Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 02: Nursing Practice in the Clinical Setting Test an! M"#T$P#E CH%$CE 1. Which nursing action is a reflection of Hildegard Peplaus theoretic framework regarding psychiatric mental health nursing? a Basing patient outcomes on expected instinctual responses . b iscussing a patients feelings regarding parents and siblings . c Pro!iding the patient with clean clothes and wholesome food . d "entering professional practice in a state run psychiatric facility . #$%& B Peplaus pioneering endea!ors and contributions were largely influenced by interpersonal psychotherapy. %he belie!ed that disorders e!ol!ed in the social context of interpersonal interactions. 'i.e.( what went on between people). *nstinctual responses are more related to intrapersonal interactions. +lorence $ightingale was instrumental in the holistic approach to nursing care( whereas ,inda -ichards practice was centered on institutional care of the mental ill. *+& "ogniti!e ,e!el& #pplication -.+& Page 1/ 01P& $ursing Process& *mplementation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment( Psychosocial *ntegrity 4. 0he nurse is attempting to pro!ide a safe en!ironment for a patient at great risk for self5 harm. Which inter!ention shows an understanding of e!idence5based practice '.BP)? a 6sing physical restraints only after all other options ha!e been pro!en ineffecti!e . b -eferring to the facilitys policies manual for guidelines for applying physical . restraints c "ollecting data regarding the short5term effects of using physical restraints on an . aggressi!e patient d -e7uiring constant monitoring of a patient whose inability to self5regulate anger . has re7uired the use of physical restraints #$%& B Health care systems are participating in the shift in nursing practice by encouraging research in their facilities and by implementing inter!entions that increase nurses knowledge about .BP. $urses are participating to make e!idence5based nursing practices a!ailable for their use( and they are helping to determine the outcomes that will benefit patients. 0he remaining options are examples of long5standing practice related to the use of physical restraints.
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*+& "ogniti!e ,e!el& #pplication -.+& Page 1; 01P& $ursing Process& *mplementation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment( Psychosocial *ntegrity <. Which statement by the patient reflects patient education that was based on the concept of integrated patient care? a =* know *m anxious when * get a tension headache.> . b =2y anxiety is a result of stressors * dont cope well with.> . c =2edication has helped me tremendously with anxiety control.> . d =#nxiety runs in my family? my entire family is trying to deal with it.> . #$%& # *ntegrated patient care is the recognition of the interplay between physical and mental health. *n integrated care( these disorders are not treated as separate illnesses? rather( they are treated together. 0he remaining options make no mention of a relationship between mental and physical illness. *+& "ogniti!e ,e!el& #pplication -.+& Page 1; .!aluation 2%"& $",.3& Psychosocial *ntegrity @. a . b . c . d . 0he nurse demonstrates obAecti!e patient care when& Being sympathetic to the patients recent loss of a spouse Protecting the anxious patient by eliminating stressors in the milieu -esponding to the patient by stating( =* know exactly how you feel.> +acilitating the patients exploration of !arious stress reduction techni7ues 01P& $ursing Process&

#$%& 0he nurse demonstrates obAecti!ity by helping the patient to process and organiBe thoughts that are directed toward the sol!ing of his or her own problems. With sympathy( the nurse loses obAecti!ity and mo!es into his or her own personal feelings. -emo!ing all stress does not allow the patient to de!elop necessary coping skills. *+& "ogniti!e ,e!el& #pplication -.+& Pages 415 44 01P& $ursing Process& *mplementation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are( Psychosocial *ntegrity

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C. Which nursing inter!ention would be appropriately addressed during the orientation phase of the nurseDpatient relationship? a %elf reflection by the nurse regarding personal biases and preAudices regarding the . patient b Patient works at prioritiBing personal needs and de!elops realistic expected . outcomes c .stablishing the contract between the nurse and the patient regarding mutual . needs and expectations d Patient commits to the reinforcement of positi!e personal characteristics while . working on problems and concerns #$%& " # contract or agreement is established during the orientation phase of the relationship. 0he contract defines limits and expectations of both the patient and the nurse. %elf -eflection occurs during the pre5orientation phase while the remaining options are addressed during the working phase of the relationship. *+& "ogniti!e ,e!el& #nalysis -.+& Page 44 01P& $ursing Process& Planning 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are( Psychosocial *ntegrity E. Which action on the part of a no!ice psychiatric mental health nurse shows a need for future de!elopment of altruism? a .xcusing a patient from attending group because( =all that talking makes me so . anxious> b $ot permitting two patients who are physically attracted to each other to engage . in public displays of affection c Placing a physically aggressi!e patient in restraints when they are unable to . internally calm their anger d %elf5reflecting on =why * continue to work with patients who are so emotionally . damaged they will ne!er be normal> #$%& # 0his option shows a misguided kindness that will ultimately ha!e a negati!e impact on the patients treatment. 0he remaining options show responsible nursing inter!entions that include self5reflection of personal moti!ation for such work. *+& "ogniti!e ,e!el& #pplication -.+& Page 4@ 01P& $ursing Process& .!aluation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are( Psychosocial *ntegrity :. 0he greatest negati!e outcome resulting from a nurses fear of a mentally ill patient is that the&

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0est Bank a . b . c . d . $urse will reinforce negati!e stereotyping of the mentally ill. Patient will experience increased bias against the nursing staff. Publics fearfulness of the mentally ill will continue to be exaggerated. 0herapeutic alliance between the nurse and patient will not de!elop effecti!ely.

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#$%& 6nrealistic preconcei!ed images( stereotyping( and biases ha!e an effect on nurses that( when resulting in fear( will negati!ely impact the therapeutic effecti!eness of the nurse and the care pro!ided. 0he remaining options do not ha!e the priority that pro!iding 7uality patient care has. *+& "ogniti!e ,e!el& #pplication -.+& Page 4E 01P& $ursing Process& #ssessment 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are( Psychosocial *ntegrity /. Which action on the part of a no!ice mental health nurse will best minimiBe fear related to effecti!ely working with the psychotic patient? a Be knowledgeable about psychotropic medications and their affect on psychosis. . b #lways arrange for staff support when working one5on5one with a psychotic . patient. c 0ake ad!antage of opportunities to attend workshops de!oted to the care of the . psychotic patient. d -ecogniBe that the psychotic patient is not in control of their beha!iors due to . their altered though processes. #$%& " +ear breeds a!oidance( but knowledge and preparation diminish fear and bring confidence. Being prepared before entering the psychiatric setting includes ha!ing knowledge and understanding of mental disorders. 0he remaining options do not pro!ide confidence but rather means of controlling or a!oiding the psychotic patient. *+& "ogniti!e ,e!el& #nalysis -.+& Page 4E 01P& $ursing Process& *mplementation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are( Psychosocial *ntegrity ;. Which response by the nurse manager to a no!ice mental health nurse is most effecti!e when the nurse asks( =How do * Austify not keeping a patients secret?> a =$e!er promise the patient that you will keep a secret for them.> .

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0est Bank b . c . d . =#lways stop the patient from telling you something as a secret.> =,et the patient know that you will not keep a secret that could ultimately cause harm or affect their treatment.> =Feep reminding yourself that you are not the patients friend but rather a professional mental health pro!ider.>

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#$%& " $urses and other healthcare professionals do not keep secrets or make promises to patients when the secret may interfere with the patients treatment or put them or others at risk for harm. 0he remaining options offer appropriate nursing actions but do not effecti!ely answer the nurses 7uestion. *+& "ogniti!e ,e!el& #nalysis -.+& Page <9 01P& $ursing Process& *mplementation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment( Psychosocial *ntegrity 19. 0he nurse is effecti!ely facilitating the nurse5patient relationship when& a %haring with an angry patient who is !erbally abusi!e that( =#lthough * can . accept that you are angry( * cannot and will not accept your !erbal abuse.> b +ocusing on the patients life experience without relating to the similarities of . ones own experiences c 1bAecti!ely pro!iding constructi!e criticism that is directed to helping the patient . identify inappropriate beha!iors d -efraining from abandoning the patient regardless of the frustration the . interaction causes #$%& # #ccepting the patients feelings is essential? howe!er( it is not necessary to accept all of the patients beha!iors. #ssist the patient by setting limits on patient beha!iors that are self5 defeating or that threaten the patient or others in any way. %etting these limits allows for mutual respect in the therapeutic alliance. 0he remaining options enhance the patients clinical experience rather than the nurse5patient relationship. *+& "ogniti!e ,e!el& #pplication -.+& Page <C 01P& $ursing Process& *mplementation 2%"& $",.3& Physiological *ntegrity 11. #n often expressed intrinsic reward of psychiatric mental health nursing is& a %eeing the seriously ill reco!er their health . b Working with patients of all ages and walks of life . c Working with well5trained( caring health care pro!iders . d Ha!ing time to really focus on the human who is the patient

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#$%& Psychiatric mental health nurses are able to spend the time to know the patient not only as a patient but as an indi!idual. 0his is an opportunity most nurses whose practice is based on the physical care of the patient is not afforded. 0he remaining options are not necessarily uni7ue to psychiatric nursing. *+& "ogniti!e ,e!el& #pplication -.+& Page <E .!aluation 2%"& $",.3& Psychosocial *ntegrity 14. Which statement is an example of an inference? a =He is an alcoholic because his wife nags a lot.> . b =He states he binges after arguing with his wife.> . c =Gou say your alcohol intake exceeds a 7uart a day.> . d =%o you are saying that you were drinking earlier today.> . #$%& # #n inference is an interpretation of beha!ior that is made by finding moti!e and forming conclusions without ha!ing all the necessary information. 0he nurse interprets the patients beha!ior( decides on a reason( assigns a moti!e( and forms a conclusion. 0he remaining options are !alidations of obser!ations. *+& "ogniti!e ,e!el& #pplication 01P& $ursing Process& #ssessment M"#T$P#E &ESP%NSE 1. Which interactions are likely outcomes of a well5established therapeutic alliance? %elect all that apply. a 0he nurse states( =*m not here to Audge but rather to help.> . b 0he patient states( =* really think * can handle this problem now.> . c 0he patient asks his abusi!e father to attend counseling with him. . d 0he nurse sets boundaries for a patient who has few social skills. . e 0he patient with anger issues !oluntarily goes into the seclusion room. . -.+& Page <@ 2%"& $",.3& Psychosocial *ntegrity 01P& $ursing Process&

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#$%& #( B( "( . 0he alliance ser!es as a !ehicle that pro!ides patients with an opportunity to freely discuss their needs and problems in the absence of Audgment and criticism( to gain insight into their abilities( to practice new coping skills( and to heal emotional wounds. %etting boundaries is not an outcome of such an alliance. *+& "ogniti!e ,e!el& #pplication -.+& Page 1; 01P& $ursing Process& *mplementation 2%"& $",.3& Psychosocial *ntegrity 4. Which nursing inter!entions are directly related to the principles on which a therapeutic alliance is based? %elect all that apply. a Hraciously declining to( ="ome !isit when * get discharged.> . b .stablishing the topic to be discussed at each group session . c .xplaining to the patient the purpose of terminating the alliance . d %haring how the nurse also has experienced the same problems . e Pro!iding subAecti!e feedback to the patients efforts at therapy . #$%& #( B( " 0he principles that focus on the de!elopment and maintenance of a healthy alliance include& the relationship is therapeutic rather than social? the focus remains on the patients needs and problems rather than on the nurse? the relationship is purposeful and goal directed? the relationship is obAecti!e rather than subAecti!e in 7uality? and the relationship is time5limited rather than open5ended. 0he sharing of experiencing is not patient centered. *+& "ogniti!e ,e!el& #pplication -.+& Page 49 01P& $ursing Process& *mplementation 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are <. 0he nurse is attempting to minimiBe the groups display of resistance during a therapy session. Which patients are at risk for displaying such beha!ior? %elect all that apply a 0he patient who is cogniti!ely impaired . b 0he patient who is older and well educated . c 0he patient who is aggressi!e and attention seeking . d 0he patient who has attended similar therapy groups in the past . e 0he patient who has been diagnosed with paranoid schiBophrenia .

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#$%& #( ( . # patient who redirects the focus away from himself or herself by changing the subAect is engaging in resistance beha!ior. Patients di!ert the topic for one or more of se!eral reasons& a fear of being Audged? a!oiding the repetition of material that has been pre!iously discussed? or the inability to stay cogniti!ely focused. 0he attention5seeking patient may attempt to monopoliBe the discussion but not necessarily be at risk for resisting the topic. #ge and education are not risk factors. *+& "ogniti!e ,e!el& #pplication -.+& Pages 49541 01P& $ursing Process& #ssessment 2%"& $",.3& %afe( .ffecti!e "are .n!ironment& 2anagement of "are( Psychosocial *ntegrity

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