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Terms in this set (143)
Which law prevents insurance companies from excluding people because of preexisting conditions?
The Patient Protection and Affordable Care Act
During the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. As a result hospital stays were shortened due to the introduction of which?
Which were major problems with large state institutions?
-Attendants were accused of abusing the residents
-Clients were geographically isolated from family and community
-Clients were not given proper nutrition or clothed properly
Nursing education has become broad in practice settings. The addition of psychiatric nursing became a requirement in nursing education in 1950 by whom?
National League of Nursing
A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client?
Report the incident to staff and the clinical instructor so boundaries can be reenforced with the
-Residents were not normally required to pay for their own care and stigma was a lesser issue because of clients' isolation from the larger population.
If a client states, "I carry this lucky rabbit's foot for luck, my dad did too, and it really works," which statement by the nurse reflects respect for the client's belief? : "I can accept that you feel it is lucky, so let's get to our activities for the day."
Why would you respond with this?
At times, a nurse's values and beliefs will conflict with those of the client or with the client's behavior. The nurse must learn to accept these differences among people and view each client as a worthwhile person regardless of that client's opinions and lifestyle. The nurse does not need to share the client's views and behavior; the nurse merely needs to accept them as different from the nurse's own and not let them interfere with care.
What organization developed and maintains standards of practice that are used to determine safe quality care and that can be used legally if incorporated into the state practice act or nurse's rules and regulations that guide the nursing profession?
ANA (American Nurses Association)
The nurse's primary commitment is to the health, safety, and welfare of people placed in his or her care, as well as to the public. This commitment is provided through evidence-based care. What does the term evidence-based care mean?
Care that integrates the best available evidence from research with clinical expertise
Why is the document Mental Health: A Report of the Surgeon General (1999) significant?
Because it states clearly that there are effective treatments for mental illness
According to the theory proposed by Sigmund Freud, a psychosis or neurosis would develop in an individual if ...
there was interference in normal development.
In the early Christian period, who treated clients thought to be possessed by demons causing their mental illness?
During which stage of Freud's developmental model does a toddler develop a sense of autonomy by withholding?
The psychiatric mental health nurse is planning the care of a client. What action best addresses the client's needs in the social domain?
Collaborating with the client's family to organize support
Which intervention is focused on a goal included in Healthy People 2020 Mental Health objectives?
Including a depression screening in the assessment interview conducted by the staff of a group of family practitioners
A client with schizophrenia has been noncompliant with medications. The client requires frequent admissions to the psychiatric unit for acute psychotic episodes. What is this process called?
Hydrotherapy, a primitive treatment, was used for what in the mentally ill population?
Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship?
In mental health nursing, the most relevant evidence is ideally from which of the following sources?
Which is a difference between counseling and psychotherapy?
Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role.
The goal of the 1963 Community Mental Health Centers Act was to ?
deinstitutionalize state hospitals
-The 1963 Community Mental Health Centers Act intimated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shift of clients with mental illness from large state institutions to care based in the community
During the moral treatment period, clients were routinely placed into which environment?
In the moral treatment period (1790-1900), moral treatment and the use of kindness, compassion, and a pleasant environment was adopted. Clients were routinely removed from their communities and placed in ASYLUMS, which was thought to be best for their safety and comfort. Community mental health centers, by and large, ignored the legions of people with serious mental illnesses and instead focused on the treatment of those with alcoholism and drug addiction.
One of the primary reforms accomplished by Dorothea Lynde Dix was the
establishment or enlargement of state hospitals.
Who was responsible for much of the reform of the mental health care system in the 19th century?
Dorothea Lynde Dix
Which sets professional standards of care?
Professional nursing organizations
Before the period of the enlightenment, treatment of the mentally ill included:
placing the mentally ill on display for the public's amusement.
Until the onset of the Renaissance, the general population held which belief regarding the presence of sickness?
It was punishment for sins and wrongdoing.
Which is the preferred educational preparation for a psychiatric nurse?
What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care?
Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice.
The newly licensed registered nurse has been hired at the local hospital in the geriatric-psychiatry unit. Today is the nurse's first day of orientation to this facility. What would be the nurse's priority action if a client becomes aggressive?
As a newly licensed registered nurse on orientation the first day, the nurse has not been trained to take down or assist in taking down an aggressive client. Serious injury can occur. Maintaining a safe distance in this situation is the most prudent, until the nurse has received the appropriate training.
In 1909, the National Mental Health Committee for Mental Hygiene was responsible for the development of what?
Which religious group was instrumental in stopping the practice of bloodletting?
Which client statement demonstrates the most positive aspect of treating clients with mental illness in community-based care?
"I can live in my own home and still see a therapist regularly."
It is not uncommon for new psychiatric mental health students to be fearful of interacting with individuals suffering from mental illness. The fear and misunderstanding of those with mental illness is known as which of the following?
TRUE OR FALSE: A key element in the definition of mental illness is that the individual must have difficulties in functioning that cause distress and/or impairment of some type.
According to the World Health Organization (WHO), by the year 2030, which of the following mental health disorders will be the leading burden worldwide?
A nurse is preparing a presentation about how mental health providers are often portrayed in the media, which leads to public stigma. Which of the following descriptors would the nurse most likely include?
One of the best ways to counteract the negative effects of stigma is to do which of the following?
Have contact with the stigmatized group.
A nurse is reading a journal article about cultural syndromes. Which of the following would the nurse identify as having been well documented?
Susto *There is little research on the syndromes, but there are two conditions, ataque de nervios and susto, that are well documented.
What activity should be included in the first step of self-reflection?
identifying one's own values, attitudes, strengths and weakness
Which of the following is most accurate about the Diagnostic and Statistical Manual of Mental Disorders-5?
Boundaries separating disorders are not absolute.
When describing wellness and mental disorders, which of the following factors would the nurse address as commonly interfering with the individual's ability to achieve wellness?
Many people with mental health problems die decades earlier than the general public from preventable disease factors such as poverty, unemployment, underemployment, trauma, and lack of education. These are common in people who have mental health issues and often prevent the achievement of wellness.
In epidemiologic terms the proportion of the cases in the population when compared with the total population refers to the ?
Which component of recovery occurs when the client creates a path to meet a specific goal?
A nurse is working as part of a research team that is examining the proportion of individuals in a population who have bipolar disorder on a particular date. Which of the following would the team be most likely measuring?
A Latino American client witnessed a traumatic event and is suspected of experiencing the cultural syndrome of susto. Which of the following would the nurse most likely assess?
Susto is a cultural syndrome involving fright, characterized by symptoms of psychomotor agitation, anorexia, insomnia, fever, diarrhea, confusion, apathy, depression, and introversion following an emotional trauma or witnessing a traumatic experience.
A nurse is watching a movie which tells the story of a person previously confined to a psychiatric hospital for several years. The movie shows the individual going on a violent murder spree after discharge. Which of the following is the movie depicting?
A client with a mental illness tells the nurse, "I'm just like what others say I am. I can never be normal." The nurse interprets this statement as reflecting which of the following?
Which of the following is the leading cause of disease in middle- and high-income countries?
TRUE OR FALSE : In epidemiological studies, the point prevalence refers to the proportion of individuals who have the disorder at a specified point in time.
Which of the following is a type of stigma that the mentally ill population faces?
When assessing a person with a mental disorder, which of the following would be most important for a nurse to consider for recovery?
Degree of disability or impairment
Which of the following is most accurate about the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)?
It specifies criteria for diagnosing mental disorders.
A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what?
The nurse has a physician's order for haloperidol (Haldol) 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response?
Accept the clients decision
Which element of malpractice occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance?
Breach of duty
A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle?
To care for clients in the least restrictive environment, treatment is usually delivered in which care setting?
The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller?
"I cannot confirm or deny the existence of any client here."
Following an assault, a client with mental illness has been declared unfit to stand trial. The nurse should draw what conclusion from this fact?
The client cannot comprehend the legal proceedings
Placing a client in restraints before using other methods of intervention violates the client's right to
Receive treatment in the least restrictive environment
An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is:
inappropriate; room restriction is not treatment in the least restrictive environment.
Which dilemmas involve the ethical principle of fidelity?
-When the nurse is unable to agree with the policies or common practices of an agency
-When the nurse is faced with a decision to violate a policy that is harmful to the client
A student nurse is assigned to administer oral medications to a client. Which of these actions should a student nurse take if a client refuses to take prescribed oral medications?
ask the client's reason for refusing and report it to the primary care nurse
Which of the following rights could the psychiatric client lose when admitted to a locked, inpatient psychiatric treatment facility?
Right to schedule his or her own time
A physician would like to include a client with schizophrenia in a research study testing a new medication. The nurse's obligation is to do what?
Assess the client's legal capacity when that client is asked to give consent.
A client was admitted to a psychiatric facility because the client was found walking around naked and talking incoherently. The client has no known next of kin and has been adjudicated incompetent. The client refuses any antipsychotic medications but has not been harmful to the self or others. What action should the facility take?
Initiate court proceedings to have a guardian named
TRUE or FALSE: Committed clients lose only their right to freedom; they still have the right to send uncensored mail.
When is a nurse legally obligated to breach confidentiality?
If threats are made to an outside party
Which of the following medication classifications are used to assist clients to calm down? Select all that apply.
Antianxiety medications, mood stabilizers, and antipsychotic medications can be given to assist agitated patients in calming down. Antipsychotic medications are used to help patients with psychosis and mania. Anti-anxiety and hypnotic medications are used for as-needed management of aggressive episodes that occur despite taking antipsychotic medication as prescribed. Mood stabilizers have also been found helpful in managing aggressive behavior.
Which of the following are criteria for instituting the short-term use of restraint or seclusion?
-The client is aggressive.
-The client is imminently dangerous to the self or to others.
-All other means of calming the client have been unsuccessful.
The nurse is attending an inservice training on safe take-down techniques for aggressive clients. Practicing these techniques helps to reinforce the proper handling of this situation. Preparation for safe physical handling prepares the nurse to practice which ethical principle?
An agitated client has been put in restraints against the client's will because of inadequate staffing. The nurse determines this as which form of malpractice?
As a result of the increasing severity of delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client?
A guardian appointed by the court
A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process?
Ask the client about any advance care directives that that the client has established
Samuel has been committed involuntarily to a psychiatric-mental health facility to allow time to determine an appropriate diagnosis. What is this type of involuntary commitment known as?
The nurse is threatening to give the client an injection in order to restrain the client for inappropriate behavior. This is an example of
Which court decision or act states that psychotherapists have a duty to exercise reasonable care in protecting the foreseeable victims of their clients' violent actions?
In Tarasoff v. Regents of the University of California, the high court said that psychotherapists have a duty to warn the foreseeable victims of their clients' violent actions.
A client who had agreed to be hospitalized for depression has decided that she wants to leave the hospital. The mental health staff caring for the client realizes that at present the client can legally:
leave without discussing the situation with anyone.
Malpractice is proven when certain criteria have been met. Which list includes the correct criteria?
Duty of care, professional performance, injury related to the nurse's action, action foreseeably could have caused the injury, and proven injury
A client who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The client continues to need routine psychiatric services. The nurse should explain to the client that she or he will most likely be referred to which of the following services?
intensive outpatient program.
This is an example of what? The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion.
While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that the client was prescribed in the hospital. This nurse may be guilty of what?
Malpractice ** The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another person in apprehension of being touched (or of bodily harm without consent), and failure of duty to warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a client's right to autonomy.
From a legal standpoint, clients hospitalized as voluntary admissions differ from other types of admissions in which way?
They have agreed to the hospitalization.
The term "standards of care" refers to expectations of nursing performance given to all clients. Standards of care are developed from what? Select all that apply.
Code of Ethics for Nurses With Interpretive Statements
State Nurse Practice Acts
Agency job descriptions
Professional nursing organizations
A client has been admitted to the psychiatric facility for the treatment of depression. The client has told the emergency department staff that she would like a close friend to make decisions surrounding her care until she "feels better." In order to identify the legal basis for the client's preference, the nurse should:
determine whether a durable power of attorney has been established.
Which of the following is an accurate statement regarding an advance care directive?
It must be witnessed by two people and notarized.
*An advance care directive does not need to be written, reviewed, or signed by an attorney. It must be witnessed by two people and notarized, and applies only if the individual is unable to make his or her own decisions as a result of being incapacitated or if, in the opinion of two physicians, the person is otherwise unable to make decisions for him- or herself.
Which ethical principle is in jeopardy when segments of the mentally ill population do not have access to care?
Which standard of practice deals with the analysis of assessment data and assessment of level of risk?
A nurse working in psychiatric-mental health who is a licensed registered nurse but also educationally prepared at the master's level and certified as a specialist is also known as which of the following?
An experienced nurse working in mental health uses the holisitc and well-supported biopsychosocial model. The nurse correctly identifies which of the following as domains of this model?
A nursing student identifies which as the most important tool of psychiatric nursing?
Self. Through relationship building, clients learn to trust the nurse, who then guides, teaches, and advocates for quality care and treatment.
While caring for a client with insomnia, the nurse teaches the client to use guided imagery. This intervention is an example of which domain?
The nurse is working with a client who has expressed a desire to discontinue treatment. The care team knows that this decision would have negative consequences for the client and is discussing the ethics of the situation. In order to best address the situation, the nurse should first:
ask reflective questions in order to fully understand the situation.
The advanced practice psychiatric nurse is working with a client who has generalized anxiety disorder. The nurse is teaching the client skills at identifying and managing the thoughts that exacerbate his anxiety. What domain is this nurse primarily addressing?
Which member of an interdisciplinary team assists the client with transition into the workplace?
An occupational therapist assists the client in transitioning into the workforce. A case manager coordinates the client's plan of care. A psychiatric social worker assists with individual psychotherapy. In the hospital, a client may see a psychiatrist or psychiatric nurse practitioner who treats the client's symptoms and prescribes medication.
Which of the following provides a foundation for clinical decision-making?
A nurse working in a remote area needs a psychiatrist to assist in diagnosing a client. The nurse schedules an interview between a psychiatrist and the client. The psychiatrist will observe and interview the client using videoconferencing software. This is a specific example of which of the following?
A client with complex psychosocial and mental health needs requires case management. What members of the healthcare team may perform case management for this client?
Psychiatric-mental health registered nurse
Psychiatric-mental health advanced practice nurse
What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)?
A guideline for nurses regarding ethical conduct
A nurse caring for a psychiatric client and using the biopsychosocial model applies the functional patterns of sleep and nutrition to which of the following domains?
A psychiatric mental health facility is undergoing a change from paper-based health records to electronic records. What action should the nurse prioritize in order to ensure client rights are protected?
Being vigilant to identify any potential threats to client confidentiality
A psychiatric-mental health registered nurse recommended a change in a client's medication dosing schedule, and in doing so violated standards of practice. To whom is the nurse ultimately accountable for this violation of nursing standards.
Nurses are ultimately held accountable by society for practicing according to their standards.
A client is being seen in the mental health clinic because of relapse. The client has been nonadherent with the medication regimen. The nurse reinforces the advantages of taking medications. The nurse is using which ethical principle?
According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which people achieve their maximal health care potential. According to the principle of autonomy, each person has the fundamental right of self-determination. Justice is the duty to be treated fairly. Veracity is the duty to tell the truth.
A client with insomnia has been prescribed a sleep medication that does not contain REM sleep suppressors. This is an example of an intervention related to which domain in the biopsychological model?
A client asks if the medication has any possible negative side effects. The nurse considers the client highly suggestible, believes the medication will benefit the client, and, since the client has no history of cardiovascular disease, does not tell her of the potential for cardiac dysrhythmias. The nurse's actions involve a conflict between which two ethical principles?
Veracity and nonmaleficence
*The conflict is between veracity and nonmaleficence. Veracity is a systematic behavior of honesty and truthfulness in speech. Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Justice in health care is seen as the equitableness of benefits, including the right to access care. Beneficence is the principle of doing good, not harm. Fidelity is the nurse's faithfulness to duties, obligations, and promises.
Providing milieu therapy is an example of the use of which ethical principle?
The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle?
The psychological domain contains which theoretical bases?
The psychological domain contains the theoretical basis of the psychological processes—thoughts, feelings, and behavior (intrapersonal dynamics) that influence one's emotion, cognition, and behavior. The social domain includes theories that account for the influence of social forces encompassing the patient, family, and community within cultural settings.
For a psychiatric client's expected outcomes to be appropriate they must be
Measurable and realistic
During the assessment, the nurse asks the client to describe his problems. The purpose of this question is to obtain information about the client's
perception of the problem
A nurse documents that "the client describes the recent breakup of a dating relationship with an emotionless tone and a flat facial expression." In which section of the mental status exam would the nurse have documented this statement?
The nurse is assessing an older adult client with lower back pain. In the course of assessment, the nurse learns that the client lost a spouse 10 weeks ago. The client laughs inappropriately and states, "My spouse just up and left me!" Which is the nurse's best response?
An apparent disconnect between content and the client's behavior should prompt the nurse to explore the matter more deeply. While grieving is indeed an individual process, it would be imprudent for the nurse to deny the incongruity between the topic and the behavior. The client's statement heightens the relevance of mental status in the assessment, but the priority would be to explore the matter more deeply and ask follow-up questions.
A client reported to the nurse that on the client's way to the clinic, a police officer in a patrol car turned on the car's lights and pulled the client over. When asked what the client did next, the client stated, "I pulled over, of course." Which was the nurse trying to assess?
The client's judgment
The nurse asks the client, "What is similar about a cow and a horse?" and "What do a bus and an airplane have in common?" These questions would best assess which area?
A client is admitted to the psychiatric unit and states, "I am president of the largest corporation in the world. Everyone comes to me for advice." The nurse knows the client is exhibiting what?
Which is the most compelling reason for the nurse to discuss matters of sexuality and suicide?
It is the nurse's professional responsibility to keep the client's safety needs first and foremost, and this includes overcoming any personal discomfort in talking about suicide. This is not required by any laws nor is it commonly required documentation for every encounter with every client.
A nurse is assessing a hospitalized client who is hearing voices due to psychosis. The client is easily distracted, and this is creating a barrier to completing the assessment. What is the most effective way for the nurse to proceed?
Complete the assessment in several short interactions.
The nurse has assessed a client's behavior and determines the need to de-escalate the situation. What action should the nurse take initially to calm the client?
Calmly call the client by name, asking them to come to their room
When asking a client to "tell me how having schizophrenia has affected your life," the nurse is assessing the client's capacity for what?
What examination is used to determine whether a client is experiencing abnormalities in thinking and reasoning ability, feelings, or behavior?
Mental status exam
In the space of five minutes, the client has been laughing and euphoric, then angry, and then crying for no reason that is apparent to the nurse. This behavior would be best described as
A nurse is completing an assessment interview, and is attempting to bring the conversation back to the questions at hand when the client goes off on a tangent. Which assessment interview behavior is the nurse using?
A client is being evaluated for dementia. The nurse knows that a client who is able to complete very few tasks is most likely to have:
a greater cognitive deficit.
A nurse can best assess a client's ability to use abstract thinking by asking the client which question?
The nurse assesses the client's ability to use abstract thinking, which is to make associations or interpretations about a situation or comment. The nurse usually can do so by asking the client to interpret a common proverb. If the client can explain the proverb correctly, his or her abstract thinking abilities are intact. Judgment refers to the ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Insight is the ability to understand the true nature of one's situation and accept some personal responsibility for that situation. The nurse assesses the client's ability to concentrate by asking the client to perform certain tasks such as "serial sevens."
A nurse suspects that a client is abusing alcohol while taking prescribed medications. The nurse plans to educate the client on the dangers of mixing medicine with alcohol. Which would be the most effective way for the nurse to approach this subject with the client?
Emphasize the importance of truthful information using a nonjudgmental approach.
The nurse is engaged in health teaching with a client who has expressed a willingness to learn about their schizophrenia diagnosis. Which client statement indicates the teaching has progressed to the next phase of the teaching process?
"I want to be able to identify what is going to cause me to relapse."
During an assessment, which would be the most important question topic?
The application of walking restraints is appropriate as a last resort for which client?
A cognitively impaired client who is at risk for injury related to frequent wandering at night
The following statement is written by the RN: "The client appears disheveled and smells of alcohol." This statement would appear under which of the following?
Mental Status Exam
The psychiatric nurse caring for a depressed client shows an understanding of the role of the nursing diagnosis when stating that it addresses
How the client is affected by the depression.
A nurse awaits the arrival of a client who is being transferred from a nursing home. The client has a history of schizophrenia and has been behaving bizarrely. The nurse begins preparing the plan of care by outlining expected outcomes. The nurse's actions are which of the following?
Inconsistent with the nursing process, because assessment always comes first.
**The five steps of the nursing process supply an organized approach for providing quality psychiatric-mental health nursing care. The five steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.
What is the expected outcome of therapeutic reminiscence?
Identification of previously effective coping skills
The nursing process is what?
The methodology of the nursing process provides a framework for critical thinking that is central to nursing care
Which of the following is part of the social component in a psychiatric-mental health nursing assessment?
Quality of life
The client spoke of a current event in the national news and described it as it relates to the client. Then the client spoke of a historical event and described it as it relates to the client. Which question might the nurse ask to determine if the client is experiencing ideas of reference?
"Where were you when this happened?"
How should the nurse describe the mood and affect of a client who has a mask-like facial expression but states, "I'm really happy."
The nurse is seeing a client who has been experiencing symptoms of depression over the past month. Recent stress includes the death of the client's mother, for whom the client was a primary caregiver. Which components of the psychosocial assessment apply to this aspect of the client's situation?
roles and relationships
Outcomes can be determined immediately after the nursing intervention or after time passes. Which of the following are attributes of a nursing outcome?
Stated in few words
Describes a client's behavior
TRUE or FALSE : Milieu therapy is a nursing intervention used in the social domain?
When assessing a client who has been referred to the outpatient mental health clinic with symptoms of depression, the psychiatric nurse should closely observe the client's affect and which assessment component?
When completing a physical assessment of an individual's response to stress, the nurse should observe and inquire about what?
appetite and sleep
A client is known to express tangential thinking. The nurse would assess for which when interacting with the client?
Wandering off the topic and never answering the question
When considering where to conduct a psychosocial assessment, the nurse can effectively interview which client in the unit's conference room?
the anxious client
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