A nurse in an acute mental health center is performing a physical assessment on a client. Which of the following findings should the nurse document under the integumentary system? (Select all that apply.)

Numbness

Skeletal deformities

Alopecia

Ecchymosis

Answer and Explanation

The Correct Answer is A

A. Transference: Transference occurs when a client projects feelings about someone from their past onto the therapist or nurse. The client’s feelings about the nurse being similar to their mother fit this description.
B. Confrontation: Confrontation involves addressing discrepancies or issues directly, which is not the focus here. The situation described is about the client’s feelings towards the nurse.
C. Countertransference: Countertransference occurs when a nurse or therapist has emotional reactions based on their own past experiences, not the client’s feelings about the nurse.
D. Incongruence: Incongruence refers to a mismatch between a person's experiences and their self-concept. The situation described involves the client's feelings toward the nurse rather than incongruence.

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Correct Answer is B

Explanation

A. "You will have to have supervision when you go out in the community." This option implies a lack of independence and control for the client, which is generally counterproductive in community-based care. The goal is to empower individuals to live as independently as possible.
B. "You will be able to live in your own home while you receive therapy regularly." This option highlights a key advantage of community-based care for individuals with mental illness: the ability to maintain independence and live within the familiar environment of their own home while receiving necessary treatment and support. This approach fosters a sense of normalcy, reduces stigma, and can contribute to improved quality of life.
C. "You will not be allowed out with friends while in the program." This option suggests a restrictive environment, which is not conducive to a healthy and fulfilling life. Social interaction is crucial for mental well-being, and community-based care should promote social connections.
D. "You will have someone in your home at all times to ask questions if you have any concerns." While having support available is important, constant supervision can be overwhelming and intrusive for many clients. The focus should be on empowering individuals to manage their own care and build independence.

A. Restricted affect B. Broad affect C. Blunt affect D. Flat affect

Correct Answer is D

Explanation

A. Restricted affect: Restricted affect indicates a limited range of emotions but not a complete lack of expression.
B. Broad affect: Broad affect indicates a wide range of emotional expressions, which is not the case here.
C. Blunt affect: Blunt affect indicates a severe reduction in the intensity of emotional expression, but some expression is still present.
D. Flat affect: Correct. Flat affect indicates a complete lack of emotional expression, which matches the client's behavior.

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A nurse in an acute mental health center is performing a physical assessment on a client. Which of the following findings should the nurse document under the integumentary system? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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