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A client is receiving care for a mental health disorder. Which behavior demonstrates that the client has achieved the primary treatment goal?
A. Client has held a part-time job consistently for the last 3 months.
B. Client is discharged to a psychiatric group home.
C. Client regularly attends scheduled therapy sessions.
D. Client is complying with the prescribed medication therapy.
Answer: A
Rationale: The primary treatment goal for a client diagnosed with a mental health disorder is to reduce the client's symptoms thus allowing the person to live and function in society with improved personal and interpersonal skills. Being employed would demonstrate that this goal has been achieved. While the other options demonstrate positive behaviors in a client diagnosed with a mental illness, none show the ability to function and live in society.
Which statement made by a client best demonstrates the existence of a therapeutic nurse–client relationship?
A. “I really like my nurse; we have a lot in common.”
B. “I need to talk out my problems and my nurse is willing to listen.”
C. “My nurse and I have discussed what changes I need to make in my life.”
D. “My nurse reminds me of my brother; he always watched out for before he died.”
Answer: C
Rationale: Trained professionals such as nurses help clients to identify and change current behavior or thought patterns that adversely affect their lives. This treatment gives the client the opportunity to set realistic goals for living. While liking and sharing interests with the nurse are not inappropriate, they are not the bases for a therapeutic relationship. A willingness to communicate with the nurse is a positive factor but there are other factors that are equally important to a therapeutic relationship. Reminding the client of a loved family member is an example of transference which is a barrier to a therapeutic relationship.
A nurse who is new to mental health care asks a psychiatric clinical nurse specialist, “What is meant by a therapeutic milieu?” Which response by the nurse specialist would be best?
A. “The dayroom is the center of the milieu because that is where the clients and staff interact with each other.”
B. “The entire unit is considered the milieu because it is provides both safety and structure.”
C. “A safe place that provides the clients with the opportunity to work on their problems with members of their health care team.”
D. “Any secure place where staff and clients can interact and develop a trust.”
Answer: C
Rationale: In mental health care, a therapeutic milieu is a safe and secure structured environment that facilitates therapeutic interaction between clients and members of the professional team. While the therapeutic milieu may be any part of the unit, it should not encompass the unit as a whole. The other options fail to introduce the concept of therapeutic work and relationships being the goal of the milieu.
A nurse is working as part of the team to maintain a therapeutic milieu so that clients are accepted regardless of their mental illness. Which intervention demonstrates the nurse's best effort to achieve this goal?
A. Nurse makes sure it is possible for every client regardless of physical or mental limitations to take part in the unit's holiday program.
B. Each new client is assigned “a unit buddy” by the nurse to help with the orientation process.
C. The nurse rotates the assignment to decorate the unit for holidays and parties among all the residents who attend art therapy.
D. Every morning at the unit meeting, the nurse repeats, “Remember that everyone here deserves and will be treated with respect and kindness.”
Answer: A
Rationale: The nurse is often in a position to maintain the milieu as a place where dignity and acceptance allow the client to practice skills without reprisal. Making sure that everyone has the opportunity to engage in a unit activity demonstrates the commitment to dignity and acceptance. Pairing the new client with one who is familiar with the unit demonstrates caring. While rotating the opportunity to decorate the unit is appropriate, limiting to those who are attending art therapy does exclude some clients. While reinforcing the expectation of the practice of respect and caring, this option lacks the action demonstrated by the correct answer.
When considering client care, which intervention may be delegated to a licensed practical/vocational nurse (LPN/VN) working on a mental health unit?
A. Performing the admission assessments
B. Updating client care plans
C. Observing for inappropriate behaviors
D. Evaluating if a client can safely go off unit for an activity
Answer: C
Rationale: The LPN/VN assists in all aspects of the nursing process, and may be responsible for basic nursing care such as observing behaviors. The registered nurse is responsible for developing the individualized care plan and ensuring that it is implemented within a safe and therapeutic environment; this would include admission assessments and safety assessments.
Which action would be most appropriate for a nurse to use to determine that a client has an understanding of their psychiatric condition?
A. Providing the educational material about the condition verbally and in written form
B. Reinforcing the information concerning their condition on a regular basis
C. Asking the client to use their own words to describe their illness
D. Providing an explanation at the client's level of understanding
Answer: C
Rationale: The most effective way for the nurse to evaluate the client's understanding of the instructions or explanation is to ask for a verbal restating or return demonstration. When the client uses their own words, it provides the nurse with a clearer picture of exactly what the client understands. The nurse needs to provide the initial education at the client's level of understanding while using verbal explanation, demonstration, and printed materials about the illness and treatment regime. Reinforcement of information is appropriate but does not evaluate understanding.
Which statement by the nurse best demonstrates the nurse as a counselor in the therapeutic process?
A. “I respect your right to disagree with your roommate but let's talk about doing that without offending them.”
B. “I can meet with you at 1:30 pm to talk about the problems you are having with your roommate.”
C. “Please clarify for me what you are saying about how your roommate irritates.”
D. “You need to learn to compromise especially when it relates to problems with your roommate.”
Answer: A
Rationale: Unconditional acceptance of the client as a person is imperative to a therapeutic outcome. By respecting the client's right while identifying problems with acting on that right, the nurse demonstrates acceptance and therapeutic communication. The other options demonstrate therapeutic interaction and communication but do not demonstrate respect.
A nurse works as an advocate for a client by demonstrating a positive regard for the client's needs. The nurse determines that the actions have been effective based on which outcome?
A. Appropriate behaviors improve
B. Compliance with treatment increases
C. Client communicates more openly
D. Client's verbalizes understanding of illness
Answer: B
Rationale: Compliance with treatment usually improves as the nurse demonstrates an empathetic positive regard for client needs. Empathy involves the nurse's willingness to understand the situation from the client's perspective. Appropriate behaviors would improve as compliance with treatment improves. Improved communication is a direct result of the nurse effectively caring for the client's needs while an understanding of their illness is associated with effective teaching.
A client with acute depression asks the nurse, “What type of treatment should I expect?” Which response by nurse would be appropriate?
A. “You should expect a brief but intensive inpatient hospital stay.”
B. “This type of diagnosis is generally treated with outpatient psychotherapy.”
C. “Generally medication therapy is all that is needed.”
D. “Typically, both psychotherapy and medication are used.”
Answer: D
Rationale: The most common treatment approach for individuals with mental illness is the use of psychotherapeutic drugs in conjunction with psychotherapy. Unless the mental illness is severe enough that clients are in danger of harming themselves or others, inpatient treatment is not generally recommended. Outpatient treatment usually is psychotherapy combined with medication.
A client diagnosed with anxiety and with a history of abuse as an adult is currently engaged in weekly psychotherapy sessions. The client asks the advanced practice nurse (APN), “What is the goal of my treatment?” Which response by the nurse practitioner would be most appropriate?
A. “The goal is to reduce the symptoms you are experiencing.”
B. “The goal is to encourage you to make good personal choices.”
C. “The goal is to help you have the life you want and deserve.”
D. “The goal is to give you good, practical advice.”
Answer: A
Rationale: Psychotherapy is a dialog between a mental health practitioner and the client with a goal of reducing the symptoms of the emotional disturbance or disorder and improving that individual's personal and social well-being. The aim of this dialog is not to give advice but to allow clients to learn about themselves, their lives, and their feelings and once this is accomplished, the client can go on to make choices toward change. When symptoms are managed, the client will then be able to work toward the life they want and deserve.
The family of an older adult client asks the nurse about the use of psychotropic medications with their family member. Based on the nurse’s understanding of the Omnibus Budget Reconciliation Act (OBRA) related to the administration of psychotropic medication, which response would be most appropriate?
A. “The medication was prescribed when none of the other interventions to control the hallucinations were successful.”
B. “The generic form of the psychotropic medication has been substituted for the brand name version.”
C. “The original prescription has been substituted with a newer generation form of psychotropic medication.”
D. “There needs to be additional research on the safe administration of psychotropic medication among the older client population.”
Answer: A
Rationale: OBRA limited the use of psychotropic medications for residents in long-term care facilities. Guidelines set by OBRA specify that these medications can only be used for specific diagnoses and when behavioral and environmental measures are unsuccessful in managing symptoms. Antipsychotic medications can cause serious side effects such as extrapyramidal symptoms and tardive dyskinesia. The newer generation of psychotropic medications are associated with fewer side effects, and they have thus become the medications of choice for older clients. However, this practice is not specified by OBRA. Neither the use of generic medications nor the need for future research data on the safety and response of the older client to psychotropic medications is addressed by OBRA.
A nurse is establishing a therapeutic milieu with a client who was recently admitted. Which nursing intervention would be most important for the nurse to implement?
A. Introducing the client to the nursing staff that is currently on the unit
B. Including a discussion on the unit rules as a part of the admission process
C. Allowing the client to select their room from among the available rooms
D. Arranging for the client to have access to the telephone to make a personal call
Answer: B
Rationale: To establish a safe and structured therapeutic milieu, rules are often needed. In the inpatient setting, explaining unit rules or policies to the client and significant others during the admission process helps to establish a sense of client trust since doing so will provide the client with some sense of control and understanding of their environment. Introduction of staff is appropriate but will not have the impact on trust as will understanding the unit rules. It may not be a therapeutically sound intervention to allow the client to select their own room and providing access to the telephone may be viewed as a privilege or an activity the client is not ready to assume.
A client with a mental health disorder is receiving nondirective, individual therapy. The therapy sessions focuses on helping the client to clarify their own feelings. Which type of therapy is the client likely receiving?
A. Behavioral
B. Cognitive therapy
C. Group
D. Humanistic
Answer: D
Rationale: Humanistic therapy centers on the client's view of the world and their problems. This therapy is nondirective but focuses on helping the client to explore and clarify their own feelings and choices. Behavioral therapy does not foster awareness but emphasizes the principles of learning with positive or negative reinforcement and observational modeling. Cognitive behavioral therapy, or CBT, is based on the cognitive model that focuses on identifying and correcting distorted thinking patterns that can lead to emotional distress and problem behaviors. In group therapy, a trained and competent therapist leads a small group of people with similar problems who discuss individual and common issues.
A client is scheduled to receive electroconvulsive therapy. When teaching the client about this therapy, which information would the nurse likely include?
A. “Electrodes will be placed on your body to deliver an electrical shock that positively affects your symptoms.”
B. “You will experience a seizure that lasts only a few seconds causing your mental disorder to improve.”
C. “Low-voltage electric shock waves cause you to have a controlled seizure helping to restore your brain’s chemical balance.”
D. “Medication is given to prevent severe muscle contractions so the treatment only lasts for a few minutes.”
Answer: C
Rationale: Electroconvulsive therapy (ECT) is a biomedical treatment using low-voltage electric shock waves passed through the brain to induce a short period of seizure activity. The seizure is medically controlled so as to minimize the effect. The treatment appears to aid in restoring a chemical balance within the brain, which helps to relieve the serious symptoms of mental illness. None of the other options provide a clear, concise description of both the process and the expected outcome.
A client is undergoing biofeedback training. The nurse determines that the training is successful based on which outcome?
A. Client identifies aggressive behaviors in response to normal stressors
B. Client redirects frustration while encouraging social interaction
C. Client demonstrates a change in behavior that negatively impacts an individual's life
D. Client demonstrates control of involuntary nervous system responses to manage anxiety
Answer: D
Rationale: Biofeedback is a training program used for specific types of anxiety that is designed to develop the client's ability to control heart rate, muscle tension, and other autonomic or involuntary functions of the nervous system by using monitoring devices during situations that trigger this reaction. This is followed by an attempt or feedback that allows the person to reproduce the desired change and control these body functions under the anxiety-producing emotional circumstances. Agitation therapy may be used in problematic and aggressive people who do not respond positively to other therapies and is designed to increase that person's self-awareness of maladaptive behavior and limitations. Recreational therapy provides an outlet for sublimating frustration and internal drives of emotion, along with encouraging social interactive skills. Behavioral therapy emphasizes the principles of learning with positive or negative reinforcement and observational modeling. The goal is to bring about behavioral change within a relatively short time.
The nurse manager on a psychiatric unit is assigning roles for the various team members involved with client care. Which activities would the nurse manager assign to the registered nurse? Select all that apply.
A. Creating a personalized care plan for each client
B. Changing the dressing on a client's wrist wound
C. Leading a group session for the severely depressed clients
D. Providing individual psychotherapy for a client with a history of abuse
E. Restraining a client who was unable to control escalating aggressiveness
Answer: A, B, E
Rationale: In the psychiatric setting, the registered nurse is accountable for both the physical and the mental health care of the client such as attending to a wrist wound. The registered nurse is responsible for developing the individualized care plan and ensuring that it is implemented within a safe and therapeutic environment that would also include assisting a client deal with their uncontrolled aggression. Leading groups and providing individual therapy are responsibilities of a clinical psychologist and psychiatrist.
. A licensed practical/vocational (LPN/VN) nurse is working on a psychiatric unit. Which action(s) would be appropriate for the nurse to complete? Select all that apply.
A. Managing the unit's monthly birthday celebration for its clients
B. Monitoring for side effects when a client is prescribed a new medication
C. Supervising the bathing of clients who need help with their activities of daily living
D. Accompanying a client to an off unit medical appointment
E. Participating in therapeutic communication with clients
Answer: B, E
Rationale: The LPN/VN assists in all aspects of the nursing process and may be responsible for basic nursing care such as observing behaviors and collecting data, administering medications, monitoring for medication side effects, participating in therapeutic communication with clients, and documenting in the client record. The mental health technician generally assists clients with physical and hygiene needs as needed, monitors unit activities, and assists with group or recreational activities.
When providing care to an older client with a mental health disorder, which age-related change(s) would be important for the nurse to keep in mind when giving psychotropic medications? Select all that apply.
A. Increase in body fat
B. Increased risk for dehydration
C. Increase in liver metabolism
D. Decrease in renal function
E. Decrease in amount of albumin in blood
Answer: A, B, D, E
Rationale: All psychotropic medications are used with caution in the older client because of age-related physiologic changes. The nurse must consider that the drug effects persist longer and remain in the body longer due to an increase in medication-retaining body fat. In addition, less serum albumin causes more free medications in the bloodstream, and the decrease in total-body fluid increases the risk of dehydration. Renal function decreases with age, accounting for slowed elimination of medication through the kidneys. Metabolism by the liver also decreases.
A licensed practical/vocational nurse (LPN/VN) is assigned to care for a client who is admitted for severe depression and suicidal ideation. The LPN/VN would perform which intervention(s)? Select all that apply.
A. Providing one-on-one observation of the client
B. Performing the client's admission assessment and interview
C. Administering an as-needed antidiarrheal medication as prescribed
D. Providing documentation about a rash noted after the client began a new antidepressant
E. Changing the dressing on the wrist wound the client created during a suicide attempt
Answer: A, C, D, E
Rationale: The LPN/VN assists in all aspects of the nursing process, and may be responsible for basic nursing care such as observing behaviors and collecting data, administering medications, monitoring for medication side effects, participating in therapeutic communication with clients, and documenting in the client record. The nurse is often able to establish and maintain a therapeutic relationship with the client while performing basic nursing interventions such as vital signs, dressing changes, or assisting with hygiene needs. It is the registered nurse (RN) who assumes the responsibility to perform the initial assessments and interview.
A nurse is working with a client who is receiving cognitive behavioral therapy (CBT). Which response(s) by the nurse help to reinforce the concepts associated with this therapy? Select all that apply.
A. “What do you expect to happen if you trust me to do as I promised?”
B. “I plan to return in 15 minutes with your medication.”
C. “If you trust me, you will begin to trust others in your life.”
D. “What was it that first made you distrustful of people?”
E. “You've identified the misconception; now let's work on changing the behavior.”
Answer: A, E
Rationale: Cognitive therapists believe that clients' response in stressful situations is based on their subjective perception of an event. Once the misperception is identified, clients can change their behaviors by changing their maladaptive thinking about themselves and their experiences. Also, when the nurse asks what the client expects to happen as a result of trusting, the nurse is implementing a concept associated with CBT. Promising and identifying when trust became an issue are associated with a general assessment of the client's condition. Changing behaviors associated with trust are associated with behavioral therapy.