INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS
Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice 8th Edition by Mary C. Townsend – Test Bank
1. The nurse uses a variety of therapeutic communication skills when working with
patients. Which of the following is a therapeutic goal that can be accomplished through
the use of therapeutic communication skills?
A) Inform the patient of priority problems
B) Assess the patient’s perception of a problem
C) Assist the patient to control emotions
D) Provide the patient with a plan of action
Therapeutic communication can help nurses to accomplish many goals including
identifying the most important concern to the client at that moment, assessing the
client’s perception of the problem, facilitating the client’s expression of emotions, and
guiding the client toward identifying a plan of action.
2. Which one of the following goals of therapeutic communication would the nurse strive
to attain first?
A) Facilitate the client’s expression of emotions.
B) Establish a therapeutic nurseñclient relationship.
C) Teach the client and family necessary self-care skills.
D) Implement interventions designed to address the client’s needs.
Establishing a therapeutic relationship is one of the most important responsibilities of
the nurse when working with clients.
3. Which of the following statements is true of empathy? Select all that apply.
A) It is the ability to place oneself into the experience of another for a moment in
B) It involves interjecting the nurse’s personal experiences and interpretations of the
C) It is developed by gathering information from the client.
D) It results in negative therapeutic outcomes.
E) The client must learn to develop empathy for the nurse.
Ans: A, C
Empathy is the ability to place oneself into the experience of another for a moment in
time. Nurses develop empathy by gathering as much information about an issue as
possible directly from the client to avoid interjecting their personal experiences and
interpretations of the situation. It does not result in negative therapeutic outcomes. The
nurse must develop empathy with the client.
4. The nurse asks the patient what he would like to talk about. This is an example of
A) broad opening.
B) encouraging expression.
D) offering self.
Broad openings allow the client to take the initiative in introducing the topic.
Encouraging expression involves asking the client to appraise the quality of his or her
experiences. The nurse uses focusing when concentrating on a single point. Offering self
occurs when making oneself available.
5. A patient says, ìIts’ been so long since I’ve been with my family.î Which statement by
the nurse is an example of restating?
A) ìYou say you haven’t seen your family in a while.î
B) ìTell me when you last saw your family.î
C) ìGo on. Tell me more.î
D) ìWhen was the last time you saw your family?î
Restating is repeating the main idea expressed. Restatement lets the client know that he
or she communicated the idea effectively. This encourages the client to continue.
Focusing or concentrating on a single point encourages the client to concentrate his or
her energies on a specific point, which may prevent a multitude of factors or problems
from overwhelming the client. General leads give encouragement to continue. They
indicate that the nurse is listening and following what the client is saying without taking
away the initiative for the interaction. Placing events in sequence clarifies the
relationship of events in time. This helps both the nurse and the client to see them in
6. The patient expresses frustration that the doctor does not spend enough time with the
patient when making rounds. The nurse replies, ìThe doctors are very busy. What can I
help you with?î The nurse incorporated which nontherapeutic technique in this
D) Introducing an unrelated topic
Defending attempts to protect someone or something from verbal attack. This implies
that the client has no right to express impressions, opinions, or feelings. Belittling is
misjudging the degree of the client’s discomfort, which implies that the discomfort is
temporary, mild, self-limiting, or not very important. Disagreeing is opposing the
client’s ideas, which may cause the client to feel defensive about his or her point of view
or ideas. Introducing an unrelated topic is evidenced when the nurse changes the
subject. This takes away the initiative for the client to interact.
7. A patient asks the nurse what she should do about her ìcheatingî husband. The nurse
replies, ìYou should divorce him. You deserve better than that.î The nurse used which
A) Giving information
B) Verbalizing the implied
C) Giving advice
The nurse should not give advice, or tell the patient what to do. Advising implies that
only the nurse knows what is best for the client. Giving information is therapeutic when
the patient needs facts. Verbalizing the implied is a therapeutic communication
technique which involves putting clearly into words what the patient has suggested.
Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval,
indicates the patient is right or wrong. Nurses should remain neutral when using
therapeutic communication skills.
8. The nurse asks the client what that experience was like. Which communication skill is
the nurse using?
A) Encouraging expression
B) Encouraging description of perceptions
D) Requesting an explanation
Encouraging expression is a therapeutic technique and involves asking the client to
appraise the quality of his or her experiences. Encouraging description of perceptions is
a therapeutic technique and involves asking the client to verbalize what he or she
perceives. Exploring is a therapeutic technique that involves delving further into a
subject or an idea. Requesting an explanation is a nontherapeutic verbal communication
technique that involves asking the client to provide reasons for thoughts, feelings,
9. Which of the following are nontherapeutic techniques? Select all that apply.
B) Voicing doubt
E) Giving approval
Ans: C, D, E
Silence is a therapeutic technique that involves the absence of verbal communication,
which provides time for the client to put thoughts or feelings into words, to regain
composure, or to continue talking. Voicing doubt is a therapeutic technique that
involves expressing uncertainty about the reality of the client’s perceptions. Agreeing is
a nontherapeutic technique that involves indicating accord with the client. Agreeing
indicates the client is ìrightî rather than ìwrong,î and there is no opportunity for the
client to change his or her mind without being ìwrong.î Challenging is a nonverbal
communication technique that involves demanding proof from the client, and this may
cause the client to defend delusions or misperceptions more strongly than before. Giving
approval is a nontherapeutic communication technique that involves sanctioning the
client’s behavior or ideas. Accepting is a therapeutic technique that involves indicating
10. Which of the following statements would be an empathetic response in a client
A) ìYou must have been embarrassed when your father yelled at you in the grocery
B) ìYou really should find your own housing and get out of the situation with your
C) ìWell, it sounds like your father has difficulty controlling his temper.î
D) ìWhy do you think your father chose that time and place to yell at you?î
This statement conveys the nurse’s understanding of the client’s feelings. Empathy is the
ability to place oneself into the experience of another for a moment in time. Nurses
develop empathy by gathering as much information about an issue as possible directly
from the client to avoid interjecting their personal experiences and interpretations of the
situation. The other choices do not convey empathy.
11. The nurse says to the client, ìYou become very anxious when we start talking about
your drinking.î Which of the following techniques is the nurse using?
A) Confronting behavior
B) Making an observation
C) Translating into feelings
D) Verbalizing the implied
The nurse is stating what he or she sees; the client can validate it or reject it. The nurse
is not confronting the behavior in this situation. The nurse is not translating the message
into feelings (seeking to verbalize client’s feelings that he or she expresses only
indirectly), nor is the nurse verbalizing the implied (voicing what the client has hinted at
12. The nurse is sitting down with a patient to begin a conversation. Which of the following
positions should the nurse take to convey acceptance of the patient?
A) Leaning forward with arms on the table sitting directly across for the patient
B) Turned slightly to the side of the patients with arms folded across the chest
C) Leaning back in the chair next to the patient with legs crossed at the knees
D) Sitting upright facing the patient with both feet on the floor
Closed body positions, such as crossed legs or arms folded across the chest, indicate that
the interaction might threaten the listener who is defensive or not accepting. A better,
more accepting body position is to sit facing the client with both feet on the floor, knees
parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.
13. A patient states, ìI feel fine. It’s a good day.î The nurse notes the patient looking away,
and a decreasing pitch in his voice while speaking. Which of the following is the most
therapeutic response by the nurse?
A) ìI’m glad you are feeling good today.î
B) ìI’m not sure I believe you.î
C) ìTell me what is good about today.î
D) ìYou say you feel fine, but you don’t really sound fine.î
This client’s verbal and nonverbal communication seems incongruent. To ensure the
accuracy of the patient’s messages, the nurse identifies the nonverbal communication
and checks its congruency with the content. An example is ìMr. Jones, you said
everything is fine today, yet you frowned as you spoke. I sense that everything is not
really fineî (verbalizing the implied). ìI’m glad you are feeling good today,î is agreeing
or indicating accord with the client. Agreeing leaves no opportunity for the client to
change his or her mind without being ìwrong.î ìI’m not sure I believe you could be
interpreted as challenging or demanding proof from the client. Challenging causes the
client to defend the misperceptions more strongly than before. ìTell me what is good
about today,î seems to be asking the client to defend his or her statement.
14. Which of the following statements about verbal and nonverbal communication skills is
A) One third of meaning is transmitted nonverbally and two thirds is communicated
B) Nonverbal communication is as important, if not more than, verbal
C) Verbal communication is most important because it is what the patient says.
D) Verbal communication involves the unconscious mind.
Nonverbal communication is as important as, if not more so than, verbal
communication. It is estimated that one third of meaning is transmitted by words and
two thirds is communicated nonverbally. Verbal communication is often what the
patient says but is not the most important. Nonverbal communication involves the
unconscious mind acting out emotions related to the verbal content, the situation, the
environment, and the relationship between the speaker and the listener.
15. The nurse must be alert to the nonverbal expressions of the client. Because the meaning
attached to nonverbal behavior is subjective, it is important for the nurse to
A) increase the client’s awareness of nonverbal behavior.
B) investigate the source of nonverbal behavior.
C) validate the client’s feelings.
D) validate the meaning of the nonverbal behavior.
It is essential to validate the meaning of nonverbal behavior (rather than assuming what
it means) before proceeding with anything else. This item is about the nurse’s
understanding of nonverbal behavior, not the client’s. Before the nurse can investigate
the source of nonverbal behavior or validate the client’s feelings the nurse must be clear
about the meaning of the nonverbal behavior.
16. A nurse has invited a patient to sit down and have a conversation. The patient takes the
first seat. The nurse pulls up another chair to sit with the patient. Approximately how far
from the patient should the nurse place her chair?
A) 1 to 2 feet
B) 3 to 4 feet
C) 6 to 8 feet
D) 8 to 10 feet
The therapeutic communication interaction is most comfortable when the nurse and
client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children,
people who mutually desire personal contact, or people whispering; 2 to 3 feet is
comfortable between family and friends who are talking; 4 to 12 feet is acceptable for
communication in social, work, and business settings.
17. The nurse is sitting with a patient who is crying. After a few minutes the nurse places
one hand on the patient’s shoulder. Which of the following best describes the purpose of
the nurse’s touch with this patient?
A) To express sympathy to the patient
B) To assess the patient’s skin temperature and circulation status
C) To offer comfort and support for the patient
D) To extend an offer of friendship to the patient
Touching a client can be comforting and supportive when it is welcome and permitted.
The nurse should not express sympathy to patients, nor should attempt to be ìfriendsî
with patients. Physical assessment is not indicated at this time.
18. Which of the following is the best reason that many psychiatric care units have policies
against clients touching one another or staff?
A) Because some clients with mental illness have difficulty knowing when touch is
or is not appropriate
B) Because clients often perceive being touched as a threat and may attempt to
protect himself or herself by striking the staff person
C) Because it can be threatening to both the client and the nurse
D) Because touching always leads to more touching
Some clients with mental illness have difficulty understanding the concept of personal
boundaries or knowing when touch is or is not appropriate. Consequently, most
psychiatric inpatient, outpatient, and ambulatory care units have policies against clients
touching one another or staff. When a staff member is going to touch a client while
performing nursing care, he or she must verbally prepare the client before starting the
procedure. A client with paranoia may interpret being touched as a threat and may
attempt to protect himself or herself by striking the staff person. Both the client and the
nurse can feel threatened if one invades the other’s personal or intimate zone, which can
result in tension, irritability, fidgeting or even flight. Touching can be comforting and
supportive when it is welcome and permitted.
19. A client has been making sexual comments when communicating with the nurse. The
nurse wants to spend some time talking to the patient while respecting the patient’s right
to privacy. Which setting would be the most appropriate setting for the nurse to talk
with the client?
A) In the patient’s room when the patient’s roommate is present and 3 feet away
B) At the nurse’s station when other clients and visitors are less than 4 feet away
C) In an interview room in a remote section of the unit with the nurse 1 foot away
from the patient
D) In a quiet corner of the dayroom at least 4 feet away from others
A quiet corner of the dayroom at least 4 feet away from others would allow the patient
privacy while being to deter any inappropriate activity would be the most appropriate
setting. Being in the patient’s room when the patient’s roommate is present and 3 feet
away or at the nurse’s station when other patients and visitors are less than 4 feet away
would not allow for the patient’s privacy. An interview room in a remote section of the
unit would not be a good choice as the area is too isolated. Additionally, the nurse
should maintain a distance of more than 1.5 feet away from the patient as closer
distances are within the intimate zone.
20. Which of the following distance zones is acceptable for people who mutually desire
The intimate zone is the amount of space that is comfortable for parents with young
children and those who desire personal contact. The social zone is the distance
acceptable for communication in social, work, and business settings. The personal zone
is comfortable between family and friends who are talking. The public zone is an
acceptable distance between a speaker and an audience.
21. The nurse should use clear concrete messages when working with patients displaying
which of the following conditions? Select all that apply.
Ans: A, C, D
Clients who lose cognitive processing, such as those who are anxious, cognitively
impaired, or suffering from some mental disorders, often function at a concrete level of
comprehension and have difficulty answering abstract questions. The nurse must be sure
that statements and questions are clear and concrete.
22. Which statements are true of concrete and abstract messages? Select all that apply.
A) Abstract messages include figures of speech that are difficult to interpret.
B) Abstract messages are important for accurate information exchange.
C) Concrete messages require the listener to interpret what the speaker says.
D) Concrete messages are clear, direct, and easy to understand.
E) Abstract messages are best used for persons who are anxious.
Ans: A, D
Abstract messages include figures of speech that are difficult to interpret. Concrete
messages are clear, direct, and easy to understand. Concrete (not abstract) messages are
important for accurate information exchange. Abstract (not concrete) messages require
the listener to interpret what the speaker says. Concrete (not abstract) messages are best
used for persons who are anxious.
23. The nurse asks the patient, ìWhat was it like for you when you first knew you had no
place to go?î The patient looks down and pauses for quite some time. Which action by
the nurse is most therapeutic?
A) Change the subject to something the patient will discuss
B) Encourage the patient to express any unpleasant feelings
C) Apologize for asking such a personal question
D) Sit quietly until the patient responds
Silence or long pauses in communication may indicate many different things. The client
may be depressed and struggling to find the energy to talk. Sometimes pauses indicate
the client is thoughtfully considering the question before responding. At times, the client
may seem to be ìlost in his or her own thoughtsî and not paying attention to the nurse. It
is important to allow the client sufficient time to respond, even if it seems like a long
24. A patient remarks, ìYou know, it’s the same thing every time.î The nurse should respond
A) ìI understand.î
B) ìI’m sure everyone is doing their best.î
C) ìI’m not sure what you mean. Please explain.î
D) ìIt’s the same thing every time?î
Consensual validationósearching for mutual understanding, for accord in the meaning of
the words. For verbal communication to be meaningful, it is essential that the words
being used have the same meaning for both (all) participants. Sometimes, words,
phrases, or slang terms have different meanings and can be easily misunderstood.
25. A patient states, ìRight before I got here I was doing alright. My job was going well, my
wife and I were happy, and we just moved into a new apartment.î The nurse responds,
ìYou said you and your wife were happy. Tell me more about that.î This is an example
of which therapeutic technique?
A) Encouraging comparison
B) General lead
Exploringódelving further into a subject or an idea. When clients deal with topics
superficially, exploring can help them examine the issue more fully. Any problem or
concern can be better understood if explored in depth.
26. A patient is sitting alone, slouched, with eyes closed. The nurse approaches. Which
statement is most likely to encourage the patient to talk?
A) ìIf you are sleepy, would you like me to help you back to your room?î
B) ìYou look like you are deep in thought.î
C) ìIs something wrong?î
D) ìWhy are you sitting with your eyes closed?î
Making observationsóverbalizing what the nurse perceives. Sometimes clients cannot
verbalize or make themselves understood. Or the client may not be ready to talk.
27. A patient yells, ìAll the nurses here are so mean. None of you really care about us!î The
most therapeutic response would be,
A) ìI cannot allow you to yell like that.î
B) ìWe care about you.î
C) ìOh, really?î
D) ìYou seem very irritated.î
Reflectingódirecting client actions, thoughts, and feelings back to client. Reflection
encourages the client to recognize and accept his or her own feelings. The nurse
indicates that the client’s point of view has value and that the client has the right to have
opinions, make decisions, and think independently.
28. Patient says to the nurse, ìI wonder what’s playing at the movie tonight.î The most
therapeutic response would be,
A) ìAre you telling me you would like to go to the movies?î
B) ìWhy don’t you look in the newspaper.î
C) ìThere’s nothing worth watching.î
D) ìDo you like to go to the movies?î
Verbalizing the impliedóvoicing what the client has hinted at or suggested. Putting into
words what the client has implied or said indirectly tends to make the discussion less
obscure. The nurse should be as direct as possible without being unfeelingly blunt or
obtuse. The client may have difficulty communicating directly. The nurse should take
care to express only what is fairly obvious; otherwise, the nurse may be jumping to
conclusions or interpreting the client’s communication.
29. The client says to the nurse, ìI have special powers because I am the mother of God. I
can heal everyone in the hospital.î The nurse’s best response would be,
A) ìThat sounds interesting. What can you do?î
B) ìIt would be unusual for anyone to have that kind of power.î
C) ìYou could not heal everyone. No one has that much power.î
D) ìWell, you can certainly try.î
When the nurse states, ìIt would be unusual for anyone to have that kind of power,î the
nurse is voicing doubt or expressing uncertainty about the reality of the client’s
perceptions. The other choices have demeaning connotations toward the client and
should not be used.
30. During the admission interview, the nurse asks the client what led to his hospitalization.
The client responds, ìThey lied about me. They said I murdered my mother. You’re the
killers. You all killed my mother. She died before I was born.î The best initial response
by the nurse would be,
A) ìI just saw your mother. She’s fine.î
B) ìYou’re having very frightening thoughts.î
C) ìWe’ll put you in a private room until you’re in better control.î
D) ìIf your mother died before you were born, you wouldn’t be here.î
When the nurse states, ìYou’re having very frightening thoughts,î the nurse is
verbalizing the implied or voicing what the client has hinted or suggested. The other
responses would not be the best initial response in this situation.
31. The client stated, ìI was so upset about my sister ignoring me when I was talking about
being ashamed.î Which nontherapeutic communication technique would the nurse be
using if the nurse would state, ìHow are your stress reduction classes going?î
A) Changing the subject
B) Offering advice
The nurse did not respond to the client’s statement and instead introduced an unrelated
topic. Advising would be telling the client what to do. Challenging would be demanding
proof from the client. Disapproving would be denouncing the client’s behavior or ideas.
32. During the mental status assessment, the client expresses the belief that the CIA is
stalking him and plans to kidnap him. The best response by the nurse would be,
A) ìThat makes no sense at all.î
B) ìYou can tell me about that after I finish asking these questions.î
C) ìWhat kinds of things have been happening?î
D) ìWhy would the CIA be interested in you?î
When the nurse responds, ìWhat kinds of things have been happening?î the nurse is
seeking information. ìThat makes no sense at all,î is inappropriate because it may make
perfect sense to the client. ìYou can tell me about that after I finish asking these
questions,î shows that the nurse is not interested in what the client has to say. ìWhy
would the CIA be interested in you,î feeds into the notion that the CIA is stalking the
33. The nurse is trying to obtain some information about family relationships from the
client. Which of the following statements is best?
A) ìIs it upsetting for you to talk about your family?î
B) ìIs your family ready for you to come home?î
C) ìSo, how is your family?î
D) ìTell me your feelings about your family situation.î
This statement asks the client to describe or discuss family; all other statements might
get only one-word answers.
34. A client is fearful and reluctant to talk. Which of the following techniques is most
effective when trying to engage the client in interaction?
A) Broad opening
C) Giving information
Broad openings allow the client to say as much or little as he or she wants. Focusing
(concentrating on a single point) can be intimidating; giving information (making
available the facts that the client needs) and silence do not encourage client interaction.
1. The nurse is assessing the anxiety level of a young school-age child. The nurse
encourages the child to express feelings through the use of toys in a play situation. The
purpose for this approach to assessment is largely related to which of the following?
A) The child has cognitive impairment and has limited vocabulary skills.
B) The child has not been intellectually stimulated and can only express self through
C) Children may not have developed the language to fully describe their feelings.
D) Children will not express themselves openly unless instructed to do so by parents.
A client’s age can influence how he or she expresses illness. A young child may lack the
understanding and ability to describe his or her feelings, which may make management
of the disorder more challenging. Nurses must be aware of the child’s level of language
and work to understand the experience as he or she describes it.
2. A nurse is teaching decision-making skills to a client with dependent personality
disorder. According to Erikson, the likely cause of the client developing dependent
personality is failure to meet the critical task of which developmental stage?
Failure to complete the critical task results in a negative outcome for that stage of
development and impedes completion of future tasks. Tasks of trust versus mistrust
include viewing the world as safe and reliable and viewing relationships as nurturing,
stable, and dependable. In autonomy versus shame and doubt, children achieve a sense
of control and free will. In initiative versus guilt, the child begins to develop a
conscience, and learns to manage conflict and anxiety. Industry versus inferiority
involves school-age children building confidence in their own abilities and taking
pleasure in accomplishments.
3. Which one of the following statements is most accurate regarding the age at onset of a
mental illness such as schizophrenia?
A) Persons who are diagnosed at a younger age will more likely have a poorer
B) Persons who are diagnosed at a younger age will more likely have a better
C) Age at diagnosis is not related to outcomes.
D) Younger clients have more experiences that will help them.
Persons who are diagnosed with schizophrenia at a younger age at onset have poorer
outcomes, such as more negative signs and less effective coping skills, than do people
with a later age at onset. A possible reason for this difference is that younger clients
have not had experiences of successful independent living or the opportunity to work
and be self-sufficient and have a less well-developed sense of personal identity than
4. Genetics have been shown to play which of the following roles in a person’s mental and
A) Several mental disorders appear to run in families.
B) Specific genes have been linked to certain mental disorders.
C) Biologic factors can be modified to change the influence on emotional health.
D) Psychiatric treatment is effective regardless of an individual’s biologic influences.
Heredity and biologic factors are not under voluntary control. We cannot change these
factors. Research has identified genetic links to several disorders. Although specific
genetic links have not been identified for several mental disorders (e.g., bipolar disorder,
major depression, and alcoholism), research has shown that these disorders tend to
appear more frequently in families. Genetic makeup tremendously influences a person’s
response to illness and perhaps even to treatment.
5. Which one of the following statements about the roles that biologic makeup plays in a
client’s emotional responses is most accurate?
A) Biologic differences can affect a client’s response to treatment with psychotropic
B) Biologic differences do not affect a client’s response to treatment with
C) Heredity and biologic factors are under voluntary control.
D) Persons cannot change their health status and improve the ability to cope.
Biologic differences can affect a client’s response to treatment with psychotropic drugs.
Heredity and biologic factors are not under voluntary control. Persons can change their
health status and improve their ability to cope.
6. Which of the following individual factors can a person modify to improve mental and
emotional health? Select all that apply.
A) Serotonin deficiency
B) Lack of exercise
C) Poor nutrition
D) Type I diabetes
Ans: B, C, E
Personal health practices, such as exercise, poor nutritional status, lack of sleep, or a
chronic physical illness, can influence the client’s response to illness. Unlike genetic
factors, how a person lives and takes care of himself or herself can alter many of these
factors. For this reason, nurses must assess the client’s physical health even when the
client is seeking help for mental health problems. Serotonin deficiency and type I
diabetes are not under voluntary control.
7. The nurse is preparing to administer PRN medication to a client of a Japanese descent
who is anxious. The prescription reads, ìAlprazolam (Xanax) 0.25 to 1.0 mg PO PRN.î
The best dose for the nurse to give initially is
A) 0.25 mg.
B) 0.5 mg.
C) 0.75 mg.
D) 1.0 mg.
In general, nonwhites treated with Western dosing protocols have higher serum levels
per dose and suffer more side effects. Persons of Asian descent often metabolize drugs
more slowly, requiring lower doses to produce therapeutic effects.
8. A client’s prognosis is said to be good due to a high degree of self-efficacy. Which of
the following is evidence of a high degree of self-efficacy?
A) The client is self-motivated and asks for help when needed.
B) The client is able to resist illness when under stress.
C) The client responds well in stressful situations.
D) The client uses good problem-solving abilities.
People with high self-efficacy set personal goals, are self-motivated, cope effectively
with stress, and request support from others when needed. Hardiness is the ability to
resist illness when under stress. Resilience is defined as having healthy responses to
stressful circumstances or risky situations. Resourcefulness involves using problemsolving
abilities and believing that one can cope with adverse or novel situations.
9. A client is actively involved in community service activities. The benefit of involvement
in meaningful daily activities will most directly contribute to which of the following
Hardiness is the ability to resist illness when under stress. Hardiness has three
components: commitmentóactive involvement in life activities; controlóability to make
appropriate decisions in life activities; and challengeóability to perceive change as
beneficial rather than just stressful. Self-efficacy is a belief that personal abilities and
efforts affect the events in our lives. Resilience is defined as having healthy responses to
stressful circumstances or risky situations. Resourcefulness involves using problemsolving
abilities and believing that one can cope with adverse or novel situations.
10. It is recorded in the client’s chart that the family is resilient. The nurse concludes which
of the following characteristics about the family life of this client? Select all that apply.
A) Family members are independent of one another.
B) Family members spend time together.
C) Family members engage in recreational activities together.
D) Family members share the same personal goals.
E) Family members allow individual members to develop unique daily routines.
Ans: B, C
Factors that are present in resilient families include positive outlook, spirituality, family
member accord, flexibility, family communication, and support networks. Resilient
families also spend time together, share recreational activities, and participate in family
rituals and routines together. Personal goal setting reflects self-efficacy.
11. Spirituality is especially important in helping people cope primarily for which of the
A) Spirituality helps people set personal goals.
B) Spirituality gives people meaningful daily activities in which to participate.
C) Spirituality provides a reliable support network.
D) Spirituality guides beliefs about the meaning of life events.
Spirituality involves the essence of a person’s being and his or her beliefs about the
meaning of life and the purpose for living. Spirituality is a genuine help to many adults
with mental illness, serving as a primary coping device and a source of meaning and
coherence in their lives. It may also help to provide a social network, but it serves
primarily as a belief system. Personal goal setting is a demonstration of self-efficacy.
Hardiness is enhanced through commitment to meaningful daily activities.
12. Which of the following statements about hope and symptoms of mental illness are true?
Select all that apply.
A) Hope is not realistic and therefore is not related to mental well-being.
B) Persons having more hope experienced fewer actual symptoms.
C) Hope is a cause of mental illness.
D) There is not a significant relationship between hopelessness and increased
E) A possible way to help clients manage and decrease symptoms would be to
support the development of hope.
Ans: B, E
Persons having more hope experienced fewer actual symptoms. A significant
relationship between hopelessness and increased symptoms was also demonstrated. This
may indicate that one of the ways to help clients manage and decrease symptoms is
having a wellness plan that includes a positive future outlook and support for the
development of hope.
13. Which of the following personal characteristics influence a client’s response to
stressors? Select all that apply.
B) Sense of belonging
Ans: A, C, D, E, F
Personal characteristics that influence a client’s response to stressors include selfefficacy,
spirituality, hardiness, resilience, and resourcefulness. Sense of belonging is an
interpersonal factor that can influence a client’s response to stressors.
14. Which of the following statements about spirituality are true? Select all that apply.
A) Many clients with mental disorders have disturbing religious delusions.
B) Religious activities have been shown to be linked with better health and a sense of
C) Spirituality only involves religion.
D) Hope and faith are two critical factors in psychiatric and physical rehabilitation.
E) Spirituality may include a relationship with the environment.
Ans: A, B, D, E
Many clients with mental disorders have disturbing religious delusions. Religious
activities have been shown to be linked with better health and a sense of well-being.
Spirituality involves the essence of a person’s being and his or her beliefs about the
meaning of life and the purpose for living. It may include belief in God or a higher
power, the practice of religion, cultural beliefs and practices, and a relationship with the
environment. Hope and faith are two critical factors in psychiatric and physical
15. Individuals who grow up in ìat-riskî environments but are able to become productive,
successful citizens are believed to possess which of the following characteristics?
C) Social skills
Resilience is having healthy responses to stressful situations or risky environments.
Hardiness is the ability to resist illness when under stress. Social skills are a type of
coping strategy. Tolerance is the ability to deal with increasing levels of stress in an
16. Which of the following factors would be the most influential in determining a client’s
response to a particular stressor?
A) The client’s experience with stress
B) The client’s perception of the stressor
C) Duration of the stressor
D) Severity of the stressor
The client will respond to the stressor based on his or her appraisal (perception) of the
stressor. Resilience is related to positive outlook. The client’s experience with stress, the
duration of the stressor, and the severity of the stressor would not be the most influential
in determining a client’s response to a stressor.
17. The client says to the nurse, ìI know I can learn to cope with my family situation. By
getting help here at the clinic, I’ll be able to deal with them more effectively, and I won’t
be so stressed out all the time.î This client is demonstrating a high level of
C) sense of belonging.
Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. A
person who believes that his or her behavior makes a difference is more likely to take
action. Persons with high self-efficacy are self-motivated, get needed support, and cope
effectively. Hardiness is the ability to resist illness when under stress. Resilience is
defined as having healthy responses to stressful circumstances or risky situations. Sense
of belonging is the client’s place in the group, family, etc.
18. A client reports feeling like he belongs among his peers with whom he shares a group
home. The nurse incorporates this sense of belonging when formulating discharge plans
because the nurse understands which of the following?
A) Living with a peer group often increases anxiety.
B) Peers may alienate the client from daily living activities.
C) The client will likely feel needed by his peers.
D) Peer groups often do too much for each other causing dependency.
An increased sense of belonging is associated with decreased levels of anxiety. Persons
with a sense of belonging are less alienated and isolated, have a sense of purpose,
believe they are needed by others, and feel productive socially.
19. Which of the following situations would most likely provide social support to a client?
A) A friend who will share his or her perspective on an issue
B) The transportation service that provides access to daily rehabilitation services
C) Fellow teammates participating in a community softball league
D) The teacher assisting a client to obtain a GED
Social support is emotional sustenance that comes from friends, family members, and
even health-care providers who help a person when a problem arises. It is different from
social contact, which does not always provide emotional support. An example of social
contact is the friendly talk that goes on at parties.
20. A holistic plan of recovery would be especially important to a client from which of the
following cultural groups?
A) American Indian
B) African American
C) Mexican American
D) Arab American
The American Indians’ concept of health is holistic and wellness oriented. African
Americans and Mexican Americans value feelings of well-being, ability to fulfill role
expectations, and being free of pain or excess stress. Arab Americans view health as a
gift of God manifested by eating well, meeting social obligations, being in a good mood,
and having no stressors or pain.
21. A nurse and a client of Chinese heritage are collaborating on treatment goals. The nurse
would document which of the following as the client’s priority goal?
A) The client will be free of pain and excess stress.
B) The client will express a feeling of balance and harmony.
C) The client will be free of physical symptoms of illness.
D) The client will express gratefulness to God for recovery.
Chinese and many other Asian cultures view health as a balance of body, mind, and
spirit. Pain-free is a major focus of African American culture. Russians and Latino
cultures focus largely on physical aspects of health. Arab cultures view health as a gift
22. The nurse is preparing to conduct an admission assessment interview with a Mexican
American client. During the interview, the nurse should respect the client’s culture
through which behavior?
A) Greet the client with a hug,
B) Encourage direct eye contact during questioning
C) Prohibiting the next of kin to remain present
D) Introduce self with a handshake
With Mexican Americans touch by strangers is not appreciated, but a handshake is
polite and welcomed. Nonverbal communication generally avoids direct eye contact
with authority figures. Socially, contact with families comes first.
23. A nurse is working with a Middle-Eastern client being treated for major depression. The
client is expressing feelings of guilt for not being able to ìsnap out of it.î A therapeutic
response by the nurse would be,
A) ìYou have to keep trying to feel better.î
B) ìWhat do you think could have caused your depression?î
C) ìClinical depression is not something you have brought on yourself.î
D) ìIt will take several weeks for your medicine to start to help you feel better.î
Arab Americans believe mental illness is something the person can control. Educating
about the etiology reduces the guilt associated with having an illness. Suggesting the
client keep trying or caused the depression in some way implies that the client is
responsible for the illness. Informing about medication ignores the client’s feelings of
24. Several family members arrive to visit an African American client. The nurse can best
meet this client’s need for socialization by providing the client and family which of the
A) Individual visits to provide the client with a calm environment
B) Group gatherings and open conversation
C) Inclusion of ritualistic health practices with the family present
D) A spiritual healer to remove the illness and protect the family
During illness, families are often a support system for the sick person. Families often
feel comfortable demonstrating public affection such as hugging and touching one
another. Conversation among family and friends may be animated and loud. Spiritual
rituals are more prevalent in Native American cultures.
25. A Filipino client meets the nurse for the first time. The client simply smiles at the nurse
when introduced. The nurse interprets this behavior as
A) a display of being shy and introverted.
B) a typical greeting for a Filipino client.
C) constricted verbal skills associated with the client’s illness.
D) a sign that the client may be suspicious of the nurse.
Smiles rather than handshakes are a common form of greeting in Pilipino culture.
Filipino clients consider direct eye contact impolite, so there is little direct eye contact
with authority figures such as nurses and physicians.
26. Females from which of the following cultures are most likely to be expected to move in
with husband’s family?
A) African Americans
B) Mexican Americans
C) South Asians
African Americans are more likely to have a nuclear family. Mexican Americans mostly
live in nuclear families. South Asians expect the daughters to move in with the
husband’s family. Haitians may have an extended or a nuclear family.
27. Culture has the most influence on a person’s health beliefs and practices. African
Americans believe that the cause of mental illness occurs because of which of the
A) Lack of harmony of emotions
B) Supernatural causes
D) Lack of spiritual balance
African Americans believe that mental illness is caused by lack of spiritual balance.
Chinese believe that mental illness is caused by lack of harmony of emotions. Haitians
believe that mental illness is caused by supernatural causes. Cubans believe that mental
illness is hereditary.
28. A client from which of the following cultural groups is likely to prefer closeness in
A) Arab Americans
D) African Americans
Arab Americans prefer closeness in personal space. Chinese keep respectful distance.
Cubans have greatly varying preferences for personal space. African Americans respect
privacy and use a respectful approach.
29. Direct eye contact is preferred by which of the following cultures?
A) Native Americans
Of these cultures, only Russians prefer direct eye contact. Native Americans
communicate respect by avoiding eye contact. For Cambodians, eye contact is
acceptable, but ìpoliteî women lower their eyes. For Chinese, eye contact is avoided
with authority figures.
30. Beliefs about the causes of pain and illness vary among cultures. In the United States
(Western culture), pain and illness are generally attributed to
A) economic class.
B) psychological influences.
C) physiologic causes.
D) sociocultural factors.
Usually, Americans believe that pain and illness arise from physical causes. Two
prevalent types of beliefs about what causes illness in non-Western cultures are natural
and unnatural or personal. Unnatural or personal beliefs attribute the causes of illness to
the active, purposeful intervention of an outside agent, spirit, or supernatural force or
deity. The natural view is rooted in a belief that natural conditions or forces, such as
cold, heat, wind, or dampness, are responsible for illness.
31. The nurse considers cultural variations pertaining to a client’s nonverbal
communication. Which of the following is the primary rationale for considering
alternative meanings of nonverbal communication?
A) The nurse must become expert at interpreting the client’s gestures.
B) Nonverbal signs indicative of certain mental illnesses transcend cultural
C) Mental illnesses impair a client’s ability to express nonverbal messages.
D) Nonverbal messages have different meanings in various cultures.
The nurse should be aware that nonverbal communication has different meanings in
various cultures. These differences are important to note because many people make
inferences about a person’s behavior. The nurse can never know all culturally relevant
messages. All communication is culturally relative. Persons with mental illness are fully
capable of nonverbal expression.
32. Which of the following cultural phenomena that should be assessed by the nurse
includes preference such as touch and eye contact?
B) Social organization
C) Environmental control
D) Biologic variations
Communication involves verbal and nonverbal communication. Social organization
refers to family structure and organization, religious values and beliefs, ethnicity, and
culture. Environmental control refers to a client’s ability to control the surroundings or
direct factors in the environment.
33. Which of the following questions best encourages the client to disclose information the
nurse must assess to provide culturally competent care?
A) ìHow do you want me to help you?î
B) ìDo you want me to contact your preacher?î
C) ìWhat special dietary preferences do you have?î
D) ìWhich family members do you want to receive calls from?î
To provide culturally competent care, the nurse must find out as much as possible about
a client’s cultural values, beliefs, and health practices. Often, the client is the best source
for that information, so the nurse must ask the client what is important to him or her. An
open and objective approach to the client is essential. Clients will be more likely to
share personal and cultural information if the nurse is genuinely interested in knowing
and does not appear skeptical or judgmental. Assuming the client wants a preacher or
has dietary preferences is assuming the client’s values. Asking about preferred family
members does little to assess the nature of family relationships.
34. The nurse is making a cultural assessment of a client. The most important data about a
client’s cultural beliefs are
A) objective data about the culture.
B) subjective data from the client.
C) subjective data from the family.
D) subjective data from society.
The client’s perception and description of cultural beliefs and values are most important.
35. How might the nurse best provide culturally competent care?
A) Behave as appropriate for the nurse’s culture.
B) Find out as much as possible about a client’s cultural values, beliefs, and health
C) Know what to expect from many cultural groups.
D) Validate knowledge about culture through continuing education.
Each client is an individual; the nurse can never assume that any individual client will
fit the general preferences of his or her culture.