Chapter 8: Skills and Principles of Mental Health Care Nursing School Test Banks

Chapter 8: Skills and Principles of Mental Health Care
Test Bank

MULTIPLE CHOICE

1. An adult female client becomes combative with the nurse during routine medication administration. What is the nurses primary responsibility in this situation?
a. To ensure that the client takes her medications
b. To ensure that the client is placed in physical restraints to protect the safety of the staff and other clients
c. To ensure that chemical restraints are used in the future until the client displays more appropriate and compliant behavior
d. To ensure that the client is kept safe while trying to protect staff safety and to reason with the client to try to de-escalate the combative behavior
ANS: D
The do no harm principle of mental health care applies to this situation. Client and staff safety are imperative. Ensuring that the client takes her medications is not of greatest concern in this situation because this most likely would cause increased combativeness. Physical restraints and chemical restraints are not reasonable options in the care of this patient.

DIF: Cognitive Level: Application REF: p. 80 OBJ: 2
TOP: Do No Harm KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

2. A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action by the nurse is going to best promote development of a mutually trusting relationship?
a. At the beginning of the shift, the nurse promises to play a game of cards with the client at some point during that day and does so before the end of the shift.
b. The nurse promises to play a game of cards with the client on the following day.
c. The nurse leads a group discussion with clients about ways to develop trust in a relationship.
d. The nurse gives the client written information about the medications he is taking.
ANS: A
Developing mutual trust is one of the principles of mental health care. The nurse most likely would be able to carry out plans on a daily basis rather than trying to make plans for the next day. Making plans with the client is a very effective way to develop trust, as long as the plans can be carried out. Leading a group discussion and giving written information are helpful to clients but are not going to promote development of trust in the same way that making plans and carrying them out would do.

DIF: Cognitive Level: Application REF: p. 81 OBJ: 3
TOP: Develop Mutual Trust KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

3. An adult female client is exhibiting behavior that the nurse interprets as anger toward another client. What is the nurses best action?
a. Continue to monitor the clients behavior and document it as anger directed toward another client.
b. Talk with the client about the observations made, and ask whether she was displaying anger toward the other client.
c. Ask the other client if she felt that the client was angry with her.
d. Ask the client to write in a journal the emotions she was feeling at that time.
ANS: B
Asking the client is an effective way of understanding the meaning of her behavior and is one of the principles of mental health care. Documentation of the nurses interpretations without clarification would not be appropriate, nor would involving another client by asking for her interpretation of the situation. Asking the client to write in a journal is fine, but not in this circumstance.

DIF: Cognitive Level: Application REF: p. 82 OBJ: 3
TOP: Explore Behaviors and Emotions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

4. A nurse and an adolescent female client develop a plan of care together that addresses the clients difficult relationship with her parents. The client says that her parents just dont understand her, and she is always getting privileges taken away for not doing things that she is supposed to do. What is the nurses best action?
a. Talk with the client about how important it is that she carry through with actions that her parents feel are important.
b. Identify two priority responsibilities that are agreed upon between the client and her parents, and monitor her ability to comply with the plan for 1 week.
c. Discuss with the parents what responsibilities they feel are important, to determine what actions should be planned with the client.
d. Identify what the client feels are reasonable responsibilities.
ANS: B
Responsibility is one of the principles of mental health care that should be fostered. It is important to work in conjunction with all involved parties to set a realistic goal and plan of action. Remaining options do not include all parties and do not set a realistic goal or plan.

DIF: Cognitive Level: Application REF: p. 83 OBJ: 3
TOP: Encourage Responsibility
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

5. __________ coping mechanisms are means of successfully solving a problem or reducing ones stress level.
a. Defensive
b. Maladaptive
c. Constructive
d. Individual
ANS: C
Constructive, or adaptive, coping mechanisms are effective because they deal with the problem to attempt to solve it and in turn reduce stress. Defensive and maladaptive mechanisms do not deal with the problem effectively. Individual coping mechanisms may or may not be effective.

DIF: Cognitive Level: Knowledge REF: p. 84 OBJ: 3
TOP: Encourage Effective Adaptation KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

6. A married woman, who is the mother of two children, has been in an abusive relationship for 4 years. She decides to leave her husband after suffering an episode of severe physical abuse. She and her children, ages 7 and 9, arrive at a crisis intervention center. What is the nurses priority intervention?
a. Offer immediate emotional support.
b. Refer her to a womans domestic abuse center.
c. Begin to develop a treatment plan for the client and her children.
d. Thoroughly assess the situation from most recent to 2 weeks prior to this incident.
ANS: A
All of the options are steps in the crisis intervention process, but emotional support is the first priority for helping to reduce high anxiety levels.

DIF: Cognitive Level: Application REF: p. 85 OBJ: 5
TOP: Crisis Intervention KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

7. A male client with the diagnosis of depression has not attended his last two group meetings. The nurse provides a printed schedule of meeting dates and times to the client the next time she sees him. The nurses actions can be described as:
a. Insight
b. Self-awareness
c. Empathy
d. Client advocacy
ANS: D
Advocacy is when the nurse works on behalf of the client by providing him with the tools needed to make decisions. It is especially important to be an advocate for clients with mental health disorders because it often is difficult for them to make informed decisions. Insight refers to the ability to see intuitively, self-awareness is looking into and analyzing oneself, and empathy encompasses the ability to understand and enter into another persons emotions. All of the options listed are skills needed if mental health care workers are to practice effectively.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 9
TOP: Caring KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

8. An adolescent female client continually displays a negative attitude toward everyone she comes into contact with and toward life in general. Which action should the nurse implement first that will be helpful in assisting this client to develop a more positive attitude?
a. Helping the client recognize negative thoughts, emotions, and attitudes
b. Pointing out every negative behavior that the client displays
c. Assisting the client to replace negative thoughts by frequently repeating positive statements
d. Praising positive behavior exhibited by the client
ANS: A
The nurse must help the client to identify negative thoughts, emotions, and attitudes before the client can concentrate on changing this behavior. Pointing out every negative behavior would not be therapeutic, and assisting the client to replace negative thoughts and praising positive behavior promote development of a positive attitude but do not constitute the first step.

DIF: Cognitive Level: Application REF: p. 89 OBJ: 10
TOP: Positive Outlook KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

9. A caregiver is said to be practicing __________ care not only when she takes into consideration the clients actual or potential problems but also when she considers the clients family, work responsibilities, and social aspects of life.
a. Competent
b. Complete
c. Holistic
d. Crisis
ANS: C
Holistic care encompasses all aspects of an individual. Competent care and complete care are essential, but neither is the best choice to answer the description in this question. Crisis intervention components are not addressed in this scenario.

DIF: Cognitive Level: Comprehension REF: p. 80 OBJ: 3
TOP: Accept Each Client as a Whole Person
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

10. A client is believed to have adapted to a situation when he or she exhibits which characteristic?
a. The client has become accustomed to his or her surroundings.
b. The client has shown improvement in behavior as evidenced by the ability to carry out activities normal to his or her life.
c. The client has accepted his or her current behavior patterns.
d. The client has established a trusting relationship with the caregivers who are providing care.
ANS: B
Adaptation, in mental health terms, is best shown in the clients improved behavior and ability to carry out activities normal to his or her life; this displays effective coping skills. The other options do not show complete adaptation.

DIF: Cognitive Level: Application REF: p. 83 OBJ: 5
TOP: Crisis Intervention KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

11. One of the goals of therapy established with a client on a mental health unit who has been given a diagnosis of obsessive-compulsive disorder (OCD) is to improve his feelings of stability in his environment. Much of his OCD behavior manifests as cleanliness and control of germs. Which nursing intervention most likely would help this client to feel more stable in his environment?
a. Encouraging visits from family members and friends
b. Rewarding him for acceptable behavior by increasing the number of times he is allowed to clean his bathroom daily
c. Encouraging him to participate in group activities
d. Allowing him to wash his hands only for an agreed upon number of times daily
ANS: D
Setting limits for clients with mental health disorders helps them to feel more stable in their environment because these clients often are incapable of setting limits on their own. Encouraging family visits may be beneficial for needs of comfort and love but not for stability. Rewarding this client by allowing him to increase the number of times he may clean the bathroom does not provide for stability because it fosters inconsistency in rules and routines. Encouraging group activities is beneficial for diversional purposes and love and belonging needs but does not best address the stability issue.

DIF: Cognitive Level: Application REF: p. 85 OBJ: 6
TOP: Provide Consistency KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

12. Which is the best way that a nursing unit manager can assist his or her staff in maintaining a professional commitment to their job and profession?
a. Frequently offering and requiring a specific number of hours of in-service training on new care modalities within the facility
b. Requiring out-of-facility continuing education hours twice a year
c. Encouraging staff to subscribe to nursing journals to keep up-to-date on new information
d. Keeping nursing journals on the unit for easy access to staff
ANS: A
Professional commitment is accomplished by keeping current with developments within ones profession, improving therapeutic effectiveness, and seeking out new knowledge. Offering and requiring in-service training are the easiest ways to seek new knowledge and remain current in the profession, while at the same time making the staff accountable to attend a certain number of sessions.

DIF: Cognitive Level: Application REF: p. 89 OBJ: 9
TOP: Commitment KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment

13. The nurse is working with a male client to instill a feeling of self-commitment to improve his self-esteem. From which of the following interventions would the client most benefit?
a. Having the client promise himself that he will do the best he can in a particular situation, knowing that failure is a possibility
b. Encouraging the client to do the best he can in any given situation, while reminding him that failure is a possibility
c. Ensuring that the client limits activities to those in which he is sure to be successful
d. Allowing the client to set goals that are nearly impossible to achieve but giving him the opportunity to try his best to meet these goals
ANS: A
Having the client promise himself, with the knowledge that failure is a possibility, is the most beneficial option because it is making the client active in the process and is also the most realistic approach. Simply encouraging the client does not make the client active in the situation. Ensuring that the client limits activities to those in which he will be successful is too protective. Allowing the client to set nearly impossible goals is setting him up for failure.

DIF: Cognitive Level: Application REF: p. 87 OBJ: 7
TOP: Risk Taking and Failure KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

14. The nurse is working with a health care team with that believes in the philosophy of reality therapy. The nurse is aware that the teams belief is centered around:
a. Reorientation of the client to his or her environment
b. Describing clients as irresponsible rather than mentally ill
c. Looking at the clients past in determining how it has affected present behavior
d. Accepting the clients perceptions of right and wrong behavior in the development of his treatment plan
ANS: B
Reality therapy focuses on responsibility and does not accept the premise of mental illness. Reality therapists look at the present and future and do not look to the past for excuses for behavior. Reality therapy also emphasizes the morality of behavior and does not allow the clients own interpretation of right and wrong.

DIF: Cognitive Level: Comprehension REF: p. 83 OBJ: 6
TOP: Encourage Responsibility KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

15. A busy community mental health center treats a client who is in crisis. The client is provided with instruction on relaxation exercises, but throws them away. Two weeks later the staff is dismayed when the client returns with her condition worsened. This lack of success after the previous visit is due to which of the following factors?
a. Disorganization
b. Pseudoresolution
c. Self-awareness
d. Lack of commitment
ANS: B
The client and health care provider did not address the cause of the crisis and did not provide opportunity for growth. This is termed pseudoresolution. Disorganization is preoccupation with the crisis situation. Self-awareness and lack of commitment are not considered in crisis.

DIF: Cognitive Level: Application REF: p. 84 OBJ: 5
TOP: Crisis Intervention KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

16. A client is monopolizing a group session, not allowing other members to participate. What is the most appropriate way to address the client?
a. You are not allowed to speak for the remainder of the session.
b. You are selfish and must leave now.
c. You are very rude when you act this way.
d. You need to stop this behavior. Lets see what others have to say.
ANS: D
Accepting the client does not mean accepting the behavior. Communication must focus on correcting the behavior and not the person. The other options focus on the person and not the behavior.

DIF: Cognitive Level: Application REF: p. 87 OBJ: 3
TOP: Skills for Mental Health Care: Acceptance
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

17. The night before her final exam, the nursing student cannot sleep, and is convinced she will fail. Which of the following actions will help to promote a more positive outlook?
a. Continue to study rather than continue attempting to sleep.
b. Accept the possibility of failure and plan to repeat the course.
c. Use the negative thoughts as motivation.
d. Visualize staying relaxed during the exam and successfully passing.
ANS: D
One of the actions in maintaining a positive attitude is to visualize a positive image. Actual level of confidence grows each time an image of self-assurance is projected. The other options do not project positive self-image.

DIF: Cognitive Level: Application REF: p. 89 OBJ: 10
TOP: Positive Outlook KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

18. A client with frequent re-admissions to the inpatient unit refuses to eat or participate in activities. The nurse functions as the client advocate by which of the following actions?
a. Respecting the clients wishes by taking food away and leaving the room door closed
b. Scolding the client as a way to motivate a change in behavior
c. Providing consistent encouragement to attend activities and having food available
d. Ignoring the client and encouraging other health care team members to do the same
ANS: C
Advocacy is the process of providing the client with information, support, and feedback needed to make a decision, and the obligation to act in the best interest of the client. The other options do not demonstrate advocacy and caring behaviors.

DIF: Cognitive Level: Application REF: p. 86 OBJ: 3
TOP: Skills for Mental Health Care: Caring
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

19. Identify the stages experienced by a person in a crisis. (Select all that apply.)
a. Recovery
b. Adaptation
c. Disorganization
d. Crisis
e. Denial
f. Reorganization
g. Perception
h. Exhaustion
ANS: A, C, D, E, F, G
These are the typical stages that a person in crisis experiences. The stages usually occur in the order of perception, denial, crisis, disorganization, recovery, and reorganization.

DIF: Cognitive Level: Knowledge REF: p. 84 OBJ: 5
TOP: Crisis Intervention KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

20. Which of the following are signs that indicate that the mental health nurse is becoming overly involved with a clients care? (Select all that apply.)
a. Knowing when to help and when not to help a client
b. Showing greater levels of concern for one client over all other clients
c. Feeling that the nurse is the only caregiver who understands the client
d. Being committed to providing competent health care at all times
ANS: B, C
Showing greater levels of concern for one client over all other clients and the nurses feeling that he or she is the only caregiver who understands the client are signs that indicate the development of a co-dependency with a client that can result from over-involvement of the practitioner with a particular client. The other options describe qualities needed to provide effective health care.

DIF: Cognitive Level: Analysis REF: p. 88 OBJ: 8
TOP: Boundaries and Overinvolvement KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

21. An important component of providing good care is for health caregivers to take care of, or nurture, themselves. Which of the following are ways that effectively assist health caregivers to nurture themselves? (Select all that apply.)
a. Be supportive of colleagues.
b. Recognize and accept ones own limitations, and strive to improve.
c. Take pride in oneself.
d. Accept all challenges presented.
e. Be responsible and accountable for ones own actions.
ANS: A, B, C, E
Caregivers are constantly serving as client advocates, but they must be careful to avoid expending their energies without renewing energy. A caregiver cannot provide quality health care unless he first takes care of himself. One does not have to take on all challenges presented to him because this can be exhausting to an individual.

DIF: Cognitive Level: Application REF: p. 90 OBJ: 10
TOP: Principles and Practices for Caregivers
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

22. A recently widowed 74-year-old male is seen in the mental health clinic for sleep disorders and depression. Which of the following nursing actions demonstrate caring? (Select all that apply.)
a. Providing a private place to interview the client
b. Delegating other tasks to a colleague while speaking to the client
c. Addressing the client as honey to provide comfort
d. Asking about his daily activities and hobbies during the interview
e. Listening intently to his responses and not being distracted by his nonverbal communication
ANS: A, B, D
Providing a private place to talk, and making oneself available with no distractions are ways of demonstrating caring. In addition, showing interest in the whole person, not only the diagnosis, is a therapeutic action. Addressing the client in this way without being instructed by the client does not convey respect and caring. Watching for nonverbal messages, not ignoring them, is also therapeutic.

DIF: Cognitive Level: Application REF: p. 87 OBJ: 3
TOP: Principles and Practices for Caregivers
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. __________ mechanisms are thoughts or actions that are used to help individuals handle or reduce stress.

ANS:
Coping
Coping mechanisms provide a way for people to deal with stress. Coping mechanisms are effective as long as they are not continually used by an individual when faced with stressful situations.

DIF: Cognitive Level: Knowledge REF: p. 84 OBJ: 5
TOP: Crisis Intervention KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

OTHER

24. Place in proper chronological order the steps in the process of growing as a result of failure. (Separate letters by a comma and space as follows: A, B, C, D, E, F, G.)
A. Consider ones failure as a learning experience.
B. Give oneself permission to fail.
C. Understand that failure is a necessary part of change.
D. Discover opportunities that are created by failure.

ANS:
C, B, A, D
For a person to grow, he or she must take risks. Taking risks allows the possibility that failure may occur. It is important to educate clients and to ensure that they understand that failure is not a negative occurrence; rather, it provides the opportunity for change.

DIF: Cognitive Level: Application REF: p. 87 OBJ: 7
TOP: Risk Taking and Failure KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

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