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Which of the following would be the least useful strategy for an American nurse as he or she enters into a cross-cultural encounter with a female client from Japan?
1. Anticipate diversity.
2. Promote a feeling of acceptance.
3. Learn what it means to be the client by assessing health beliefs.
4. Facilitate communication by using direct eye contact and a handshake.
A mental health nurse with 3 years inpatient experience has been assigned to work in a medication follow-up clinic beginning Monday. The clinic sees culturally diverse clients. To prepare for work in the clinic it would be advisable for the nurse to
1. review the literature on cultural differences in client responses to psychotropic medications
2. read a handbook on the various health beliefs of members of diverse cultures
3. contact the clinical nurse specialist for guidelines for cultural competence
4. take a course in psychotropic pharmacology
A mental health nurse with 3 years inpatient experience is about to begin work in a medication follow-up clinic that serves a culturally diverse client population. Which way of sitting during an interview is most neutral and acceptable to people of most cultures?
1. sitting with legs crossed, leaning slightly backward in chair with one arm extended on the desk
2. sitting with feet on the floor and upper body leaning slightly forward toward client
3. sitting with one leg crossed and the upper body turned slightly away from client
4. sitting straight in chair with feet on the floor and arms crossed over chest
Which question would help the nurse assess power and control issues governing the availability of healing options for a woman of a culture with an interdependent worldview?
1. “What does someone of your culture call this illness?”
2. “How does someone with this illness usually behave?”
3. “How does being a woman affect someone with this illness?”
4. “How do people of your culture express dislike or displeasure?”
During the assessment interview the nurse has ascertained that the client follows cultural tradition and uses spiritual healing. Which question would help the nurse understand healing options available as part of this health system?
1. “What do people believe cause this illness?”
2. “Do people shun or avoid someone who has this illness?”
3. “Are there any ceremonies or prayers used to treat this illness?”
4. “What language do your people generally use when speaking among yourselves?”
1. A new nurse tells his mentor, “I want to convey to my clients that I am interested in them and that I want to listen to what they have to say.” Supervision reveals that the nurse does each of the following things. Which behavior is least helpful in meeting his goal?
1. He introduces himself to the client and identifies his staff role.
2. He sits with his body and head parallel to the client’s.
3. He uses facial expressions that convey interest and encouragement.
4. He assumes an open body posture and sometimes uses mirror imaging.
The nurse is talking with a young male client and has 5 minutes to go in the session with him. He has been silent and sullen most of the session, and has been staring at the floor for the last 10 minutes. A troubled young woman comes to the door of the room and says to the nurse, “I really need to talk to you.” The nurse should
1. end the session and spend time with the young woman
2. tell the woman she is busy at the present time
3. invite the woman to sit down and join in the session with her client
4. tell the woman that the session with this client will take 5 more minutes, after which she can have time to talk
Documentation in a client’s chart includes the following information: “Throughout a 5-minute interaction the client fidgeted and tapped his left foot, periodically covered his face with his hands, looked under his chair, while stating he was enjoying spending time with this nurse.” Of the following assessments, which is most accurate?
1. The client is giving positive feedback about the nurse’s communication techniques.
2. The nurse is viewing the client’s behavior through a cultural filter.
3. The client’s verbal and nonverbal messages are incongruent.
4. The client is demonstrating psychotic behaviors.
The nurse finds himself feeling angry with a client. The nurse should
1. tell the nurse manager to assign the client to another nurse
2. suppress the angry feelings
3. express the anger openly
4. discuss the anger with a clinician during a supervision session
During a nurse-client interview the client attempts to shift the session focus from himself to the nurse by asking personal questions. The nurse should respond by saying
1. “You have no right to ask questions about my personal life.”
2. “Nurses prefer to direct the interview.”
3. “You’ve turned the tables on me.”
4. “This time we spend together is for you to discuss your concerns.”
The nurse is working with a client who is having difficulty in staying focused. Which communication will help the client stay focused?
1. “Go on.”
2. “What would you like to discuss?”
3. “Are you hearing voices?”
4. “It seems as though you have having trouble staying focused.”
After several days of therapeutic encounters with P, a client who recently attempted suicide, what behavior would cause Nurse G to consider the possibility of countertransference?
1. P’s reactions toward him seem realistic and appropriate.
2. P states he is concerned about her, just like her father.
3. He feels exceptionally happy when P’s mood begins to lift.
4. He develops a trusting relationship with P.
As Nurse V considers her relationship with K, a client, at what point in the nurse-client relationship should she plan to first address the issue of termination?
1. in the working phase
2. in the termination phase
3. in the orientation phase
4. when the client initially brings up the topic
The nurse caring for a withdrawn suspicious client finds himself feeling angry with the client. The nurse should
1. suppress the angry feelings
2. express the anger openly
3. tell the nurse manager to assign the client to another nurse
4. discuss the anger with a clinician during a supervisory session
A client states, “I think people should be allowed to commit suicide with no one interfering.” A nurse replies, “You’re wrong! Nothing is ever so bad that dying is justified.” What assessment about this interchange is accurate?
1. The client is correct in his thinking.
2. The nurse is correct.
3. Neither person is totally correct.
4 .Differing values are reflected in the two statements
A nurse remarks to a peer, “All the literature tells nurses that relationships are facilitated by consistency. I wish someone would give me some concrete examples.” The least helpful response would be
1. “Have the same nurse care for a client on a daily basis.”
2. “Provide a schedule of client activities daily.”
3. “ Set a time for regular sessions with the client.”
4. “ Encourage the client to share initial impressions of staff.”
A client asks the nurse, “What are neurotransmitters? My doctor says they’re at the root of my problem.” The best reply would be
1. “You must feel relieved to know that your problem has a physical basis.”
2. “It’s a pretty high-level concept to explain. Perhaps you should ask the doctor to tell you more.”
3. “Neurotransmitters are substances we eat daily that influence the brain functions of memory and mood.”
4. “Neurotransmitters are chemicals manufactured in the brain that are responsible for passing messages between brain cells.”
The mother of an adolescent client with OCD tells the nurse, “My daughter’s doctor wants her to be in a research study and to have a PET scan. I don’t want her to have to go through any tests that are painful. What should I do?” The best reply for the nurse would be
1. “The doctor has made the diagnosis, but having a PET scan would confirm it.”
2. “You might want to ask who will pay for the PET scan, as they’re very expensive.”
3. “PET scans involve an injection and lying still while a machine visualizes brain activity.”
4. “PET scans involve passing an electrical current through the brain and can be uncomfortable.”
A client taking medication for his mental illness develops a profound sense of restlessness and an uncontrollable need to be in motion. The nurse can correctly hypothesize that these symptoms are related to the drugs
1. dopamine blocking effects
2. anticholinergic effects
3. endocrine stimulating effects
4. ability to stimulate spinal nerves
A nurse makes the assessment that the client demonstrates anxiety and a number of responses consistent with sympathetic nervous system stimulation. The nurse would expect the presence of a high concentration of
A client’s laboratory reports show marked deficiencies of both serum sodium and potassium. Based on this finding the nurse should assess the client for symptoms of electrical conduction problems
1. throughout the body
2. in skeletal muscle function only
3. in the central nervous system only
4. in the cardiac conduction system only
The teaching plan for a client taking clozapine should include the following instruction:
1. Report sore throat and fever immediately.
2. Avoid foods high in polyunsaturated fats.
3. Practice unprotected sex.
4. Use over-the-counter preparations for rashes.
The nurse is caring for clients taking various medications, including buspirone, Desyrel, Haldol, Tegretol, Nardil, and Risperdal. The nurse must check to ensure that a special diet has been ordered for each client receiving
1. buspirone and haloperidol
2. trazodone and carbamazepine
Clients taking phenelzine, an MAOI, must be on a tyramine-free diet to prevent hypertensive crisis.
The nurse must tell a client taking a drug that acts by inhibiting monoamine oxidase to avoid certain foods and drugs or risk
1. hypotensive shock
2. hypertensive crisis
3. cardiac dysrhythmia
4. cardiogenic shock
Two psychotic clients on the inpatient unit fight whenever they are together in the same room. During a team meeting, one nurse suggests the safety of the two clients is of paramount importance and that their treatment plans should call for both to be placed in seclusion to keep them from injuring each other. What is the significance of this suggestion?
1. It violates the civil rights of the two clients.
2. It reinforces the autonomy of the two clients.
3. It reveals that the nurse values the principle of justice.
4. It represents the intentional tort of battery.
In a treatment team planning meeting a nurse states her concern about whether the staff is behaving ethically in using restraint to prevent one client from engaging in self-mutilative behavior when the care plan for another self-mutilating client calls for one-on-one supervision. The ethical principle that should govern the situation is
A client tells the nurse, “When I saw my therapist yesterday, he made sexual advances. He stroked my breast and suggested that he will give me a pass to leave the hospital if I will meet him at his apartment.” What action should the nurse take?
1. None. Psychiatric clients are not reliable.
2. Report the client’s statements to the unit nurse manager.
3. Discuss the statements with the medical director.
4. Call the state medical board.
J became aggressive, struck another client, and required seclusion. Which of the following would be an appropriate way to document this event?
1. “Client apparently doesn’t like client X as evidenced by his striking client X when client attempted to leave day room to go to bathroom. Seclusion necessary at 2:15 pm. Plan: Maintain seclusion for 8 hours and keep this client and client X away from each other for 24 hours.”
2. “Seclusion ordered by Dr. at 2:15 pm when voices told the client to hit another client.”
3. “Client pacing, shouting at people not present in the environment. Chlorpromazine 50 mg p.o. at 1 pm with no effect by 2 pm. At 2:15 pm client shouted that he would punch the first person who got near him, then struck client X on the jaw with his fist as client X walked out of day room to go to bathroom. Client physically restrained by staff and placed in seclusion by order of Dr.”
4. “Seclusion begun at 2:15 pm. Maintained for 2 hours without incident.”
Which nursing intervention could be considered to violate the rights of the psychiatric client?
1. The nurse imposes suicide precautions before the client has been interviewed by the physician.
2. The nurse opens and reads mail the client has left at the nurse’s station to be mailed.
3. The nurse places the client’s expensive watch in the hospital safe.
4. The nurse reports overhearing the client tell a friend that he will spit out his oral medication.
M, age 26 months, is very negativistic. He refuses to have anything to do with toilet training and shouts “No!” all the time. Using Freud’s stages of psychosexual development, the nurse would assess M as being in the stage of development termed
M, age 26 months, is very negativistic. He refuses to have anything to do with toilet training and shouts “No!” all the time. His mother asks what might be the matter with M. The nurse can assess M as dealing with the psychosocial crisis of
1. autonomy versus shame and doubt
2. initiative versus guilt
3. industry versus inferiority
4. trust versus mistrust
M, age 26 months, is very negativistic. He refuses to have anything to do with toilet training and shouts “No!” all the time. His mother asks what might be the matter with M. According to Piaget’s stages of cognitive development, M would be in the period called
3. concrete operational
4. formal operational
Steve is M’s 4-year-old brother. He sometimes grabs toys away from M, saying “I want that!” Using Freudian theory the nurse can interpret this behavior as a product of impulses originating in the
A client mentions, “I’m going to be engaging in cognitive therapy. What can I expect from the sessions?” Which remark would the nurse, framing a reply, find inappropriate to include?
1. “The therapist will be active and questioning.”
2. “You may be given homework assignments.”
3. “The therapist will help you look at ideas and beliefs you have about yourself.”
4. “The goal is to increase your subjectivity about the thoughts that govern your behavior.”
A young male client in a therapy group relates to the therapist as one might to a parent. The client asks permission to attend activities, to socialize with others, etc. This phenomenon is known as
In which stage of a group’s development would the following interaction most likely occur? Leader: “Shall we begin?” Client 1: “Why do you ask us if we want to begin?” Client 2: “You ought to just tell us what you want us to do.” Leader: “You seem irritated.” Client 3: “We thought someone in this group would give us help with our problems, but you don’t give us any answers.”
During group therapy, T states, “When I first started in this group, B wasn’t able to make a decision. Now she can. She’s made a lot of progress. I’m beginning to think that maybe I can conquer my fears, too.” According to Yalom, this statement reflects
N has talked constantly throughout the group therapy session. She has repeated the same material several times. Other members were initially attentive, and then became bored and inattentive. Which intervention would be least effective for the nurse psychotherapist to take?
1.asking the group why they have permitted N to take up their time with her repetitions
2.asking the group members how they have felt when N repeated herself throughout the session
3.mentioning that the group seems withdrawn and uninterested
4.telling N she must allow others to have an opportunity to speak
The most effective actions the nurse psychotherapist can take will be those that encourage the group to solve its own problems.
A client with a dual diagnosis of bipolar disorder and alcoholism is referred to Alcoholics Anonymous. He asks what good meeting with a bunch of ex-drunks is going to do him. The answer that will give the client relevant information about AA is
1.“The group will work to help you create new defenses.”
2.“People with a common problem provide mutual support.”
3.“The group leader sets tasks for members to promote behavioral change.”
4.“You’ll have a sponsor who will watch you to prevent a return to drinking.”
Bowen’s approach to family therapy focuses on differentiation of members. A therapist using this approach would negotiate with the family to arrive at the outcome criteria. The family will
1.restructure dysfunctional triangles
2.use straight messages without manipulation
3.achieve greater individuation of members
4.assess itself in terms of life cycle stage and multicultural issues
D remarks to the nurse, “The family therapist mentioned that our family is enmeshed. Can you tell me what that means?” The best reply from the nurse would be
1.“It means that your family members don’t have a strong sense of their own individual selves.”
2.“It means that your communication patterns often give double messages. Your body language doesn’t match the meaning of what you say.”
3.“Enmeshment refers to the tendency of your family to try to maintain balance. When the balance tips, you take measures to restore the balance.”
4.“Enmeshment refers to blaming the weakest family member for all the troubles of the family.
Enmeshed families have unclear distinctions among family members
The J family has revealed that Mr. J has begun to be verbally abusive to his wife and physically abusive to his oldest son since he lost his job 3 months ago. The son is threatening to run away and the wife/mother has developed increased anxiety. An appropriate nursing diagnosis for the family would be
1.Ineffective coping related to job loss
2.Impaired parenting related to father beating son
3.Caregiver role strain related to increased tension between parents
4.Disabling family coping related to use of verbal and physical abuse
A woman tells the BSN-prepared community health nurse that she and her son, B, fight all the time since B started using drugs. B tells his mother when she counsels against drug use that his drug use is none of her business. The most effective nursing intervention would be to
1.arrange drug detox and rehabilitation for B
2.provide family therapy for both B and his mother
3.turn B in to the police
4.arrange a referral to a family counselor
The advanced practice nurse is assigned to be M’s case manager. Discharge planning includes return to independent living in the community, attendance at a day hospital program, and a maintenance medication program. The activity that the case manager would be least likely to assume would be
1.providing individual counseling
2.serving as M’s advocate with the landlord
3.coordinating services M will receive
4.transporting M within the community
Case management roles include counselor, advocate, teacher, community organizer, and coordinator of services.
While working with K to establish goals for treatment, the nurse believes that one particular client goal is not in the client’s best interest. The best action for the nurse would be to
1. remain silent
2. tell the client that the goal isn’t realistic
3. formulate a different, appropriate goal for the client
4. explore the negative consequences that might occur if the goal is achieved
Which of the following is a correctly written goal?
1. R will find positive outlets for his dependency needs by the end of his hospitalization.
2. By 4 pm A will state her anxiety level has lowered from severe to moderate.
3. B will decide on her future career plans by the end of the week.4. By May 15, S will communicate effectively with the nursing staff and other clients
Which statement made by D during the initial assessment interview can be identified as his chief complaint?
1. “I can always trust my wife.”
2. “You never know who will turn against you.”
3. “I’ve been hearing the voices of my dead parents.”
4. “I wish I knew what I’ve done to deserve so much persecution.”
When the nurse begins the assessment interview with B, age 72, she notes that the client gives answers to questions that seem somewhat vague or slightly unrelated to the question. The client also leans forward and frowns as she listens intently to the nurse. An appropriate question for the nurse to ask would be
1. “I notice you frowning. Are you feeling annoyed with me?”
2. “Are you able to hear clearly when I speak in this tone of voice?”
3. “You seem to be having some trouble focusing on what I’m saying. Is something distracting you?”
4. “How can I make this interview easier for you?”
A nurse is reluctant to ask questions related to spiritual matters when she interviews clients. At what point in the interview could the nurse logically ask the question, “Does your faith help you in stressful situations?”
1. during assessment of substance use and abuse
2. during assessment of client’s childhood
3. during assessment of client coping strategies
4. during client assessment of own symptoms
§ )” I want you to tell the person who did this what you just told me.”
§ b) “How do you know that this person has discussed group business with others.?”
§ c) “I would also be hesitant about sharing anything else in the group”d) “How do you feel about what that person did?
§ a) “What will you do if you get anxious again?”
§ b) “Have you spoken to your physician about changing your medication.”
§ c) “ Are you feeling anxious right now?”
§ d) “I think your anxiety is caused from too much medication.”
best response to give
§ There are no other voices in this room.”
§ b) “What are the voices telling you?”
§ c) “You are frightened?”
§ d) “What can you do to stop hearing voices?”
§ Living with someone who has an addiction must be painful.”
§ b) “How much does your husband drink?”
§ c) “How do your children feel about your husband’s drinking?”
§ d) “I think you should go to Al-Anon.”
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