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Psychiatric Mental Health Nursing 4th Edition Fortinash Worret Test Bank

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Psychiatric Mental Health Nursing 4th Edition Fortinash Worret Test Bank

  • ISBN-10:0323046754
  • ISBN-13:978-0323046756

 

Description

Psychiatric Mental Health Nursing 4th Edition Fortinash Worret Test Bank

  • ISBN-10:0323046754
  • ISBN-13:978-0323046756

 

 

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Fortinash: Psychiatric Mental Health Nursing, 4th Edition

 

Test Bank

 

Chapter 23: Therapies in Clinical Practice

 

MULTIPLE CHOICE

 

  1. Which intervention will be most valuable for the nurse in developing a therapeutic nurse-client relationship?
1. Administering the prescribed medications accurately
2. Interacting with members of the health care team
3. Being aware of therapeutic modalities
4. Possessing self-awareness and understanding

 

 

ANS:   4

Self-awareness is fundamental to development of effective use of self in the therapeutic relationship. Without self-awareness, the nurse cannot separate his or her own subjective beliefs from facts. Each of the other options is relevant to providing nursing care but is not basic to development of a relationship.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 521         OBJ:    3

TOP:    Communication                                  KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A new nurse asks the mentor, “How can I be sure I’m not developing a social relationship with a client?” The mentor uses as a basis for the response the fact that in a therapeutic relationship:
1. The focus is shared equally between the participants
2. Absence of boundaries is generally accepted
3. Time constraints do not apply
4. A specific client-centered goal is established

 

 

ANS:   4

In a therapeutic relationship the focus is on the client, boundaries are established early and maintained throughout, definite beginning and ending times are established, and the relationship has a specific client-centered goal.

 

DIF:    Cognitive Level: Application             REF:    Page 521         OBJ:    2

TOP:    Boundaries      KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. To plan care for a client with a psychiatric disorder, the nurse keeps in mind that the goal of a therapeutic relationship is to:
1. Accomplish tasks in a timely manner
2. Provide a support system for the client
3. Assist the client to become a healthy, responsible individual
4. Carry out relevant and necessary interventions for the client

 

 

ANS:   3

Assisting the client to become a healthier, more responsible person is the goal of a therapeutic relationship. The other options mention relevant activities, but none can be identified as the goal.

 

DIF:    Cognitive Level: Application             REF:    Page 521         OBJ:    2

TOP:    Milieu Therapy                                   KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. Which statement would the nurse use to describe the primary purpose of boundaries?
1. Boundaries define responsibilities and duties to one’s self in relation to others.
2. Boundaries determine objectives of the working stage of the relationship.
3. Boundaries differentiate the roles of the nurse and the client.
4. Boundaries prevent the possibility for undesired material to emerge during the interaction.

 

 

ANS:   1

Boundaries are the social, physical, and emotional limits of the interaction. As such, they serve to define the responsibilities and duties of the nurse in relation to the client. Options 2 and 3: Objectives and role are determined during the orientation stage. Option 4: Emergence of undesired material may be a significant issue for the client.

 

DIF:    Cognitive Level: Application             REF:    Page 521         OBJ:    1

TOP:    Boundaries      KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse is concerned that a client will not be able to trust her enough to establish a therapeutic relationship. Which action will best facilitate the development of trust?
1. Responding positively to the client’s demands
2. Following through with what was promised
3. Clarifying with the client when in doubt
4. Staying with the client for the entire shift

 

 

ANS:   2

Being consistent in keeping one’s word implies that the nurse is trustworthy and does what is agreed upon. 1. This action is nontherapeutic. Instead, the client will need to learn new techniques for meeting her needs. 3. Clarification is important but is not the best method for promoting trust. 4. Trust is better served by shorter contacts at agreed-upon intervals.

 

DIF:    Cognitive Level: Application             REF:    Page 521         OBJ:    2

TOP:    Therapeutic Interactions                    KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A nurse on the unit is meeting with her client for the first time. After introducing herself, which of these possible statements best defines the nurse’s role as the client’s ally and helper?
1. “I will work with your doctor to help you get better.”
2. “I’ll be working with you to look at problems that are troubling you.”
3. “Your medications will help you feel better as soon as they take effect.”
4. “You will be expected to attend group activities while you are here.”

 

 

ANS:   2

This statement clearly specifies the nurse’s purpose as a helping professional, and establishes the relationship as therapeutic, rather than social. 1. This statement is true but limiting. The nurse has independent functions. 3. This statement overlooks the contributions of staff and the therapeutic milieu. 4. Giving information is appropriate, but this statement does not define the nurse’s role as helper and ally.

 

DIF:    Cognitive Level: Evaluation              REF:    Page 522         OBJ:    3

TOP:    Client and Nurse Roles                      KEY:   Nursing Process: Evaluation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurses on the unit were planning care for a group of clients and determining whether they could best meet client needs in a task or a process group. Their decision was based on the understanding that a task group focuses on:
1. Relations among the members
2. Communication styles
3. Content issues
4. The “here and now”

 

 

ANS:   3

Content-oriented groups focus on goals and tasks of the group. Thus a task-oriented group would focus on content issues. 1. Process groups focus on interpersonal relationships. 2. This is not relevant to describing task-oriented groups. 4. This refers to dealing with issues that are taking place at the present time.

 

DIF:    Cognitive Level: Application             REF:    Page 524         OBJ:    2

TOP:    Task vs. Process Groups                    KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. The treatment team was engaged in planning how group therapy could be included as a part of the structured daily activities of the unit. A new team member asked, “Why is it so important to include group therapy for the clients?” The most accurate response would be based on the assumption that:
1. Psychopathology has its source in disordered relationships
2. Some persons do not relate well on an individual basis
3. Hidden agendas frequently surface in group sessions
4. Group therapy is far more cost-effective for the clients

 

 

ANS:   1

A key assumption of group therapy is that psychopathology has its source in disordered relationships. It follows that individuals will behave in the group as they do in other settings, so group provides an opportunity to help individuals develop more functional relationships. 2. This is not relevant to group work. It is dealt with in one-to-one therapy. 3. This is not a reason to offer group therapy. 4. This is not an assumption about the reason group therapy is effective.

 

DIF:    Cognitive Level: Application             REF:    Page 524         OBJ:    2

TOP:    Group Therapy                                   KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. Which client would the group co-leaders determine is demonstrating Yalom’s therapeutic factor termed universality?
1. Client A, who states he realizes he is not the only person who has a problem with loneliness
2. Client B, who displays dysfunctional interaction patterns learned in his family of origin
3. Client C, who states he finally feels a strong sense of belonging
4. Client D, who openly expresses his anger about his work

 

 

ANS:   1

Universality is the factor that refers to understanding that one is not unique, that others share thoughts, reactions, and discomforts like your own. Option 2 refers to corrective recapitulation of the family group. Option 3 provides an example of cohesiveness. Option 4 is an example of catharsis.

 

DIF:    Cognitive Level: Application             REF:    Page 526         OBJ:    2

TOP:    Universality    KEY:   Nursing Process: Evaluation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A nurse, leading an inpatient group dealing with women’s issues, identifies a client who is assuming the role of aggressor. Which behavior characterizes this role?
1. Seeking a position between contending sides
2. Mediating conflicts and disagreements
3. Attempting to manipulate others
4. Criticizing the contributions of others

 

 

ANS:   4

An aggressor acts in negative ways, displaying hostility, attacking the group, or criticizing the members. Option 1 describes the compromiser. Option 2 describes the harmonizer. Option 3 describes the dominator.

 

DIF:    Cognitive Level: Application             REF:    Page 527         OBJ:    2

TOP:    Individual Roles Within the Group    KEY:   Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse was reviewing notes she had written following a session with a family who had begun therapy in hopes of becoming a more unified family. Because of their schedules, they were feeling alienated and estranged from each other. Which statement by the 16-year-old son was considered by the therapist as positive evidence of movement toward problem resolution?
1. “I have stopped playing football since practice required me to be away from home so often.”
2. “Eating dinner with my parents on Sunday nights has helped us be more aware of each other’s needs.”
3. “Since my mother quit her job, she is more available to keep the home running smoothly.”
4. “My dad has stopped giving me advice on how to live my life.”

 

 

ANS:   2

This statement shows the family has made an effort to improve communication and deal with alienation without any one member bearing complete responsibility. 1. Withdrawing from the team suggests he felt solely responsible for the family problem. 3. Quitting the job suggests the mother saw herself as responsible; however, being home does not guarantee unification. 4. This suggests withdrawal of the father from participation in family matters.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 528         OBJ:    4

TOP:    Family Therapy                                  KEY:   Nursing Process: Evaluation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse and client were interacting during a one-to-one session on the psychiatric unit. In response to the nurse’s statement, “Tell me about your family,” the client became silent and displayed nonverbally that he was uncomfortable. Which of these statements reflects the nurse’s sensitivity to the client?
1. “I’m so sorry. I didn’t realize your family was a problem for you.”
2. “Learning to express negative feelings will assist you in getting well.”
3. “Perhaps you can talk about your feelings to the physician next time you meet.”
4. “That seems to be a difficult subject for you. We can discuss it later, if you prefer.”

 

 

ANS:   4

This response acknowledges the situation, is respectful, and refocuses the therapeutic interaction. Option 1 is not sensitively worded. Option 2 offers false reassurance and implies that feelings are negative. Option 3 represents avoidance of dealing with the client’s feelings.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 513         OBJ:    3

TOP:    Communication                                  KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. After attending a group session for 6 weeks, a client was terminating from the group. She believed she had successfully met her established objectives and could manage without the group support. When sharing her feelings about separating, the client stated, “I feel a bit sad and empty that I won’t be seeing you folks again.” What is the most accurate evaluation of the client’s statement?
1. It indicates regression and her lack of readiness to terminate.
2. Unconsciously, she is hoping she will be permitted to continue the group.
3. She is demonstrating normal feelings associated with termination.
4. She needs further evaluation by her therapist to determine readiness to terminate.

 

 

ANS:   3

The client is expressing feelings of sadness over the loss of the therapeutic group relationships that have been helpful to her. Such feelings are considered normal, just as they are considered normal when the nurse-client relationship terminates. 1. The feelings expressed are normal, not regressive. 2. No hidden meaning is present; the client openly expressed genuine feelings. 4. Further evaluation is not needed. The expression of feelings by the client is considered normal.

 

DIF:    Cognitive Level: Evaluation              REF:    Page 528         OBJ:    3

TOP:    Termination     KEY:   Nursing Process: Evaluation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A 60-year-old client on the psychiatric unit was angry because of a remark another client made to her. The client asked the nurse manager to help resolve the situation. Which action would best support the client’s feelings of safety when experimenting with new ways of being?
1. Offer to be present with the client as she discusses her feelings about the incident with the other client.
2. Intervene on the client’s behalf and sort out the incident with the other client.
3. Suggest that the client ignore the situation since the other client was probably not aware of her behavior.
4. Encourage the client to report the incident to the other client’s physician.

 

 

ANS:   1

Offering to be with the client affords her a safe nonthreatening opportunity to assume responsibility for meeting her own needs assertively. Option 2 removes the responsibility from the client. Option 3 supports passive behavior. Option 4. There is no need to bring in another person. The client is capable of addressing the problem herself.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 521         OBJ:    3

TOP:    Enabling a Client                               KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse knows that a client who is being admitted to the hospital has been approved for only a 4-day stay. This will require the nurse to:
1. Choose a specific theoretical model as the basis for care
2. Establish a relationship that is client-centered and goal-oriented
3. Focus on the milieu and psychopharmacology
4. Promote positive transference in the client

 

 

ANS:   2

All therapeutic relationships are client-centered and goal-oriented. This becomes critical when the stay is short and the issues of boundaries, safety, and trust must be addressed before beginning work on the identified problem. 1. This is not a requisite. 3. Milieu will be important, but psychopharmacology may not be used. 4. This is not a requirement.

 

DIF:    Cognitive Level: Application             REF:    Page 514         OBJ:    3

TOP:    Nurse-Client Relationship                  KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A client tells the nurse, “I really like you. You’re the only true friend I have.” The client’s remarks call for the nurse to revisit the issue of:
1. Boundaries
2. Trust
3. Safety
4. Countertransference

 

 

ANS:   1

The client’s remarks call for the nurse to remind the client of the parameters of the nurse-client relationship. The remark would also give the nurse the opening to go on to discuss the matter of friends. Options 2, 3, and 4: The client’s remarks do not suggest the need to deal with any of these three issues.

 

DIF:    Cognitive Level: Application             REF:    Page 521         OBJ:    2

TOP:    Boundary Development                     KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. By day 2 (the end of the orientation phase), which outcome can be identified for a newly admitted client? The client will demonstrate:
1. Ability to problem solve one issue
2. Trust in at least one nurse
3. Positive transference with a staff member
4. Ability to ask for help in meeting needs

 

 

ANS:   2

Establishing trust in the nurse is a fundamental task of the orientation phase of the relationship; thus it is an appropriate outcome to identify. When trust is present, the client is free to focus on the work and tasks of therapy. 1. This is an outcome appropriate for the working phase. 3. This would not be an identified outcome. 4. This would not be an identified outcome for the orientation phase.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 528         OBJ:    3

TOP:    Client and Nurse Roles

KEY:   Nursing Process: Outcome Identification

MSC:   NCLEX: Psychosocial Integrity

 

  1. The client and the nurse have agreed on problems to be addressed during a short course of outpatient therapy. At the beginning of the appointment, the client states, “I’d like to work on the issue of relationships today.” Which assessment can be made?
1. Nurse-client roles have not been clearly delineated.
2. The nurse should suggest several alternative behaviors.
3. The client must be able to manage emotions before continuing.
4. The relationship is moving from orientation to working phase.

 

 

ANS:   4

Once the client and nurse have collaborated to define and prioritize problems, the relationship moves from orientation to working phase. Options 1, 2, and 3 have no relevance to the scenario.

 

DIF:    Cognitive Level: Application             REF:    Page 528         OBJ:    2

TOP:    Client and Nurse Roles                      KEY:   Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity

 

  1. A nurse and client are entering the termination phase in the group experience. An important nursing intervention will be to:
1. Encourage the group to describe goals for change
2. Inquire whether the group needs more time to accomplish goals
3. Assist the group to explore alternative coping strategies for problems
4. Discuss feelings about termination with the group

 

 

ANS:   4

Healthy termination is facilitated when the group and nurse express reactions to termination. The nurse serves as a role model by being open and genuine as the feelings about the losses incurred with ending are discussed. On a positive note, accomplishments and growth are acknowledged and the transfer of safety and trust to the group members are accomplished. Option 1 is accomplished in the orientation phase. Option 2 is part of the working phase in a relationship that does not have a strict time limit. Option 3 would be part of the working stage.

 

DIF:    Cognitive Level: Application             REF:    Page 528         OBJ:    2

TOP:    Termination     KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A client attending group therapy has improved greatly and is near discharge. The client mentions, “In the beginning, I was so sick that everyone had to help me. For the last few days, it’s felt good to be able to give something back to the group.” This statement can be assessed as an example of Yalom’s factor of:
1. Altruism
2. Harmonizing
3. Cohesiveness
4. Imitative behavior

 

 

ANS:   1

Altruism refers to the experience of being helpful to others and is clearly what the client is displaying in the scenario. The other factors are not applicable.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 526         OBJ:    3

TOP:    Altruism          KEY:   Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity

 

  1. The family of a teenage boy has been referred by the school to the mental health clinic for family therapy related to the boy’s truancy and emotional outbursts. During the first interview the mother asks the nurse, “Why are you bothering to ask the rest of us questions? My son is the one with the problems.” The best response for the nurse would be:
1. “We’ll get more accurate information if the entire family is involved.”
2. “It may seem strange to you, but we’ll get better results this way.”
3. “When one member is sick, the whole family system is sick.”
4. “Every family member’s perceptions are important to the total picture.”

 

 

ANS:   4

This response orients the family to the idea that each person’s opinion will be valued. Having the family present for assessment prepares them for working together to identify family issues, identify outcomes, and solve problems. Option 1 may or may not be true. Option 2 doesn’t convey the real reason. Option 3 is pessimistic and conveys a threatening message.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 528         OBJ:    4

TOP:    Family Therapy                                  KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. After a nurse who had worked with persistently mentally ill clients transfers to the short-term inpatient unit, he tells his mentor, “I’ll never get used to playing cards or other games with clients. It seems like a poor use of scarce nursing time.” The best response for the mentor would be:
1. “Perhaps you’ll want to rethink your transfer to this unit if you’re really uncomfortable.”
2. “Your comments make a point about scarce resources. I’ll ask the treatment team to review our position on activities.”
3. “Activity co-leadership puts us in a position to help clients develop social skills and support them as they take small risks.”
4. “Managed care has cost us activities therapists. Activities are necessary to give clients something to do, so we have to fill in.”

 

 

ANS:   3

Nurses who engage in co-leadership of therapeutic activities recognize that each activity contributes to outcome attainment. During activities clients practice skills needed in life situations, process emotions, and give and receive validation and feedback. Option 1 is not supportive of the nurse. Options 2 and 4 do not acknowledge the value of activities therapy.

 

DIF:    Cognitive Level: Application             REF:    Page 533         OBJ:    3

TOP:    Activity/Adjunct Therapy: Nurse as Activities Co-Therapist

KEY:   Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the primary reason for the nurse to have an understanding of the various types of activity and adjunct therapies?
1. The nurse is expected to interpret clients’ involvement in the therapies.
2. The nurse needs to be supportive of the treatment team members who direct these       therapies.
3. The nurse is responsible for placing the client in the appropriate group.
4. The nurse chooses the most cost-effective therapy group.

 

 

ANS:   1

The nurse must interpret to clients and others that the purpose of activity therapies is to increase client awareness of feelings and behaviors and to minimize pathology and promote mental health. 2. This is true but not the primary reason. 3. This is the responsibility of the treatment team. 4. This is not the primary reason the nurse needs knowledge of activity therapy.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 533         OBJ:    5

TOP:    Activity Therapy                                KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse notes that an anxious client sits tensely and moves stiffly. Which of the activity therapies should the nurse recommend to the treatment team to assist the client to relieve tension and achieve increased body awareness?
1. Psychodrama
2. Music therapy
3. Dance therapy
4. Recreation

 

 

ANS:   3

The large movements involved in dance therapy would enable the client to relieve tension and move with greater body awareness and freedom. The other options will not promote body awareness.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 533         OBJ:    5

TOP:    Activity Therapy                                KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. To effectively plan care for a client, the nurse will understand that activity and adjunct therapies may be more useful in some situations than verbal therapies because adjunct therapies:
1. Allow the client to express feelings on multiple levels at the same time
2. Do not require specific training or expertise to facilitate
3. Provide the client the opportunity to use ego-protective mechanisms
4. Are readily available in the treatment setting

 

 

ANS:   1

A client is able to express feelings on the emotional, physical, and symbolic level during activity therapy, whereas verbal therapies are limited to one dimension. 2. The primary facilitator of the selected therapy is required to have formal education and supervised experience. 3. Adjunct therapy does not provide this opportunity, which would be considered nontherapeutic. 4. This is not always the case.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 533         OBJ:    5

TOP:    Activity Therapy                                KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. A client is scheduled to attend an occupational therapy group to work on the identified goal of “recognizing and using more effective coping techniques.” What measure can the nurse use to continue to support the client’s attainment of this goal after he returns to the unit?
1. Avoiding setting limits that would increase his anxiety level
2. Praising him for positive behavioral changes
3. Isolating him from more seriously ill clients
4. Permitting him to make mistakes prior to intervening on his behalf

 

 

ANS:   2

Recognizing and pointing out positive changes provides encouragement to continue pursuing change. Options 1, 3, and 4 would not achieve the nurse’s goal.

 

DIF:    Cognitive Level: Application             REF:    Page 534         OBJ:    5

TOP:    Activity Therapy                                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A female nurse is assisting the recreational therapist with a dance activity for a mixed adult inpatient group of clients. How can the nurse encourage an extremely shy male client to participate?
1. Offer to dance with the client.
2. Ask the client if this is the first dance he has attended.
3. Sit with the client away from the group.
4. Encourage another client to ask him to dance.

 

 

ANS:   1

If trust has been established, the client may feel safe enough to dance with the nurse. If trust has not yet been established the client will see the nurse’s invitation as demonstrating respect and reaching out to him. Either way, the action will encourage participation. Options 2 and 3 do not encourage participation. 4. The nurse should not make another client responsible for this client’s participation.

 

DIF:    Cognitive Level: Application             REF:    Page 533         OBJ:    5

TOP:    Activity Therapy                                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A 12-year-old client was referred for art therapy. The nurse and the therapist directing the activity assessed the client’s level of functioning as age-appropriate. Which art materials have the potential to promote regression?
1. Colored pens and pencils
2. Magic markers and crayons
3. Large unlined paper
4. Finger paints and Play-doh

 

 

ANS:   4

Finger paints and Play-doh are useful for preschool children. Options 1 and 2 would be age-appropriate media. Option 3 would promote free expression.

 

DIF:    Cognitive Level: Application             REF:    Page 534         OBJ:    5

TOP:    Art Therapy     KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

  1. A new client describes having been in an outpatient group in which he reenacted troublesome incidents with his wife. Other clients served as “alter egos.” From this description, the nurse can document that the client had been engaged in:
1. Role-playing
2. Psychodrama
3. Cognitive therapy
4. Consensus building

 

 

ANS:   2

Psychodrama uses spontaneous dramas to act out emotional problems to promote health through development of new perceptions, behaviors, and connections with others. Others in the group take the role of significant others. 1. Role-playing does not use the technique of alter egos. 3. This is not a description of cognitive therapy. 4. Consensus building is not a form of therapy.

 

DIF:    Cognitive Level: Application             REF:    Page 534         OBJ:    5

TOP:    Activity/Adjunct Therapy: Psychodrama

KEY:   Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse is collecting the paintings from the clients after the art session is over. A client hands the nurse his paper, which consists of several black scribbles. Which statement reveals nurse understanding of the goals and objectives of art therapy?
1. “(Name), do you want to complete your painting?”
2. “What happened, (Name), don’t you like to paint?”
3. “Can you tell me what happened, (Name)?”
4. “Thank you, (Name), I’ll put this away for you.”

 

 

ANS:   4

Art therapy is used to help resolve conflicts and promote self-awareness. The nurse should not comment on the quality of the art or the client’s talents, but rather treat the project with respect and value. The work is simply each client’s self-expression. The other options make judgments about the work.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 534         OBJ:    5

TOP:    Activity/Adjunct Therapy: Art Therapy

KEY:   Nursing Process: Evaluation              MSC:   NCLEX: Psychosocial Integrity

 

  1. A student asks the nurse, “Why do you go to music therapy every morning at 10?” The nurse explains the nurse’s role in music therapy as:
1. Noting client verbal and nonverbal expression of feelings
2. Teaching clients about various styles of music
3. Fostering and encouraging performance talent
4. Selecting and playing numbers that will reduce anxiety and stress

 

 

ANS:   1

A goal of music therapy is to promote expression and social connection. The nurse should observe and document expression of feelings as they occur. The observations may be used later, as a basis for further consideration by the nurse and client. The other options do not reflect aspects of the nurse’s role in music therapy.

 

DIF:    Cognitive Level: Application             REF:    Page 534         OBJ:    5

TOP:    Music Therapy                                   KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. When an orientee asks why the unit has a multidisciplinary approach to therapeutic activities, the nurse should explain that multidisciplinary collaboration:
1. Produces a higher level of insurance reimbursement
2. Reduces the incidence of aggressive behavior by clients
3. Produces quicker results and earlier discharge to the community
4. Produces better outcomes when client problems are viewed from multiple perspectives

 

 

ANS:   4

Broader input in problem identification and resolution enhances client outcomes. Options 1, 2, and 3 are either untrue or not relevant.

 

DIF:    Cognitive Level: Application             REF:    Page 533         OBJ:    5

TOP:    Activity Therapy                                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. When a client asks the nurse, “How can jolting me with an electrical shock possibly do me any good?” the answer most reflective of current biologic theory would be:
1. “ECT produces a change in brain chemistry that results in improved mood.”
2. “ECT provides you with external punishment so you can stop punishing yourself.”
3. “ECT interrupts brain impulses causing hallucinations and delusions.”
4. “ECT must sound like a very frightening treatment alternative to you.”

 

 

ANS:   1

Current theory regarding use of ECT is that the electrical stimulus causes electrochemical changes within the brain, resulting in increased availability of neurotransmitters at the synapses and improvement of mood. The other options do not address current biologic theories.

 

DIF:    Cognitive Level: Application             REF:    Page 534         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. Which statement made by a client about a half hour before a scheduled ECT treatment would result in cancellation of the treatment?
1. “I’ll be so glad when this treatment is over.”
2. “Will I remember having this treatment?”
3. “I just had some crackers and milk, since I’ll miss breakfast.”
4. “I’m so tired of being depressed.”

 

 

ANS:   3

Since the client is to receive general anesthesia and has orders to remain NPO, the nurse should notify the physician immediately. The introduction of food into the stomach could result in aspiration of stomach contents during treatment. The other options offer no contraindication to treatment.

 

DIF:    Cognitive Level: Application             REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. The physician has ordered atropine 0.5 mg IM for a client to be administered 30 minutes prior to ECT. The rationale for use of this medication is that it reduces secretions and:
1. Protects against vagal bradycardia
2. Prevents incontinence of urine
3. Reduces the need for recovery room staff
4. Improves the scope of convulsive activity

 

 

ANS:   1

Atropine is used for its ability to prevent vagal bradycardia associated with the electrical stimulus. The other options are either irrelevant or untrue.

 

DIF:    Cognitive Level: Application             REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. Which statement by a client who has given informed consent for ECT confirms the client’s understanding of the side effects of this treatment?
1. “I won’t remember the pain.”
2. “It will take several weeks before I feel good again.”
3. “Memory loss will be only temporary.”
4. “I will be at increased risk for developing epilepsy.”

 

 

ANS:   3

Temporary impairment of recent memory is an expected side effect that occurs to some degree during the course of ECT. The other options suggest the client’s understanding of treatment and side effects is flawed.

 

DIF:    Cognitive Level: Evaluation              REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. In the ECT treatment preparation period the morning of treatment, the nurse should:
1. Adequately hydrate the client
2. Assess cognitive function
3. Have the client exercise for 10 minutes
4. Ensure that the client does not void

 

 

ANS:   2

Client assessment is advisable to provide a baseline against which changes resulting from ECT can be measured. While taking vital signs and performing other preparatory tasks, the nurse can assess orientation, immediate memory, thought processes, and attention span. The other options are interventions the nurse should not undertake.

 

DIF:    Cognitive Level: Application             REF:    Page 534         OBJ:    6

TOP:    ECT: Pretreatment Nursing Care       KEY:   Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity

 

  1. Immediately after ECT, nursing care of the client is most similar to care of a client:
1. With severe dementia
2. With delirium tremens
3. Recovering from conscious sedation
4. Recovering from general anesthesia

 

 

ANS:   4

The client who has ECT receives a short-acting IV anesthetic and a skeletal muscle relaxant. Thus care is most similar to the client recovering from general anesthesia. The nurse will assess vital signs, quality of respirations, presence or absence of the gag reflex, level of consciousness, orientation, and motor abilities during the posttreatment period.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A new nurse who will be assessing a client who is receiving ECT asks her mentor, “What sort of memory impairment is present after several ECT treatments?” The best response for the mentor would be:
1. “It’s hard to say. Treatment affects everyone differently.”
2. “Usually the client has severe difficulty remembering remote events.”
3. “Clients have mild difficulty remembering recent events like what was eaten for breakfast.”
4. “Both recent and remote memory is affected, producing profound confusional states.”

 

 

ANS:   3

Most clients experience transient recent memory impairment after ECT. The cognitive deficit becomes more pronounced as the number of treatments increases. When the course of treatments is completed, cognitive deficit generally improves to the pretreatment level. The other options are incorrect.

 

DIF:    Cognitive Level: Application             REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. About an hour after the client has ECT, he complains of having a headache. The nurse should:
1. Notify the physician stat
2. Administer a prn dose of acetaminophen
3. Take the client through a progressive relaxation sequence
4. Advise going to activities to expend energy and relieve tension

 

 

ANS:   2

Post-ECT headache is common. Most physicians routinely write a prn order for a headache remedy. Option 1 is unnecessary, since this is an expected side effect. Options 3 and 4 would not be as useful as medication in this instance.

 

DIF:    Cognitive Level: Application             REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. For which client is the nurse most likely to need to schedule a pre-ECT workup and teaching?
1. Client A, who is newly diagnosed with dysthymic disorder
2. Client B, who has melancholic depression that responded well to ECT 2 years ago
3. Client C, who was unresponsive to a 6-week trial of SSRI antidepressant
4. Client D, who has depression associated with diagnosis of inoperable brain tumor

 

 

ANS:   2

Indications for ECT include clients with major mood disorders, clients who have responded to ECT in the past, clients who are unresponsive to antidepressants or unable to tolerate their side effects and clients who are acutely suicidal or in danger of fluid and electrolyte imbalance related to inability to eat due to depression, severe mania, or severe catatonia. 1. Clients with dysthymia are not candidates for ECT. 3. This client has not run out of medication options. 4. Clients with space-occupying lesions of the brain are not candidates for ECT.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. Which nursing intervention will the nurse anticipate taking in the first half hour after the client has received ECT?
1. Continually stimulate client to respond, using physical and verbal means.
2. Continue bagging client to improve respiratory function until client is responsive for 10 minutes.
3. Reorient as necessary to time, place, and person as client level of consciousness improves.
4. Encourage walking and eating breakfast as quickly as possible.

 

 

ANS:   3

Client memory is likely to be impaired in the immediate post-ECT period. Reorientation will be necessary to help the individual return to a functional state. 1. Continual stimulation is not necessary. 2. This is unnecessary. 4. The client may be allowed to rest and recover at his own pace.

 

DIF:    Cognitive Level: Application             REF:    Page 535         OBJ:    6

TOP:    ECT                KEY:   Nursing Process: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. What milieu factor would need most attention from the nurse who is caring for a client who has received six ECT treatments and has two more scheduled?
1. Boundary maintenance
2. Trust attainment
3. Safety
4. Therapeutic activities

 

 

ANS:   3

To feel safe, clients need to know what is expected of them in their role as clients. The client receiving ECT often has impaired recent memory and may become confused about the milieu and expectations. The nurse will need to reorient and reteach the client with cognitive deficit. Options 1, 2, and 4 will require attention but not to the same extent as safety.

 

DIF:    Cognitive Level: Analysis                  REF:    Page 534         OBJ:    6

TOP:    ECT: Milieu: Safety                          KEY:   Nursing Process: Planning

MSC:   NCLEX: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. During a nurse-client interaction, the nurse will identify cognitive errors when he or she hears which of these statements? (You may select more than one answer.)
1. “I think I will do well on the next exam, because I have studied.”
2. “I failed the last exam; I know I will fail the next one.”
3. “Whenever I burn the toast in the morning, I know the whole day will be a mess.”
4. “I never do anything right.”
5. “My parents had a lot of problems, but I have learned from their mistakes.”

 

 

ANS:   2, 3, 4

Option 1 is a rational thought. Option 2 is the cognitive error of overgeneralization. Option 3 is catastrophizing. Option 4 is overgeneralization. Option 5 is a rational thought.

 

DIF:    Cognitive Level: Application             REF:    Page 518         OBJ:    2

TOP:    Cognitive Errors                                 KEY:   Nursing Process: Assessment

MSC:   NCLEX: Psychosocial Integrity