Mental Final (Davis exam review questions)

34. A nursing student states, "The instructor gave me a failing grade on my research paper. I know it's because the instructor doesn't like me." Which cognitive error does the nurse recognize in this student's statement? 1. Dichotomous thinking 2. Catastrophic thinking 3. Magnification 4. Overgeneralization

ANS 3 Magnification is exaggerating the negative significance of an event. Catastrophic thinking is always thinking the worst will occur without considering the possibility of positive outcomes.

80. A forensic nurse identified patterned injuries on a 3-year-old child. Which assessment data led to this conclusion? 1. Multiple minute cuts and abrasions 2. Generalized bruising of the buttock 3. Circular burn marks the size of a lit cigarette 4. Stab wounds resulting from sharp-object penetration

ANS 3 Patterned injuries are specific injuries that reflect the pattern of the weapon used to inflict the injury—in this case, a lit cigarette.

56. Warren's college roommate actively resists going out with friends whenever they invite him. He says he can't stand to be around other people and confides to Warren "They wouldn't like me anyway." Which disorder is Warren's roommate likely suffering from? 1. Agoraphobia 2. Mysophobia 3. Social anxiety disorder (social phobia) 4. Panic disorder

ANS 3 Social anxiety disorder is an excessive fear of social situations related to fear that one might do something embarrassing or be evaluated negatively by others.

72. A nursing student who has no knowledge of alternative treatments states, "Aren't these therapies 'bogus' and, like a fad? Won't they eventually fade away?" Which is the most accurate nursing reply? 1. "Like nursing, complementary therapies take a holistic approach to healing." 2. "The American Nurses Association is researching the effectiveness of these therapies." 3. "It is important to remain nonjudgmental about these therapies." 4. "Alternative therapy concepts are rooted in psychoanalysis."

ANS 1 Complementary therapies and nursing view the person as consisting of multiple integrated elements. Diagnostic measures are based on the holistic assessment of the person.

77. According to Peplau, treatment of client symptoms should involve which nursing action? 1. Establishing a therapeutic nurse-client relationship 2. Using the technique of desensitization 3. Challenging clients' negative thoughts 4. Uncovering clients' past experiences

ANS 1 Peplau applied interpersonal theory to nursing practice and provided the framework for the nurse-client relationship.

69. Providing nursing education on drug abuse to a high-school class is an example of which level of preventive care? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Primary intervention

ANS 1 Providing nursing education on drug abuse to a high-school class is an example of primary prevention. Primary prevention services are aimed at reducing the incidence of mental health disorders within the population.

37. A client scheduled for ECT at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. Based on this observation, which is the most appropriate nursing action? 1. The nurse notifies the client's physician of the situation and cancels the ECT. 2. The nurse removes the breakfast tray and assists the client to the ECT procedure room. 3. The nurse allows the client to finish breakfast and reschedules ECT for 10:00 a.m. 4. The nurse increases the client's fluid intake to facilitate the digestive process.

ANS 1 A client who is scheduled for an ECT treatment is given nothing by mouth (NPO) for a minimum of 6 to 8 hours before treatment.

79. A forensic nurse collects a semen sample from a rape victim. Which nursing action maintains the proper chain of evidence? 1. A collected sample is labeled, sealed, and kept in a locked refrigerator until given to police. 2. The sample is locked in a special container and given to the pathologist. 3. The sample is placed in the medication room refrigerator prior to police collection. 4. The sample is sealed and immediately given to police to avoid contamination.

ANS 1 Collected evidence must be kept separate from other items, labeled, and sealed to prevent tampering or loss. Sealed and correctly labeled evidence kits or bags may be stored in a secure location until they are transferred to law enforcement officials. The best place to store evidence is in a locked drop box and locked refrigerator, located in a limited-access room that requires key entry.

68. A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to the nurse that the student is handling this situation in a healthy manner? 1. "I know that it was not my fault." 2. "My boyfriend has trouble controlling his sexual urges." 3. "If I don't put myself in a dating situation, I won't be at risk." 4. "Next time I will think twice about wearing a sexy dress."

ANS 1 The client has begun the process of a healthy grief resolution. Nonjudgmental listening provides an avenue for catharsis the client needs to begin healing.

44. The mental health nurse is evaluating care of a client who is recovering from an episode of schizophrenic psychosis. Which is the most appropriate long-term goal for the client? 1. Define and test reality. 2. Participate in social activities. 3. Maintain appropriate eye contact. 4. Verbalize feelings of anxiety.

ANS 1 The most appropriate long-term goal for a client recovering from a psychotic episode is to be able to define and test reality, reducing or eliminating the occurrence of hallucinations.

17. 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 The nurse is demonstrating a democratic leadership style. Democratic leaders share information with group members, promote decision-making by the members of the group, and provide guidance and expertise as needed.

51. A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention is most therapeutic for this client? 1. Use a calm, unemotional approach during client interactions. 2. Focus primarily on enforcing limits. 3. Limit interactions to decrease external stimuli. 4. Encourage the client to establish social relationships with peers.

ANS 1 The nurse's most therapeutic action is to maintain a calm, unemotional approach during client interactions. Clients experiencing mania are subject to frequent mood variations, easily changing from irritability and anger to sadness and crying. Accelerated thinking proceeds to racing thoughts, over connection of ideas, and rapid, abrupt movement from one thought to another.

19. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? 1. The teenager is attempting to differentiate self. 2. The teenager is triangulating self. 3. The teenager is cutting self off emotionally. 4. The teenager is exhibiting antisocial traits.

ANS 1 The teenager is attempting the normal task of adolescence of differentiating himself or herself. The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity.

33. A nurse recognizes which intervention within a behavioral therapy program is best? 1. A child is given a popsicle for staying dry and clean. 2. A child is put in time-out after soiling his or her undergarments. 3. A child is allowed to remain in soiled undergarments. 4. A child is taught the advantages of staying dry and clean.

ANS 1 This is an example of positive reinforcement. A stimulus that follows a behavior or response is called a reinforcing stimulus or reinforcer. The popsicle is a reinforcer, or stimulus, for the child to stay dry and clean. This is an example of operant conditioning, a form of behavioral therapy.

1. A new psychiatric nurse states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of the nurse's statement? 1. Defense mechanisms are self-protective responses to stress and do not need to be eliminated. 2. Defense mechanisms are maladaptive attempts of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms are used by individuals with weak ego integrity and should not be eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

ANS 1 This is correct. Defense mechanisms serve the purpose of reducing anxiety during times of stress. A client with no defense mechanisms may have a lower tolerance for stress, predisposing him or her to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills.

82. While reviewing laboratory results of a newly admitted client, the nurse discovers that the client's thyroid-stimulating hormone (TSH) levels are elevated. The nurse anticipates the client will exhibit which symptoms? Select all that apply. 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

ANS 1, 2 1. Elevated TSH levels are indicative of hypothyroidism. Symptoms include depression and fatigue. Memory impairment, decreased libido, and suicidal ideation can occur with chronic hypothyroidism. 2. Elevated TSH levels are indicative of hypothyroidism. Symptoms include depression and fatigue. Memory impairment, decreased libido, and suicidal ideation can occur with chronic hypothyroidism.

97. Which of the following risk factors noted during a family history assessment should the nurse associate with the potential development of ID? Select all that apply. 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

ANS 1, 2, 3 1. A family history of Tay-Sachs disease, childhood meningococcal infections, and deprivation of nurturance and social contact are risk factors that predispose a child to ID. The major predisposing factors of ID include hereditary factors, early alterations in embryonic development, pregnancy and perinatal factors, medical conditions acquired in infancy or childhood, environmental influences, and other mental disorders. 2. A family history of Tay-Sachs disease, childhood meningococcal infections, and deprivation of nurturance and social contact are risk factors that predispose a child to ID. The major predisposing factors of ID include hereditary factors, early alterations in embryonic development, pregnancy and perinatal factors, medical conditions acquired in infancy or childhood, environmental influences, and other mental disorders. 3. A family history of Tay-Sachs disease, childhood meningococcal infections, and deprivation of nurturance and social contact are risk factors that predispose a child to ID. The major predisposing factors of ID include hereditary factors, early alterations in embryonic development, pregnancy and perinatal factors, medical conditions acquired in infancy or childhood, environmental influences, and other mental disorders.

98. The community health nurse is visiting a homebound elderly patient who lives alone. The nurse assesses the patient's environment and finds the home dark and cold. The food pantry contains two cans of soup and half a package of crackers. The contents of the refrigerator have spoiled due to the lack of electricity. The patient states that her electricity has been turned off because her nephew who looks after her has not paid the bill this month even though she gave him the money to do so. During the physical assessment, the nurse finds that the patient has lost 8 pounds since the last visit and has what appear to be cigarette burn marks in various stages of healing on the patient's arms. The nurse determines that the patient is the victim of which type of abuse? Select all that apply. 1. Neglect 2. Financial 3. Physical 4. Sexual

ANS 1, 2, 3 1. Neglect implies failure to fulfill the physical needs of an individual who cannot do so independently. The nephew has neglected to provide the patient with adequate food, water, and electricity. 2. Financial abuse occurs when the perpetrator misuses the elderly person's finances. The nephew was given the money to pay the patient's electricity bill and instead used the money for something other than caring for the patient. 3. Physical abuse is described as striking, shoving, beating, burning, or restraint. The patient has cigarette burns in various stages of healing on the arms that indicates physical abuse.

85. Which of the following are most appropriate when performing a nursing assessment with an individual in crisis? Select all that apply. 1. "Tell me what happened." 2. "What coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened." 4. "Let's focus on the current problem." 5. "I'll assist you in selecting functional coping strategies."

ANS 1, 2, 3 1. The nurse should first assess to gather information regarding the precipitating stressor of the client's current crisis. 2. The nurse should first assess to gather information regarding the precipitating stressor of the client's current crisis. 3. The nurse should first assess to gather information regarding the precipitating stressor of the client's current crisis.

91. A client and nurse therapist are developing a treatment plan that includes strategies to manage bipolar disorder. Which should be included? Select all that apply. 1. Maintain a consistent sleep schedule. 2. Become an expert on mental health. 3. Create a daily medication schedule. 4. Set a time frame to achieve remission. 5. Develop an emergency plan.

ANS 1, 2, 3, 5 1. Strategies to help the individual with bipolar disorder take control of and manage his or her illness include managing lifestyle factors such as sleep time and exercise, becoming an expert on the disorder, taking medications regularly, and developing a plan for emergencies. Other strategies include identifying and reducing sources of stress and recognizing symptoms early. 2. Strategies to help the individual with bipolar disorder take control of and manage his or her illness include managing lifestyle factors such as sleep time and exercise, becoming an expert on the disorder, taking medications regularly, and developing a plan for emergencies. Other strategies include identifying and reducing sources of stress and recognizing symptoms early. 3. Strategies to help the individual with bipolar disorder take control of and manage his or her illness include managing lifestyle factors such as sleep time and exercise, becoming an expert on the disorder, taking medications regularly, and developing a plan for emergencies. Other strategies include identifying and reducing sources of stress and recognizing symptoms early. 5. Strategies to help the individual with bipolar disorder take control of and manage his or her illness include managing lifestyle factors such as sleep time and exercise, becoming an expert on the disorder, taking medications regularly, and developing a plan for emergencies. Other strategies include identifying and reducing sources of stress and recognizing symptoms early.

95. Mary is a 56-year-old female who is brought to the emergency department by the police because she was found wandering confusedly in a busy shopping center several miles from her home. The nurse assesses Mary and finds that she has been the victim of domestic violence for 32 years and has recently been beaten by her husband. Mary's recollection of current events is hazy and she is not able to give the nurse a detailed account of the abuse. Which of Mary's symptoms cause the nurse to suspect that Mary is suffering from dissociative fugue? Select all that apply. 1. Mary's travel to a shopping center several miles from her home 2. Mary's confused wandering 3. Mary's ability to stay with an abuser all these years 4. Mary's inability to offer details about the domestic abuse 5. Mary's inability to focus on the questioning

ANS 1, 2, 4 1. Dissociative fugue can cause the patient to travel suddenly and unexpectedly away from customary places. 2. Patients who exhibit dissociative fugue may engage in confused or bewildered wandering. 4. Patients with dissociative fugue are often unable to recall some or all of their past. These patients may not be able to recall personal identity and sometimes assume a new identity.

99. When planning care for women in abusive relationships, which of the following information is important for the nurse to understand? Select all that apply. 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by parental discord. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay in abusive relationships.

ANS 1, 2, 4 1. It often takes a woman several attempts to leave an abusive situation. Women in abusive relationships are often isolated from their families, feel unsupported, and have limited economic options. Substance abuse is a common factor in many abusive relationships. 2. Substance abuse is a common factor in many abusive relationships. It often takes a woman several attempts to leave an abusive situation. Women in abusive relationships are often isolated from their families, feel unsupported, and have limited economic options. 4. It often takes a woman several attempts to leave an abusive situation. Women in abusive relationships are often isolated from their families, feel unsupported, and have limited economic options. Substance abuse is a common factor in many abusive relationships.

71. Rebecca expresses to the nurse that she feels like she didn't do enough to prevent the loss of her father. Which of the following interventions should the nurse use to address Rebecca's feelings? 1. Encourage Rebecca to examine the guilt and validate the appropriateness of this feeling. 2. Review the circumstances of the loss and the reality that it could not be prevented. 3. Role-play the events and assist Rebecca with understanding the decisions leading to the loss. 4. Explain that this feeling is a pathological defense that will prevent her from progressing through the stages of grief.

ANS 2 If the client feels that he or she did not do enough to prevent the loss, the appropriate nursing intervention is to help the client by reviewing the circumstances of the loss and the reality that it could not be prevented. Feelings of guilt prolong resolution of the grief process.

87. Which of the following nursing statements exemplifies important insights to promote effective intervention with clients diagnosed with Substance Use Disorders? 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. "Drinking is legal, so the diagnosis of substance use disorder is an infringement on client rights." 4. "Opiate addicts are typically uneducated, unrefined individuals who will need a lot of education and social skills training." 5. "I can fix clients diagnosed with substance use disorders as long as I truly care about them."

ANS 1, 2, 4 1. The nurse must examine his or her feelings about working with clients diagnosed with Substance Use Disorders. The role alcohol or other substances have played (or play) in the life of the nurse will affect the way in which he or she interacts with a client who has a substance use disorder. 2. The nurse must examine his or her feelings about working with clients diagnosed with Substance Use Disorders. The role alcohol or other substances have played (or play) in the life of the nurse will affect the way in which he or she interacts with a client who has a substance use disorder. 4. The nurse must examine his or her feelings about working with clients diagnosed with Substance Use Disorders. Unless nurses fully understand and accept their own attitudes and feelings, they cannot be empathetic toward clients' problems. Nurses must be able to separate the client from the behavior and to accept that individual with unconditional positive regard.

100. Aisha has just experienced the unexpected death of her father. Which of the following criteria may the nurse use for measurement of outcomes in Aisha's grief care? Select all that apply. 1. Acknowledges awareness of the loss 2. Expresses feelings about the loss 3. Verbalizes positive aspects about her life at present and in the future 4. Expresses anger toward the loss appropriately 5. Expresses personal satisfaction and support from spiritual practices

ANS 1, 2, 5 1. Acknowledges awareness of the loss is a criterion used for measurement of outcomes in the care of the grieving client. 2. Expresses feelings about the loss is a criterion used for measurement of outcomes in the care of the grieving client. 5. Expresses personal satisfaction and support from spiritual practices is a criterion used for measurement of outcomes in the care of the grieving client.

96. Nina is an artist who dresses in long, colorful kaftans and wears sequin and rhinestone hats. Her makeup is dramatic and her long, false fingernails are always painted a bright color. Every time Nina attends a social event, she waltzes into the room and shouts "Hello people! I have arrived." Which behavior is congruent with Nina's diagnosis? Select all that apply. 1. Nina flirts with a man significantly younger who tells her that she doesn't look or act her age. 2. Nina responds with rage when a partygoer tells her that her dress is inappropriate for the event. 3. Nina becomes anxious when the hostess of a party excuses herself from speaking with Nina to greet other guests. 4. Nina feels awkward and uncomfortable in social situations due to her fear of rejection by others.

ANS 1, 3 1. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance from others. This often gives rise to seductive, flirtatious behavior in efforts to reassure themselves of their attractiveness and gain approval. 3. People with histrionic personality disorder often demonstrate, to an extreme, what our society tends to foster and admire in its members: to be well liked, successful, popular, extroverted, attractive, and sociable. However, beneath these surface characteristics is a driven quality—an all-consuming need for approval and a desperate striving to be conspicuous and evoke affection or attract attention at all costs. Failure to evoke the attention and approval they seek often results in feelings of dejection and anxiety.

86. Which of the following client statements indicate teaching about benzodiazepines has been successful? Select all that apply. 1. "I can't drink alcohol when taking lorazepam (Ativan)." 2. "If I abruptly stop taking buspirone (BuSpar), I may have a seizure." 3. "Valium can make me drowsy, so I shouldn't drive for a while." 4. "My new diet cannot include aged cheese or pickled herring." 5. "When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax)."

ANS 1, 3 1. The nurse recognizes teaching is successful when a client states correct information. Patient teaching is a cognitive approach that reflects the core concept, indicating cognitive theory relates to the mental process of thinking and reasoning. 3. The nurse recognizes teaching is successful when a client states correct information. Patient teaching is a cognitive approach that reflects the core concept, indicating cognitive theory relates to the mental process of thinking and reasoning.

93. George recently lost his wife and two small children in a house fire. George did not return to work after the trauma and thus lost his job. George also withdrew from family and friends. George's pastor reached out and encouraged George to seek psychiatric help, which he did. George is currently a patient at a psychiatric facility. The nurse assigned to George is evaluating the plan of care. Which statements made by George would require the nurse to reevaluate George's care plan? Select all that apply. 1. "I keep going over in my mind what I could have done to prevent the fire." 2. "I know I will see my family again someday. I can feel them watching over me." 3. "I've lost everything and don't wish to be around others, especially if they are happy." 4. "I would like to drink scotch all day until I pass out, so I don't have to feel anything."

ANS 1, 3, 4 1. Individuals who are experiencing complicated grieving often experience feelings of guilt at having survived a trauma in which others died. The nurse should reevaluate the care plan and develop interventions to help George discuss his feelings and recognize that he is not responsible for what happened. 3. George's grief is interfering with his interpersonal relationships because he wishes to isolate himself from others. The nurse should reevaluate the care plan and develop interventions that help George slowly reengage with his previous life and encourage activities of daily living. 4. George is considering the maladaptive coping strategy of substance abuse, which interferes with the recovery process. Consumption of large amounts of alcohol in the presence of feelings of hopelessness and depression can lead to high risk for suicide. The nurse should reevaluate the care plan to include interventions that promote the development of effective coping strategies and ensure patient safety.

9. Which phase of the nurse-client relationship begins when the nurse and client first meet and is characterized by an agreement to continue meeting and working on setting client-centered goals? 1. Preinteraction 2. Orientation 3. Working 4. Termination

ANS 2 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.

88. The nurse is administering risperidone (Risperdal) to a client diagnosed with Schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? Select all that apply. 1. Somatic delusions 2. Social isolation 3. Gustatory hallucinations 4. Flat affect 5. Clang associations

ANS 1, 3, 5 1. Atypical antipsychotics, such as risperidone (Risperdal), have been shown to be effective in the treatment and prevention of the positive symptoms and schizophrenia. Somatic delusions, gustatory hallucinations, and clang associations are some of the positive symptoms of schizophrenia. 3. Atypical antipsychotics, such as risperidone (Risperdal), have been shown to be effective in the treatment and prevention of the positive symptoms and schizophrenia. Somatic delusions, gustatory hallucinations, and clang associations are some of the positive symptoms of schizophrenia. 5. Atypical antipsychotics, such as risperidone (Risperdal), have been shown to be effective in the treatment and prevention of the positive symptoms and schizophrenia. Somatic delusions, gustatory hallucinations, and clang associations are some of the positive symptoms of schizophrenia.

81. The nurse recognizes which statements regarding defense mechanisms are true? Select all that apply. 1. They are employed when there is a threat to biological or psychological integrity. 2. They are controlled by the id and deal with primal urges. 3. They are used to relieve mild to moderate anxiety. 4. They are protective devices for the superego. 5. They are mechanisms that are characteristically self-deceptive.

ANS 1, 3, 5 1. Defense mechanisms are employed by the ego in the face of threats to biological and psychological integrity to relieve mild to moderate anxiety. Because they redirect focus, they are characteristically self-deceptive. 3. Defense mechanisms are employed by the ego in the face of threats to biological and psychological integrity to relieve mild to moderate anxiety. Because they redirect focus, they are characteristically self-deceptive. 5. Defense mechanisms are employed by the ego in the face of threats to biological and psychological integrity to relieve mild to moderate anxiety. Because they redirect focus, they are characteristically self-deceptive.

94. Which of the following somatic symptom and dissociative disorders are identified with known effective pharmacological treatments for that disorder? Select all that apply. 1. Antidepressants have been used effectively in treating pain associated with somatic symptom disorder. 2. Lithium has been effective in treating illness anxiety disorder. 3. Muscle relaxants have been effective in resolving conversion disorder symptoms. 4. The antidepressant clomipramine (Anafranil) has shown promise in treating depersonalization-derealization disorder.

ANS 1, 4 1. Based on studies of somatization disorder, medication treatment is not effective unless it used to treat underlying depression or anxiety (Sadock, 2015; Yates, 2014). When antidepressant therapy is warranted, selective serotonin reuptake inhibitors (SSRIs) are generally preferred. Anxiety may be treated in the short term with antianxiety agents such as benzodiazepines, but long-term use should be avoided because of the potential for addiction. 4. Based on studies of somatization disorder, medication treatment is not effective unless it used to treat underlying depression or anxiety (Sadock, 2015; Yates, 2014). When antidepressant therapy is warranted, SSRIs are generally preferred. Anxiety may be treated in the short term with antianxiety agents such as benzodiazepines, but long-term use should be avoided because of the potential for addiction.

92. A college student has been diagnosed with GAD. Which of the following symptoms should a campus nurse expect this client to exhibit? Select all that apply. 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

ANS 1, 4, 5 1. A client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry. 4. A client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry. 5. A client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.

38. A nursing student is observing an ECT procedure. The student notices a blood pressure cuff on the client's lower leg. The student questions the instructor about the cuff placement. Which is the most accurate instructor reply? 1. "The cuff has to be placed on the leg because both arms are used for IV fluids." 2. "The cuff functions to prevent succinylcholine from reaching the foot." 3. "The cuff position gives a more accurate blood pressure reading during the treatment." 4. "The cuff is placed on the leg so that arms can easily be restrained during seizure."

ANS 2 A blood pressure cuff is placed on the lower leg and inflated above systolic pressure before injection of succinylcholine. This is to ensure that seizure activity can be observed and timed in the one limb that is unaffected by the paralytic agent.

67. The nurse has taken report for the evening shift on an adolescent inpatient unit. Which client should the nurse address first? 1. A client diagnosed with Oppositional Defiant Disorder being sexually inappropriate with staff 2. A client diagnosed with Conduct Disorder who is verbally abusing a peer in the milieu 3. A client diagnosed with Conduct Disorder who is demanding special attention from staff 4. A client diagnosed with ADHD who has a history of self-mutilation

ANS 2 A client diagnosed with Conduct Disorder who is verbally abusing a peer in the milieu creates risk for injury to others.

31. A stockbroker commits suicide after being convicted of insider trading. While speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? 1. "Your grieving will subside within 1 year; until then, I recommend antidepressants." 2. "Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area." 3. "The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them." 4. "Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

ANS 2 Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work.

75. A client who has been referred for stress management asks the nurse, "Which one of these relaxation techniques might be eligible for reimbursement by my health insurance?" Which is the appropriate nursing reply? 1. "Meditation may be eligible for reimbursement." 2. "Biofeedback may be eligible for reimbursement." 3. "Physical exercise may be eligible for reimbursement." 4. "Deep breathing may be eligible for reimbursement."

ANS 2 Biofeedback may be eligible for reimbursement by the client's health insurance, as it involves the use of a biofeedback machine that provides physiological data requiring interpretation by a health-care professional.

48. A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates learning has occurred? 1. "This disorder is more prevalent in lower socioeconomic groups." 2. "This disorder is more prevalent in higher socioeconomic groups." 3. "This disorder is equally prevalent in all socioeconomic groups." 4. "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups."

ANS 2 Bipolar disorder is more prevalent in higher socioeconomic groups.

62. A nursing instructor is teaching students about clients diagnosed with Histrionic Personality Disorder and the quality of their relationships. Which student statement indicates that learning has occurred? 1. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." 2. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." 3. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." 4. "They pay particular attention to details, which can frustrate the development of relationships."

ANS 2 Clients diagnosed with Histrionic Personality Disorder have shallow, fleeting interpersonal relationships that serve their dependency needs. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior. These individuals also have difficulty maintaining long-lasting relationships.

42. 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? 1. Present evidence that supports the reality of the situation. 2. Focus on feelings suggested by the delusion. 3. Address the delusion with logical explanations. 4. Explore reasons why the client has the delusion.

ANS 2 Delusions are false personal beliefs inconsistent with the person's intelligence or cultural background. The individual continues to have the belief despite obvious proof that it is false or irrational. The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking using evidence or logical explanations.

32. A nursing instructor is teaching about suicide in the elderly population. Which information does the instructor include? 1. Elderly people use less lethal means to commit suicide. 2. Although the elderly make up less than 13 percent of the population, they account for 15 percent of all suicides. 3. Suicide is the second-leading cause of death among the elderly. 4. It is normal for elderly individuals to express a desire to die because they have come to terms with their mortality.

ANS 2 Expressing a desire to die is not normal for any age group. Although the elderly comprise just over 13 percent of the population, they account for almost 15 percent of all suicides.

70. A community health nurse is teaching a class to expectant parents. All participants lack infant care knowledge. A student nurse asks, "If you had to assign a nursing diagnosis to this group, what would it be?" What is the best nursing reply? 1. "I would assign the nursing diagnosis of cognitive deficit." 2. "I would assign the nursing diagnosis of knowledge deficit." 3. "I would assign the nursing diagnosis of altered family processes." 4. "I would assign the nursing diagnosis of risk for caregiver role strain."

ANS 2 Knowledge deficit is defined as the absence or deficiency of cognitive information related to a specific topic.

43. The nurse is obtaining the mental health history of a newly admitted client diagnosed with Schizophrenia. The client's family reports the client is hearing voices and cannot stay focused on the topic of a discussion. Which thought disturbance is the client demonstrating? 1. Delusions of reference 2. Tangentiality 3. Neologism 4. Loose associations

ANS 2 Tangentiality refers to a veering away from the topic of discussion and demonstrates difficulty in maintaining focus and attention.

65. A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of intellectual disability? 1. Risk for injury R/T self-mutilation 2. Altered social interaction R/T nonadherence to social convention 3. Altered verbal communication R/T delusional thinking 4. Social isolation R/T severely decreased gross motor skills

ANS 2 The appropriate nursing diagnosis is altered social interaction R/T nonadherence to social convention. Moderate intellectual disability is associated with an IQ of 47. The client would demonstrate limitations in speech communications and may have difficulty adhering to social conventions that would interfere with peer relationships.

12. A student nurse tells the instructor, "I'm concerned that when a client asks me for advice, I won't have a good solution." Which should be the nursing instructor's best response? 1. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." 2. "Remember, clients, not nurses, are responsible for their own choices and decisions." 3. "Just keep the client's best interests in mind and do the best that you can." 4. "Set a goal to continue to work on this aspect of your practice."

ANS 2 The instructor's statement "Remember, clients, not nurses, are responsible for their own choices and decisions" provides the best rationale for advising students not to use advice giving. Advice giving is a nontherapeutic communication technique in which the nurse tells the client what to do or how to behave, and it implies the nurse knows what is best and that the client is incapable of any self-direction.

46. A newly admitted client diagnosed with MDD states, "I have never considered suicide." Later, the client confides to the nurse about plans to end it all by medication overdose. Which is the most helpful nursing reply? 1. "There is nothing to worry about. We will handle it together." 2. "Bringing this up is a very positive action on your part." 3. "We need to talk about the things you have to live for." 4. "I think you should consider all of your options prior to taking this action."

ANS 2 The most helpful reply is to convey an attitude of unconditional acceptance of the client by acknowledging sharing of a suicide plan was a positive action. The nurse will also encourage the client to participate actively in establishing a safety plan.

7. Which situation exemplifies both assault and battery? 1. The nurse becomes angry, calls the client offensive names, and withholds treatment. 2. The nurse threatens to "tie down" the client and then does so against the client's wishes. 3. The nurse hides the client's clothes and medicates the client to prevent elopement. 4. The nurse restrains the client without just cause and communicates this to family.

ANS 2 The nurse has committed the acts of both assault and battery. Assault refers to an action that results in fear and apprehension that the person will be touched without consent. Battery is the touching of another person without consent.

8. A hungry, homeless client, diagnosed with Schizophrenia, refuses to participate in an admission interview. The nurse postpones the admission interview, verbally assures safety, and provides the client a warm meal. Which of the following does the nurse's action demonstrate? 1. Sympathy 2. Trust 3. Veracity 4. Manipulation

ANS 2 The nurse is promoting trust, which 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.

52. As clients are leaving the dayroom following a group therapy session, the nurse notices a client admitted for acute mania is clenching and unclenching both fists, swearing, and glaring at a staff member. Which action should the nurse take first? 1. Calmly ask the client to go to the "quiet room." 2. Instruct clients to return to the dayroom. 3. Prepare to administer a sedative medication. 4. Ask a staff member to call hospital security.

ANS 2 The nurse should intervene at the first sign of increased anxiety, agitation, or verbal or behavioral aggression and should remove others from the environment to ensure client and others' safety.

55. A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member asks, "Should I seek psychiatric help for my mother?" Which is the nurse's most appropriate reply? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

ANS 2 The nurse's most appropriate reply is to explain that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

13. Which statement reflects the therapeutic communication technique the nurse should use when communicating with a client who is experiencing auditory hallucinations? 1. "My sister has the same diagnosis as you and she also hears voices." 2. "I understand that the voices seem real to you, but I do not hear any voices." 3. "Why not turn up the radio so that the voices are muted." 4. "I wouldn't worry about these voices. The medication will make them disappear."

ANS 2 The nurse's statement "I understand that the voices seem real to you, but I do not hear any voices" is an example of presenting reality, which should be used when the client has a misperception of the environment. Presenting reality is when the nurse defines or indicates the nurse's perception of the situation for the client.

15. Which is the nurse's purpose when gathering client information? 1. It enables the nurse to modify client behaviors related to personality disorders. 2. It enables the nurse to make sound clinical judgments and plan appropriate client 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 The purpose of gathering client information is to enable the nurse to make sound clinical nursing 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.

25. A teenager gets a C in algebra. The mother angrily states, "All you ever do is listen to music and text your friends." The teenager replies, "What is it that you're really upset about, mom?" Which response pattern is the teenager expressing? 1. Clouding and fogging 2. Shifting from content to process 3. Delaying assertively 4. Assuming responsibility for one's own statements

ANS 2 The teenager's response reflects the use of shifting from content to process, which involves changing the focus of the communication from discussing the topic at hand to analyzing what is going on in the interaction.

2. For which would the nurse be required to employ Maslow's Hierarchy of Needs to determine if immediate intervention due to an unfulfilled lower level is needed? 1. A client rudely complaining about limited visiting hours 2. A client exhibiting aggressive behavior toward another client 3. A client stating expressing feelings of sadness and loneliness 4. A client verbalizing feelings of failure and hopelessness

ANS 2 This is correct. The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Maslow's Hierarchy of Needs indicates safety and security are lower-level needs, which must be fulfilled before higher-level needs can be met. This client demonstrates the lower-level need for safety and security.

16. A client is assigned the nursing diagnosis of impaired social interaction R/T sociocultural differences AEB client stating, "Although I'd like to, I don't join in because I don't speak the language so good." Which correctly written outcome addresses this client's problem? 1. The client will collaborate with nursing staff to set specific goals by day 3. 2. The client will participate in one group activity of choice by day 2. 3. The client will express a desire to interact with others. 4. The client will become increasingly independent by discharge.

ANS 2 This outcome is directly related to the client's situation. In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client's need or to the situation.

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

ANS 2 Elevated dopamine levels may be a contributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.

5. A client was recently admitted to the inpatient unit after a suicide attempt. He has been placed on a tricyclic antidepressant. Which action should the nurse implement to maintain the client's safety when he is discharged? 1. Provide a 6-month supply to ensure long-term compliance. 2. Provide a 1-week supply of medication with refills authorized only after he visits his provider. 3. Encourage him to increase fluid intake to counteract the common side effect of diarrhea. 4. Educate him not to eat foods that contain tyramine.

ANS 2 Suicide risk often increases as antidepressant medication takes effect and the client's level of depression and mood improve. The client may then have increased energy with which to implement a suicide plan.

27. An adult client assaults another client and is placed in restraints. Which client statement alerts the nurse that further assessment is necessary? 1. "I hate all of you!" 2. "My fingers are tingly." 3. "You wait until I tell my lawyer." 4. "I have a sinus headache."

ANS 2 The client statement "My fingers are tingly" indicates that the restraints are too tight and impeding circulation.

90. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should the nurse identify as most likely to contribute to the etiology of these symptoms? Select all that apply. 1. Gender differences in social opportunities that occur with age 2. Drastic temperature and barometric pressure changes 3. Increased levels of melatonin 4. Variations in serotonergic functioning 5. Inaccessibility of resources for dealing with life stressors

ANS 2, 3, 4 2. Drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning are contributing to the etiology of the client's symptoms. Several studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November). 3. Drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning are contributing to the etiology of the client's symptoms. Several studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November). 4. Drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning are contributing to the etiology of the client's symptoms. Several studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November).

20. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? 1. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. 2. The grandparental subsystem is not successfully managing separation from the parental subsystem. 3. Extended family living arrangements are common in some cultures. 4. The nuclear family living arrangement is the preferred environment for childrearing.

ANS 3 In some U.S. subcultures, it is not uncommon to find several generations living together. Members of the Asian culture value older family members for their experience and wisdom.

49. A client is diagnosed with Bipolar Disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client? 1. The client will accomplish activities of daily living independently by discharge. 2. The client will verbalize feelings during group sessions by discharge. 3. The client will remain safe throughout hospitalization. 4. The client will use problem-solving to cope adequately after discharge.

ANS 3 A client diagnosed with Bipolar Disorder is at risk for injury in either pole of this disorder. In the manic phase, the client is hyperactive and can inadvertently injure self or others. In the depressive phase, the client is at risk for self-harm.

59. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should the nurse associate with the development of this disorder? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment.

ANS 3 A home environment that is overprotective and demands perfection may be an influence in the development of anorexia nervosa.

18. 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. Psychodrama group 2. Psychotherapy group 3. Parenting group 4. Family therapy group

ANS 3 A psychiatric registered nurse is qualified to lead a parenting group, which would be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy groups must be facilitated by qualified leaders who have advanced degrees in psychology, social work, nursing, or medicine.

53. Which treatment should the nurse identify as most appropriate for clients diagnosed with GAD? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

ANS 3 Buspirone (BuSpar) is an anxiolytic medication that is the drug of choice for treatment of GAD. Buspirone is effective in 60 to 80 percent of clients with GAD and takes 10 to 14 days for alleviation of symptoms; it does not have the physical dependency or tolerance effects of other anxiolytics.

61. The 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? 1. The client will use stress-reducing techniques to avoid purging. 2. The client will discuss chaos in personal life and be able to verbalize a link to purging. 3. The client will gain 2 pounds prior to the next weekly appointment. 4. The client will remain free of signs and symptoms of malnutrition and dehydration.

ANS 3 Clients diagnosed with Anorexia Nervosa demonstrate excessive weight loss. The priority, short-term outcome for this client is related to the nursing diagnosis imbalanced nutrition: less than body requirements. Correctly written outcomes must be client centered, specific, realistic, and measurable, and include a time frame.

24. A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness? 1. Disturbed personal identity 2. Disturbed thought processes 3. Defensive coping 4. Impaired verbal communication

ANS 3 Defensive coping reflects a self-protective pattern that defends against underlying perceived threats to positive self-regard. Clients who are utilizing defensive coping lack assertiveness skills.

35. A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? 1. "My baby is refusing to nurse, and I know it's because she hates me." 2. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me." 3. "My baby is wonderful, but I'm depressed because I wanted twins." 4. "My baby has an elevated bilirubin, and I know it will get worse and she will die."

ANS 3 In selective abstraction, the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred.

60. 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? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive an ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.

ANS 3 The appropriate outcome for this client is to perceive an ideal body weight and shape as normal. The distorted body image is manifested by the individual's perception of being "fat" when he or she is obviously underweight or even emaciated. Additional goals include self-acceptance based on the individual's attributes rather than appearance and to realize perfection is unrealistic.

41. A client diagnosed with Schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." Which symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? 1. Magical thinking; administer an antipsychotic medication. 2. Persecutory delusions; orient the client to reality. 3. Command hallucinations; warn the psychiatrist. 4. Altered thought processes; call an emergency treatment team meeting.

ANS 3 The client exhibiting command hallucinations could potentially become physically, emotionally, and/or sexually harmful to others or to self, indicating a risk for self-directed or other-directed violence. The nurse has a legal duty to warn the psychiatrist of the potential for harm.

40. A client with a history of insomnia has been taking chlordiazepoxide (Librium), 15 mg, at night for the past year. The client currently reports this dose is no longer helping him fall asleep. Which nursing diagnosis appropriately documents this problem? 1. Ineffective coping R/T unresolved anxiety AEB substance abuse 2. Anxiety R/T poor sleep AEB difficulty falling asleep 3. Disturbed sleep pattern R/T chlordiazepoxide (Librium) tolerance AEB difficulty falling asleep 4. Risk for injury R/T addiction to chlordiazepoxide (Librium)

ANS 3 The client has developed tolerance to chlordiazepoxide (Librium). Tolerance is defined as the need for increasingly larger or more frequent doses of a substance to obtain the desired effects originally produced by a lower dose.

66. Which should be the priority nursing intervention when caring for a child diagnosed with Conduct Disorder? 1. Modify the environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behaviors and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors.

ANS 3 The client's behaviors create risk of other-directed violence. The nurse's priority is safety

26. The dean of nursing criticizes a faculty member about views on academic freedom. The faculty member states, "Are you upset because I believe in academic freedom or because you don't?" Which technique is the faculty member using to promote assertive behavior? 1. Standing up for one's basic human rights 2. Delaying assertively 3. Inquiring assertively 4. Responding assertively with irony

ANS 3 The faculty member is using the technique of inquiring assertively, which involves seeking additional information about critical statements

57. Carly has been diagnosed with Somatic Symptom Disorder. As the nurse is talking with Carly and her family, which of the following statements suggest primary or secondary gains that the physical symptoms are providing for the client? 1. The family agrees that Carly began having physical symptoms after she lost her job. 2. Carly states that even though medical tests have not found anything wrong, she is convinced her headaches are indicative of a brain tumor. 3. Carly's mother reports that someone from the family stays with Carly each night because the physical symptoms are incapacitating. 4. Carly states she noticed feeling hotter than usual the last time she had a headache.

ANS 3 The mother's report that someone from the family stays with Carly each night because the physical symptoms are incapacitating indicates that Carly may be receiving primary and/or secondary gains that reinforce illness behavior and enable her to avoid stressful situations or postpone unwelcome challenges.

36. A client diagnosed with Borderline Personality Disorder states, "Get out of here. No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention? 1. "You have an antianxiety medication ordered. It may make you feel better." 2. "It sounds like you are feeling really frustrated." 3. "Can you explain further your thinking about your situation?" 4. "No one cares about you?"

ANS 3 The nurse is using a cognitive approach to assessment by asking for an explanation about the client's thinking. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors.

45. Which client information does the nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? 1. The client's understanding of the need for regular bloodwork 2. The client's mood and affect score, according to the facility's mood scale 3. The client's cognitive ability to understand information about the medication 4. The client's access to a support network willing to participate in treatment

ANS 3 The nurse must assess the client's cognitive ability to understand information about the medication. Phenelzine (Nardil) is an MAOI. To avoid a hypertensive emergency, clients taking MAOIs should not ingest foods high in tyramine, take certain medications, or use alcohol.

29. A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, is much more communicative, and rates mood at 9/10. Which action should be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase frequency of client observation. 4. Request that the psychiatrist reevaluate the current medication protocol.

ANS 3 The nurse should monitor the client more frequently or implement one-to-one observation. A sudden increase in mood rating and change in affect may indicate the client is at serious risk for suicide. Serious suicide risk may occur early during treatment with antidepressants.

22. 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? 1. Dream analysis 2. Creative cooking 3. Paint by number 4. Stress management

ANS 4 The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a client's learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance.

50. A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client? 1. Ineffective individual coping R/T hospitalization AEB alcohol abuse 2. Altered nutrition: less than body requirements R/T mania AEB 10-pound weight loss 3. Risk for violence: directed toward others R/T agitation and hyperactivity 4. Sleep pattern disturbance R/T flight of ideas AEB sleeps 1 to 2 hours per night

ANS 3 The priority nursing diagnosis is risk for violence: self-directed or other-directed. Clients experiencing mania demonstrate excessive psychomotor activity, low frustration tolerance, and impulsivity, which can lead to aggressive behavior. Hallucinations and delusions are common in acute mania.

14. A client tells the nurse, "I have nothing left to enjoy in life. My children are grown and married." The nurse replies, "I'm sure you are looking forward to having grandchildren." Which communication technique is the nurse using? 1. Giving advice 2. Reflecting 3. Using denial 4. Verbalizing the implied

ANS 3 This is correct. The nurse is using the nontherapeutic communication technique of denial. Denying that a problem exists blocks discussion with the client and avoids helping the client identify and explore areas of difficulty.

3. Which part of the nervous system should the 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

ANS 3 This is correct. The sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressed state.

6. Which situation contradicts the ethical principle of veracity? 1. A nurse provides a client with outpatient resources to benefit recovery. 2. A nurse refuses to give information to a physician who is not responsible for a client's care. 3. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. 4. A nurse treats all clients equally, regardless of the acuity of their illness.

ANS 3 Tricking a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.

10. When interviewing a client, which nonverbal behavior should a nurse employ? 1. Maintaining indirect eye contact with the client 2. Providing space by leaning back away from the client 3. Sitting squarely, facing the client 4. Maintaining open posture with arms and legs crossed

ANS 3 When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

84. Which of the following are characteristics of accurately developed client outcomes? Select all that apply. 1. Client outcomes are formulated by each nurse independent of other team members. 2. Client outcomes are not restricted by time frames. 3. Client outcomes are specific and measurable. 4. Client outcomes are realistically based on client capability. 5. Client outcomes are formally approved by the psychiatrist.

ANS 3, 4 3. Client outcomes should be specific, measurable, and realistically based on client capability. 4. Client outcomes should be specific, measurable, and realistically based on client capability.

83. The psychiatric nurse is obtaining informed consent for a client who is scheduled for ECT the following morning. Which major elements must be addressed when obtaining informed consent? Select all that apply. 1. Client signature and date 2. Physician order 3. Lack of coercion 4. Unimpaired cognition 5. Necessity for treatment 6. Client knowledge of the procedure

ANS 3, 4, 6 3. Informed consent requires the client to give consent voluntarily and without coercion from others. The three major elements that must be addressed when obtaining informed consent are knowledge, competency, and free will. 4. The client's cognition must not be impaired to an extent that would interfere with decision-making. The three major elements that must be addressed when obtaining informed consent are knowledge, competency, and free will. 6. The client must have received adequate information on which to base his or her decision. The three major elements that must be addressed when obtaining informed consent are knowledge, competency, and free will.

30. The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision? 1. No previous admissions for major depressive disorder 2. Vital signs stable; no psychosis noted 3. Able to comply with medication regimen; able to problem-solve life issues 4. Able to participate in a plan for safety; family agrees to constant observation

ANS 4 A detailed safety plan should be developed that is an outgrowth of a comprehensive risk assessment and a collaborative, problem-solving discussion with the client. Family observation will also decrease the risk for self-harm.

73. The nurse understands that when a practitioner corrects subluxation by manipulating the vertebrae of the spinal column, the practitioner is employing which therapy? 1. Allopathic therapy 2. Therapeutic touch therapy 3. Massage therapy 4. Chiropractic therapy

ANS 4 Chiropractic therapy involves the correction of subluxations by manipulating the vertebrae of the spinal column. The theory behind chiropractic medicine is that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves.

28. During the planning of care for a suicidal client, which correctly written outcome should be the nurse's priority? 1. The client will not physically harm self. 2. The client will express hope for the future by day 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during the hospital stay.

ANS 4 Client safety is always the nurse's priority. The outcome "the client will not physically harm self" is incorrect. Correctly written outcomes must be client focused, measurable, and realistic and contain a time frame.

64. A client exhibits dependency on staff and peers and expresses fear of abandonment. Using Mahler's theory of object relations, which should the nurse expect to note in this client's childhood? 1. Lack of fulfillment of basic needs by parental figures 2. Absence of the client's maternal figure during symbiosis 3. Difficulty establishing trust with the maternal figure 4. Inconsistency by the maternal figure during individuation

ANS 4 During phase three (5 to 36 months) of Margaret Mahler's individuation theory, there should be a strengthening of the ego and an acceptance of "self" with independent ego boundaries. Inconsistency by the maternal figure during individuation may in later years result in feelings of helplessness when the client is alone because of exaggerated fears of being unable to care for self.

39. Which term should the nurse use to describe the administration of a CNS depressant during alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy

ANS 4 Substitution therapy may be required to reduce the life-threatening effects of intoxication or withdrawal from some substances. Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol withdrawal.

54. A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive work-up in an emergency department reveals no pathology. Which medical diagnosis is suspected, and which nursing diagnosis is the priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Altered sensory perception and a nursing diagnosis of panic disorder 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of panic anxiety

ANS 4 The client exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis is panic anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.

76. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau's interpersonal theory, which stage of development should the nurse identify the client needs to improve? 1. Learning to count on others 2. Learning to delay satisfaction 3. Identifying oneself 4. Developing skills in participation

ANS 4 The client needs to improve in the developing skills in participation stage of Peplau's interpersonal theory. During this stage, the child develops the capacity to compromise, compete, and cooperate with others.

74. The nurse is caring for a client who suffered a stress-related myocardial infarction. Which client statement indicates that the client is ready to learn about the relationship of stress to physical illness? 1. "I just need to take my blood pressure medication religiously." 2. "The first thing I will do will be to cut down on my smoking." 3. "My father had six heart attacks and survived them all. I plan to do the same." 4. "I eat well and exercise. What else do you think could have led to my heart attack?"

ANS 4 The client's statement indicates an understanding that diet and exercise influence health. Asking about causative factors reflects the client's readiness to learn how to prevent further illness and complications.

63. Which client situation statement should the nurse identify as reflective of the impulsive behavior that is commonly associated with BPD? 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 The client's statement reflects self-mutilating behavior commonly associated with the diagnosis of borderline personality disorder. Other types of destructive behaviors include scratching and burning. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others.

23. After vying for a nurse management position, nurse A is chosen over nurse B. When nurse manager A calls for staff meetings, nurse B is chronically late or absent. Nurse B is exhibiting which type of behavior? 1. Passive 2. Assertive 3. Aggressive 4. Passive-aggressive

ANS 4 The colleague is expressing anger indirectly by being late or absent from the meetings. Individuals using passive-aggressive behavior respond to others by appearing passive and accepting of other's demands while behaving in ways that suggest anger and resentment are their true feelings.

58. A client is diagnosed with DID. What is the primary goal of therapy for this client? 1. To recover memories and improve thinking patterns 2. To prevent social isolation 3. To decrease anxiety and need for secondary gain 4. To collaborate among subpersonalities to improve functioning

ANS 4 The goal of therapy for the client with DID is to optimize the client's function and potential. The achievement of integration (a blending of all the personalities into one) is usually considered desirable, but some clients choose not to pursue this lengthy therapeutic regimen. In these cases, resolution, or a smooth collaboration among the subpersonalities, may be all that is realistic.

21. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? 1. The mother is withholding supportive messages. 2. The mother is expressing denigrating remarks. 3. The mother is communicating indirectly. 4. The mother is using double-bind communication.

ANS 4 The mother's statement is an example of sending a mixed message through double-bind communication. Double-bind communication occurs when a statement is made and is then succeeded by a contradictory statement.

47. A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

ANS 4 The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting signs of irritation accompanied by aggressive behavior. Grandiosity refers to an exaggerated sense of power, importance, knowledge, or identity.

11. A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? 1. "It's quite common for clients to feel that way after a lengthy hospitalization." 2. "Why don't you talk to your mother? You may find out she doesn't feel that way." 3. "Your mother seems like an understanding person. I'll help you approach her." 4. "You feel that your mother does not want you to come back home?"

ANS 4 The nurse's question "You feel that your mother does not want you to come back home?" is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea the client has verbalized and lets the client know whether the statement has been understood and gives him or her the chance to continue or clarify if necessary.

78. An 18-year-old client is admitted to an emergency department, reporting that she has just been raped. On physical assessment, the nurse notices no trauma to the genital region. Which information should influence the forensic nurse's evaluation of this assessment data? 1. Between 60 and 80 percent of confirmed rapes show genital trauma. 2. Inconsistency of verbalized reports and collected evidence suggests deception. 3. Lack of genital trauma indicates consensual sex. 4. Between 40 and 60 percent of sexual assaults leave no visible injuries.

ANS 4 There may be no visible injuries in 40 to 60 percent of sexual assaults.

89. Laboratory results reveal elevated levels of prolactin in a client diagnosed with Schizophrenia. When assessing the client, which symptoms should the nurse expect to observe? Select all that apply. 1. Apathy 2. Social withdrawal 3. Anhedonia 4. Galactorrhea 5. Gynecomastia

ANS 4, 5 4. Galactorrhea and gynecomastia are symptoms of prolactin elevation. Antipsychotic medications used to treat schizophrenia cause elevated prolactin levels by blocking dopamine. 5. Galactorrhea and gynecomastia are symptoms of prolactin elevation. Antipsychotic medications used to treat schizophrenia cause elevated prolactin levels by blocking dopamine.