Which action by the nurse or client represents the working phase of the therapeutic relationship?

Which is a difference between counselling and psychotherapy?

Generalist psychiatric nurses may perform counselling interventions, but psychotherapy is an advanced practice role.

The psychiatric nurse uses counselling interventions, but psychotherapy requires advanced certification according to the American Nurses Association. Psychotherapy is not reserved solely for those who have not responded to counseling

Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function?

Milieu Therapy

A basic level function is milieu therapy, which is the maintenance of the therapeutic environment.

A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client?

Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client.

Some clients have difficulty recognizing or maintaining interpersonal boundaries. When a client seeks contact of any type outside the nurse–client relationship, it is important for the student (with the assistance of the instructor or staff) to clarify the boundaries of the professional relationship. The behaviour should not be ignored or minimized but rather addressed in a professional, matter-of-fact manner so that the client understands the limits being placed on such behaviors.

Which is an inaccurate depiction of self-awareness?

It involves changing one's values or beliefs.

Which intervention is appropriate for a psychiatric–mental health nurse at the basic level of practice?

Promoting symptom management

Basic psychiatric–mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric–mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.

Chlorpromazine is a drug in which classification?

Initially, the nurse should focus on successfully achieving which goal in order to effectively provide care for a client diagnosed with a mental illness?

Establishing trust and rapport with the client

Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy?

Lack of parity.

Parity refers to the various inequities inherent in any health care system. Many health plans cover the costs of psychotropic drugs at far lower rates than they do for other medications. Health care inequities are largely a result of social values and perceived significance. A gap exists between the most effective treatments available and what people actually receive. It is difficult for clients and families to determine what services are needed and where to find them, which causes limited access to services. Medication noncompliance occurs when clients do not take their medications as prescribed.

The advanced practice registered nurse is planning interventions for clients in a mental health practice. Which are considered basic level?

Improving client function and health, Ensuring a therapeutic environment

Which is a result of deinstitutionalization?

A "revolving door" of repetitive hospital admissions

One result of deinstitutionalization is the "revolving door" of repetitive hospital admission without adequate community follow-up. There are decreased community resources, and the majority of those who are mentally ill are unable to achieve independence.

Which is a criterion for mental health?

Satisfaction with personal relationships and self

People in a state of emotional, physical, and social well-being fulfill life responsibilities, function effectively in daily life, and are satisfied with their interpersonal relationships and themselves. None of the remaining options fully satisfy the criteria for a healthy mental status.

Which mental health service is an advanced-level function?

Which term is used to describe the amount of the drug needed to achieve the maximum effect?

Potency

Potency is the amount of the drug needed to achieve the maximum effect

Which neurological function is governed by the action of serotonin?

Mood

The limbic system is an area of the brain that contains high levels of three neurotransmitters: epinephrine, norepinephrine, and serotonin. Stimulation of this area, which appears to be responsible for the expression of emotions, may lead to anger, pleasure, motivation, stress, and so on.

Benzodiazepines increase which neurotransmitter function?

GABA

Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep. Benzodiazepines do not increase the function of serotonin, norepinephrine, or acetylcholine.

A client has been diagnosed with Parkinson's disease. Which neurotransmitter is decreased in those with Parkinson's disease?

Dopamine

Dopamine concentrations are decreased in people with Parkinson's disease. Concentrations of norepinephrine, serotonin, and epinephrine are not decreased in those with Parkinson's disease.

Which is considered the first-line treatment for bipolar disorder?

Lithium

Lithium is considered the first-line treatment for bipolar disorder. Lithium is the most established mood stabilizer.

Which antipsychotic drug can cause a lengthening of the QT interval?

Thioridazine

Certain antipsychotic drugs, such as thioridazine, can cause a lengthening of the QT interval.

Antipsychotics function by blocking receptors of which neurotransmitter?

Dopamine

Antipsychotic drugs work by blocking receptors of the neurotransmitter dopamine that reduces dopamine activity leading to improved cognition and regulation of emotional responses.

Which antidepressant is potentially lethal in overdose?

Phenelzine

Phenelzine, an MAOI, is potentially lethal in overdose (hypertensive crisis) and poses a potential risk in clients with depression who may be considering suicide. None of the other medications carry that risk.

Abnormalities in which lobe is believed to be associated with schizophrenia?

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

Agranulocytosis

Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a reduction in neutrophils in the blood, to develop. While the remaining options are potential side effects of antipsychotics, agranulocytosis is both life threatening and specific to clozapine

Which is not an action expected of a benzodiazepine?

Antidepressant.

Benzodiazepines do not function as an antidepressant. This drug classification has anticonvulsant, muscle relaxant, and anti-anxiety properties.

A client is experiencing hallucinations and delusions. The nurse would expect the physician to order which classification of medication?

Antipsychotic

Antipsychotic agents are indicated for the treatment of schizophrenia, mania, and autism and to treat the symptoms of psychosis, such as hallucinations, delusions, bizarre behavior, disorganized thinking, and agitation. Mood stabilizers are indicated to treat mania in patients with bipolar disorders. Antianxiety agents are used to anxiety disorders. Stimulants are used to treat narcolepsy and attention deficit hyperactivity disorders

The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?

The foods contain tyramine, which may provoke hypertensive crisis.

Several neuroimaging techniques are available for researchers and practitioners. What value does this technology have in diagnosing disorders of the brain?

It provides data about the structures of the brain correlated with their activity.

Imaging allows for visualization of abnormal brain structures. These techniques can be classified as anatomical and functional. Anatomical techniques have a goal of locating a lesion, tumor, or other abnormal structure. Functional techniques are designed to understand the physiologic changes that correlate with behavioral or cognitive alternations. Neuroimaging does not provide data about the actual number of stimuli an individual can take in, nor does it give information regarding genetic reproduction of DNA at the time of transcription. It can be a very valuable tool for diagnosis.

A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?

"Make sure that you don't drink any alcohol when you're taking this medication."

A nurse is teaching family members about the brain's connection to behaviors commonly seen in mental illnesses. How can the nurse best explain the term "neurotransmitter" to the family?

A molecular substance released in the brain.

Which medication classification blocks serotonin reuptake?

Which client would not be able to undergo a magnetic resonance imaging scan (MRI)?

A client with a pacemaker

A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what?

Lithium was one of the first psychotropic drugs developed. Lithium is in which medication classification?

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation?

It exists to promote rehabilitation alliance.

Which mental health treatment setting is not a residential treatment setting?

Partial hospitalization programs

Partial hospitalization programs are designed to help the client make a gradual transition from being inpatients to having independence and to prevent repeat admissions. The remaining options are all settings that are associated with long-term living arrangements.

The greatest impact case management has had on mental health care is that it has caused what?

Has increased client access to appropriate mental health care

Which is often more predictive of the client's success than the characteristics of his or her illness?

A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services?

Identifying and meeting the client's health and human service needs

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual client's health and human service needs.

When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness

Spend more time in jail.

Homeless people who are mentally ill spend more time in jail. They are homeless longer, spend more time in shelters, have fewer contacts with family, and face greater barriers to employment

Which type of residential setting may care for one to three clients in a family-like atmosphere, including meals and social activities with the family?

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use?

Ability to provide services in a variety of locations

E-mental health services can be delivered in a variety of locations, such as schools, places of employment, and clinics. Although the use of e-mental health applications is increasing, concerns have been expressed about using the Internet for the delivery of mental health care. Difficulties may occur in developing a therapeutic client-provider relationship via the Internet. There are concerns about the ability to ensure the quality of online mental health interventions. Client privacy and confidentiality may be compromised in a web-based, e-mental health application. In addition, the Internet is often not available to subpopulations of clients with chronic and severe mental illnesses who require high-intensity services, such as those diagnosed with schizophrenia.

The client is a 32-year-old diagnosed with bipolar disorder. The client attends group therapy for 6 hours a day and then returns home to the client's residence. In which setting would the client receive this type of care?

Partial hospitalization program

Partial (day) hospitalization programs are an alternative for those who continue to need some supervision, but are not appropriate clients for long-term admission. Partial (day) hospitalization programs provide activities and therapy sessions (group and individual) for 6 to 8 hours per day. Clients then return to their primary residence or workplace.

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems?

To address the needs of adults with mental illness and increase their ability to function

A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living.

A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time?

A day-treatment program

Day-treatment programs are ideal for clients who are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care.

The nurse working in a psychiatric institution is researching treatment systems that facilitate effective learning. The nurse believes that effective milieu therapy cannot be practiced in today's institutional settings. What disadvantage related to milieu therapy may have led the nurse to believe this?

It requires clients to have longer lengths of stay.

Milieu therapy refers to the method of therapy where the clients take part in group sessions and have client-to-client interactions. This therapy required longer length of stay in the hospital as new clients were paired with clients that had been in the hospital for a period of time. With the advent of managed health care in the 1990s, the length of hospital stays decreased significantly. Open space is not a requirement for this therapy. As this milieu therapy involves interactions between clients, the nurse is not required to be present during the entire session. This form of therapy is least expensive as it just involves communication between clients.

Assertive Community Treatment (ACT) reduces the use of which type of service?

In-patient Hospital

ACT, a community based service, reduces the use of hospital and emergency room services, which in turn reduces the cost of mental health treatment for clients with serious mental illnesses. ACT does not reduce the use of crisis intervention, or detoxification.

Which would not be considered an impediment to successful discharge planning?

Compliance with the therapeutic regimen

Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning

Which goal for an individual client is consistent with the overall objectives of community support service programs?

The client's functional ability will improve.

The goal of community support service programs is to enable those with severe mental illness to remain in the community and function as independently as possible.

The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend?

A client is experiencing hallucinations and delusions. The nurse would expect the physician to order which classification of medication?

Antihsychotic Agent

Antipsychotic agents are indicated for the treatment of schizophrenia, mania, and autism and to treat the symptoms of psychosis, such as hallucinations, delusions, bizarre behavior, disorganized thinking, and agitation. Mood stabilizers are indicated to treat mania in patients with bipolar disorders. Antianxiety agents are used to anxiety disorders. Stimulants are used to treat narcolepsy and attention deficit hyperactivity disorders.

A nurse is teaching family members about the brain's connection to behaviors commonly seen in mental illnesses. How can the nurse best explain the term "neurotransmitter" to the family?

A molecular substance released in the brain.

Neurotransmitters are small molecules that play a key role in synaptic transmission. They are chemicals stored in the neuron and released as neural messengers when stimulated by an electrical impulse. They are involved with functions that affect human emotions and behavior. Neurotransmitters are the target for drugs used to treat mental illnesses. They are stored in the axon terminal of the presynaptic neuron. A neurotransmitter is not a hormone that is stored in a gland or a location in the brain, nor is it a nerve.

Antipsychotics function by blocking receptors of which neurotransmitter?

Dopamine

Antipsychotic drugs work by blocking receptors of the neurotransmitter dopamine that reduces dopamine activity leading to improved cognition and regulation of emotional responses.

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems?

To address the needs of adults with mental illness and increase their ability to function

A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living

The greatest impact case management has had on mental health care is that it has caused what?

Has increased client access to appropriate mental health care

Case management has increased client access to appropriate mental health services and offers availability of a choice of providers based on the type of care required

Assertive Community Treatment (ACT) reduces the use of which type of service?

In-patient Hospital

ACT, a community based service, reduces the use of hospital and emergency room services, which in turn reduces the cost of mental health treatment for clients with serious mental illnesses. ACT does not reduce the use of crisis intervention, or detoxification.

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship?

Orientation

During the orientation phase, the nurse's responsibility is to define the boundaries of the relationship. The orientation phase of the nurse-client relationship involves the establishment of a therapeutic environment by the nurse. The working phase of the nurse-client relationship includes exploration of feelings and participation in identifying problems. The termination phase is the final stage in the nurse-client relationship. Problem identification occurs in the working phase.

When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self?

"Asking for help from those who care about us isn't a sign of weakness."

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?

Shifting the emphasis to the nurse

Self-disclosure examples are most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics. Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than to the client's. None of the option are inappropriate.

A nurse is engaged in a therapeutic nurse–client relationship. The relationship is in the working phase. The nurse recognizes the client should be involved with which actions? Select all that apply.

Testing new ways for problem solving, Examining personal issues, Discussing problems related to needs

A nursing instructor is describing the nurse–client relationship to a group of nursing students. Which would the instructor emphasize as most important to establishing and maintaining the relationship?

Self Awareness

Self-awareness is crucial in a nurse–client relationship. Without it, nurses will find it impossible to establish and maintain therapeutic relationships with clients. Although rapport and empathy are important considerations for a nurse–client relationship, self-awareness is key. Values are inherent in nurses, and a nurse must be self-aware of his or her own values.

A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session?

Rambling due to nervousness

A client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Showing up late, being confrontational, and bragging are nontherapeutic ways to not participate in the session.

Which statement would indicate that the nurse has a non-judgmental attitude?

"The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment?

"Our relationship is one of a professional nature."

The nurse who does not become upset or responds negatively to a client's outbursts, anger, or acting out conveys acceptance to the client. Avoiding judgments of the person, no matter what the behavior, is acceptance. This does not mean acceptance of inappropriate behavior but acceptance of the person as worthy. When responding to such a situation, the reaction should be respectful and controlled by the nurse.

Which is an inaccurate statement regarding a preconception?

It enables the nurse to get an accurate picture of the client's problems.

A preconception does not enable the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave and can prevent people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference?

"There's no need to get rude with me. I'm just trying to do my job and to help you out."

Reciprocating a client's hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the client's behavior or interaction.

A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity?

Seeking assistance

During the orientation phase, the client seeks assistance, identifies needs, and commits to a therapeutic relationship; the client begins to test the relationship later in this phase. The client discusses underlying needs and tests new ways to solve problems in the working phase. The nurse is responsible for establishing boundaries during the orientation phase.

Which action by the nurse or client represents the working phase of the therapeutic relationship?

Identifying past ineffective behaviors

In the working phase of the relationship, the client is involved actively in achieving goals set during the initial phase. The tasks of the working phase of the therapeutic relationship include identifying past behaviors that have been ineffective for coping with the focal problem; developing a plan of action, practicing implementing it, and evaluating its effectiveness; integrating a new self-concept, worldview, or attitude toward one's illness as a result of changes in behavior and circumstances; and increasing hopefulness for the future and ability to function independently. Communicating interest in the client is the role of the nurse, and this takes place in the orientation phase of the relationship. The client tests the relationship during the orientation phase. Reviewing the work that has been done takes place during the resolution phase of the relationship.

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes?

Advocate

In the advocate role, the nurse informs the client and then supports the client in whatever decision the client makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the client's medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role.

Which is not a goal of the working phase of the therapeutic relationship?

Reducing the client's anxieties

A reduction in anxiety must be achieved by the client, not by the nurse, and indicates a positive outcome of the termination stage.

Which zone is an acceptable distance between a speaker and an audience?

Public

The public zone is an acceptable distance between a speaker and an audience. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The personal zone is the distance comfortable between family and friends who are talking. The social zone is the distance acceptable for communication in social, work, and business settings.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?

The client's room

If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

Which question should be avoided because it may be perceived as criticism by the client?

Why

Asking "why" questions may be perceived as criticism by the client, conveying a negative judgment from the nurse.

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply.

"I am frustrated with the situation.", "I am feeling disrespected by your comments."

A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited?

Impassive

An impassive face is frozen into an emotionless deadpan expression similar to a mask. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one that is the opposite of what the person wants to convey, or incongrue

Which term is used to refer to signals that encourage effective communication?

Cue

A cue is a verbal or nonverbal message that signals key words or issues for the client. An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?

Presenting reality

Presenting reality is offering for consideration of what is real. Reflecting is directing client actions, thoughts, and feelings back to the client. Making observations is verbalizing what the nurse perceives. Seeking information is seeking to make clear something that is not meaningful or that is vague.

Which statement by the nurse is an example of assertive communication?

"I understand that group can be difficult to attend but coming late is disruptive."

Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way. It recognizes the rights of both parties. Losing one's temper is an example of aggressive communication. The other options demonstrate passive-aggressive and passive communication.

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening?

General leads

General leads give encouragement to continue. Focusing is concentrating on a single point. Accepting is indicating reception. Exploring is delving further into a subject or idea.

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique?

Exploring

Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations

Which type of cue is being used when the client states, "Nothing can help me"?

Covert

Cues are considered to be either covert or overt. Covert cues are vague or hidden messages that need interpretation and exploration. Overt cues are clear statements of intent, such as "I want to die."

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process?

"Can you explain to me what made you so angry?"

Identifying the problem (trigger for the anger) is the initial step in the problem solving process followed by brainstorming all possible solutions (different ways to manage the anger). Selecting the best alternative, implementing the selected alternation, and then evaluating the situation are the remaining steps in the process.

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?

3 to 6 feet apart

The therapeutic communication interaction is most comfortable when the nurse is 3 to 6 feet away from the client

Which zone is a distance that is comfortable between family and friends who are talking?

Personal

The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.

A psychiatric-mental health nurse is working with several clients and decides to use silence during the interaction. In which situation would it be therapeutically appropriate to use silence? Select all that apply.

Client who is pondering the question, Client who is experiencing depression, Client who is lost in own thoughts, Client who is constructing a response

As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?

A guardian appointed by the court

If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.

Which ethical principle requires a nurse to prevent clients from harming themselves or others?

Nonmaleficence

Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Beneficence refers to one's duty to benefit or promote good for others. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness.

Which client most likely has the legal right to refuse treatment?

A client who voluntarily entered a substance abuse treatment facility to address an addiction to alcohol

Many people who are psychiatric inpatients have been admitted involuntarily as a result of the threat they pose to themselves or others. Competent clients who admit themselves voluntarily have the right to refuse any treatment prescribed and may initiate their own discharge at any time.

A nurse tells a client that the nurse will bring the client pain medicine in 5 minutes after checking on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which principle by returning as promised?

Fidelity

Fidelity is faithfulness to obligations and duties. It is keeping promises and is important in establishing trusting relationships.

While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that the client was prescribed in the hospital. This nurse may be guilty of what?

Short-term use of restraints is permitted only in which situation?

The client is imminently aggressive and a danger to the self or others.

Short-term use of restraints is permitted when the client is imminently aggressive and a danger to the self or others. Noncompliance with treatment, wanting to leave the hospital without an order to do so, and client agitation and talkativeness are not reasons to apply restraints.

A client informs the nurse that the client is feeling better and does not want to take antidepressant medication. This client is exhibiting which ethical principle when making this decision?

The inappropriate use of restraints or seclusion is considered which form of intentional tort

False Imprisonment

False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle?

Justice

Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth

Which client behavior would prompt the nurse manager to discuss the duty to warn with staff members?

Danger to others.

Duty to warn refers to the responsibility of the nurse or the health care provider to warn identifiable third parties of threats made by clients. If the client is dangerous to any other member, the nurse is supposed to notify the person in danger immediately about the client's ideation. This law is not applicable to the client who has suicidal ideation, is extremely aggressive, or is unwilling to take medications. Client confidentiality is a very strict policy that should be abided by the nurses in any other circumstances.

A client comes to the emergency department with severe depression and suicidal ideation. Staff members determine that the client does not have adequate insurance to cover inpatient psychiatric services at their facility, so they discharge the client with some prescriptions for medication. Which principle is being ignored by discharging this client?

Justice

Justice is the duty to treat all clients fairly. It can become an ethical issue in mental health when a segment of the population does not have access to care, as in this case, in which access to inpatient care is warranted but denied.

What is the therapeutic goal of seclusion?

Give the client the opportunity to gain self-control

The goal of seclusion is to give the client an opportunity to regain physical and emotional self-control. Clients are not to be punished for behaviors. The client who meets the criteria for seclusion is not in the emotional state to engage in self-reflection. Seclusion is used for the purpose of assuring client and staff safety.

Earlier in the shift, the nurse promised to help a client acquire some paper and a pen and draft a letter to a family member later in the day. The nurse became increasingly busy during the shift but has now taken some time to assist the client in this way. What ethical principle has the nurse best exemplified?

Fidelity

Fidelity involves keeping promises. Veracity is truth-telling while beneficence is doing good and nonmaleficence is avoiding harm.

A 22-year-old client has voluntarily sought treatment for an eating disorder at a rural residential facility. Despite a promising start, the client has been involved in recent conflicts with staff members and insists that the client wants to leave the facility. Staff members have refused to facilitate the client's transportation from the facility and have stated that they will not return the client's money and identification that were held when the client was admitted. Staff at the treatment facility may be guilty of false imprisonment due to what?

The client voluntarily admitted for treatment.

False imprisonment is the intentional and unjustifiable detention of a person against his or her will. The client voluntarily sought treatment and is not a physical threat to the self or others. The client's prognosis and the location of facility are not among the criteria for false imprisonment. Eating disorders are psychiatric illnesses.

When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented?

Human

Human restraint is when staff members physically control the client and move him or her to a seclusion room. A mechanical restraint is a device, usually ankle or wrist restraints, fastened to a bed frame to curtail the client's physical aggression. Long- and short-term restraint refers to the time frame for the use of the restraint.

A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which would the nurse include in the plan of care to meet the client's physical needs?

Providing high energy snacks

For the client experiencing acute mania, the nurse would provide snacks and high energy foods because it is highly likely that the client is unable to sit long enough to eat. Sleep hygiene is a priority but may not be realistic until medications take effect. Because of the client's activity level, frequent rest periods would be unlikely. Limiting stimuli would be helpful in decreasing agitation.

Which characteristic is most common among suicidal clients?

Ambivalence

Suicide involves ambivalence. Many fatal accidents may be impulsive suicides. It is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally.

A 51-year-old client has been severely depressed and has been contemplating suicide. While feeling like the client has no other way out, the client also wishes someone would help. What is this is known as?

A client with which psychiatric disorder is at high risk for suicide?

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

When teaching a group of new mental health nurses about the major difference between bipolar I and bipolar II disorders, which would be most appropriate for the nurse to include?

The mania symptoms of bipolar II disorder have little effect on functioning.

A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which is the priority nursing diagnosis for this client?

Risk for self-harm

The client is experiencing severe hyperactivity, disorientation, and agitation as well as suicidal ideation. Therefore, the client's safety is the priority. The nurse's first action is to provide a safe environment and to address the client's risk for self-harm. The nursing diagnosis of risk for self-harm takes priority over any nursing diagnoses.

When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?

Confusion

After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom of ECT.

The nurse knows that the most dangerous time period following a previous suicide attempt is what?

First 3 months

The first 2 years after a suicide attempt represent the highest risk period, especially the first 3 months.

Limit setting is most appropriate in which client population?

Manic

Most of the time, anxious, depressed, and suicidal clients do not test the limits of the caregiver.

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply.

Confusion, Agitation, Hallucinations

A client has just been diagnosed with a major depressive disorder following recent problems with the client's mood, work performance, and sleep quality. When planning this client's care, the nurse should anticipate what interventions? Select all that apply.

Cognitive therapy, Administration of a sustained serotonin reuptake inhibitor (SSRI)

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.

A client comes to the emergency department reporting a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with an MAOI. Which question by the nurse would be most important to ask at this time?

"What have you had to eat or drink today?

A 42-year-old client with major depression is in an inpatient psychiatric hospital. The client has been taking phenelzine, a monoamine oxidase inhibitor (MAOI), for depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine. Which action by the nurse is indicated?

Call the therapist to discuss the need for a washout period before starting fluoxetine.

A client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client's suicidal risk has increased?

The client says the client feels better, with more energy to interact with others

During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have increased energy, they may be at a greater risk for suicide. If a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. The nurse may misinterpret the mood improvement as a positive move toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety.

A client has been diagnosed with major depression and placed on amitriptyline. Which is a side effect of amitriptyline?

In a therapy session, a client with a diagnosis of major depression admits to the nurse–therapist, "I actually went out driving on the interstate this morning and had every intention of getting up to speed and plowing right into the overpass by my exit. Maybe tomorrow." The nurse would recognize the client's statement as what?

What is the working phase of a therapeutic relationship?

What are the 4 phases of a therapeutic relationship?

Which client action should a nurse expect during the working phase of the nurse

Which action would the nurse perform during the working phase of a helping relationship in a hospital setting?