HC3B Exam 3
Which patient behaviors noted by the nurse supports the diagnosis of severe level panic? A) Reports being "too nervous too eat" B) Too preoccupied to respond when unit fire alarm is tested C) Pacing nervously D) Repeatedly demands that the staff, "make the voices stop saying those bad things"
B) Too preoccupied to respond when unit fire alarm is tested
An older adult seems to make up stories to fill for memory lapses. Which behavior is the client displaying? A) Lying B) Denying C) Fantasizing D) Confabulating
D) Confabulating
Aphasia
Loss of language ability
Undoing (Intermediate Defense)
Performing an action to make up for a previous behavior
In which situation is a client likely to experience a phobic reaction? A) When seeking attention from others B) When thinking about the feared object C) When coming into contact with the feared object D) When being exposed to an unfamiliar environment
C) When coming into contact with the feared object
Which stress management behavior is most reflective of those associated with personality disorders? A) Having difficulty making a decision concerning which movie to view B) Holding spouse responsible for the client's poor work performance C) Binge drinking every weekend D) Demonstrating ritualistic behaviors
B) Holding spouse responsible for the client's poor work performance
The nurse assesses a new patient suspected of having a schizoid personality disorder. Which assessment question is this patient most likely to answer affirmatively? A) "Do some types of situations frighten you?" B) "Do you often have episodes of prolonged crying?" C) "Has anyone in your family ever been diagnosed with a mental illness?" D) "Is it ever very important for you to do everything correctly?"
C) "Has anyone in your family ever been diagnosed with a mental illness?"
Which behavior is most commonly used by an individual with a phobic disorder? A) Rumination B) Desensitization C) Avoidance D) Confrontation
C) Avoidance
Agnosia
Loss of sensory ability to recognize objects
Which behavior is characteristic of panic during a crisis? A) Being physically immobile B) Sobbing for no apparent reason C) Difficulties with falling asleep D) Startling to loud noises and touch
A) Being physically immobile
According to the DSM-5, which behaviors describe an individual with a cluster A personality disorder? A) Odd and eccentric B) Anxious and fearful C) Dramatic and erratic D) Hostile and impulsive
A) Odd and eccentric
Which defense mechanism is related to paranoid delusions? A) Projection B) Regression C) Repression D) Identification
A) Projection
Which defense mechanism would a 6-year-old child who has been wetting the bed at night since the birth of a baby brother be using? A) Regression B) Repression C) Dissociation D) Displacement
A) Regression
Which statement by a nurse providing care for clients diagnosed with personality disorders demonstrates therapeutic management of manipulative client behavior? SATA. A) "Tell me what triggered your angry response to what I said." B) "The staff is responsible for determining unit rules that are fair to all clients." C) "Tell me what you are trying to accomplish by being so rude to the staff and other clients." D) "Remember that all clients must follow the rules regarding the use of the telephone." E) "Missing group today means that you will not be able to attend the pizza party later."
A, B, D
Identify Cluster A personality disorders: SATA. A) Schizotypal B) Antisocial C) Schizoid D) Paranoid
A, C, D
The nurse instructs the client's spouse about how to cope with the client's anxiety. The nurse determines teaching is successful if the spouse makes which statement? A) "Anxiety is a conscious means of resolving conflict." B) "Anxiety represents an unconscious conflict of needs." C) "It is important to confront my spouse during periods of anxiety." D) "Anxiety is increased by using defense mechanisms."
B) "Anxiety represents an unconscious conflict of needs."
Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike next week. The adult replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident? A) Displacement B) Rationalization C) Passive aggression D) Reaction formation
B) Rationalization
Which type of delusion is a client displaying when he proclaims, "I am the second son of God."? A) Influence B) Religious C) Reference D) Persecutory
B) Religious
Which benefit accompanies mild apprehension? A) Physiological functions are slowed B) There is an increase in alertness C) Behavioral responses become automatic D) Ego defense mechanisms are mobilized
B) There is an increase in alertness
The nurse is interacting with the client diagnosed with OCD. The client says to the nurse, "I don't understand what is wrong with rules, organization, and schedules." The nurse understands the client uses defense mechanisms in order to accomplish which goal? A) To apply a logical approach to a need B) To provide a feeling of safety and protect the person's sense of self-worth C) To fragment the personality causing mental illness D) To bring suppressed material into awareness
B) To provide a feeling of safety and protect the person's sense of self-worth
Identify Cluster B personality disorders: SATA. A) Schizotypal B) Antisocial C) Histrionic D) Paranoid E) Narcissistic F) Borderline
B, C, E, F
Which signs and symptoms are characteristic of Alzheimer's dementia? SATA. A) Ambivalence B) Forgetfulness C) Flight of ideas D) Loose associations E) Expressive aphasia
B, E
Which therapeutic technique can the nurse use when an anxious client exhibits pressured and rambling speech? A) Touch B) Silence C) Focusing D) Summarizing
C) Focusing
Rationalization (Intermediate Defense)
Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations for the behavior
A client who uses ritualistic behavior taps other clients on the shoulder three times as part of the ritual. Which rationale best explains the client's behavior? A) Client demonstrates blurred personality identity B) Client has poor control of sudden urges C) Client has a disturbance in spatial boundaries D) Client has limited ability to adapt to stressors
D) Client has limited ability to adapt to stressors
Which characteristic uniquely associated with psychophysiological disorders would differentiate them from somatic symptom disorders? A) Emotional cause B) Felling of illness C) Restriction of activities D) Underlying pathophysiology
D) Underlying pathophysiology
Safety is not a concern with patient's with Alzheimer's or dementia. True or False?
False
Denial (Immature Defense)
Involves escaping unpleasant realities by ignoring their existence
Repression (Intermediate Defense)
The exclusion of unpleasant or wanted experiences, emotions, or ideas from conscious awareness
Displacement (Intermediate Defense)
Transfer of emotions associated with a specific person, object, or situation to another person, object, or situation that is nonthreatening
A mental health nurse assesses a patient diagnosed with an antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment? A) Generalized anxiety B) Alcohol or substance abuse use disorder C) Compulsions and phobias D) Dysfunctional sleep patterns
B) Alcohol or substance abuse use disorder
All of the following would be signs of improvement with a patient with OCD except: A) Limiting rituals B) Avoid stressful situations and limit interactions C) Engaging in thought stopping D) Identifying triggers of OCD behaviors
B) Avoid stressful situations and limit interactions
Which term or description would the nurse use for a client who repeatedly performs ritualistic behaviors throughout the day to limit anxious feelings? A) Obsessions B) Compulsions C) Under personal control D) Related to rebelliousness
B) Compulsions
Diet education for a patient with generalized anxiety disorder (GAD) would include: A) Increase protein intake B) Decrease caffeine intake C) Limit carb intake D) Cut back on dairy products
B) Decrease caffeine intake
Which term would the nurse use to describe the thought processes of a male client who insists that he is a commander of alien spaceship despite repeated reality orientation? A) Illusion B) Delusion C) Confabulation D) Hallucination
B) Delusion
Which term would the nurse use to describe the thought processes of a male client who insists that he is the commander of an alien spaceship despite repeated reality orientation? A) Illusion B) Delusion C) Confabulation D) Hallucination
B) Delusion
Acting-Out Behaviors (Immature Defense)
An individual addresses emotional conflicts or stressors by actions rather than by reflections or feelings
An adult diagnosed with stage 2 Alzheimer's disease begins a new prescription for rivastigmine (Exelon). Which nursing diagnosis has the highest priority to add to the plan of care? A) Risk for constipation B) Impaired perception C) Impaired oral mucous membranes D) Risk for impaired nutritional status
D) Risk for impaired nutritional status
Altruism (Health Defense)
Emotional conflicts and stressors are addressed by meeting the needs of others
Idealization (Immature Defense)
Emotional conflicts or stressors are addressed by attributing exaggerated positive qualities to others
With antisocial personality disorder, boundaries with consequences are not needed. True or False?
False
Devaluation (Immature Defense)
Occurs when emotional conflicts or stressors are handled by attributing negative qualities to self or others
Somatization (Intermediate Defense)
Occurs when repressed anxiety is demonstrated in the form of physical symptoms that have no organic cause
Dissociation (Immature Defense)
A disruption in the usually integrated functions of conscious memory, identity, or perception of the environment
Projection (Immature Defense)
A person unconsciously rejects emotionally unacceptable personal features in one's self and attributes those unacceptable traits to other people, objects, or situations
An older client has been diagnosed with infection-induced delirium. Which statement by the nurse to the client's family best demonstrates an understanding of the disorder while addressing the family's concerns? A) "Delirium isn't permanent when treated appropriately. The prescribed medication should eliminate the infection causing the symptoms." B) "The symptoms of delirium can be very difficult to watch in a loved one. Try not to worry since the condition is not permanent." C) "The symptoms will come and go during the next few days. It's a common condition." D) "Infections commonly cause delirium in older clients. You'll see improvement in just a few days."
A) "Delirium isn't permanent when treated appropriately. The prescribed medication should eliminate the infection causing the symptoms."
The nurse cares for the client diagnosed with antisocial personality disorder. Which client statement best indicates improvement in the client's condition? A) "I get into trouble because I don't think before I act." B) "My parents have difficulty accepting my independence." C) "I've spent very little time actually enjoying life." D) "It's sad that others don't recognize my potential."
A) "I get into trouble because I don't think before I act."
The home care nurse makes an initial visit to the client diagnosed with an MI. The client's spouse states the family is having difficulty coping with the client's "obsessive-compulsive" tendencies. Which client statement is consistent with OCD? A) "I have difficulty making decisions and adjusting to change." B) "I am sure I am being followed by someone from work." C) "All of my life I've had problems with being unkempt." D) "I spend money excessively, which upsets my spouse."
A) "I have difficulty making decisions and adjusting to change."
The client, who is a veteran and has PTSD, tells the nurse about the horror and mass destruction of war. He states, "I killed all of those people for nothing." Which response by the nurse is appropriate? A) "You did what you had to do at that time." B) "Maybe you didn't kill as many people as you think." C) "How many people did you kill?" D) "War is a terrible thing."
A) "You did what you had to do at that time."
Which newly hospitalized patient should the nurse monitor closely for the development of delirium? A) A 48-year-old who usually drinks a six-pack of beer daily B) A 68-year-old who takes aspirin 650 mg twice daily for arthritis pain C) A 72-year-old who says, "I have a glass of wine every evening to stimulate my appetite." D) A 78-year-old diabetic whose blood glucose levels are consistently greater than 250 mg/dL
A) A 48-year-old who usually drinks a six-pack of beer daily
Which signs and symptoms are the 'four A's of Alzheimer's disease'? A) Amnesia, apraxia, agnosia, aphasia B) Avoidance, aloofness, asocial, asexual C) Autism, loose association, apathy, affect D) Aggressive, amoral, ambivalent, attractive
A) Amnesia, apraxia, agnosia, aphasia
A person shoplifts merchandise from a community cancer thrift shop. When confronted, the thief replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? A) Antisocial B) Histrionic C) Borderline D) Schizotypal
A) Antisocial
Which feelings are often the basis of OCD? A) Anxiety and guilt B) Anger and hostility C) Embarrassment and shame D) Hopelessness and powerlessness
A) Anxiety and guilt
A veteran of the war in Afghanistan tells the nurse, "Every day, something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't." What is the nurse's first priority? A) Assess the veteran for suicide risk B) Refer the veteran for specialized mental health services C) Assess the veteran for evidence of traumatic brain injury D) Refer the veteran's family to a posttraumatic stress disorder group
A) Assess the veteran for suicide risk
An acute mental disturbance causing confused thinking and possible hallucinations is: A) Delirium B) Dementia C) Alzheimer's disease D) Parkinson's disease
A) Delirium
Which defense mechanism is most commonly used by clients who are alcoholics? A) Denial B) Projection C) Displacement D) Compensation
A) Denial
A client diagnosed with delusional disorder says, "My ex-girlfriend is having affairs to re-create our relationship; that proves that she wants to come back to me." Which specific subtype is the client experiencing? A) Erotomanic B) Somatic C) Grandiose D) Persecutory
A) Erotomanic
Which intervention is best for a client who has a borderline personality disorder? A) Establishing clear boundaries B) Exploring vocational possibilities C) Discussing feelings of being victimized D) Spending 1-2 hours per day with the client
A) Establishing clear boundaries
The nurse is talking with a client who has been diagnosed with antisocial personality disorder about how to socialize during activities without being seductive. The nurse should focus on the discussion on which area? A) Explaining the negative reactions of others toward his behavior B) Suggesting he apologize to others for his behavior C) Asking him to explain the reasons for his seductive behavior D) Discussing his relationship with his mother
A) Explaining the negative reactions of others toward his behavior
A client who is disheveled and agitated demands, "Do something to make these feelings stop!" Which clinical manifestation is the client most likely experiencing? A) Feelings of panic B) Suicidal tendencies C) Manic hyperactivity D) Generalized dissociation
A) Feelings of panic
A client says, "It sounds like there is a roaring fire in the bathroom!" In reality, the client's roommate has just turned on the shower. Which term describes this experience? A) Illusion B) Delusion C) Dissociation D) Hallucination
A) Illusion
A nurse plans care for a patient diagnosed with borderline personality disorder. Which patient problem is most likely to apply to this patient? A) Ineffective relationships related to frequent splitting B) Social isolation related to fear of embarrassment or rejection C) Ineffective impulse control related to violence as evidenced by cruelty to animals D) Disturbed thought processes related to recurrent suspiciousness of people and situations
A) Ineffective relationships related to frequent splitting
Which behavior would the nurse observe when caring for a client with major neurocognitive disorder? A) Lability B) Independence C) Curiosity D) Being outgoing
A) Lability
A patient with Alzheimer's experiences agnosia often, which means: A) Loss of the ability to identify objects using one or more senses B) Difficulty with comprehension of reading, speaking, or writing C) Difficulty in performing daily tasks even if instructions are understood D) Frequent changing of moods, increased anxiousness and anger
A) Loss of the ability to identify objects using one or more senses
For a client with the diagnosis of borderline personality disorder, which problem is most likely to underlie angry or hostile behavior? A) Low self-esteem B) Inability to test reality C) Reaction to command hallucination D) Ineffective verbal communication
A) Low self-esteem
A student is anxious about an exam but is able to effectively study despite the roommate's loud music. Which level of anxiety does the student display? A) Mild B) Panic C) Severe D) Moderate
A) Mild
Which level of anxiety enhances the client's learning abilities? A) Mild B) Panic C) Severe D) Moderate
A) Mild
Which primary purpose is served when an individual takes action to reduce anxiety? A) Reduction of tension B) Denial of the situation C) Avoidance of physical discomfort D) Resolution in decision-making
A) Reduction of tension
When developing the plan of care for a client diagnosed with a personality disorder, the nurse plans to assist the the client primarily with what factor? A) Specific dysfunctional behaviors B) Psychopharmacologic compliance C) Examination of developmental conflicts D) Manipulation of the environment
A) Specific dysfunctional behaviors
A client, diagnosed with borderline personality disorder, declares that the whole staff is 'bad' after being disappointed by one staff member. Which defense mechanism is the client using? A) Splitting B) Rationalization C) Undoing D) Reaction formation
A) Splitting
The nurse orients a UAP new to the mental health unit about the principles for the care of a client diagnosed with a personality disorder. What information should the nurse include? A) The clients are accepted, although their behavior may not be B) The clients need limits on their behavior C) The staff members are the primary ones left to care about these clients D) The staff should use minimal humor when working with these clients
A) The clients are accepted, although their behavior may not be
A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions three times a week. Which outcome indicates this activity has been successful? A) The student reports improved feelings of well-being B) The student increases the use of caffeine to enhance concentration C) The student reports, "Now I am sleeping about 10 hours every day." D) The student says, "I withdrew from two courses to reduce my academic load."
A) The student reports improved feelings of well-being
For a client with OCD, which rationale explains the function of obsessions and compulsions? A) Unconscious control of acceptable feelings B) Intentional act to punish self for shortcomings C) Obedience to voices that direct behaviors D) Symbolic reenactment of punishing others
A) Unconscious control of acceptable feelings
For a client with OCD, which rationale explains the function of obsessions and compulsions? A) Unconscious control of unacceptable feelings B) Intentional act to punish self for shortcomings C) Obedience to voices that direct behaviors D) Symbolic reenactment of punishing others
A) Unconscious control of unacceptable feelings
Which defense mechanism is a client using when the client's hands are raw and bloody from a ritual involving frequent hand washing? A) Undoing B) Projection C) Introjection D) Suppression
A) Undoing
A client diagnosed with paranoid personality disorder is being admitted on an involuntary 24-hour hold after a physical altercation with a police officer who was investigating the client's threatening phone calls to his neighbors. He states that his neighbors are spying on him for the government, saying, "I want them to stop and leave me alone. Now they have you nurses and doctors involved in their conspiracy." Which nursing approaches are most appropriate? SATA. A) Approach the client in a professional, matter-of-fact manner B) Avoid intrusive interactions with the client C) Gently present reality to counteract the client's current paranoid beliefs D) Develop trust consistently with the client E) Avoid pressuring the client to attend any groups
A, B, D, E
What teaching will the nurse provide to an older adult who has a history of heat exhaustion? SATA. A) Take frequent rest breaks when doing activities B) Drink caffeinated beverages before going in the sun C) Wear dark clothing to protect the skin from burning D) Stay indoors in an air-conditioned room when possible E) Take warm baths or showers to regulate body temperature
A, D, E
Humor (Healthy Defense)
An individual may deal with emotional conflicts or stressors by emphasizing the amusing or ironic aspects of the conflict or stressor
Sublimation (Healthy Defense)
An unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not usually considered acceptable
A client who is pacing and wringing his hand states, "I just need to walk" when questioned by the nurse about what he is feeling. Which response by the nurse is most therapeutic? A) "You need to sit down and relax." B) "Are you feeling anxious?" C) "Is something bothering you?" D) "You must be experiencing a problem now."
B) "Are you feeling anxious?"
Which statement indicates that the client is experiencing auditory hallucinations? A) "Get these horrible snakes out of my room!" B) "I am not the devil! Stop calling me names!" C) "The food on this plate has poison in it." D) "I saw an alien spaceship and now I feel sick."
B) "I am not the devil! Stop calling me names!"
Four adult patients describe frightening events that resulted in panic levels of anxiety/fear. Which patient's report most clearly indicates a reasonable fear response? A) "I saw a large spider crawling along my kitchen wall." B) "I was at the mall when a gunman began firing an assault weapon." C) "I was at home when a storm with heavy thunder and lightning lasted over an hour." D) "I was trapped in an elevator that stopped between floors when the power went out."
B) "I was at the mall when a gunman began firing an assault weapon."
An 84-year-old tells the nurse, "I do four or five number puzzles every day to keep my brain healthy and sharp." When considering a holistic approach to maintaining mental health, the nurse should respond: A) "It is more important for you to have physical activity every day." B) "Let's think of some other activities we can add to your routine." C) "Repetition of the same activity is not helpful for keeping your brain healthy." D) "There are some herbal preparations that will also help keep your brain sharp."
B) "Let's think of some other activities we can add to your routine."
An adolescent female client who has been treated for an anxiety disorder since middle school with behavioral treatment and as needed (PRN) anxiety medication is preparing to go to college. The parents are concerned that she will experience an exacerbation of symptoms if she attends college out of town and want their daughter to attend the local community college and live at home. The girl believes she can handle the challenge of leaving home for college. How should the nurse in the outpatient clinic respond to the family's concerns? A) "Your parents have a point; transition have been hard for you in the past." B) "There are many pros and cons here that we all need to discuss together." C) "Every high school graduate deserves the chance to take on new challenges." D) "It may be premature for you to think of college at this point in time."
B) "There are many pros and cons here that we all need to discuss together."
Which statement demonstrates a defense mechanism often implemented by clients diagnosed with a borderline personality disorder? A) "I'm so ashamed when I lose my temper." B) "There is nothing good I can say about my mother." C) "I've attempted suicide on three different occasions." D) "I can't go to group unless you go with me."
B) "There is nothing good I can say about my mother."
In comparing assessment findings in client with vascular dementia and dementia of the Alzheimer type, which factor is unique to vascular dementia? A) Memory impairment B) Abrupt onset of symptoms C) Difficulty making decisions D) Inability to use words to communicate
B) Abrupt onset of symptoms
The client can no longer recognize familiar objects such as his glasses and toothbrush. Which term describes these assessment findings? A) Apraxia B) Agnosia C) Aphasia D) Amnesia
B) Agnosia
A delirious client sees a design on the wallpaper and perceives it as an animal. Which positive symptom is the client experiencing? A) A delusion B) An illusion C) A hallucination D) An idea of reference
B) An illusion
A patient just diagnosed with cancer says the test must be wrong. What defense mechanism is this? A) Projection B) Denial C) Regression D) Idealization
B) Denial
The client reports screaming hysterically whenever a spider comes close to her. Which defense mechanism is the client using? A) Sublimation B) Displacement C) Repression D) Introjection
B) Displacement
Which behavior is typical for antisocial personality disorder? A) Sexual acting out B) Disregard for others C) Loss of contact with family D) Compulsive, repetitive behaviors
B) Disregard for others
Which behavior is typical for antisocial personality disorder? A) Sexual acting out B) Disregard for others C) Loss of contact with reality D) Compulsive, repetitive behaviors
B) Disregard for others
A mature, professional couple plans a large wedding in city that is 100 miles from their home. Which response is most likely to be associated with this experience? A) Distress B) Eustress C) Acute stress D) Depersonalization
B) Eustress
An assistant at a local university claims to be president of the university. Which type of delusion is the client displaying? A) Somatic B) Grandiose C) Erotomanic D) Persecutory
B) Grandiose
Which description is correct for Alzheimer disease? A) Emerges in the fourth decade of life B) Is a slow, relentless deterioration of the mind C) Is functional in origin and occurs in the later years D) Is diagnosed through lab and psychological tests
B) Is a slow, relentless deterioration of the mind
Which description is correct for Alzheimer's disease? A) Emerges in the fourth decade of life B) Is a slow, relentless deterioration of the mind C) Is functional in origin and occurs in the later years D) Is diagnosed through lab and psychological tests
B) Is a slow, relentless deterioration of the mind
Which defense mechanism is considered a conscious measure that is used to cope with anxiety? A) Undoing B) Projection C) Suppression D) Intellectualization
C) Suppression
The nurse orients the client to the unit. The nurse observes the client is pacing, talking rapidly, and has elevated respirations. Which action by the nurse is best? A) Provide an informational booklet B) Keep the explanation simple C) Delay the orientation until the anxiety has ceased D) Stress the positive aspects of the unit
B) Keep the explanation simple
When speaking with a PTSD patient about their trauma trigger, what is the best therapeutic response? A) Ask many questions to get more information B) Listen attentively and be present in the conversation C) Change the topic if it appears the patient is uncomfortable D) Tell the patient to just write down their feeling and you will read it later
B) Listen attentively and be present in the conversation
Which signs and symptoms would the nurse anticipate with a patient with agoraphobia? A) Hallucinations B) Panic attacks C) Increased cognition D) Increased mood
B) Panic attacks
Which characteristic distinguishes PTSD from other anxiety disorders? A) Lack of interest in family and others B) Reliving the trauma in dreams and flashbacks C) Avoidance of situations that resemble the stress D) Blunted affect when discussing the traumatic situation
B) Reliving the trauma in dreams and flashbacks
Which intervention will the nurse include in the plan of care to address a common co-morbid condition demonstrated by many clients diagnosed with body dysmorphic disorder (BDD)? A) Anger management group B) Suicide precautions C) Frequent re-orientation to time and place D) Set and enforce reasonable limits regarding boundaries
B) Suicide precautions
Which approach is most appropriate to use with a client diagnosed with narcissistic personality disorder when discrepancies exist between what the client states and what actually exists? A) Limit setting B) Supportive confrontation C) Consistency D) Rationalization
B) Supportive confrontation
Which benefit accompanies mild apprehension? A) Physiological functions are slowed B) There is an increased in alertness C) Behavioral responses become automatic D) Ego defense mechanisms are mobilized
B) There is an increased in alertness
A patient diagnosed with dissociative identity disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting, which staff nurse's comment should prompt the nursing supervisor to intervene? A) "I have never taken care of a patient diagnosed with this disorder." B) "I think this patient was misdiagnosed and probably has schizophrenia." C) "I find myself more fascinated and engaged with this patient than others." D) "I recently read an autobiographical book about someone with this problem."
C) "I find myself more fascinated and engaged with this patient than others."
A family member asks the nurse, "I know my uncle's Alzheimer's disease has progressed but is there any medications that can help him now?" Which response by the nurse is correct? A) "I'm sorry, but there are no medications that help with severe Alzheimer's disease." B) "Alzheimer's disease sometimes stabilizes. Let's hope that happens in this situation." C) "There are a few medications that may help. Let's discuss it with the health care provider." D) "It sounds like you're having difficulty accepting that your uncle's disease is irreversible. Would you like to talk about those feelings?"
C) "There are a few medications that may help. Let's discuss it with the health care provider."
The nurse cares for a client with OCD. The nurse observes that the client has difficulty getting to meals on time because of a handwashing ritual. Which statement by the nurse is best? A) "Starting tomorrow, you can eat in your room." B) "I know you are feeling anxious, but it is important to eat properly." C) "Tomorrow, I will call you 15 minutes earlier to help you get ready." D) "It is important that you discuss this with your health care provider."
C) "Tomorrow, I will call you 15 minutes earlier to help you get ready."
After a power outage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with a narcissistic personality disorder? A) "These sandwiches are probably contaminated with bacteria." B) "I suppose it's the best we can hope for under these circumstances." C) "You should have ordered a to-go meal from a local restaurant for me." D) "I would rather wait to eat until the dietary department can prepare a meal."
C) "You should have ordered a to-go meal from a local restaurant for me."
Select the best example of altruism. A) After recovering from a gunshot wound, a police officer attends a local support group B) After recovering from open-heart surgery, an individual plays tennis three times a week C) An individual who received a liver transplant volunteers at a local organ procurement agency D) An individual with a long-standing fear of animals volunteers at a community animal shelter
C) An individual who received a liver transplant volunteers at a local organ procurement agency
A client is diagnosed with agoraphobia without panic disorder. Which type of therapy would the nurse most expect to see included in the plan of care? A) Insight therapy B) Group therapy C) Behavior therapy D) Psychoanalysis
C) Behavior therapy
For a client with OCD, which rationale supports giving the client time to perform a specific ritual? A) It demonstrates respect for the client's autonomy B) This behavior is viewed as a result of anger turned inward C) Denying this activity may precipitate an increased level of anxiety D) Successful performance of independent activities enhances self-esteem
C) Denying this activity may precipitate an increased level of anxiety
Compulsive behavior usually incorporates the use of which defense mechanism? A) Projection B) Regression C) Displacement D) Rationalization
C) Displacement
Which assessment finding would the nurse observe in a client who has been found to have an antisocial personality disorder? A) Pays great attention to detail and demonstrates a high level of anxiety B) Has scars from self-mutilation and a history of many negative relationships C) Displays charm, has above-average intelligence, and tends to manipulate others D) Demonstrates suspiciousness, avoids eye contact, and engages in limited conversation
C) Displays charm, has above-average intelligence, and tends to manipulate others
A patient is taking a benzodiazepine for anxiety. What is the most important teaching point with this class of medication? A) Take with a glass of wine at night to help sleep B) Take them just when anxiety is too much to bear C) Don't abruptly stop taking the medication D) There are not any safety issues to convey to the patient
C) Don't abruptly stop taking the medication
Which of the following medications would be appropriate for a client with beginning stages of Alzheimers? A) Buspirone B) Lorazepam C) Donepezil D) Haldol
C) Donepezil
A nurse is planning interventions for a veteran who has recently been discharged from the military and is reporting difficulty sleeping. When considering the client's past medical history, which data is most relevant to the development of posttraumatic stress disorder (PTSD)? A) Regularly smoked marijuana as a teenager B) Quit smoking tobacco 2 months ago C) Family history of depression D) Sustained a concussion a month before discharge
C) Family history of depression
How can the nurse manager on a mental health unit devoted to the care of clients diagnosed with personality disorders address the needs of the nursing staff? A) Schedule monthly in-services on the management of this client population B) Design schedules to provide staff with 3 consecutive days off each period C) Hold a daily meeting to focus on communication between nursing and supervisory staff D) Require that nursing staff rotate to another nursing unit for 6 months every 24 months
C) Hold a daily meeting to focus on communication between nursing and supervisory staff
Which behavior is most typical for clients with borderline personality disorder? A) Arrogant B) Eccentric C) Impulsive D) Dependent
C) Impulsive
Which intervention is best associated with minimizing the effects of dementia-induced aphasia? A) Speaking in a slow, deliberate manner B) Delivering information in short, simple phrases C) Increasing reliance on nonverbal communication methods D) Engaging in reminiscing therapy by focusing on familiar topics
C) Increasing reliance on nonverbal communication methods
Which factor would precipitate a client's use of confabulation? A) Ideas of grandeur B) Need for attention C) Marked memory loss D) Difficulty in accepting the diagnosis
C) Marked memory loss
A client is diagnosed with paranoid personality disorder is hospitalized for physically threatening his wife because he suspects her of having an affair with a coworker. What approach should the nurse employ with this client? A) Authoritarian B) Parental C) Matter of fact D) Controlling
C) Matter of fact
An older adult client reports flashbacks related to his experiences in Vietnam; he exhibits startle reactions and poor concentration. Which mental health disorder is associated with these symptoms? A) Schizophrenia B) Bipolar disorder C) PTSD D) OCD
C) PTSD
A client says, "The doctors lied about me. They said I murdered my mother. You killed her. She died before I was born." Which psychotic feature is the client experiencing? A) Ideas of grandeur B) Confusing illusions C) Persecutory delusions D) Auditory hallucinations
C) Persecutory delusions
A female client tells the nurse that she hates her roommate. Later, the client tells the roommate, "I missed you. Where have you been?" Which defense mechanism is the client using? A) Projection B) Sublimation C) Reaction formation D) Compensation
C) Reaction formation
Which defense mechanism is most commonly used by clients who are diagnosed with schizophrenia, undifferentiated type? A) Projection B) Repression C) Regression D) Conversion
C) Regression
Which defense mechanism is a client displaying when the client can no longer remember why an event was stressful, even though it happened just 3 days ago? A) Denial B) Regression C) Repression D) Dissociation
C) Repression
A patient in the ER following a car accident has difficulty concentrating, is hyperventilating, and is experiencing tachycardia. What level of anxiety is this? A) Mild B) Moderate C) Severe D) Panic
C) Severe
A client has been diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe? A) Making huge efforts to avoid 'any kind of bug or spider' B) Experiencing flashbacks to an event that involved a sexual attack C) Spending hours each day worrying about something 'bad happening' D) Becoming suddenly tachycardic and diaphoretic for no apparent reason
C) Spending hours each day worrying about something 'bad happening'
The nurse plans care for the client diagnosed with antisocial personality disorder. The nurse understands which is the purpose of group therapy for this client? A) To provide extra time to explore the client's past B) To demonstrate acceptance of the client and their behavior C) To set limits on the client in a non-punitive manner D) To encourage sublimation of the client's leadership potential
C) To set limits on the client in a non-punitive manner
While interacting with a 62-year-old adult diagnosed with a progressive neurocognitive disorder, the nurse observes that the adult has slow responses and difficulty finding the right words. What is the nurse's best initial action? A) Suggest words that the adult may be trying to remember B) Ask the adult, "Are you having problems saying what you mean?" C) Use silence to allow the adult an opportunity to compose responses D) Discontinue the interaction to prevent further frustration for the adult
C) Use silence to allow the adult an opportunity to compose responses
After being discharged from the hospital with acute stress disorder, a client is referred to the outpatient clinic for follow-up. What is most important for the client to use for continued alleviation of anxiety? A) Recognizing when she is feeling anxious B) Understanding reasons for her anxiety C) Using adaptive and palliative methods to reduce anxiety D) Describing the situations preceding her feelings of anxiety
C) Using adaptive and palliative methods to reduce anxiety
Passive Aggression (Immature Defense)
Can be seen when an individual deals with emotional conflict or stressors by indirectly and assertively expressing aggression towards others
The client with a diagnosis if antisocial personality disorder fails to arrive on time for a scheduled appointment with the nurse. The nurse contacts the client to remind the client of the appointment, and the client states, "I would rather meet between 12 and 1." Which response by the nurse is best? A) "Perhaps we can make that change the next time." B) "Is there something you are having trouble discussing?" C) "I would have to discuss any changes with the team first." D) "Are you having some difficulty with the time you agreed to?"
D) "Are you having some difficulty with the time you agreed to?"
The nurse is meeting with a client on the psychiatric unit when another client diagnosed with antisocial personality disorder walks into the room and sits down. Which response by the nurse is best? A) "This client and I are talking. If you'd like to sit with us for awhile, you'll have to remain quiet." B) "Get out of this room! This is a private conversation!" C) "Do you have something you'd like to discuss?" D) "Right now we are talking. Please leave this room and I'll talk to you later."
D) "Right now we are talking. Please leave this room and I'll talk to you later."
A client with acute stress disorder states to the nurse, "I keep having horrible nightmares about the car accident that killed my daughter. I should not have taken her with me to the store." Which response by the nurse is most therapeutic? A) "Don't keep torturing yourself with such horrible thoughts." B) "Stop blaming yourself. It's only hurting you." C) "Let's talk about something that's a bit more pleasant." D) "The accident just happened and couldn't have been predicted."
D) "The accident just happened and couldn't have been predicted."
A nursing student arrives late for a clinical experience and is not wearing the correct attire. When the instructor privately criticizes the behavior, the student responds, "I'm always the one who gets caught. You're going to cause me to fail." Select the instructor's best response. A) "Other students get caught as well." B) "I am not trying to cause you to fail. I am here to help you." C) "I am sorry you feel that way. I try to treat all my students equally." D) "The requirements for this experience were discussed during our orientation."
D) "The requirements for this experience were discussed during our orientation."
When caring for four clients, which does the nurse identify as at the highest risk for frostbite? A) 19-year-old who takes antihistamines B) 28-year-old who is a vegetarian C) 41-year-old who is being treated for hypothyroidism D) 57-year-old who drinks 4-5 beers per day
D) 57-year-old who drinks 4-5 beers per day
The nurse cares for clients in the mental health clinic. The client diagnosed with OCD tells the nurse of being afraid of contracting AIDS. The client reports spending much of the day washing the hands and spraying disinfectant in the room. The nurse understands this hand washing behavior represents which statement? A) A drive that needs to be denied B) A dissociative response to trauma C) A hidden wish to become ill and disabled D) A symbolic expression of conflict and guilt
D) A symbolic expression of conflict and guilt
Before discharging an anxious client, which information about anxiety would the nurse teach the family? A) Anxiety is a totally unique feeling and experience B) Apprehension is generalized to the total environment C) Fears results from conscious actions, thoughts, and wishes D) Anxiety is a pattern of emotional and behavioral responses to stress
D) Anxiety is a pattern of emotional and behavioral responses to stress
When planning care for a client diagnosed with schizotypal personality disorder, which intervention helps the client become involved with others? A) Participating solely in group activities B) Being involved with primarily one-to-one activities C) Leading a sing-along in the afternoon D) Attending an activity with the nurse
D) Attending an activity with the nurse
A young adult client is admitted to a psychiatric unit with a diagnosis of alcohol abuse and personality disorder. The client's mother states, "He's always in trouble, just like when he was a boy. Now he's just a bigger prankster and out of control." In view of the client's history, which intervention is most important initially? A) Letting the client know the staff has the authority to subdue him if he gets unruly B) Keeping the client isolated from other clients until he is better known by the staff C) Emphasizing to the client that he will have to pay for any damage he causes D) Closely observing the client's behavior to establish a baseline pattern of functioning
D) Closely observing the client's behavior to establish a baseline pattern of functioning
Which mental mechanism would the nurse suspect when a client with alcohol use disorder who has not worked for the past 10 years states, "I currently work in the office of a local construction company."? A) Regression B) Sublimation C) Compensation D) Confabulation
D) Confabulation
Which characteristics usually accompany OCD? A) Marked emotional maturity B) Rapid, frequent mood swings C) Elaborate delusional systems D) Doubt, fears, and indecisiveness
D) Doubt, fears, and indecisiveness
Which characteristics usually accompany OCD? A) Marked emotional maturity B) Rapid, frequent mood swings C) Elaborate delusional systems D) Doubts, fears, and indecisiveness
D) Doubts, fears, and indecisiveness
Which physical manifestation would the nurse expect to observe if a client is anxious? A) Constricted pupils B) Narrowed bronchioles C) Decreased BP D) Increased blood glucose level
D) Increased blood glucose level
Which behavior is most characteristic of a client diagnosed with an antisocial personality disorder? A) Repeatedly accusing the staff of favoring another client. B) Throwing a book when asked to turn down the volume on the television. C) Insisting that it is necessary to eat only green foods on Thursdays. D) Justifying taking another client's dessert by stating, "I deserve two desserts."
D) Justifying taking another client's dessert by stating, "I deserve two desserts."
For a client with OCD, which event will increase the client's anxiety level? A) The day progresses and the sun is close to setting B) Family members come to the unit to visit C) The nurse performs the morning physical assessment D) Limits are set on the performance of a ritual
D) Limits are set on the performance of a ritual
An obviously upset client comes to the mental health clinic and, after pushing ahead of the other clients, states, "I had an argument with my daughter, and now I'm tense, and worried, and angry." What level of anxiety does the nurse determine that the client is experiencing? A) Mild B) Panic C) Severe D) Moderate
D) Moderate
Which term describes the client's use of made-up words that have no meaning to other people? A) Avolition B) Echolalia C) Anhedonia D) Neologisms
D) Neologisms
A disaster relief nurse has just arrived to help efforts after a tornado that destroys a town. Which approach would be most appropriate when talking with survivors? A) Provide active listening B) Help the survivors generate possible solutions C) Help the survivors develop self-awareness to understand their stress response D) Offer firm, short, simple statements and instructions
D) Offer firm, short, simple statements and instructions
Childhood abuse, kidnapping, military combat are possible risk factors for development of this disorder: A) Acute anxiety B) Borderline personality disorder C) OCD D) PTSD
D) PTSD
Which benefit does a client gain by confabulating? A) Increases respect from others B) Blocks conscious awareness C) Explains and justifies behavior D) Protects self-esteem
D) Protects self-esteem
A person with a history of alcoholism says, "I've been drinking since last Friday to celebrate my son's graduation from college." Which defense mechanism is the person displaying? A) Denial B) Projection C) Identification D) Rationalization
D) Rationalization
Which defense mechanism would be exhibited when a client with alcohol use disorder states, "I function better when I'm drinking than when I'm sober."? A) Sublimation B) Suppression C) Compensation D) Rationalization
D) Rationalization
Which defense mechanism would be exhibited when a client with alcohol use disorder states, "I functions better when I'm drinking than when I'm sober."? A) Sublimation B) Suppression C) Compensation D) Rationalization
D) Rationalization
An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting in persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for five years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse? A) Explore the spouse's feelings, showing care and compassion B) Encourage the spouse to attend a community support group C) Teach stress reduction and relaxation techniques to the spouse D) Refer the spouse to the primary care provider for health assessment
D) Refer the spouse to the primary care provider for health assessment
The client with histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. The nurse should recommend which activity for this client? A) Party planning B) Music group C) Cooking class D) Role-playing
D) Role-playing
Which description of symptoms is consistent with dementia of the Alzheimer type? A) Symptom onset is fairly rapid B) Symptoms will subside periodically C) Symptoms are triggered by personal crisis D) Symptoms reflect progressive disintegration
D) Symptoms reflect progressive disintegration
Which description of symptoms is consistent with dementia of the Alzheimer's type? A) Symptom onset is fairly rapid B) Symptoms will subside periodically C) Symptoms are triggered by a personal crisis D) Symptoms reflect progressive disintegration
D) Symptoms reflect progressive disintegration
An adult client diagnosed with anxiety disorder becomes anxious when she touches fruits and vegetables. What should the nurse do? A) Instruct the woman to avoid touching these foods B) Ask the woman why she becomes anxious in these situations C) Assist the woman to make a plan for her family to do the food shopping and preparation D) Teach the woman to use cognitive-behavioral approaches to manage her anxiety
D) Teach the woman to use cognitive-behavioral approaches to manage her anxiety
Which explanation best describes what is known about the pathophysiology of dementia of the Alzheimer type? A) There is a genetic predisposition and dysregulation of neurotransmitters B) The dementia is transient and secondary to a physical imbalance disorder C) Hypoxia and decreased perfusion of select areas of the brain causes tissue damage D) The presence of amyloid plaques is associated with brain tissue destruction
D) The presence of amyloid plaques is associated with brain tissue destruction
Which personality disorder would the nurse suspect in a client telling a rambling, lengthy, unclear, and overly detailed story about their dog, who they say is president? SATA. A) Schizoid B) Paranoid C) Histrionic D) Borderline E) Narcissistic F) Schizotypal
F) Schizotypal
One day a parent of an adolescent client diagnosed with antisocial personality disorder says to the nurse, "My child seems much better. I feel my child will finally grow up and assume responsibility for their own actions." What teaching is most important for the nurse to provide the parent? A) The client is not exhibiting any psychotic behaviors at this time, which means the client is in complete remission and the statement by the parent is absolutely true B) Psychotherapy is the only treatment that works, and family sessions are not recommended C) The prognosis is good because with medication and psychotherapy, the problem will be resolved D) The prognosis is doubtful because only some antisocial clients change their behavior, and consistently follow the treatment plan
D) The prognosis is doubtful because only some antisocial clients change their behavior, and consistently follow the treatment plan
For a client with OCD, which purpose is served by ritualistic behavior? A) The rituals are useless but uncontrollable B) Rituals lessens rigidity and inflexibility C) Ritualistic behavior decreases depression D) The rituals temporarily relieve anxiety
D) The rituals temporarily relieve anxiety
Suppression (Healthy Defense)
The conscious denial of a disturbing situation or feeling
Splitting (Immature Defense)
The inability to integrate the positive and negative qualities of oneself or others into a cohesive image
A patient with generalized anxiety disorder (GAD) often finds it difficult to control their worrying. True or False?
True
Limiting environmental distractions can be helpful when conversing with a patient having a panic attack. True or False?
True
Reaction Formation (Intermediate Defense)
Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion
