Which assessment is most important when evaluating signs and symptoms of mental illness?

Correct Answer: D

Rationale: The correct answer is D because assessing the client's social and cultural norms is crucial in understanding their behavior within the context of their community. By considering these norms, the evaluator can differentiate between normal variations and potential signs of mental illness. Understanding social and cultural influences helps in providing effective and culturally sensitive interventions. Choice A is incorrect because creativity is not a definitive indicator of mental illness. Choice B is incorrect as the inability to face problems can be a symptom of mental illness, but it is not the most important assessment. Choice C is incorrect as the intensity of emotional reactions alone does not determine mental illness; it must be considered in relation to social and cultural norms.

Correct Answer: B

Rationale: The correct answer is B: nursing actions. NANDA provides nursing diagnoses, which guide clinical judgment in determining appropriate nursing interventions. Similarly, NIC (Nursing Interventions Classification) provides a standardized language for identifying nursing actions to achieve patient outcomes based on the identified nursing diagnoses. Therefore, the analogy between NANDA and clinical judgment is parallel to NIC and nursing actions. Summary: A: Patient outcomes - Incorrect. While patient outcomes are the ultimate goal of nursing care, NIC specifically focuses on the actions taken to achieve these outcomes. C: Diagnosis - Incorrect. NANDA provides nursing diagnoses, while NIC focuses on interventions rather than diagnoses. D: Symptoms - Incorrect. NIC is not focused on symptoms but rather on the actions nurses take to address the identified nursing diagnoses.

Correct Answer: A

Rationale: Step 1: The nurse holds a Western worldview and uses pamphlets, which may not align with Hispanic patients' cultural beliefs and preferences. Step 2: The patients may perceive the nurse as uncaring because of cultural mismatch and lack of personalized approach. Step 3: Short and concise groups may be seen as rushed or lacking in depth, contributing to the perception of uncaring behavior. Step 4: Overall, the patients are likely to believe the nurse was uncaring due to cultural insensitivity and ineffective communication. Other choices are incorrect as they do not address the cultural aspect and the impact it has on patient perception.

Correct Answer: D

Rationale: Correct Answer: D Rationale: 1. Validating the child's feelings encourages open communication and trust. 2. Asking the child to share more helps the nurse understand the situation better. 3. It shows empathy and provides an opportunity for support and guidance. 4. Encourages the child to express emotions and promotes problem-solving skills. Incorrect Choices: A: Ignoring bullies may not solve the problem and can lead to further isolation. B: Making friends is not always easy and might not address the current issue. C: Encouraging retaliation can escalate the situation and promote negative behavior.

Correct Answer: A

Rationale: The correct answer is A: Hildegarde Peplau. Peplau is known for her work on interpersonal relations in nursing, emphasizing the therapeutic nurse-patient relationship. She developed the Theory of Interpersonal Relations, which focuses on the nurse's role in facilitating the patient's growth and development. Through this theory, nurses use themselves as therapeutic tools to promote healing. Florence Nightingale is known for her contributions to nursing practice, but not specifically for therapeutic use of self. Dorothea Dix was a mental health advocate, not directly related to therapeutic nurse-patient relationship. Sigmund Freud is known for psychoanalytic theory, which is not directly related to nurse-patient interactions.