new insights, and identifies future goals; encourages members to focus on progress and post-hospital/therapy goals Q. What question by the nurse leader is helpful in managing a monopolizing member of a group? a. "You seem angry. Is there something you want to discuss with the group." b. "Would it be helpful if you had time to think about the question?" c. "Would you tell us about experiences that have frightened you?" d. "Who else would like to share feelings about this issue?" ANSWER d. "Who else would like to share feelings about this issue?" Q. What advantages does group therapy have over those of individual therapy? Select all that apply: a. groups are less expensive than one-to-one therapy b. groups provide an opportunity to learn from others c. groups are homogenous in composition d. feedback is available from the group leader and group members e. interpersonal skills can be practiced in a safe environment ANSWER a, b, d, e Q. What group would benefit most from a laissez-faire leader? a. art group b. grief group c. social skills group d. anger management group ANSWER A. art group Q. The nurse tells groups members that they will be working on expressing conflicts during the current group session. which phase of group development is represented? a. planning (formation) phase b. orientation phase c. working phase d. termination phase ANSWER B. orientation phase Q. Group dynamics can vary widely and at times members are capable of disrupting the group process. which of the following participant traits may indicate a need for additional support for a new nurse facilitator? Select all that apply: a. a member w/ paranoid delusions b. a quietly tearful participant expressing suicidal thoughts c. an angry woman who raises her voice d. a calm but ineffective communicator ANSWER a, b Q. Group members are having difficulty deciding what topic to cover in today's session. Which nurse leader response reflects autocratic leadership? a. "We are talking about fear of rejection today." b. "Let's go around the room and make suggestions for today's topic." c. "I will let you come to a conclusion together about what to talk about." d. "I'll work with you to find a suitable topic for today." ANSWER A. "We are talking about fear of rejection today." Q. A pt. continues to dominate the group conversation despite having been asked to allow others to speak. What is the most appropriate group leader response? a. "You are monopolizing the conversation." b. "When you talk constantly, it makes everyone feel angry." c. "You are supposed to allow other to talk also." d. "When you speak out of turn, I am concerned that others cannot participate equally." ANSWER D. "When you speak out of turn, I am concerned that others cannot participate equally." Q. The nurse is planning care, which includes a dual-diagnosis group. Which pt. would be appropriate for this group? The pt. with: a. depression and suicidal tendencies b. anxiety and frequent migraine headaches c. bipolar disorder and anorexia nervosa d. schizophrenia and alcohol abuse ANSWER D. schizophrenia and alcohol abuse Q. What assessment question is focused on identifying a long-term consequence of chronic stress on physical health? a. "Do you have any problems with seeping well?" b. "How many infections have you experienced in the past 6 months?" c. "How much moderate exercise do you engage in on a regular basis?" d. "What management techniques do you regularly use to manage your stress?" ANSWER b. "How many infections have you experienced in the past 6 months?" Q. Which nursing assessment are directed at monitoring a pt.'s fight-or-flight response? Select all that apply: a. blood pressure b. heart rate c. respiratory rate c. abdominal pain e. dilated pupils ANSWER a, b, c, e Which question is focused on the assessment of an individual's personal ability to manage stress? Select all that apply: a. "Have you ever been diagnosed with cancer?" b. "Do you engage in any hobbies now that you have retired?" c. "Have you been taking your antihypertensive medication as it is prescribed?" d. "Who can you rely on if you need help after you're discharged from the hospital?" e. "What do you do to help manage the demands of parenting a 4 y/o and a newborn?" b, d, e When considering stress, what is the primary goal of making daily entries into a personal journal? a. providing a distraction from the daily stress b. expressing emotions to manage stress c. identifying stress triggers d. focusing on one's stress c. identifying stress triggers Jackson has suffered from migraine headaches all of his life. Fatima, his nurse practitioner, suspects muscle tension as a trigger fro his headaches. Fatima teaches him a technique that promoted relaxation by using: a. biofeedback b. guided imagery c. deep breathing d. progressive muscle relaxation d. progressive muscle relaxation Hugo is 21 and diagnosed with schizophrenia. His history includes significant turmoil as child and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother Hugo's early exposure to stress most likely: a. made him resilient to stressful situations b. increased his future vulnerability to psychiatric disorders c. developed strong survival skills d. shaped his nurturing nature B. increased his future vulnerability to psychiatric disorders Hugo has a fraternal twin names Franco who is unaffected by mental illness even though they were raised int he same dysfunctional household. Franco asks the nurse, "Why Hugo and not me?" The nurse replies: a. "Your father was probably less abusive to you." b. "Hugo likely has a genetic vulnerability." c. "You probably ignored the situation." d. "Hugo responded to perceived threats by focusing on an internal world." B. "Hugo likely has a genetic vulnerability." First responders and emergency department healthcare providers use dark humor in an effort to: a. reduce stress and anxiety b. relive the experience c. rectify mortal distress d. alert others to the stress A. reduce stress and anxiety Your 39 y/o patient Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is: a. mindfulness is focusing on an object and repeating a word or phrase while deep breathing b. mindfulness is progressively tensing, then relaxing, body muscles c. mindfulness is focusing on the here and now, not the pat or future, and paying attention to what is going on around you d. mindfulness is a memory system to assist you in short-term memory recall C. mindfulness is focusing on the here and now, not the pat or future, and paying attention to what is going on around you the Nurse is providing care for a pt demonstrating behavior w/ moderate levels of anxiety. what question should the nurse ask initially when attempting to help the pt deescalate their anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began to increase?" d. "Are you feeling anxious right now?" C. "Can you identify what was happening when your anxiety began to increase?" Which pt has an increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply a. Exacerbation of asthma signs and sx b. History of peanut and strawberry allergies c. history of chronic obstructive pulmonary disease d. current tx for unstable angina pectoris e. history of a traumatic brain injury A, C, D, E Which medication should the nurse be prepared to educate pt's on when they are prescribed a SSRI for panic attacks? a. Alprazolam (Xanax) b. Fluoxetine (Prozac) c. Clonazepam (Klonopin) d. Venlafaxine (Effexor) B. Fluoxetine (Prozac) Which statement(s) made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply a. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tension." b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterdays therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written description of the various relaxation exercises for you to review." B, C, D, E To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a pt who has been recently prescribed an antianxiety medication? a. Eating high protein foods b. Using acetaminophen without first discussing it with a healthcare provider c. Taking medications after eating dinner or while having a bedtime snack d. Buying a large coffee w/ sugar and extra cream each morning on the way to work D. Buying a large coffee w/ sugar and extra cream each morning on the way to work In a parent teacher conference, the school nurse meets w/ the parents of a profoundly shy 8 y/o girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognized that the child is most likely exposed to parental modeling and: a. the inherited shyness trait b. a lack of affection in the home c. severe punishment by the parents d. is afraid to say something foolish a. the inherited shyness trait Isabel is a straight A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states: a. "I would like to try a Benzodiapine for my anxiety." b. "If I study harder, my anxiety level will go down." c. "Mild anxiety is okay bc it helps me focus." d. "I have fear that I will fail at college." C. "Mild anxiety is okay bc it helps me focus." The activity of gamma-aminobutyric GABA) contributed to a slowing of neutral activity. Which of the following drugs facilitates the action of GABA? a. Benzodiapines B. Antihistimaines c. Anticonvulsants d. Noradrengic A. Benzodiapines Samantha is a new pt to the mental health clinic and is seeking assistance for what she describes as "Severe anxiety." In addition to daily self-medicating w/ alcohol, Samantha described long-term use of herbal kava. The nurse knows that kava is associated with inhibiting P450 and orders which of the following tests? a. electrocardiogram b. liver enzymes c. glomerular filtration rate d. complete blood count B. liver enzymes a homebound pt diagnosed w/ agoraphobia has been receiving therapy in the home. the nurse evaluated pt teaching is effective when the pt states: a. "I may never leave the house again." b. "having groceries delivered is very convenient" c. "my risk for agoraphobia is increased by my family history" d. "I will go out again, someday, just not today" C. "my risk for agoraphobia is increased by my family history" A nurse wants to teach alternative coping strategies to a pt experiencing severe anxiety. Which action should Nurse perform first? a. verify pt.'s learning style b. lower pt's current anxiety c. create outcomes and a teaching plan d. assess how the pt uses defense mechanisms B. lower the pt's current anxiety A pt experiencing moderate anxiety says "I feel undone." An appropriate response for the nurse would be: a. "what would you like me to do to help you?" b. Why do you suppose you are feeling anxious?" c. "I'm not sure I understand. Give me an example." d. "You must get your feelings under control before we can continue" c. "I'm not sure I understand. Give me an example." a pt fearfully runs from chair to chair crying, "They're coming! They're coming!" The pt does not follow the staff's directions or responses to verbal interventions. Which nursing diagnosis has the highest priority? a. fear b. risk for injury c. self-care deficit d. disturbed thought processes B. Risk for injury a pt fearfully runs from chair to chair crying, "They're coming! They're coming!" The pt does not follow the staff's directions or responses to verbal interventions. The initial nursing intervention of highest priority is to: a. provide for pt's safety b. encourage clarification of feelings c. respect pt's personal space d. offer an outlet for the pt's energy A. provide for the pt's safety A pt w/ an abdominal mass is scheduled for a biopsy. The pt has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the pt's level of anxiety? a. mild b. moderate c. severe d. panic B. moderate (rationale: the pt has "difficulty understanding") a pt undergoing a diagnostic test says, "nothing is wrong w/ me except a stubborn chest cold." The spouse reports the pt smokes, coughs daily, lost 15 lbs, and is easily fatigued. Which defense mechanism is the pt using? a. displacement b. regression c. projection d. denial D. denial A pt is experiencing moderate anxiety. The nurse encourages the pt to talk about feelings and concerns. What is the rationale for this intervention? a. offering hope allays and defuses the pt's anxiety b. concerns stated aloud become less overwhelming and help problem solving begin c. anxiety is reduced by focusing on and validating what is occurring in the environment d. encouraging pt's to explore alternatives increases the sense of controls and lessens anxiety B. concerns stated aloud become less overwhelming and help problem solving begin A nurse assess a pt w/ a tentative diagnosis of Generalized Anxiety Disorder. Which question would be most appropriate for the nurse to ask? a. "have you been a victim of a crime or seen someone badly injured or killed?" b. "do you feel especially uncomfortable in social situations involving people?" c. "do you repeatedly do certain things over and over again?" d. "do you find it difficult to control your worrying?" D. "do you find it difficult to control your worrying?" (rationale: GAD is defined as "Excessive worrying and anxiety") A person has minor physical injuries after an auto accident. The person is unable to focus, and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is this person's level of anxiety? a. mild b. moderate c. severe d. panic C. severe A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as: a. culturally influenced b. displacement c. trait anxiety d. mild anxiety D. mild anxiety A pt experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action. a. ask, "I'm not sure what you mean. Give me an example." b. capture the pt in a basket-hold to increase feelings of control c. tell the pt "Stop running and take a deep breath. I will help you." d. assemble several staff members and say, "we will take you to seclusion to help you regain control" C. tell the pt "Stop running and take a deep breath. I will help you." Which pt statement indicates the helpfulness of the nurse-pt relationship? a. "I appreciate the time you spent w/ me. I have a better understanding of what I can do to manage my problem" b. "I really need to talk w/ you. you always give me good advice about how to address my anger issues" c. "If it wasn't for you and the hours we've spent talking, I don't think I would be on my way to getting my anxiety under control" d. "you always showed my sympathy when I was at my lowest point after the sexual assault. knowing you had been there too was such a help" A. "I appreciate the time you spent w/ me. I have a better understanding of what I can do to manage my problem" A female nurse had been sexually assaulted as a teenager. she finds it difficult to work w/ pt's who have undergone the same trauma. What is the most helpful response? a. discussing these feelings w. the nurse supervisor b. requesting that these pt's not be a part of her assignment c. discussing these feelings w/ a mental health professional d. accepting her role in providing unbiased, respectful, and professional care to all pt's C. discussing these feelings w/ a mental health professional A pt whose history included experiences w/ abusive partners is being treated for major depressive disorder. The pt's care plan includes "rape-trauma syndrome" among its nursing diagnosis. What goal is directly associated w/ this diagnosis? a. remains free from self-harm b. wears appropriate clothing c. reports feeling strong and having a self of hopefulness d. demonstrates appropriate affect for both positive and negative emotions C. reports feeling strong and having a self of hopefulness The nurse is engaged in crisis intervention w/ a pt reporting, "I have no reason to keep on living." What is the nurse's initial intervention? a. advice pt about there services available to them b. ask the pt, "have you ever been this depressed before?" c. ask pt, "do you have any plan to hurt yourself or anyone else?" d. assure pt that he or she is in a safe place and will be well cared for C. ask pt, "do you have any plan to hurt yourself or anyone else? Which statement concerning a crisis experience is true and should be used as a guideline for crisis management care? Select all that apply a. a crisis is self-limiting and usually resolves in 4-6 weeks b. the earlier interventions are implemented, the better the expect prognosis c. the nurse should maintain a non directive role d. the pt in crisis is assumed to be mentally health and in an extreme state of disequilibrium e. the goal of crisis management is to return the pt to at least the pre-crisis level of functioning A, B, E Which statement about crisis theory will provide a basis for nursing intervention? a. a crisis is an acute time-limited phenomena experienced as an overwhelming emotion reaction to a problem perceived as unsolvable b. a person in crisis has always had adjustment problems and has coped inadequately in the usual life situations c. crisis is precipitated by an event that enhances a person's self-concept and self-esteem d. nursing intervention in crisis situations rarely has the effect of stopping the crisis A. a crisis is an acute time-limited phenomena experienced as an overwhelming emotion reaction to a problem perceived as unsolvable Lilly, a single mother of 4, comes to the crisis center 24 hrs after a fire in which all the houses within a one-block area were wiped out. All of Lill's household goods and clothing were lost. Lilly has no other family in the area. Her effort to mobilize assistance have been disorganized, and she is still w/o shelter. She is distraught and confused. You assess the situation as: a. a maturation crisis b. an adventitious crisis c. a crisis of confidence d. an existential crisis B. an adventitious crisis Lilly, a single mother of 4, comes to the crisis center 24 hrs after a fire in which all the houses within a one-block area were wiped out. All of Lill's household goods and clothing were lost. Lilly has no other family in the area. Her effort to mobilize assistance have been disorganized, and she is still w/o shelter. She is distraught and confused. Which intervention takes priority: a. reduce anxiety b. arrange shelter c. contact our of area family d. hospitalize and place pt on suicide percautions A. reduce anxiety Which belief would be least helpful for a nurse working in crisis intervention? a. a person in crisis in incapable of responding to instruction b. the crisis counseling relationship is one between partners c. crisis counseling helps the pt refocus to gain new perspectives on the situation d. anxiety-reduction techniques are used so the pt's inner resources can be accessed A. a person in crisis in incapable of responding to instruction b. the crisis counseling The highest-priorty goal of crisis intervention is: a. anxiety reduction b. identification of situational supports c. teaching specific coping skills that are lacking d. pt's safety D. pt's safety Which statement made by the pt demonstrates and understanding of the treatment of choice for pt's managing the effects of traumatic events? a. "I attend my therapy sessions regularly" b. those intrusive memories are hidden for a reason and should stay hidden" c. "keeping busy is the key to getting mentally healthy" d. "I've agreed to move in w/ my parents so I'll get the support I need" A. "I attend my therapy sessions regularly" Which goal should be addressed initially when providing care for 10 y/o Harper who is diagnosed w/ PTSD? a. harper will be able to identify feelings through the use of play therapy b. harper and her parents will have access to protective resources available through social services c. harper will demonstrate the effective use of relaxation techniques to restore a sense of control over disturbing thoughts d. harper and her parents will demonstrate an understanding of the personal human response to traumatic events c. harper will demonstrate the effective use of relaxation techniques to restore a sense of control over disturbing thoughts The care plan of a male pt diagnosed w/ a dissociative disorder includes the nursing diagnosis "ineffective coping." Which behavior by the pt supports this nursing diagnosis? a. has no memory of the physical abuse he endured b. using both alcohol and marijuana c. often reports being unaware of surroundings d. reports feelings of "not really being here" b. using both alcohol and marijuana Which statement accurately describes the effects of emotional trauma on the individual physically? a. emotional trauma is a distinct category and unrelated to physical problems b. the physical manifestations of emotional trauma are usually temporary c. emotional trauma is often manifested as physical symptoms d. pt's are more aware pf the physical problems caused by trauma c. emotional trauma is often manifested as physical symptoms the school nurse has bee alerted to the fact that an 8 y/o you routinely playacts as a police officer "locking up" other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of: a. the need to dominate others b. inventing traumatic events c. a need to develop close relationships d. a potential symptom of traumatization d. a potential symptom of traumatization A pregnant woman is in a relationship w/ a male who routinely abuses her. Her unborn child may engage in high-risk behavior as a tees as a result of: a. maternal stress b. parental nurturing c. appropriate stress responses in the brain d. memories of the abuse A. maternal stress Maggie, a child in protective custody, is found to have an imaginary friend, Holly. Her foster family shares this information w/ the nurse. The nurse teaches the family members about children who have suffered trauma and knows her teaching was effective when the foster mother states: a. "I understand that imaginary friends are abnormal" b. "I understand that imaginary friends are a maladaptive behavior" c. "I understand that imaginary friends are a coping mechanism" d. "I understand that we should tell the child that imaginary friends are unacceptable" c. "I understand that imaginary friends are a coping mechanism" An incest survivor undergoing treatment at the mental health clinic is relieved when she learns that her anxiety and depression are: a. going to be eradicated w/ tx b. normal and will soon pass c. abnormal but will pass d. a normal reaction to post traumatic events d. a normal reaction to post traumatic events During a routine health screening, a grieving widow whose husband died 15 months ago reports emptiness, a loss of self, difficulty thinking of the future, and anger at her dead husband. The nurse suggests bereavement counseling. The widow is most likely suffering from: a. major depression b. normal grieving c. adjustment disorder d. post traumatic stress disorder c. adjustment disorder A round child is found wandering along at a mall. A male store employee approaches and asks where her parents are. She responds, "I don't know. Maybe you will take me home w/ you?" This sort of response in children may be due to: a. a lack of bonding as an infant b. a healthy confidence in the child c. adequate parental bonding d. normal parenting A. a lack of bonding as an infant Which statement made by a 9 y/o after hitting a classmate is a typical comment associated w/ childhood conduct disorder? a. "I'm sorry, I won't hit him again" b. "He deserves it for being a sissy" c. "I didn't think I hit him very hard" d. "He hit me first. You just didn't see it" B. "He deserves it for being a sissy" What assessment data would support a diagnosis of conduct disorder? Select all that apply. a. evidence of social isolation b. arrested twice for disorderly conduct c. expresses difficult in keeping employment d. exhibits signs of chronic self-mutilation A, B, C Which event experienced in the pt's childhood increases the risk of the development of behaviors associated w/ intermittent explosive disorder? a. orphaned at age 4 b. physically abused from ages 3-10 c. born w/ a chronic congenital disorder d. one parent was diagnosed w/ OCD b. physically abused from ages 3-10 What is a common behavior observes in a pt diagnosed w/ intermittent explosive disorder? Select all that apply a. short attention span b. threatens suicide c. often purges after eating d. uses alcohol to excess e. states, "Everyone is out to get me" A, B, D When discussing oppositional defiant disorder w/ a group of parents, what information should the nurse include about the disorder? Select all that apply: a. classic sx include anger, irritation, and defiant behavior b. children generally outgrow the behaviors w/o formal treatment c. severity is considered mild when sx are present in only one setting d. disorder is diagnosed equally in both males and females e. argumentative and defiant are terms often used to describe the pt A, B, C, E Tommy, a 12 y/o boy admitted to the pediatric psychiatric unit, has recently been diagnosed w/ conduct disorder. In the activity room, the games he wanted to play were already in use. He responded by threatening to throw furniture and to hurt his peers who had the game he wanted. Nancy, a RN, recognizes that Tommy's therapy must include: a. consistency in implementing the consequences of breaking rules b. empathetic reasoning when Tommy acts out in the activity room c. teaching Tommy the benefits of socializing d. solitary time to that Tommy can think about his actions A. consistency in implementing the consequences of breaking rules Some cultures have lower rates of undiagnosed conduct disorders than observes in Western societies. The lower rate of incidence may be contributed to: a. strict parenting w/ corporal punishment b. cultural expression of anger as normal behavior c. parent's limited tolerance for externalizing behavior d. widespread acceptance of conduct disorders b. cultural expression of anger as normal behavior Larry, a middle-aged male in a treatment facility, is loudly displaying anger in the say room w/ a visiting family member. It is obvious to the nurse this pattern has played out before. Violence is often escalated when family members or authority figures: a. use a soft tone of voice to gain control of the situation b. move away from the agitated person in fear c. use simple words to communicate d. engage in a power struggle d. engage in a power struggle The impulse control spectrum can begin in childhood and continue on into adulthood, often morphing into criminal behaviors. Working w/ pt's diagnosed w/ these disorders, the best examples of expressed emotion by the nursing staff are: a. low to prevent emotional reactions b. matched to the pt's level of emotion c. flat w/o evidence of any emotional output d. high expression to improve therapeutic pt emotions a. low to prevent emotional reactions Claude is a new nurse on the psychiatric unit. He asks a senior nurse on staff for the "best advice" when working w/ oppositional defiant disorder. Which statement reflects advice on sold therapeutic communication? a. "when correcting behavior, use a loud firm tone" b. "use language beyond the pt's education level" c. "when setting limits, be specific and outline consequences" d. "an aggressive body language will make the pt's respect your position" c. "when setting limits, be specific and outline consequences" Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological sx. Channeling of emotions, conflicts, and stressors int physical sx is thought to be the cause in conversion disorder. Which statement is true? a. people w/ conversion disorder are extremely upset about often dramatic sx b. abnormal patterns of cerebral activation have been found in individuals w/ conversation disorder c. an organic cause is usually found in most cases of conversation disorder d. sx can be turns off and on depending on the pt's choice b. abnormal patterns of cerebral activation have been found in individuals w/ conversation disorder Melanie is a 38 y/o female admitted to the hospital to rule our a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may: a. consciously be trying to maintain her role of a sick pt b. not recognize her unmet needs to be cared for c. protect her child from illness d. recognize physical sx as a coping mechanism a. consciously be trying to maintain her role of a sick pt Which statement made by either the nurse or pt demonstrates and ineffective patient-nurse relationship? a. "I've given a lot of though about what triggers me to be os angry" b. "why do you think it's acceptable for you to be so disrespectful to staff?" c. "will your spouse be available to attend tomorrow's family group session?" d. "I wanted you to know that the medication seems to be helping me feel less anxious" b. "why do you think it's acceptable for you to be so disrespectful to staff? The pt expresses sadness as "being all alone w/ no one to share my life with." Which response by the nurse demonstrates the existence of a therapeutic relationship? a. "loneliness can be a very painful and difficult emotion" b. "let's talk and see if you and I have any interests in common" c. "I use Facebook to find people who share my love for cooking" d. "loneliness is managed by getting involved w/ people" a. "loneliness can be a very painful and difficult emotion" Which pt outcome is directly associated w/ the goals of a therapeutic nurse-patient relationship? a. pt will be respectful of other pt's on the unit b. pt will identify suicidal feelings to staff whenever they occur c. pt will engage in at least one social interaction w/ the unit population daily d. pt will consume a daily diet to meet both nutritional and hydration needs b. pt will identify suicidal feelings to staff whenever they occur What is the greatest trigger for the development of a pt's nurse focused transference? a. the similarity between the nurse and someone the pt already dislikes b. the nature of the pt's diagnosed mental illness c. the history the pt has w/ her parents d. the degree of authority the nurse has over the pt d. the degree of authority the nurse has over the pt Which pt statement demonstrates a value held regarding children? a. "Nothing is more important to me than the safety of my children" b. "I believe my spouse wants to leave both me and out children" c. "I don't think my child's success depends on going to college" d. "I know my children will help me through my hard times" a. "Nothing is more important to me than the safety of my children" Mary is a 39 y/o attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son cause her problems. Listening to Mary describe the problems the nurse displays therapeutic communication in which response? a. "I understand you are in a difficult situation" b. "thinking about being wronged repeatedly does more harm than good" c. "I feel bad about your situation, and I am so sorry it is happening to you and your family" d. "it must be so difficult to live w/ uncaring people" a. "I understand you are in a difficult situation" A RN is caring for an older male who reports depressive sx since his wife of 54 years died suddenly. He cries, maintains closed body posture, and avoids eye contact. Which nursing action describes attending behavior? a. reminding the pt gently that he will "feel better over time" b. using a soft tone or voice for questioning c. sitting w/ the pt and taking cues for when to talk or when to remain silent d. offering medication and bereavement services c. sitting w/ the pt and taking cues for when to talk or when to remain silent The nurse is interviewing a client admitted to an inpatient psychiatric unit with a diagnosis of depressive disorder. Which is the primary goal in the assessment phase of the nursing process for this client? A. To build trust and rapport. B. To identify goals and outcomes. C. To collect and organize information. D. To identify and validate the medical diagnosis. A. To build trust and rapport. Which nursing intervention would establish trust with a client who is experiencing concrete thinking? A. Being consistent in adhering to unit guidelines. B. Calling the client by name. C. Sharing what the client is feeling. D. Teaching the meaning of any idioms used. A. Being consistent in adhering to unit guidelines. Which is a nursing intervention that would promote the development of trust in the nurse-client relationship? A. Simply and clearly providing reasons for policies and procedures. B. Calling the client by name and title such as "Mr. Hawkins." C. Striving to understand the motivations behind the client's behavior. D. Taking the client's ideas into consideration when planning care. A. Simply and clearly providing reasons for policies and procedures. In a psychiatric inpatient setting, the nurse observes an adolescent client's peers calling the client names. In this context, which statement by the nurse exemplifies the concept of empathy? A. "I can see that you are upset. Tell me how you feel." B. "Your peers are being insensitive. I would be upset also." C. "I used to be called names as a child. I know it can hurt feelings." D. "I get angry when people are treated cruelly." A. "I can see that you are upset. Tell me how you feel." Which is the goal for the orientation phase of the nurse-client relationship? A. Explore self-perceptions. B. Establish trust. C. Promote change. D. Evaluate goal attainment. B. Establish trust. On an inpatient psychiatric unit, a client states, "I want to learn better ways to handle my anger." This interaction is most likely to occur in which phase of the nurse-client relationship? A. Pre-interaction phase. B. Orientation (introductory) phase. C. Working phase. D. Termination phase.. B. Orientation (introductory) phase. The nurse helps a client practice various techniques of assertive communication by giving positive feedback for improvement of passive-aggressive interactions. This intervention would occur in which phase of the nurse-client relationship? A. Pre-interaction phase. B. Orientation (introductory) phase. C. Working phase. D. Termination phase. C. Working phase On an inpatient psychiatric unit, the goals of therapy have been met, but the client cries and states, "I have to keep coming back to therapy to handle my anger better." This interaction occurs in which phase of the nurse-client relationship? A. Pre-interaction phase. B. Orientation (introductory) phase. C. Working phase. D. Termination phase. D. Termination phase The nurse reviews a client's record in preparation for client care. This action is one of the tasks that occur in a phase of the nurse-client relationship. What is the purpose of this phase? A. Getting to know each other and establishing trust. B. Implementing nursing interventions to achieve outcomes. C. Achievement of independence and maintenance of health without nursing care. D. Understanding the client's diagnosis and evaluating the nurse's attitudes D. Understanding the client's diagnosis and evaluating the nurse's attitudes A depressed client discussing marital problems with the nurse says, "What will I do if my husband asks me for a divorce?" Which response by the nurse would be an example of therapeutic communication? • 1. "Why do you think that your husband will ask you for a divorce?" • 2. "You seem to be worrying over nothing. I'm sure everything will be fine." • 3. "What has happened to make you think that your husband will ask for a divorce?" • 4. "Talking about this will only make you more anxious and increase your depression." 3. "What has happened to make you think that your husband will ask for a divorce The nurse states to a client on an inpatient unit, "Tell me what's been on your mind." Which describes the purpose of this therapeutic communication technique? A. To have the client choose the topic of the conversation. B. To present new ideas for consideration. C. To convey interest in what the client is saying. D. To provide time for the nurse and client to gather thoughts and reflect. A. To have the client choose the topic of the conversation. The nurse states to the client, "You say that you are sad, but you are smiling and laughing." Which describes the purpose of this therapeutic communication technique? A. To provide suggestions for coping strategies. B. To redirect the client to an idea of importance. C. To bring incongruences or inconsistencies into awareness. D. To provide feedback to the client. C. To bring incongruences or inconsistencies into awareness. A client asks the evening shift nurse, "How do you feel about my refusing to attend group therapy this morning?" The nurse responds, "How did your refusing to attend group make you feel?" This nurse is using which communication technique? A. Therapeutic use of "restatement." B. Nontherapeutic use of "probing." C. Therapeutic use of "reflection." D. Nontherapeutic use of "interpreting." C. Therapeutic use of "reflection." Which of the following are examples of nontherapeutic communication blocks? Select all that apply. A. "You acted out in group. It made the other clients uncomfortable." B. "Why did you refuse your medication this afternoon?" C. "I'm so sorry you feel that way. It is a feeling typical of hospitalized clients." D. "You just think that you are not getting better. You'll see. Everything will work out." E. "What I am hearing you say is that everyone is out to get you." B. "Why did you refuse your medication this afternoon?" C. "I'm so sorry you feel that way. It is a feeling typical of hospitalized clients." D. "You just think that you are not getting better. You'll see. Everything will work out." The nurse is attempting to establish a therapeutic relationship with an angry, depressed client on a psychiatric unit. Which is the most appropriate nursing intervention? A. Work on establishing a friendship with the client. B. Use humor to defuse emotionally charged topics of discussion. C. Show respect that is not based on the client's behavior. D. Sympathize with the client when the client shares sad feelings. C. Show respect that is not based on the client's behavior. A client has been fired from work because of downsizing. Although clearly upset, when explaining the situation to a friend, the client states, "Imagine what I can do with this extra time." Which defense mechanism is this client using? A. Denial. B. Intellectualization. C. Rationalization. D. Suppression. B. Intellectualization Which best exemplifies an individual's use of the defense mechanism of compensation? A. A woman feels unattractive but decides to pursue fashion design as a career. B. Ashy woman who abuses alcohol tells others that alcohol helps her overcome her shyness. C. A poorly paid employee consistently yells at his assistant for minimal mistakes. D. A teenager injures an ankle playing basketball and curls into a fetal position to deal with the pain. A. A woman feels unattractive but decides to pursue fashion design as a career. A client is admitted to the emergency department after a car accident but does not remember anything about it. The client is unconsciously using which defense mechanism? A. Undoing. B. Rationalization. C. Suppression. D. Repression. D. Repression. Which of the following are examples of cognitive responses to mild levels of anxiety? Select all that apply. A. Increased respirations. B. Feelings of horror or dread. C. Pacing the hall. D. Increased concentration. E. Heightened alertness. D. Increased concentration E. Heightened alertness Which is an example of a behavioral response to a moderate level of anxiety? A. Narrowing perception. B. Heart palpitations. C. Limited attention span. D. Restlessness. D. Restlessness. Which is an example of a physiological response to a panic level of anxiety? A. Inability to focus. B. Loss of consciousness. C. Dilated pupils. D. Possible psychosis. C. Dilated pupils. In which situation would the nurse suspect a diagnosis of social anxiety disorder? A. A client abuses marijuana daily and avoids social situations because of fear of humiliation. B. An 8-year-old child isolates from adults because of fear of embarrassment but has good peer relationships in school. C. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. D. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others. D. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others. Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. A. Chronic obstructive pulmonary disease. B. Hyperthyroidism. C. Hypertension. D. Diverticulosis. E. Hypoglycemia. A. Chronic obstructive pulmonary disease. B. Hyperthyroidism (Graves's disease). E. Hypoglycemia. Which of the following symptom assessments would validate the diagnosis of GAD? Select all that apply. A. Excessive worry about items difficult to control. B. Muscle tension. C. Hypersomnia. D. Excessive amounts of energy. E. Feeling "keyed up" or "on edge." A. Excessive worry about items difficult to control. B. Muscle tension. E. Feeling "keyed up" or "on edge." A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? A. Elopement precautions. B. Suicide precautions. C. Homicide precautions. D. Fall precautions. B. Suicide precautions. During an intake assessment, a client diagnosed with GAD rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? A. Teach the client relaxation techniques. B. Ask the client, "Do you have a plan to commit suicide?" C. Call the physician to obtain a prn order for an anxiolytic medication. D. Encourage the client to participate in group activities. B. Ask the client, "Do you have a plan to commit suicide?" Which of the following would the nurse expect to assess in a client diagnosed with PTSD? Select all that apply. A. Dissociative events. B. Intense fear and helplessness. C. Excessive attachment and dependence toward others. D. Full range of affect. E. Avoidance of activities that are associated with the trauma. A. Dissociative events. B. Intense fear and helplessness. E. Avoidance of activities that are associated with the trauma. A newly admitted client diagnosed with PTSD is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? A. Posttrauma syndrome R/T a distressing event AEB flashbacks and nightmares. B. Social isolation R/T anxiety AEB isolating because of fear of flashbacks. C. Ineffective coping R/T flashbacks AEB inappropriate use of alcohol. D. Risk for injury R/T exhaustion because of sustained levels of anxiety. D. Risk for injury R/T exhaustion because of sustained levels of anxiety. The nursing student is developing a plan of care for a client experiencing a crisis situation. Number the following in priority order for implementation of this plan. 1. - Assess for suicidal and homicidal ideation. 2. - Discuss coping skills used in the past and note if they were effective. 3. - Establish a working relationship by active listening. 4. - Develop a plan of action for dealing with future stressors. 5. - Evaluate the developed plan's effectiveness. 1. - Assess for suicidal and homicidal ideation. 3. - Establish a working relationship by active listening. 2. - Discuss coping skills used in the past and note if they were effective. 4. - Develop a plan of action for dealing with future stressors. 5. - Evaluate the developed plan's effectiveness. A client on an inpatient psychiatric unit is experiencing a flashback. Which intervention takes priority? A. Maintain and reassure the client of his or her safety and security. B. Encourage the client to express feelings. C. Decrease extraneous external stimuli. D. Use a nonjudgmental and matter-of-fact approach. A. Maintain and reassure the client of his or her safety and security. At an out-patient obstetric clinic, a pregnant client on welfare exhibits extreme anxiety when discussing a failure in school. This is an example of which type of crisis? A. Dispositional crisis. B. Crisis of anticipated life transition. C. Maturational/developmental crisis. D. Crisis reflecting psychopathology. B. Crisis of anticipated life transition A client is diagnosed with illness anxiety disorder. Which of the following assessment data validate this diagnosis? Select all that apply. A. Preoccupation with disease processes and organ function. B. Long history of "doctor shopping." C. Physical symptoms are managed by using the defense mechanism of denial. D. Depression and obsessive-compulsive traits are common. E. Social and occupational functioning may be impaired. A. Preoccupation with disease processes and organ function. B. Long history of "doctor shopping." D. Depression and obsessive-compulsive traits are common. E. Social and occupational functioning may be impaired. A client admitted with dissociative amnesia with dissociative fugue is being evaluated. Which of the following assessment information would indicate that the client is ready for discharge? Select all that apply. 1. The client is able to maintain reality during stressful situations. 2. The client is able to verbalize why alternate personalities exist. 3. The client is able to discuss feelings such as depersonalization. 4. The client is able to integrate subpersonalities into a whole personality. 5. The client is observed using relaxation techniques when visibly upset. 1. The client is able to maintain reality during stressful situations. 2. The client is able to verbalize why alternate personalities exist. 5. The client is observed using relaxation techniques when visibly upset. A client diagnosed with somatic symptom disorder visits multiple physicians because of various, vague symptoms involving many body systems. Which nursing diagnosis takes priority? 1. Risk for injury R/T treatment from multiple physicians. 2. Anxiety R/T unexplained multiple somatic symptoms. 3. Ineffective coping R/T psychosocial distress. 4. Fear R/T multiple physiological complaints. 1. Risk for injury R/T treatment from multiple physicians. A client who currently complains of vague weakness and multisystem symptoms has been diagnosed with a somatic symptom disorder. Which nursing intervention takes priority? 1. Discuss the client's symptoms to provide secondary gains. 2. Discuss the stressor that the client is experiencing. 3. Evaluate signs and symptoms, vital signs, and laboratory tests. 4. Teach the client appropriate coping mechanisms to deal with stress. 3. Evaluate signs and symptoms, vital signs, and laboratory tests. When admitting a child diagnosed with a conduct disorder, which symptom would the nurse expect to assess? A. Excessive distress about separation from home and family. B. Repeated complaints of physical symptoms such as headaches and stomachaches. C. History of cruelty toward people and animals. D. Confabulation when confronted with wrongdoing. C. History of cruelty toward people and animals. A child diagnosed with a conduct disorder is disruptive and nonadherent with rules in the milieu. Which correctly written outcome, related to this client's problem, should the nurse expect the client to achieve? • 1. The child will maintain anxiety at a reasonable level by day two. • 2. The child will interact with others in a socially appropriate manner by day two. • 3. The child will accept direction without becoming defensive by discharge. • 4. The child will contract not to harm self during this shift. • 3. The child will accept direction without becoming defensive by discharge.