ATI RN MENT AL HEALTH
Terms in this set (83)
1. A nurse assesses a client
at a community ment al
health facility using the SAD
PERSONS tool. The nur se
knows that this tool
provides which of the
following data related to a
client?
A.Current anxiety level
B.Problem-sol ving ability
C.Suicide pot ential
D.Moo d disturbanceC
A.INCORRECT : SAD PERSONS is not a tool to provide
data related to the client's current anxiety level.
B.INCORRECT : SAD PERSONS is not a tool to provide
data related to a client's ability to problem sol ve.
C.CORRECT : SAD PERSONS is a tool that provides data
related to a client's suicide pot ential.
D.INCORRECT : SAD PERSONS does not provide data
related to a client's moo d disturbance .
NCLE X ® Connection: P sychosocial Integrity , Crisis
Intervention 1. A nurse is assisting the
parents of a school -age
child who has oppositional
defiant disor der in
identifying s trategies to
promot e positiv e beha vior.
Which of the following is an
appr opria te strategy for the
nurse to recommend ?
(Select all that apply.)
A.Allow the child to choose
consequences for nega tive
beha vior.
B.Use role playing to act out
unaccept able beha vior.
C.De velop a reward system
for accept able beha vior.
D.Encour age the child to
particip ate in school sports.
E.Be consis tent when aC, D, E
A.IncOrr Ect: The p arents shoul d set clear limits on
unaccept able beha vior.
B.IncOrr Ect: The p arents shoul d focus on accept able
beha vior and shoul d demons trate this through mo deling.
C.CORRECT : The p arents shoul d have a metho d to
reward the child for accept able beha vior.
D.CORRECT : The p arents shoul d encour age phy sical
activity through which the child can use ener gy and
obtain success.
E.CORRECT : The p arents shoul d set clear limits on
unaccept able beha vior and shoul d be consis tent.
NCLE X ® Connection: P sychosocial Integrity , Beha vioral
Interventions 1. A nurse mana ger is
discussing the care of a
client who has a personal ity
disor der with a newly
licensed nur se. Which of the
following s tatements by the
newly licensed nur se
indica tes a need for further
teaching ?
A."I can pr omot e my client's
sense of contr ol by
establishing a schedul e."
B."Self-assessment will help
me cope with emotional
reactions to client care."
C."I shoul d practice l imit-
setting to help prevent
client manipul ation."
D."Maint aining pr ofessional
boundaries is a priority of clA
1. A. CoRRECT : Rather than es tablishing a schedul e, the
nurse shoul d ask for the client's input and offer realistic
choices to promot e the client's sense of contr ol.
B. inCorrECt: Caring for a client who has a personal ity
disor der can e voke an int ense emotional response by
the nur se. Self-assessment assists the nur se to cope with
these r eactions.
C. inC orrECt: When caring for a client who has a
personal ity disor der, limit-setting is appr opria te to help
prevent client manipul ation.
D. inCorrECt: When caring for a client who has a
personal ity disor der, the nur se shoul d always maint ain
professional boundaries.
NCLE X ® Connection: P sychosocial Integrity , Beha vioral
Interventions
2. A client says, "I pl an to
commit suicide ." Which of
the following shoul d be the
nurse's priority assessment?
A.Client's educa tional and
economic b ackground
B.Lethal ity of the metho d
and availability of means
C.Qual ity of the client's
social support
D.Client's insight into the
reasons for the decisionB
A.INCORRECT : This is an appr opria te action by the
nurse. However, it is not the priority .
B.CORRECT : The greatest risk to the client is self-harm as
a result of carrying out a suicide pl an. Therefore, the
priority assessment is to determine ho w lethal the
metho d is, ho w available the metho d is, and ho w
detailed the pl an is.
C.INCORRECT : This is an appr opria te action by the
nurse. However, it is not the priority .
D.INCORRECT : This is an appr opria te action by the
nurse. However, it is not the priority .
NCLE X ® Connection: P sychosocial Integrity , Crisis
Intervention 2. A nurse is caring for a
client who has avoidant
personal ity disor der. Which
of the following s tatements
is expect ed from a client
who has this type of
personal ity disor der?
A."I'm scar ed that you're
going to leave me ."
B. "I'll go to group therapy if
you'll let me smok e."
C."I need to feel that
everyone admir es me."
D."I sometimes feel bett er if
I cut myself."A
A. CoRRECT : Clients who have avoidant personal ity
disor der often ha ve a fear of abandonment . Therefore,
this type of statement is expect ed.
B. inCorrECt: This statement indica tes manipul ation,
which is not expect ed from a client who has borderline
rather than avoidant personal ity disor der.
C. inC orrECt: This statement indica tes a need for
admir ation, which is expect ed from a client who has
narcissis tic rather than avoidant personal ity disor der.
D. inCorrECt: This statement indica tes a risk for self-injur y,
which is expect ed from a client who has borderline
rather than avoidant personal ity disor der.
NCLE X ® Connection: P sychosocial Integrity , Ment al
Heal th Concepts
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