Chapter 1 1. D In the psychiatricmental health clinical setting, street clothes typically are worn.

Street clothes should be neat, clean, and professional in appearance. Slacks, sweater, and loafers would be appropriate. The clothing items listed in the other options, such as sandals, shorts, blue jeans, or mini-skirt, are inappropriate because they are not professional in appearance. In addition, they could be interpreted as being too casual or provocative. 2. D When in doubt in any situation in the clinical area, it is always best to discuss your client care concerns with your instructor, who can provide you with guidance as to how to proceed. Your instructor is knowledgeable about the clinical area as well as aware of your nursing programs policies and procedures. If additional information is needed, then you, together with your instructor, can discuss the clients care with the staff member caring for the client. Asking a peer to introduce you to the client is inappropriate and could lead to client confusion about who will be providing care. Waiting for the client to approach the nurse is inappropriate because the client is verbalizing feelings of hopelessness, and thus would not seek out contact with others. 3. B The statement that a client looks like a drug addict reflects a judgmental attitude, an opinion based on ones own values without regard for others or substantiating facts. An introvert is an individual who is quiet and relates to the internal environment of thoughts, ideas, and feelings. An extrovert is an individual who is outgoing and relates easily to others and things in the external environment. Prejudice refers to feelings of intolerance for another. 4. A Stereotyping refers to categorizing persons on the basis of generalized beliefs about a group. Prejudice refers to feelings of intolerance for another. Introspection refers to self-reflection, an attempt to examine ones attitudes and feelings about a topic. Censorship refers to the stoppage, blockage, or cessation of information that would be considered objectionable. 5. A In the psychiatricmental health clinical setting, clients frequently need repeated encouragement and prompting to complete a task, an essential component of the clients plan of care. Thus, completing the task for the client would be ineffective and possibly interfere with the clients ability to ultimately achieve the goals of care. Adjusting to a slower pace, avoiding frustration, and using listening and observing skills are all important in adjusting to the role of a student nurse in the psychiatricmental health clinical setting. 6. A, B, C, E, and F Self-awareness refers to the ability to recognize ones own attitudes, emotions, and behavior. Statements involving being a quiet person, lacking spontaneity, not taking things at face value, identifying issues of frustration, and trying to stay on schedule reflect a beginning understanding about personal attitudes, emotions, and behaviors. Although personality traits are influential in self-awareness, stating that ones personality is fine suggests a lack of introspection and lack of understanding about ones self. Chapter 2 1. D Inherited characteristics are considered a factor that can affect ones mental health and subsequently lead to mental illness. Life circumstances, including environmental stresses, also can impact ones mental health. If these circumstances are negative, the person is at risk for depression, substance abuse, or other mental health disorders. Relationships between individuals who either love or refuse to love one are the key to childhood nurturing. Negative nurturing can lead to the development of poor self-esteem, poor communication skills, and socially unacceptable behaviors.

2. A Defense mechanisms are unconscious protective barriers used to manage instinct and affect in stressful situations. They are not used for improved insight. Rather, they help to resolve a mental conflict, reduce anxiety, and protect ones self-esteem. 3. A Superficial level of communication involves no sharing of emotion. Thus it is most likely used when rejection by another is feared. A lack of awareness of feelings, poor communication ability, and poor emotional maturity are not suggested by a superficial level of communication. 4. B, C, E, D, and A The first event was the introduction of psychoanalytic theory and therapy by Sigmund Freud during the time from 1856 to 1939. The National Institute of Mental Health was established in 1949. Then in 1952, the text Interpersonal Relations in Nursing by Hildegard Peplau was published. In 1981, the Omnibus Budget Reconciliation Act drastically curtailed federal funding for health care services. During the 1990s, the National Alliance for the Mentally Ill (NAMI) was formed. 5. D Whereas careful client assessment, concerns about the effect of environmental conditions, and attempts to understand the causes of mental illness are still key components of current psychiatricmental health nursing that have continued from earlier years, nursing diagnoses were not developed until the 1990s. 6. D According to the Standards of Care, the certified clinical nurse specialist or nurse practitioner is an advanced-practice nursing role that allows the nurse to perform psychotherapy and prescribe medications. Case management and health promotion, counseling and establishment of nursing diagnosis, and health teaching and milieu therapy are interventions that may be performed by the psychiatric nurse generalist. Chapter 3 1. B and D Although nursing theorists differ in their beliefs and concepts, they do agree on some points. Nursing theorists agree that nursing theories provide descriptions of how to promote or enhance high-level wellness, how to help clients become comfortable, and how to deliver treatment with the least damage. They also agree that nursing theories offer a beginning description of what roles nurses play and what nursing is, as well as a beginning common language. Moreover, nursing theorists agree that the recipients of care must be viewed holistically. 2. B Although nursing theorists may differ in their beliefs and concepts, they all do believe in the need to view the client holistically, not as a biologic, psychological, or sociologic being. 3. B The client described has obvious self-care deficits, which are addressed by Orems Behavioral Nursing theory. Leiningers theory focuses on cultural care; Peplaus Interpersonal theory focuses on communication and relationships; and Roys Adaptation theory focuses on coping mechanisms to adapt to internal and external stimuli. 4. D Roys Adaptation theory focuses on coping mechanisms to adapt to internal and external stimuli. Levines theory focuses on conservation; Hendersons theory focuses on needs; and Peplaus Interpersonal theory focuses on communication and relationships.

5. A The eclectic approach refers to an individualized approach that incorporates the clients own resources as a unique person with the most suitable theoretical model or models. This approach is not limited because the nurse therapist realizes that there is no one way to deal with all of lifes stresses or problems. The interaction-oriented approach incorporates the use of the nurse as a therapeutic tool. Although all theories are considered to be research based, more than one theory is being used here. 6. A Use of the nurse as a therapeutic tool is characteristic of an interaction-oriented approach. The eclectic approach refers to an individualized approach that incorporates the clients own resources as a unique person with the most suitable theoretical model or models. A needs-oriented approach focuses on care based on the identified needs or presenting problems of the client. An outcome-oriented approach focuses on maintaining and promoting energy and harmony within the clients environment. Chapter 4 1. C The nurses priority is to respect the clients belief, thereby providing culturally competent care. Questioning the validity of the belief would interfere with the development of trust and undermine the nurseclient relationship. There is no reason to expect that the clients response to treatment would be poor. Seeking assistance from family members would not be the priority. Additionally, they too may have the same belief. 2. D Communication is key. Therefore, using the services of a translator is best to ensure that the messages from the sender and receiver are clear and interpreted accurately. Gestures and pictures would be helpful but only in addition to the use of a translator. Evaluating the clients ability to understand written English would be ineffective and probably time consuming. Assigning the client to a private room would have little effect on communication, and doing so isolates the client. 3. A Applying cultural care accommodation/negotiation, the nurse adapts care to accommodate the clients beliefs and negotiates with the client about incorporating the curandero in his or her plan of care. Cultural care preservation/maintenance involves assisting the client in maintaining health practices derived from the clients membership in a specific ethnic group. Cultural care repatterning/restructuring involves educating the client to change practices that are not conducive to health. Leininger does not identify supporting/providing as a culturally congruent nurse care mode. 4. C Applying knowledge of ethnopharmacology, the nurse would anticipate that the client would need a lower than usual adult dose of the medication because the client would be considered a poor metabolizer of the drug. Because of this decreased metabolism, standard (equal) or higher doses would lead to increased incidence of side effects. The drug must be given as prescribed; changing the schedule of administration would have no effect on the clients metabolism of the drug. 5. B To elicit the most appropriate information, the nurse would use indirect questioning, thereby allowing the client to tell the story in his or her own words and providing an opportunity for the client to express feelings. Using yesno direct questioning limits the amount of information provided and does not provide an opportunity for the client to express his or her feelings. Additionally, this type of questioning could intimidate the client. A supportive and empathetic approach, rather than a confrontational approach, is most effective. Asking the family to provide information is appropriate only with the clients consent and if the culture allows.

6. B, D, and E The culture-bound syndrome of ghost sickness typically associated with American Indian tribes is manifested by a preoccupation with death and the deceased, bad dreams, weakness, feelings of danger, anxiety, and possible hallucinations. Uncontrollable crying and shouting is associated with the culture-bound syndrome of ataque de nervios. Indigestion and anorexia are associated with the culture-bound syndrome of hwa-byung. A sudden outburst of agitation and aggression is associated with boufe delirante. Chapter 5 1. C, A, E, B, D, and F When facing an ethical dilemma, the nurse would first clarify the problem, including determining whose problem it is, who should make the decision, who is affected by the decision, and what ethical principles are related to the problem. Next, the nurse would gather additional data about the dilemma and then identify alternate acceptable and available options. The nurse would make a decision about which option is the most acceptable and therapeutic. This would be followed by carrying out the decision or choice and then evaluating or determining the impact of this decision on what went right or wrong. 2. A The clients statement indicates a lack of understanding or awareness of the procedure, which would lead the nurse to investigate whether the client has given informed consent. Although identifying possible disagreement between the client and family and evaluating for anxiety may be surrounding issues, the key here is the clients understanding. More information is needed to determine whether ethical principles are being followed. 3. A Continuing to restrain a client by failing to adhere to policies regarding frequency of assessment suggests false imprisonment, the intentional and unjustifiable detention of a person against his or her will. If policies were followed, assessment findings may have indicated that the clients restraints were no longer needed. Breach of client privacy involves invasion of the persons life and sharing of client information with others without the clients consent. Defamation involves injury to the persons reputation or character through oral or written communications. Negligence refers to conduct that falls below the standard of care established by law, placing the client at an unreasonable risk of harm. 4. C Failure to maintain client confidentiality occurs when a copy of a clients record is sent to another agency without the clients written consent. Discussion during a treatment team meeting (because all members are involved with the clients care), explaining to visitors about not discussing a clients care, and telling a co-worker not to discuss client problems in the cafeteria are examples of ways to maintain confidentiality. 5. B The key element or criteria for involuntary admission is that the client is considered to be a threat to himself or others. Refusing admission, a long history of mental illness, and a familys request for admission are not considered appropriate criteria. 6. C The plea not guilty by reason of insanity could be used for a client who allegedly commits a criminal act while a mental illness also is present at that same time. Diminished capacity is used to state that a client could not form the specific mental state needed for an offense due to a mental impairment. Guilty but mentally ill may be used when an individual exhibits clinical symptoms of a DSM-IV-TR psychiatric disorder and the criminal act occurred because of the psychiatric illness; the client is responsible for his or her behavior. Special circumstances of responsibility is not an appropriate plea. Chapter 9

1. A Asking the client a general lead-in question such as What are you feeling? provides information about the clients affect, or feelings or emotions. Asking whether the client is happy or sad or asking whether the client is upset labels the emotion and does not allow the client to verbalize the emotion or feeling. Asking the client about what brought him to the hospital does not address the clients emotion or affect; rather, it focuses on the clients chief complaint or problem. 2. B The client is exhibiting circumstantiality, in which the client provides much unnecessary detail. Blocking refers to a sudden stoppage in spontaneous flow or stream of thinking, or speaking for no apparent external or environmental reason. Perseveration refers to repetition of the same response to different questions, or repetitive motor responses to various stimuli. Neologism refers to the use of a new word or combination of words invented by the client and not readily understood by others. 3. D A person exhibiting flight of ideas continuously shifts from one idea to another and these ideas are fragmentary. Sudden stops in the flow of conversation indicate blocking. Coining new words or combinations of several words indicates neologism. Providing excessive detail that delays starting a point indicates circumstantiality. 4. C The clients description suggests depersonalization, a feeling of unreality or strangeness about ones self, the environment, or both. A compulsion is an insistent, repetitive, intrusive, and unwanted urge to act contrary to ones ordinary wishes or standards. Hallucination refers to sensory perceptions that occur without an actual external stimulus. Obsession is an insistent thought from within ones self. 5. A Insight indicates self-understanding about the nature or origin of ones attitudes and behavior, and the ability to identify strengths and weaknesses that may affect ones response to treatment. Verbalizing acceptance does not indicate that the client truly understands her illness. Placing responsibility for the problems on a dysfunctional family or suggesting that the problem results from bad nerves indicates a lack of understanding on the clients part. 6. C, D, and F Neurovegetative changes involve changes in psychophysiologic functions such as sleep patterns, eating patterns, energy levels, sexual functioning, or bowel functioning. Insomnia, constipation, and loss of appetite would be identified as neurovegetative changes. Amnesia is a disturbance in memory. Flat affect reflects the clients emotional state. Perseveration reflects communication. Chapter 11 1. B Nonverbal communication, which involves gestures, body language, and other factors such as facial expression, may be a more accurate reflection of the clients feelings regardless of whether a client tells the nurse what is or is not expected. Nonverbal communication is assessed to determine whether it is congruent with what is being said verbally. Both verbal and nonverbal communications are necessary to obtain a complete client assessment. Although verbal communication may be misinterpreted, this is not the reason to pay close attention to the clients nonverbal communication. 2. D Telling the client that she will do the right thing provides the client with false reassurance. Such a response blocks communication and is ineffective, possibly leading to mistrust if the statement turns out to be incorrect. False reassurance does not foster client independence, provide time for the nurse to think about the situation, or provide the client with support and encouragement.

3. D Nurses refrain from giving advice because it may facilitate dependency and also possibly cause the client to feel inadequate, ultimately leading to ineffective communication. A more constructive method is to encourage client problem-solving. Nurses do not refrain from giving advice based on the assumption that advice is more appropriate from the physician. Clients frequently ask for nurses advice out of a desire to please and gain more information, not as a means for testing the nurses ability. Although the nurse may not be aware of the clients options, this is not the underlying reason for avoiding advice. 4. B During the initial phase of the nurseclient relationship, a therapeutic contract is established. Verbalization of feelings is encouraged, and alternate behaviors are explored during the working phase. The plan of action is evaluated during the termination phase. 5. B According to Peplau, the nurse is functioning in the role of socializing agent, thus promoting the clients social skills. The counselor role involves the use of therapeutic skills to help clients identify and deal with stressors or problems resulting in dysfunctional coping. The surrogate parent role involves providing for the nurturing needs of clients who are unable to carry out simple tasks. The teacher role involves educating the client about his or her illness and medications to promote stabilization of the condition. 6. B, C, and F Therapeutic communication techniques include making observations (such as I notice you are trembling, and You seem to be angry right now) and exploring (such as Would you describe how you take your medications?). The statement You really should stop smoking all the time is judgmental and ineffective. Telling the client not to worry is an example of false reassurance. The statement about being Superman and flying away is challenging, belittling, and non-therapeutic.