Psychiatric Nursing | NCLEX Quiz 195 - Quiz, Flashcards & Trivia

1. A student nurse is caring for a 75-year-old client who is very confused. The student's communication tools should include:

Written directions for bathing.

Speaking very loudly.

Gentle touch while guiding ADLs (activities of daily living).

Flat facial expression.

Nonverbal. gentle touch is an important tool here. Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals. families. and cultures. the nurse must be sensitive to the differences in attitudes and practices of clients and self.

Explanation

Nonverbal. gentle touch is an important tool here. Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals. families. and cultures. the nurse must be sensitive to the differences in attitudes and practices of clients and self.

2. The nurse is caring for a severely depressed client who has just been admitted to the in-client psychiatric unit. Which of the following is a PRIORITY of care?

Nutrition

Elimination

Rest

Safety

Safety is a priority of care for the depressed client. Precautions to prevent suicide must be a part of the plan.

Explanation

Safety is a priority of care for the depressed client. Precautions to prevent suicide must be a part of the plan.

3. Which of these statements by the nurse reflects the best use of therapeutic interaction techniques?

“You look upset. Would you like to talk about it?”

“I’d like to know more about your family. Tell me about them.”

“I understand that you lost your partner. I don’t think I could go on if that happened to me.”

“You look very sad. How long have you been this way?”

Giving broad opening statements and making observations are examples of therapeutic communication. The other options are too specific or focused on being therapeutic.

Explanation

Giving broad opening statements and making observations are examples of therapeutic communication. The other options are too specific or focused on being therapeutic.

4. When planning the therapeutic milieu. it is MOST important to select group activities which

Match the clients’ preferences

Are consistent with clients’ skills

Achieve clients’ therapeutic goals

Build skills of group participation

Activity groups are used to enhance the therapeutic milieu and to meet the clinical and social needs of clients. e.g.. to minimize withdrawal and regression. to develop self-care skills. etc.

Explanation

Activity groups are used to enhance the therapeutic milieu and to meet the clinical and social needs of clients. e.g.. to minimize withdrawal and regression. to develop self-care skills. etc.

5. When a husband takes out his work frustrations and anger by abusing his wife at home. the nurse will identify this crisis as which type?

Psychiatric emergency crisis

Developmental crisis

Anticipated life transition

Dispositional crisis

A dispositional crisis is a response to an external situational crisis. External anger at work is the dispositional crisis displaced to his wife through abuse.Option A: Psychiatric emergency crisis is when the individual’s general functioning has been severely impaired. and the individual has been rendered incompetent.Option B: Developmental crisis occurs in response to triggering emotions related to unresolved conflict in one’s life. This is called a developmental crisis based on Freudian psychology.Option C: An anticipated life transition crisis is a crisis that is normal in the life cycle; transitional is one over which the person has no control.

Explanation

A dispositional crisis is a response to an external situational crisis. External anger at work is the dispositional crisis displaced to his wife through abuse.Option A: Psychiatric emergency crisis is when the individual’s general functioning has been severely impaired. and the individual has been rendered incompetent.Option B: Developmental crisis occurs in response to triggering emotions related to unresolved conflict in one’s life. This is called a developmental crisis based on Freudian psychology.Option C: An anticipated life transition crisis is a crisis that is normal in the life cycle; transitional is one over which the person has no control.

6. Which statement by the client during the initial assessment in the emergency department is most indicative of suspected domestic violence?

“I am determined to leave my house in a week.”

“No one else in the family has been treated like this.”

“I have only been married for two (2) months.”

“I have tried leaving. but have always gone back.”

Victims develop a high tolerance for abuse. They blame themselves for being victimized. All members of the family suffer from the effects of abuse. even if they are not the actual victims. For these reasons. victims often have an extensive history of abuse and struggle for a long time before they can leave permanently.

Explanation

Victims develop a high tolerance for abuse. They blame themselves for being victimized. All members of the family suffer from the effects of abuse. even if they are not the actual victims. For these reasons. victims often have an extensive history of abuse and struggle for a long time before they can leave permanently.

7. A nurse is teaching a stress-management program for a client. Which of the following beliefs will the nurse advocate as a method of coping with stressful life events?

Avoidance of stress is an important goal for living.

Control over one’s response to stress is possible.

Most people have no control over their level of stress.

Significant others are important to provide care and concern.

When learning to manage stress. it is helpful to believe that one has the ability to control one’s response to stress.Option A: It is impossible to avoid stress. which is a normal experience.Options C and D: Stress can be positive and growth enhancing as well as harmful. The belief that one has some control can minimize the stress response.

Explanation

When learning to manage stress. it is helpful to believe that one has the ability to control one’s response to stress.Option A: It is impossible to avoid stress. which is a normal experience.Options C and D: Stress can be positive and growth enhancing as well as harmful. The belief that one has some control can minimize the stress response.

8. A client was admitted to the psychiatric unit for severe depression. After several days. the client continues to withdraw from other clients. Which of the following would be the MOST appropriate statement by the nurse to promote interaction with other clients?

“Your doctor thinks its good for you to spend time with others.”

“It is important for you to participate in group activities.”

“Painting this picture will help you feel better.”

“Come play Chinese Checkers with Gerry and me.”

This gradually engages the client in interactions with others and uses positive behavioral expectation.

Explanation

This gradually engages the client in interactions with others and uses positive behavioral expectation.

9. The nurse can BEST ensure the safety of a demented client who wanders from the room by

Repeatedly reminding the client of time and place

Explaining the risks of becoming lost

Using soft restraints

Attaching a wander guard sensor band to the client’s wrist

This type of identification band easily tracks the client’s movements and ensures safety while wandering on the unit.

Explanation

This type of identification band easily tracks the client’s movements and ensures safety while wandering on the unit.

10. A client with paranoid thoughts refuses to eat because he believes the food has poisoned. The MOST appropriate initial action is to

Taste the food in the client’s presence

Suggest that food be brought from home

Simply state the food is not poisoned

Inform the client he will be tube fed if he does not eat

This action presents reality.

Explanation

This action presents reality.