Final

A psychiatrist prescribes a MAOI for a client. When teaching the client about the effects of tyramine, which foods will the nurse caution the client to avoid? 1. Pepperoni pizza and red wine 2. Bagels with cream cheese and tea 3. Apple pie and coffee 4. Potato chips and Diet Coke

1

Which action should the nurse take when a depressed client refuses electroconvulsive therapy (ECT)? 1. Accept the client's decision 2. Inform the client that the procedure is mandatory 3. Tell the client that the signature verifies informed consent 4. Call the family to receive approval

1 The nurse should accept the client's decision. Consent for ECT may be withdrawn at any time.

Which statement by a client who is beginning tricyclic antidepressant therapy indicates successful teaching? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I will start to see results in about 2 weeks." 3. "I will continue to smoke." 4. "I will start to cut down on my alcohol intake and have only one glass of wine at supper."

1 This statement indicates successful teaching. Clients should continue to take the medication even if symptoms have not subsided. The therapeutic effect may not be seen for as long as 4 weeks.

A nurse is assessing a client diagnosed with fetishistic disorder. What would differentiate this paraphilic disorder from frotteuristic disorder? 1. To derive sexual excitement, fetishistic disorder involves the use of nonliving objects, whereas frotteuristic disorder involves touching and rubbing against non-consenting people. 2. To derive sexual excitement, frotteuristic disorder involves the use of nonliving objects, whereas fetishistic disorder involves touching and rubbing against non-consenting people. 3. Clients diagnosed with frotteuristic disorder are heterosexual cross-dressing males, whereas Clients diagnosed with fetishistic disorder are homosexual cross-dressing males. 4. Clients diagnosed with fetishistic disorder are heterosexual cross-dressing males, whereas Clients diagnosed with frotteuristic disorder are homosexual cross-dressing males.

1 ~ Fetishistic disorder involves recurrent and intense sexual arousal from the use of either nonliving objects or specific nongenital body part(s). Frotteuristic disorder is the recurrent and intense sexual arousal involving touching and rubbing against a non-consenting person. Transvestic disorder involves recurrent and intense sexual arousal from dressing in the clothes of the opposite gender.

A newly married woman comes to a gynecology clinic reporting anorexia, insomnia, and extreme pain during intercourse that has affected her intimate relationship. What initial intervention should the nurse expect a physician to implement? 1. A thorough physical, including gynecological examination 2. Referral to a sex therapist 3. Assessment of sexual history and previous satisfaction with sexual relationships 4. Referral to the recreational therapist for relaxation therapy

1 ~ The nurse should expect the physician to implement a thorough physical, including a gynecological examination to assess for any physiological causes of the client's symptoms. If no pathology exists the client may be diagnosed with genito-pelvic pain/penetration disorder. In this disorder, the individual experiences considerable difficulty with vaginal intercourse and attempts at penetration. Pain is felt in the vagina, around the vaginal entrance and clitoris, or deep in the pelvis. There is fear and anxiety associated with anticipation of pain or vaginal penetration. A tensing and tightening of the pelvic floor muscles occurs during attempted vaginal penetration.

A nurse is instructing a client diagnosed with sexual female sexual interest/arousal disorder. Which symptom and treatment of this disorder should the nurse describe to the client? 1. Avoidance of all genital sexual contact treated by sensate focus exercises 2. Avoidance of all genital sexual contact treated by medicating with tadalafil (Cialis) 3. Anorgasmia treated by vardenafil (Levitra) 4. Anorgasmia treated by systematic desensitization

1 ~ The nurse should explain to the client that female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Senate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy.

In the course of an assessment interview, a female client reveals a history of bisexual orientation. Which action should the nurse initially implement when working with this client? 1. Self-assess personal attitudes toward homosexuality. 2. Review client's possible childhood sexual abuse history. 3. Encourage discussion of aversion to heterosexual relationships. 4. Explore client's family history of homosexuality.

1 ~ The nurse should initially self-assess personal attitudes toward homosexuality. The nurse must be able to recognize when negative feelings compromise care. Unconditional acceptance of each individual is an essential component of compassionate nursing.

The nurse is preparing to assess a client before the physician prescribes a regimen of psychopharmacological therapy. Which components will the nurse assess? (Select all that apply.) 1. Medical history 2. Physical examination findings 3. Ethnocultural characteristics 4. Current medication

1, 2, 3, 4

The depressed client is prescribed a monoamine oxidase inhibitor (MAOI). Which statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food labels." 4. "I'm going to drink my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

1,2,3,5

A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.) 1. "Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner." 2. "Intimate partner violence is used to gain power and control over the other intimate partner." 3. "Fifty-one percent of victims of intimate violence are women." 4. "Women ages 25 to 34 experience the highest per capita rates of intimate violence." 5. "Victims are typically young married women who are dependent housewives."

1. "Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner." 2. "Intimate partner violence is used to gain power and control over the other intimate partner." 4. "Women ages 25 to 34 experience the highest per capita rates of intimate violence." Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. It is used to gain power and control over the other intimate partner. Women ages 25 to 34 experience the highest per capita rates of intimate violence. Eighty-five percent of victims of intimate violence are women. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives.

Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? Select all that apply. 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

1. Depression 2. Fatigue

A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Body dysmorphic disorder 4. Parkinson's disease

1. Schizophrenia spectrum disorder Rationale: Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania.

A client was recently admitted to the inpatient unit after a suicide attempt and has not responded to SSRIs or tricyclic antidepressants. The client asks the nurse, "I heard about monoamine oxidase inhibitors (MAOIs). Why can't they be added to what I am on now? Wouldn't adding one help?" Which is the appropriate nursing response? 1. "Electroconvulsive therapy is your best option at this point." 2. "Combined use can lead to a life-threatening condition called hypertensive crisis." 3. "There is no reason why an MAOI couldn't be added to your therapy." 4. "They can't be used together because their mechanisms of action are very different."

2

A physician prescribes an additional medication for a client taking an antipsychotic agent. The medication is to be administered "prn for EPS." When will the nurse plan to give this medication? 1. When the client's white blood cell count falls below 3,000/mm3 2. When the client exhibits tremors and a shuffling gait 3. When the client complains of dry mouth 4. When the client experiences a seizure

2

The depressed client is receiving light therapy. Which instruction would the nurse share with the client? 1. "White LED lights will be used with protective glasses to block ultraviolet rays." 2. "You will sit in front of the light box with your eyes open." 3. "The light sessions will start out at 5 minutes and work up to 30 minute intervals." 4. "Vagal stimulation from the light waves will help release melatonin in the brain."

2 The individual sits in front of the box with the eyes open (although the client should not look directly into the light).

After 5 months of taking nortriptyline (Aventyl) for depressive symptoms, a client reports that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "When did you last eat yogurt?"

2 The nurse would ask this question. Nortriptyline is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect.

The nurse is teaching the depressed client about bupropion (Wellbutrin). Which statement by the client indicates effective teaching? 1. "I will begin to wear short sleeves when outdoors." 2. "I will not take two pills if I miss a dose." 3. "I will discontinue the medication when my depression is gone." 4. "I will stand up smoothly and quickly to keep my balance."

2 This statement indicates effective teaching. Clients should never double up on a dose if they miss a day, as this could increase the risk of seizures or other adverse reactions.

A nurse is assessing a client diagnosed with pedophilic disorder. What would differentiate this sexual disorder from a sexual dysfunction? 1. Symptoms of sexual dysfunction include inappropriate sexual behaviors, whereas symptoms of a sexual disorder include impairment in normal sexual response. 2. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response. 3. Sexual dysfunction can be caused by increased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual disorders. 4. Sexual disorders can be caused by decreased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual dysfunction.

2 ~ The nurse should identify that pedophilic disorder is a sexual disorder in which individuals partake in inappropriate sexual behaviors. Sexual dysfunction involves impairment in normal sexual response. Pedophilic disorder involves having sexual urges, behaviors, or sexually arousing fantasies involving sexual activity with a prepubescent child.

A nursing instructor is teaching about the various categories of paraphilic disorders. Which categories are correctly matched with expected behaviors? (SATA) 1. Exhibitionistic disorder: Mary models lingerie for a company that specializes in home parties. 2. Voyeuristic disorder: John is arrested for peering in a neighbors bathroom window. 3. Frotteuristic disorder: Peter enjoys subway rush-hour female contact that results in arousal. 4. Pedophilic disorder: George can experience an orgasm by holding and feeling shoes. 5. Fetishistic disorder: Henry masturbates into his wife's silk panties.

2, 3, 5 ~ Categories of paraphilic disorders include voyeuristic disorder (observing unsuspecting people, who are naked, dressing, or engaged in sexual activity), frotteuristic disorder (touching or rubbing against a non-consenting person), and fetishistic disorder (using nonliving objects in sexual ways). Exhibitionistic disorder is a paraphilic disorder but involves the urge to show ones genitals to unsuspecting strangers. Other categories include sexual masochism disorder, sexual sadism disorder, and transvestic disorder.

A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

2. Dopamine Rationale: Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.

A nurse attends an interdisciplinary team meeting regarding a newly admitted client. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.)

2. Occupational therapist and psychologist 3. Recreational therapist and art therapist. 5. Mental health technician and chaplain

An instructor is teaching nursing students about neurotransmitters. Which term best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? 1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission

2. Reuptake Rationale: Reuptake is the process by which neurotransmitter are stored for use.

Which mental illness should a nurse identify as being associated with a increase in prolactin hormone level? 1. Major depression 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

2. Schizophrenia Rationale: Although the exact mechanism is unknown, there may be some correlation between increased levels of the hormone prolactin and schizophrenia.

Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

2. The limbic system Rationale: The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior.

Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? 1. The study of neuroendocrinology 2. The study of psychoimmunology 3. The study of diagnostic technology 4. The study of neurophysiology

2. The study of psychoimmunology Rationale: Psychoneuroimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system.

which of the following conditions promote a therapeutic community? (Select all that apply.)

2. Unit responsibilities are assigned according to client capabilities. 5. A democratic form of government exists.

A client is diagnosed with anxiety disorder. Which medication is prescribed for anxiety? 1. Chlorpromazine (Thorazine) 2. Clozapine (Clozaril) 3. Diazepam (Valium) 4. Methylphenidate (Ritalin)

3

An aging client with chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol) for hypertension and an antipsychotic. Given the combined side effects of these drugs, what teaching should the nurse provide? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3

Which medication is most likely to be prescribed for the extrapyramidal side effects of antipsychotic medications? 1. Diazepam (Valium) 2. Amitriptyline (Elavil) 3. Benztropine (Cogentin) 4. Methylphenidate (Ritalin)

3

The nurse is assisting with electroconvulsive therapy (ECT). What is the rationale for administering 100% oxygen to a client during and after ECT? 1. To prevent brain damage from the electrical impulse of the procedure 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

3 The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. Because succinylcholine paralyzes respiratory muscles, the client is oxygenated with pure oxygen during and after the treatment, except for the brief interval of electrical stimulation, until spontaneous respirations return.

A client is prescribed transdermal selegiline (Emsam) for depressive symptoms. Which action would the nurse take to administer this medication? 1. Apply new patch to the lower abdomen. 2. Apply new patch to inner surface of upper arm. 3. Place new patch on dry, intact skin. 4. Place direct heat to new patch for a tight seal.

3 The patch is applied to dry, intact skin at approximately the same time each day.

A nurse is assessing a client diagnosed with sexual masochistic disorder. What would differentiate this paraphilic disorder from sexual sadistic disorder? 1. Symptoms of sexual masochistic disorder are chronic acts of humiliation, whereas symptoms of sexual sadistic disorder are acute. 2. Symptoms of sexual sadistic disorder are chronic acts of humiliation, whereas symptoms of sexual masochistic disorder are acute. 3. Masochistic acts can be performed alone, whereas sadistic acts must have a consenting or non-consenting partner. 4. Sadistic acts can be performed alone, whereas mascochistic acts must have a consenting or non-consenting partner.

3 ~ The identifying feature of sexual masochistic disorder is recurrent and intense sexual arousal when being humiliated, beaten, bound, or otherwise made to suffer. These masochistic activities may be fantasized and may be performed alone (e.g., self-inflicted pain) or with a partner. The identifying feature of sexual sadistic disorder is the recurrent and intense sexual arousal from the physical or psychological suffering of another individual. Both sexual masochistic and sadistic disorders are chronic in nature.

A female client on an inpatient unit enters the common area for visiting hours dressed in a see-through blouse. Which intervention should be a nurses first priority? 1. Discuss with the client the inappropriateness of her attire. 2. Avoid addressing her attention-seeking behavior. 3. Lead the client back to her room and assist her with a change of clothing. 4. Restrict client to room until visiting hours are over.

3 ~ The most appropriate intervention by the nurse is to lead the client back to her room and assist her with a change of clothing. The client could be exhibiting symptoms of exhibitionistic disorder, which is characterized by urges to expose oneself to unsuspecting strangers.

A nurse understands that abnormal secretion of growth hormone may play a role in which illness? 1. Acute mania 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

3. Anorexia nervosa Rationale: The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.

A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites 2. Axons 3. Neurotransmitters 4. Synapses

3. Neurotransmitters Rationale: Neurotransmitters play an essential function in the role of human emotion and behavior. They are targeted and affece

Which part of the nervous system should a nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

3. Sympathetic nervous system Rationale: The sympathetic nervous system prepares the body for fight-or-flight.

A client has been diagnosed with major depression and is prescribed imipramine (Tofranil). What information specifically related to this class of antidepressants will the nurse plan to include in client and family education? 1. The medication may cause dry mouth. 2. The medication may cause nausea. 3. The medication should not be discontinued abruptly. 4. The medication may cause photosensitivity.

4

Which medication does not require periodic blood-level monitoring? 1. Eskalith (lithium carbonate) 2. Depakote (valproic acid) 3. Clozaril (clozapine) 4. Paxil (paroxetine)

4

The nurse is preparing an antidepressant medication for a 13-year-old client who is experiencing major depressive disorder. Which FDA-approved medication should the nurse administer? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

4 Escitalopram (Lexapro) was FDA approved in 2009 for treatment of major depression in adolescents aged 12 to 17 years. Fluoxetine (Prozac) has also been approved by the FDA to treat depression in children and adolescents. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents

A client is taking phenelzine (Nardil). Which statement by the client should cause the nurse to intervene? 1. "I cannot use over-the-counter medications for my colds." 2. "I have to cut out eating my raisin bran every morning." 3. "I will have to avoid pepperoni pizza when eating with my friends." 4. "I am taking diet pills to lose weight for my friend's wedding."

4 The nurse would have to intervene because this is an incorrect statement and needs to be corrected. The client cannot take diet pills and phenelzine, a MAOI, together because this could cause a life-threatening hypertensive crisis.

seven stage crisis model

4 Psycosocial and lethality assessment 5 identify the major problem 2 generate and explore alternatives 1 deal with feelings and emotions 3 rapidly establish rapport 7 implement action 6 follow up

When planning care for a client diagnosed with female sexual interest/arousal disorder, what should a nurse document as an expected outcome of senate focus exercises? 1. To initiate immediate orgasm 2. To reduce anxiety by eliminating physical touch 3. To focus on touching breasts and genitals 4. To reduce goal-oriented demands of intercourse

4 ~ Female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Senate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. The expected outcome of senate focus exercises is to reduce goal-oriented demands of intercourse. The reduction in demands reduces performance pressures and anxiety associated with possible failure.

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? 1. "The occipital lobe governs perceptions, judging them as positive or negative." 2. "The parietal lobe has been linked to depression." 3. "The medulla regulates key biological and psychological activities." 4. "The limbic system is largely responsible for one's emotional state."

4. "The limbic system is largely responsible for one's emotional state." Rationale: This system is often called the "emotional brain" and is associated with feelings, sexuality, and social behavior.

A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of dopamine 3. Increased levels of norepinephrine 4. Decreased levels of acetycholine

4. Decreased levels of acetycholine Rationale: Acetycholine is a major chemical effector of the autonomic nervous system. Functions of acetycholine include sleep regualtion, pain perception, the modulation and coordination of movement, and memory.

A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? 1. Bipolar disorder: mania 2. Schizophrenia spectrum disorder 3. Generalized anxiety disorder 4. Major depressive episode

4. Major depressive episode Rationale: The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

A nurse concludes that a restless, agitated client is manifesting a "fight-or-flight" response. The nurse should associate this response with which neurotransmitter? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine

4. Norepinephrine Rationale: Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist is using an interpersonal approach. 2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest. 4. The client is susceptible to illness because of effects of stress on the immune system.

4. The client is susceptible to illness because of effects of stress on the immune system. Rationale: The therapist's recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoneuroimmunology.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

A (The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.)

C (The bipolar condition would be stabilized first before medication for the ADHD would be given.)

A child with bipolar disorder also has attention deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? A) No medication would be given for either condition. B) Medication would be given for both conditions simultaneously. C) The bipolar condition would be stabilized first before medication for the ADHD would be given. D) The ADHD would be treated before consideration of the bipolar disorder.

D. The client will return to previous adaptive levels of functioning by week 6.

A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this clients crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6.

2 (Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss) Rationale: The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity AEB weight loss. Because of the client's rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition and physical health.

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

1 (Risk for suicide R/T hopelessness) (Rationale: The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt.)

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

C (Quietly walk with her back to her room and help her change into something more appropriate.)

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? A) Tell the client she cannot wear this outfit while she is in the hospital. B) Do nothing, and allow her to learn from the responses of her peers. C) Quietly walk with her back to her room and help her change into something more appropriate. D) Explain to her that if she wears this outfit, she must remain in her room.

D. I carry mace when I jog. It makes me feel safe and secure.

A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. Youve really been helpful. Can I count on you for continued support? B. I dont work out anymore. C. Im really glad I didnt go home. It would have been hard to come back. D. I carry mace when I jog. It makes me feel safe and secure.

B. This may not be the best time for you to make such an important decision.

A despondent client, who has recently lost her husband of 30 years, tearfully states, Ill feel a lot better if I sell my house and move away. Which nursing reply is most appropriate? A. Im confident you know whats best for you. B. This may not be the best time for you to make such an important decision. C. Your children will be terribly disappointed. D. Tell me why you want to make this change.

C. Risk for self-directed violence R/T hopelessness

A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations

D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

B (Tinnitus, severe diarrhea, ataxia)

A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? A) Fever, sore throat, malaise B) Tinnitus, severe diarrhea, ataxia C) Occipital headache, palpitations, chest pain D) Skin rash, marked rise in blood pressure, bradycardia

3 (3, 1, 4, 2) (Rationale: The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the client's safety and physical health as most important.)

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? Client Outcomes: 1. Maintains nutritional status 2. Interacts appropriately with peers 3. Remains free from injury 4. Sleeps 6 to 8 hours a night 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

4 ( "Treatment is compromised when clients choose not to take their medications.") (Rationale: The nursing student is accurate when stating that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose not to take their medications. Clients diagnosed with bipolar disorder feel most productive and creative during manic episodes. This may lead to purposeful medication nonadherence. Symptoms of bipolar disorder will reemerge if medication is stopped.)

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. "Treatment is compromised when clients can't sleep." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

B. Psychiatric emergency crisis

A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

A, B, D, E (The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.)

16. Number the following nursing interventions as they would proceed through the steps of the nursing process. ________ Determine if an antianxiety medication is decreasing a client's stress. ________ Measure a client's vital signs and review past history. ________ Encourage deep breathing and teach relaxation techniques. ________ Aim, with client collaboration, for a seven-hour night's sleep. ________ Recognize and document the client's problem.

ANS: 2, 5, 4, 3, 1. Page: 147 Feedback: Measuring a client's vital signs and reviewing past history is a nursing intervention that occurs in the assessment step of the nursing process. Recognizing and documenting the client's problem occurs in the nursing diagnosis step. Setting a goal with client collaboration, for a seven-hour night's sleep occurs in the planning step. Encouraging deep breathing and teaching relaxation techniques occurs in the implementation step. Determining if an antianxiety medication is decreasing a client's stress occurs in the evaluation step.

25. Order the following stages of the codependency recovery process according to Cermak. ________ The Core Issues Stage ________ The Reintegration Stage ________ The Survival Stage ________ The Reidentification Stage

ANS: The correct order is 3, 4, 1, 2 Page: 324 Feedback: Cermak in 1986 identified four stages in the recovery process for individuals with codependent personality. During the survival stage, the codependent must begin to let go of denial. During the reidentification stage, the individual begins to glimpse their true selves. During the core issues stage, the individual must face the fact that relationships cannot be managed by force or will. During the reintegration stage, control is achieved through self-discipline and self-confidence. 1. The Survival Stage 2. The Reidentification Stage 3. The Core Issues Stage 4. The Reintegration Stage

26. The concept of _______________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

ANS: codependency Page: 323 Feedback: The concept of codependency arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person. The term has been expanded to include all individuals from families that harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions.

17. A _________________ provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.

ANS: nursing diagnosis Page: 154 Feedback: Nursing diagnoses are clinical judgments about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.

20. A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: 1 Page: 289 Feedback 1. The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing. The treatment of hepatic encephalopathy requires abstention from alcohol and temporary elimination of protein from the diet. 2. This statement indicates that teaching has been effective. 3. This statement indicates that no further education is required. 4. The instructor should interpret this statement as accurate.

15. A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands a psychiatrist to prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics are expensive and have numerous side effects. 3. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

ANS: 1 Page: 291 Feedback 1 The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction. 2 These drugs do not have numerous side effects. 3 The drugs do not interfere with REM sleep. 4 These drugs are effective for inducing sleep.

5. A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation? 1. Psychological addiction 2. Codependence 3. Substance induced disorder 4. Social induced disorder

ANS: 1 Page: 294 Feedback 1 The nurse should use the term psychological addiction to best describe the client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure or avoid discomfort. 2 Codependence describes depending on others for decision-making. 3 Substance induced disorders are induced by the use of a drug or substance. 4 Social induced disorders describe using a drug or substance in the presence of others, or socially.

17. A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

ANS: 1 Page: 330-331 Feedback 1 There is a correlation between pathological gambling and abnormalities in the serotonergic, noradrenergic, and dopaminergic neurotransmitter systems. This is not the case with non-pathological gambling. 2 Pathological gambling occurs more commonly among men not women and generally runs a chronic, not acute course. 3 This statement is inaccurate regarding the pathological gambler. 4 For a pathological gambler, the preoccupation with and impulse to gamble intensifies when the individual is under stress.

8. During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to a nurse leader that the client is assuming which group role? 1. The group role of aggressor 2. The group role of initiator 3. The group role of gatekeeper 4. The group role of blocker

ANS: 1 Rationale: The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others.

2. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? 1. Democratic 2. Autocratic 3. Laissez-faire 4. Bureaucratic

ANS: 1 Rationale: The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision-making by the members of the group. The leader provides guidance and expertise as needed.

19. Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

ANS: 1, 2, 4 Page: 312 Feedback 1. The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. 2. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients diagnosed with this problem. 3. This statement does not exemplify the cognitive process that must be completed by a nurse prior to client care. 4. Determining the need to set boundaries is an example of a cognitive process that must be completed by a nurse prior to client care. 5. This statement does not exemplify the cognitive process that must be completed by a nurse prior to client care.

24. A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply.) 1. The client has a long history of focusing thoughts and behaviors on other people. 2. The client, as a child, experienced overindulgent and overprotective parents. 3. The client is a people pleaser and does almost anything to gain approval. 4. The client exhibits helpless behaviors but actually feels very competent. 5. The client can achieve a sense of control only through fulfilling the needs of others.

ANS: 1, 3, 5 Page: 323-324 Feedback 1. The codependent person has a long history of focusing thoughts and behavior on other people and is able to achieve a sense of control only through fulfilling the needs of others. 2. They usually have experienced abuse or emotional neglect as a child. 3. Codependent clients are "people pleasers" and will do almost anything to get the approval of others. 4. They outwardly appear very competent, but actually feel quite needy, helpless, or perhaps nothing at all. 5. Codependent clients achieve a sense of control when they are fulfilling the needs of others.

1. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? 1. Medical history is of little significance and can be eliminated from the nursing assessment. 2. Assessment provides a holistic view of the client, including biopsychosocial aspects. 3. Comprehensive assessments can be performed only by advanced practice nurses. 4. Psychosocial evaluations are gained by subjective reports rather than objective observations.

ANS: 2 Page: 148 Feedback 1 Medical history is significant and should not be eliminated from the nursing assessment. 2 The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. 3 Assessments can be completed by a variety of health-care providers. 4 The nurse should gather subject and objective information.

7. What is the purpose of a nurse gathering client information? 1. It enables the nurse to modify behaviors related to personality disorders. 2. It enables the nurse to make sound clinical judgments and plan appropriate care. 3. It enables the nurse to prescribe the appropriate medications. 4. It enables the nurse to assign the appropriate Axis I diagnosis.

ANS: 2 Page: 156 Feedback 1 Modifying behaviors can occur after the nurse completes a thorough assessment. 2 The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client, including information collected from the client, significant others, and health-care providers. 3 After completing a thorough assessment, the nurse can prescribe the appropriate medications. 4 After completing a thorough assessment, the nurse can assign the appropriate Axis I diagnosis.

3. Within the nurse's scope of practice, which function is exclusive to the advanced practice psychiatric nurse? 1. Teaching about the side effects of neuroleptic medications 2. Using psychotherapy to improve mental health status 3. Using milieu therapy to structure a therapeutic environment 4. Providing case management to coordinate continuity of health services

ANS: 2 Page: 156 Feedback 1 Teaching about the side effects of neuroleptic medications can be completed by Registered Nurses. 2 The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. 3 Using milieu therapy to structure a therapeutic environment can be completed by Registered Nurses. 4 Providing case management to coordinate continuity of health services can be completed by Registered Nurses.

14. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis, which was recently removed from the NANDA-I list, still accurately reflects this client's problem? 1. Disturbed thought processes 2. Disturbed sensory perception 3. Anxiety 4. Chronic confusion

ANS: 2 Page: 161 Feedback 1 The nursing diagnosis, disturbed thought processes, does not accurately reflect the client's problem. 2 The nursing diagnosis disturbed sensory perception accurately reflects the client's symptoms of hearing things that others do not. The nursing diagnosis describes the client's condition and facilitates the prescription of interventions. 3 The nursing diagnosis, anxiety, does not accurately reflect the client's problem. 4 The nursing diagnosis, chronic confusion, does not accurately reflect the client's problem.

3. Which situation should a nurse identify as an example of an autocratic leadership style? 1. The president of Sigma Theta Tau assigns members to committees to research problems. 2. Without faculty input, the dean mandates that all course content be delivered via the Internet. 3. During a community meeting, a nurse listens as clients generate solutions. 4. The student nurses' association advertises for candidates for president.

ANS: 2 Rationale: The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation owing to lack of member input and creativity.

9. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? 1. "It's hard for me to tell my story when I'm not sure about the reactions of others." 2. "I think Joe's Antabuse suggestion is a good one and might work for me." 3. "My situation is very complex, and I need professional, not peer, advice." 4. "I am really upset that you expect me to solve my own problems."

ANS: 2 Rationale: The nurse should recognize that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and use it constructively to create change.

17. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.) 1. Encourage members to provide feedback to each other about individual progress. 2. Ensure that group rules do not interfere with goal fulfillment. 3. Work with group members to establish rules that will govern the group. 4. Emphasize the need for and importance of confidentiality within the group. 5. Help the leader to resolve conflicts and foster cohesiveness within the group.

ANS: 2, 3, 4 Rationale: During the orientation phase of group development, the nurse leader should work together with members to establish rules that will govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion in order to move into the working phase.

13. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the student's question? 1. "You can use NIC, a standardized reference for nursing outcomes." 2. "Look at your client's problems and set a realistic, achievable goal." 3. "With client collaboration, outcomes should be based on client problems." 4. "Copy your standard outcomes from a nursing care plan textbook."

ANS: 3 Page: 155 Feedback 1 Using NIC does not help develop outcomes specific for the client. 2 This option is helpful, but the most attainable goals are set with collaboration. 3 Client outcomes are most realistic and achievable when there is collaboration among the interdisciplinary team members, the client, and significant others. 4 Goals should be personalized for each client.

6. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? 1. Mood 2. Perception 3. Orientation 4. Affect

ANS: 3 Page: 155 Feedback 1 These questions do not assess mood. 2 These questions do not assess perception. 3 The nurse should ask the client to identify name, date, residential address, and situation to assess the client's orientation. Assessment of the client's orientation to reality is part of a mental status evaluation. 4 These questions do not assess affect.

8. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? 1. Health teacher 2. Case manager 3. Milieu manager 4. Psychotherapist

ANS: 3 Page: 156 Feedback 1 Health teaching involves promoting health in a safe environment. 2 Case management is used to organize client care so that outcomes are achieved. 3 The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. 4 Psychotherapy involves conducting individual, couples, group, and family counseling.

12. A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

ANS: 3 Page: 323-324 Feedback 1 Stating, "Why do you assume responsibility for his behaviors?" may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse. 2 Stating, "I think you should start to confront his behavior." may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse. 3 The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Codependency is a typical behavior of spouses of alcoholics. Partners of clients with substance addiction must come to realize that the only behavior they can control is their own. 4 Stating, "Do you understand what the term enabler means?" may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse.

15. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Which group is this nurse most qualified to lead? 1. A psychodrama group 2. A psychotherapy group 3. A parenting group 4. A family therapy group

ANS: 3 Rationale: A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy and must be lead by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine.

1. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? 1. The nurse mandates that all group members reveal an embarrassing personal situation. 2. The nurse asks for a show of hands to determine group topic preference. 3. The nurse sits silently as the group members stray from the assigned topic. 4. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: 3 Rationale: The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style.

6. Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy

ANS: 4 Page: 291 Feedback 1 Antagonist therapy does not accurately describe this CNS depressant medication. 2 Deterrent therapy does not accurately describe this CNS depressant medication. 3 Codependency therapy does not accurately describe this CNS depressant medication. 4 Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called substitution therapy and may be required to reduce the life-threatening effects of alcohol withdrawal.

10. Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development? 1. The group leader establishes the rules that will govern the group after discharge. 2. The group leader encourages members to rely on each other for problem solving. 3. The group leader presents and discusses the concept of group termination. 4. The group leader helps the members to process feelings of loss.

ANS: 4 Rationale: The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress.

13. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? 1. The leader should referee the debate. 2. The leader should adamantly oppose physical disciplining measures. 3. The leader should redirect the group to a less-controversial topic. 4. The leader should encourage the group to solve the problem collectively.

ANS: 4 Rationale: The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to solve issues that relate to the group cooperatively.

11. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? 1. "There is little research to support AA's effectiveness." 2. "Self-help groups used to be the treatment of choice, but their popularity is waning." 3. "These groups have no external regulation, so clients need to be cautious." 4. "Members themselves run the group, with leadership usually rotating among the members."

ANS: 4 Rationale: The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences.

A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to find when assessing this client? A. A client feeling confident about achieving goals in life. B. A client who is aware of the need to set goals in life. C. A client who has mobilized personal and external resources. D. A client who begins to actively take control of his or her life.

ANS: A Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1, Moratorium; Stage 2, Awareness; Stage 3, Preparation; Stage 4, Rebuilding; and Stage 5, Growth. In the growth stage, the individual feels a sense of optimism and hope of a rewarding future. Skills that have been nurtured in the previous stages are applied with confidence, and the individual strives for higher levels of well-being. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching about donepezil (Aricept). A student asks, "How does this work? Will this cure Alzheimer's disease (AD)?" Which is the appropriate instructor reply? A. "This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD." B. "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease." C. "This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD." D. "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

ANS: A The most appropriate response by the instructor is to explain that donepezil (Aricept) delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of AD. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? A. To clarify personal attitudes, values, and beliefs B. To obtain thorough assessment data C. To determine the client's length of stay D. To establish personal goals for the interaction

ANS: A The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which client response should a nurse expect during the working phase of the nurse-client relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors.

ANS: A The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which client statement may indicate a transference reaction? A. "I need a real nurse. You are young enough to be my daughter and I don't want to tell you about my personal life." B. "I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor." C. "I don't seem to be able to relate to people. I would rather stay in my room and be by myself." D. "My mother is the source of my problems. She has always told me what to do and what to say."

ANS: A Transference occurs when a client unconsciously displaces or "transfers" to the nurse feelings formed toward a person from the past. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which of the following has the SAMHSA described, as major dimensions of support for a life of recovery? Select all that apply. A. Health B. Community C. Home D. Religious affiliation E. Purpose

ANS: A, B, C, E SAMHSA suggests that a life in recovery is supported by four major dimensions: health, home, purpose, and community. Religious affiliation is not included in the listed dimensions. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

When planning care for women in abusive relationships, which of the following information is important for the nurse to consider? (Select all that apply.) A. It often takes several attempts before a woman leaves an abusive situation. B. Substance abuse is a common factor in abusive relationships. C. Until children reach school age, they are usually not affected by parental discord. D. Women in abusive relationships usually feel isolated and unsupported. E. Economic factors rarely play a role in the decision to stay in abusive relationships.

ANS: A, B, D A. It often takes several attempts before a woman leaves an abusive situation. B. Substance abuse is a common factor in abusive relationships. D. Women in abusive relationships usually feel isolated and unsupported. When planning care for women who have been victims of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

A nurse uses the commitments of the Tidal Model of Recovery in psychiatric nursing practice. Which of the following nursing actions reflect the use of the Develop Genuine Curiosity commitment? Select all that apply. A. The nurse expresses interest in the client's story. B. The nurse asks for clarification of certain points. C. The nurse encourages the client to speak his own words in his own unique way. D. The nurse assists the client to unfold the story at his or her own rate. E. The nurse provides the clients with copies of all documents relevant to care.

ANS: A, B, D Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. This nurse is employing the Develop Genuine Curiosity commitment, by expressing interest, asking for clarification, and assisting the client to unfold the story at his or her own rate. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? A. "I know that it was not my fault." B. "My boyfriend has trouble controlling his sexual urges." C. "If I don't put myself in a dating situation, I won't be at risk." D. "Next time I will think twice about wearing a sexy dress."

ANS: A. "I know that it was not my fault." The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

Which statement made by an emergency department nurse indicates accurate knowledge of domestic violence? A. "Power and control are central to the dynamic of domestic violence." B. "Poor communication and social isolation are central to the dynamic of domestic violence." C. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." D. "Emotional injury and learned helplessness are central to the dynamic of domestic violence."

ANS: A. "Power and control are central to the dynamic of domestic violence." The nurse accurately states that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

Which assessment data should a school nurse recognize as signs of physical neglect? A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors.

ANS: A. The child is often absent from school and seems apathetic and tired. The nurse should recognize that a child who is often absent from school and seems apathetic and tired might be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

ANS: A. The child shrinks at the approach of adults. The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

ANS: A. The client will identify two alternative methods of dealing with isolation by day 3. The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

A nursing instructor is teaching about components present in the recovery process, as described by Andresen and associates, which led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed? A. "A client has a better chance of recovery if he or she truly believes that recovery can occur." B. "If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover." C. "A client who has a positive sense of self and a positive identity is likely to recover." D. "A client has a better chance of recovery if he or she has purpose and meaning in life."

ANS: B In examining a number of studies, Andresen and associates identified four components that were consistently evident in the recovery process. These components are hope, responsibility, self and identity, and meaning and purpose. Under responsibility, this model tasks the client, not the health-care team, with taking responsibility for his or her life and well-being. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed? A. "Recovery occurs via many pathways." B. "Recovery emerges from strong religious affiliations." C. "Recovery is supported by peers and allies." D. "Recovery is culturally based and influenced."

ANS: B SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. Recovery emerges from hope, but affiliation with any particular religion would have little bearing on the recovery process. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A nurse maintains a client's confidentiality, addresses the client appropriately, and does not discriminate on the basis of gender, age, race, or religion. Which guiding principle of recovery has this nurse employed? A. Recovery is culturally based and influenced. B. Recovery is based on respect. C. Recovery involves individual, family, and community strengths and responsibility. D. Recovery is person-driven.

ANS: B The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. This nurse accepts and appreciates clients who are affected by mental health and substance use problems. This nurse protects the rights of clients and does not discriminate against them. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed? A. "The goal of recovery is improved health and wellness." B. "The goal of recovery is expedient, comprehensive behavioral change." C. "The goal of recovery is the ability to live a self-directed life." D. "The goal of recovery is the ability to reach full potential."

ANS: B The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental health disorders and substance use disorders as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Change in recovery is not an expedient process. It occurs incrementally over time. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which is the priority focus of recovery models? A. Empowerment of the health-care team to bring their expertise to decision-making B. Empowerment of the client to make decisions related to individual health care C. Empowerment of the family system to provide supportive care D. Empowerment of the physician to provide appropriate treatments

ANS: B The basic concept of a recovery model is empowerment of the client. The recovery model is designed to allow clients primary control over decisions about their own care. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

What is the main goal of the working phase of the nurse-client therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the client's problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment

ANS: B The goal of the working phase of the nurse-client therapeutic relationship is to resolve client problems by promoting behavioral change. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following? A. Sympathy B. Trust C. Veracity D. Manipulation

ANS: B The nurse is promoting trust by postponing the admission interview, assuring safety, and providing a warm meal. Trust implies a feeling of confidence that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated through nursing interventions that convey a sense of warmth and caring to the client. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

If an individual is "two-faced," which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? A. Respect B. Genuineness C. Sympathy D. Rapport

ANS: B The nurse should identify that genuineness is missing in the relationship. Genuineness refers to an individual's ability to be open and honest and maintain congruence between what is felt and what is communicated. Genuineness is essential to establishing trust in a relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, "Do you want to be my girlfriend?" Which nursing response is most appropriate? A. "You are upset now. It would be best if you go to your room until you feel better." B. "Remember, we have a professional relationship. Are you feeling uncomfortable?" C. "We have discussed this before. I am not allowed to date clients." D. "I think you should discuss your fantasies with your therapist."

ANS: B The nurse should promote the client's insight and perception of reality by confirming appropriate roles in the nurse-client relationship and identifying what is troubling the client in this situation. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

ANS: B The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the client's health. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which phase of the nurse-client relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals? A. Preinteraction B. Orientation C. Working D. Termination

ANS: B The orientation phase is when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals. There are four phases of relationship development: preinteraction, orientation, working, and termination. KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

What is the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? A. Acknowledge the client's actions and generate alternative behaviors. B. Establish rapport and develop treatment goals. C. Attempt to find alternative placement. D. Explore how thoughts and feelings about this client may adversely impact care.

ANS: B The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

The nurse-client therapeutic relationship includes which of the following characteristics? Select all that apply. A. Meeting the psychological needs of the nurse and the client B. Ensuring therapeutic termination C. Promoting client insight into problematic behavior D. Collaborating to set appropriate goals E. Meeting both the physical and psychological needs of the client

ANS: B, C, D, E The nurse-client therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. The nurse's psychological needs should not be addressed within the nurse-client relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

An anorexic client states to a nurse, "My father has recently moved back to town." Since that time the client has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated and lives alone. What should the nurse suspect? A. Possible major depressive disorder B. Possible history of childhood incest C. Possible histrionic personality disorder D. Possible history of childhood physical abuse

ANS: B. Possible history of childhood incest The nurse should suspect that this client might have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? A. Discourage the client from discussing the event as this may lead to further emotional trauma. B. Remain nonjudgmental and actively listen to the client's description of the event. C. Meet the client's self-care needs by assisting with showering and perineal care. D. Provide cues, based on police information, to encourage further description of the event.

ANS: B. Remain nonjudgmental and actively listen to the client's description of the event. The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he or she is safe and that it is not his or her fault. Nonjudgmental listening provides an avenue for client catharsis needed in order to begin the process of healing.

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan

ANS: B. To emphasize that the client is capable of consuming food without purging By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future.

A client is in the late stage of Alzheimer's disease. To address the client's symptoms, which nursing intervention should take priority? A. Improve cognitive status by encouraging involvement in social activities. B. Decrease social isolation by providing group therapies. C. Promote dignity by providing comfort, safety, and self-care measures. D. Facilitate communication by providing assistive devices.

ANS: C KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity: Basic Care and Comfort

Which client statement indicates that termination of the therapeutic nurse-client relationship has been handled successfully? A. "I know I can count on you for continued support." B. "I am looking forward to discharge, but I am surprised that we will no longer work together." C. "Reviewing the changes that have happened during our time together has helped me put things in perspective." D. "I don't know how comfortable I will feel when talking to someone else."

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurse-client relationship ends. Bringing a therapeutic conclusion to the relationship occurs when progress has been made toward attainment of mutually set goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, "I'm not well enough to switch to a different nurse." What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. B. The client is using the defense mechanism of denial. C. The client is having trouble terminating the relationship. D. The client is using "splitting" as a way to remain dependent on the nurse.

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurse-client relationship ends. When a client feels sadness and loss, behaviors to delay termination may become evident. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

At what time during a 24-hour period should a nurse expect clients with Alzheimer's disease to exhibit more pronounced symptoms? A. When they first awaken B. In the middle of the night C. At twilight D. After taking medications

ANS: C The nurse should determine that clients with Alzheimer's disease exhibit more pronounced symptoms at twilight. Sundowning is the term used to describe the worsening of symptoms in the late afternoon and evening. KEY: Cognitive Level: Comprehension| Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

Which symptom should a nurse identify that would differentiate clients diagnosed with neurocognitive disorders from clients with pseudodementia (depression)? A. Altered sleep B. Impaired attention and concentration C. Altered task performance D. Impaired psychomotor activity

ANS: C The nurse should identify that attention and concentration are impaired in neurocognitive disorder and not in pseudodementia (depression). KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? A. "I can't bear the thought of leaving here and failing." B. "I might have a hard time working with you. You remind me of my mother." C. "I can't tell my husband how I feel; he wouldn't listen anyway." D. "I'm not sure that I can count on you to protect my confidentiality."

ANS: C The nurse should identify that the client statement "I can't tell my husband how I feel; he wouldn't listen anyway" reflects resistance to change, which is a common behavior in the working phase of the nurse-client relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

After 1 week of continuous mental confusion, an elderly African American client is admitted with a preliminary diagnosis of major neurocognitive disorder due to Alzheimer's disease. What should cause the nurse to question this diagnosis? A. Neurocognitive disorder does not typically occur in African American clients. B. The symptoms presented are more indicative of Parkinsonism. C. Neurocognitive disorder does not develop suddenly. D. There has been no T3 or T4 level evaluation ordered.

ANS: C The nurse should know that neurocognitive disorder (NCD) does not develop suddenly and should question this diagnosis. The onset of NCD symptoms is slow and insidious and is unrelated to race, culture, or creed. The disease is generally progressive and debilitating. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

A client is experiencing progressive changes in memory that have interfered with personal, social, and occupational functioning. The client exhibits poor judgment and has a short attention span. A nurse should recognize these as classic signs of which condition? A. Mania B. Delirium C. Neurocognitive disorder D. Parkinsonism

ANS: C The nurse should recognize that the client is exhibiting signs of neurocognitive disorder (NCD). In NCD, impairment is evident in abstract thinking, judgment, and impulse control. Behavior may be uninhibited and inappropriate. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

What should be the nurse's primary goal during the preinteraction phase of the nurse-client relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self-perceptions D. To promote client change

ANS: C The nurse's primary goal of the preinteraction phase should be to explore self-perceptions. The nurse should be aware of how any preconceptions may affect his or her ability to care for individual clients. Another goal of the preinteraction phase is to obtain available client information. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

A client diagnosed with neurocognitive disorder due to Alzheimer's disease is disoriented and ataxic, and he wanders. Which is the priority nursing diagnosis? A. Disturbed thought processes B. Self-care deficit C. Risk for injury D. Altered health-care maintenance

ANS: C The priority nursing diagnosis for this client is risk for injury. Both ataxia (muscular incoordination) and purposeless wandering place the client at an increased risk for injury. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity: Reduction of Risk Potential

As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurse's most therapeutic statement? A. "I want to assure you that I will maintain your confidentiality." B. "A long-term goal for someone your age would be to develop better job skills." C. "Which identified problems would you like for us to initially address?" D. "I think first we need to focus on your relationship issues."

ANS: C When moving on a continuum from the orientation to working phase of the nurse-client relationship, the client's identified goals are addressed through mutual therapeutic work to promote client behavioral change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nursing student asks an emergency department nurse, "Why does a rapist use a weapon during the act of rape?" Which nursing reply is most accurate? A. "A weapon is used to increase the victimizer's security." B. "A weapon is used to inflict physical harm." C. "A weapon is used to terrorize and subdue the victim." D. "A weapon is used to mirror learned family behavior patterns."

ANS: C. "A weapon is used to terrorize and subdue the victim." The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid that next time he might kill me." Which is the appropriate nursing reply? A. "Leopards don't change their spots, and neither will he." B. "There are things you can do to prevent him from losing control." C. "Let's talk about your options so that you don't have to go home." D. "Why don't we call the police so that they can confront your husband with his behavior?"

ANS: C. "Let's talk about your options so that you don't have to go home." The most appropriate reply by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions independently without the nurse being the "rescuer." Imposing judgments and giving advice is nontherapeutic.

A client who has been raped is crying, pacing, and cursing her attacker in an emergency department. Which behavioral defense should a nurse recognize? A. Controlled response pattern B. Compounded rape reaction C. Expressed response pattern D. Silent rape reaction

ANS: C. Expressed response pattern The nurse should recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen.

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? A. Phase I: The tension-building phase B. Phase II: The acute battering incident phase C. Phase III: The honeymoon phase D. Phase IV: The resolution and reorganization phase

ANS: C. Phase III: The honeymoon phase The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.

ANS: C. The client demonstrates healthy coping mechanisms that decrease anxiety. The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing which is followed by inappropriate compensatory behaviors.

In the emergency department, a raped client appears calm and exhibits a blunt affect. The client answers a nurse's questions in a monotone using single words. How should the nurse interpret this client's responses? A. The client may be lying about the incident. B. The client may be experiencing a silent rape reaction. C. The client may be demonstrating a controlled response pattern. D. The client may be having a compounded rape reaction.

ANS: C. The client may be demonstrating a controlled response pattern. This client is most likely demonstrating a controlled response pattern. In a controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension.

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.

ANS: C. The client will gain 2 pounds prior to the next weekly appointment. The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

ANS: C. The client will perceive an ideal body weight and shape as normal. The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

ANS: C. To promote the processing of anxiety associated with eating. When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

When is self-disclosure by the nurse appropriate in a therapeutic nurse-client relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client

ANS: D Self-disclosure on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the client. It should never be undertaken for the purpose of meeting the nurse's needs. KEY: Cognitive Level: Knowledge | Integrated Processes: Communication and Documentation | Client Need: Psychosocial Integrity

On which task should a nurse place priority during the working phase of relationship development? A. Establishing a contract for intervention B. Examining feelings about working with a particular client C. Establishing a plan for continuing aftercare D. Promoting the client's insight and perception of reality

ANS: D The nurse should place priority on promoting the client's insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the preinteraction phase. Establishing a plan for aftercare would occur in the termination phase. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with neurocognitive disorder due to Alzheimer's disease can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent verbalizations. The nurse recognizes these symptoms as indicative of which stage of the illness? A. Confabulation stage B. Early stage C. Middle stage D. Late stage

ANS: D The nurse should recognize that this client is in the late stage of Alzheimer's disease. The late stage is characterized by a severe cognitive decline. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity

Which is the best nursing action when a client demonstrates transference toward a nurse? A. Promoting safety and immediately terminating the relationship with the client B. Encouraging the client to ignore these thoughts and feelings C. Immediately reassigning the client to another staff member D. Helping the client to clarify the meaning of the current nurse-client relationship

ANS: D The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship, based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from the past. The nurse should assist the client in separating the past from the present. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with neurocognitive disorder due to Alzheimer's disease has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority? A. Present evidence of objective reality to improve cognition B. Design a bulletin board to represent the current season C. Label the client's room with name and number D. Assist with bathing and toileting

ANS: D The priority nursing intervention for this client is to assist with bathing and toileting. A client who is incapable of performing activities of daily living requires assistance in these areas to ensure health and safety. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

Which situation presents an example of the basic concept of a recovery model? A. The client's family is encouraged to make decisions in order to facilitate discharge. B. A social worker, discovering the client's income, changes the client's discharge placement. C. A psychiatrist prescribes an antipsychotic drug on the basis of observed symptoms. D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.

ANS: D The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? A. "These clients don't know life any other way, and change is not an option until they have improved insight." B. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." C. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

ANS: D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness." The nursing supervisor is accurate when stating that clients in severely abusive relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner for some of the following reasons: for the children, for financial reasons, fear of retaliation, lack of a support network, religious reasons, and/or hopelessness.

Which teaching should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? A. Have ready access to a gun and learn how to use it B. Research lawyers who can aid in divorce proceedings C. File charges of assault and battery D. Have ready access to the number of a safe house for battered women

ANS: D. Have ready access to the number of a safe house for battered women The nurse should provide information about safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear for their lives.

A woman describes a history of physical and emotional abuse in intimate relationships. Which additional factor should a nurse suspect? A. The woman may be exhibiting a controlled response pattern. B. The woman may have a history of childhood neglect. C. The woman may be exhibiting codependent characteristics. D. The woman might be a victim of incest.

ANS: D. The woman might be a victim of incest. The nurse should suspect that this client might be a victim of incest. Women in abusive relationships often grew up in abusive homes.

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.

ANS: D. These programs allow clients to maintain control. Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight.

_________________________ from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

ANS: Recovery Recovery from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Recovery is the restoration to a former or better state or condition. KEY: Cognitive Level: Knowledge | Integrated Processes: Nursing Process: Assessment | Client Need: Health Promotion and Maintenance

18. Order the following leadership expectations that occur in the three phases of the group development process. _____The leader encourages members to provide feedback to each other about individual progress and to review goals and discuss outcomes. _____The leader promotes an environment of trust and ensures that rules established by the group do not interfere with fulfillment of the goals. _____The leader helps to resolve conflict and fosters cohesiveness, while ensuring that members do not deviate from the intended task.

ANS: The correct order is 3, 1, 2 Rationale: 1. In the Initial, or Orientation, phase, the leader is expected to orient members to specific group processes, encourage members to participate without disclosing too much too soon, promote an environment of trust, and ensure that rules established by the group do not interfere with fulfillment of the goals. 2. In the Middle, or Working, phase, the role of leader diminishes and becomes more one of facilitator. Some leadership functions are shared by certain members of the group as they progress toward resolution. The leader helps to resolve conflicts and continues to foster cohesiveness among the members, while ensuring that they do not deviate from the intended task or purpose for which the group was organized. 3. In the Final, or Termination, phase, the leader encourages the group members to reminisce about what has occurred within the group, to review the goals and discuss the actual outcomes, and to encourage members to provide feedback to each other about individual progress within the group. The leader encourages members to discuss feelings of loss associated with termination of the group.

19. A ______________________ is a collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose.

ANS: group Rationale: A group is a collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose. Membership in a group is generally by chance (born into the group), by choice (voluntary affiliation), or by circumstance (the result of life-cycle events over which an individual may or may not have control).

A. Are you currently thinking about harming yourself?

After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. Are you currently thinking about harming yourself? B. Why do you want to harm yourself? C. Have you thought about the consequences of your actions? D. Who is your emergency contact person?

What types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? Select all that apply. 1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy. 2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who are mentally ill. 3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents. 4. Studies in which monozygotic twins were raised together by mentally ill biological parents.

All of the above.

B. The client has a tense facial expression and body language.

An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers.

D. With staff support and a show of solidarity, set firm limits on the behavior.

An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior.

5. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? 1. Being firm, consistent, and empathic, while addressing specific client behaviors 2. Promoting client self-expression by implementing laissez-faire leadership 3. Using authoritative leadership to help clients learn to conform to society norms 4. Overlooking inappropriate behaviors to avoid providing secondary gains

Ans: 1

8. Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response? 1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. 2. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant personality disorder do not. 3. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. 4. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

Ans: 1

25. A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.) 1. The client has been diagnosed with sickle cell anemia. 2. The client has an inflated self-appraisal and feels a sense of entitlement. 3. The client has a history of a substance use disorder. 4. The client is odd and eccentric but not delusional. 5. The client has an intellectual developmental disorder.

Ans: 1, 3, 5

11. When planning care for a client diagnosed with borderline personality disorder, which self- harm behavior should a nurse expect the client to exhibit? 1. The use of highly lethal methods to commit suicide 2. The use of suicidal gestures to elicit a rescue response from others 3. The use of isolation and starvation as suicidal methods 4. The use of self-mutilation to decrease endorphins in the body

Ans: 2

16. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? 1. A client diagnosed with antisocial personality disorder 2. A client diagnosed with borderline personality disorder 3. A client diagnosed with schizoid personality disorder 4. A client diagnosed with paranoid personality disorder

Ans: 2

20. From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Contract with the client to reinforce positive behaviors with unit privileges. 3. Teach the purpose of anti-anxiety medications to improve medication compliance. 4. Encourage the client to journal feelings to improve awareness of abandonment issues.

Ans: 2

4. A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? 1. Allow the clients to apply the democratic process when developing unit rules. 2. Maintain consistency of care by open communication to avoid staff manipulation. 3. Allow the client spokesman to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of autocratic leadership.

Ans: 2

7. A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which statement best explains the etiology of this client's personality disorder? 1. Childhood nurturance was provided from many sources, and independent behaviors were encouraged. 2. Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged. 3. Childhood nurturance was provided exclusively from one source, and independent behaviors were encouraged. 4. Childhood nurturance was provided from many sources, and independent behaviors were discouraged.

Ans: 2

13. Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? 1. Interpreting the compliment as a secret code used to increase personal power 2. Feeling the compliment was well deserved 3. Being grateful for the compliment but fearing later rejection and humiliation 4. Wondering what deep meaning and purpose is attached to the compliment

Ans: 3

14. Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety. 3. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis. 4. Clients diagnosed with schizoid personality disorder avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate self on a continual basis.

Ans: 3

18. Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder? 1. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." 2. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." 3. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." 4. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

Ans: 4

24. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

Ans: 4

9. Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? 1. Altered thought processes R/T increased stress 2. Risk for suicide R/T loneliness 3. Risk for violence: directed toward others R/T paranoid thinking 4. Social isolation R/T inability to relate to others

Ans: 4

29. _______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.

Ans: Schizoid

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

B (The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior.)

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

B (The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.)

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

B (The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.)

A college student has quit attending classes, isolates self due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

B (The nursing diagnosis that must be prioritized in this situation should be risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized.)

How does a democratic form of self-government in the milieu contribute to client therapy?

By setting expectations wherein all clients are treated on an equal basis

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

C (The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of his or her illness is a way to help the client accept that the hallucinations are not real.)

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? A. "Tell him to stop discussing the voices." B. "Ignore what he is saying, while attempting to discover the underlying cause." C. "Focus on the feelings generated by the hallucinations and present reality." D. "Present objective evidence that the voices are not real."

C (The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.)

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

C (The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.)

A client diagnosed with psychosis NOS (not otherwise specified) tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

C (The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.)

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

D (The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.)

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications

D (The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.)

To promote self-reliance, how should a psychiatric nurse best conduct medication administration?

Encourage clients to request their medications at the appropriate times.

A client on an inpatient unit angrily says to a nurse, Peter is not cleaning up after himself in the community bathroom. You need to address this problem. Which is the appropriate nursing response?

I can see that you are angry. Lets discuss ways to approach Peter with your concerns.

An angry client on an inpatient unit approaches a nurse stating, Someone took my lunch! People need to respect others, and you need to do something about this now! The nurses response should be guided by which basic assumption of milieu therapy?

On inpatient units, every interaction is an opportunity for therapeutic intervention.

In the role of milieu manager, which activity should the nurse prioritize?

Searching newly admitted clients for hazardous objects

A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic?

Stress management

A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment?

Structured programming

A client is to undergo psychological testing. Which member of the interdisciplinary team should a nurse consult for this purpose?

The clinical psychologist

What is the best rationale for including family in the clients therapy within the inpatient milieu?

To facilitate discharge from hospitalization

C. To process feelings and concerns related to the witnessed intervention

What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being taken down after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger

A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. D. Set limits on the behavior.

Which of the following are effective interventions that a nurse should utilize when caring for an inpatient client who expresses anger inappropriately? Select all that apply. A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. C. Use therapeutic touch to convey empathy. D. Set limits on the behavior. E. Teach the client to avoid I statements related to expression of feelings.

A. Tell me what happened. B. What coping methods have you used, and did they work? C. Describe to me what your life was like before this happened.

Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? Select all that apply. A. Tell me what happened. B. What coping methods have you used, and did they work? C. Describe to me what your life was like before this happened. D. Lets focus on the current problem. E. Ill assist you in selecting functional coping strategies.

A scientific structuring of the environment in order to effect behavioral changes and to improve the psychological health and functioning of the individual is defined as _______________ therapy.

milieu

A newly admitted client asks, Why do we need a unit schedule? Im not going to these groups. Im here to get some rest. Which is the most appropriate nursing response?

the purpose of group therapy is to learn and practice new coping skills.

Guafacine

to treat hypertension and ADHD, can cause hypotension and if stopped abruptly hypertension crisis