Mental Health Test #3 Practice Questions

Which of the following assessment findings is seen in a client diagnosed with borderline personality disorder? 1. Abrasions in various healing stages 2. Intermittent episodes of hypertension 3. Alternating tachycardia and bradycardia 4. Mild state of euphoria with disorientation

1. Abrasions in various healing stages. Clients with borderline personality disorder tend to self-mutilate and have abrasions in various stages of healing.

Which of the following information must be included for the family of a client diagnosed with dependent personality disorder? 1. Address coping skills 2. Explore panic attacks 3. Promote exercise programs 4. Decrease aggressive outbursts

1. Address coping skills. The family needs information about coping skills to help the client learn to handle stress. Option 2: They don't tend to have panic attacks. Option3: Exercise is a health promotion activity for all clients. Clients with a dependent personality disorder wouldn't need exercise promoted more than other people. Option 4: Clients with a dependent personality disorder don't have aggressive outbursts; they tend to be passive and submit to others.

In planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? 1. Binge eating 2. Memory loss 3. Cult membership 4. Delusional thinking

1. Binge eating. Clients with borderline personality disorder are likely to develop dysfunctional coping and act out in self-destructive ways such as binge eating.

A client with borderline personality disorder is admitted to the unit after slashing his wrist. Which of the following goals is most important after promoting safety? 1. Establish a therapeutic relationship with the client 2. Identify whether splitting is present in the client's thoughts 3. Talk about the client's acting out and self-destructive tendencies. 4. Encourage the client to understand why he blames others

1. Establish a therapeutic relationship with the client. After promoting safety, the nurse establishes a rapport with the client to facilitate appropriate expression of feelings. At this time, the client isn't ready to address the unhealthy behavior. A therapeutic relationship must be established before the nurse can effectively work with the client on self-destructive tendencies and the issues of splitting.

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be: 1. Fluvoxamine (Luvox) 2. Benztropine (Cogentin) 3. Amantadine (Symmetrel) 4. Diphenhydramine (Benadryl)

1. Fluvoxamine (Luvox). This drug blocks the uptake of serotonin.

3. A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? *Select all that apply.* 1. Impulsiveness 2. Lability of mood 3. Ritualistic behavior 4. psychomotor retardation 5. Self-destructive behavior

1. Impulsiveness 2. Lability of mood 5. Self-destructive behavior

The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be: 1. Ineffective coping 2. Impaired adjustment 3. Personal identity disturbance 4. Sensory/perceptual alterations

1. Ineffective coping. Ineffective coping is the impairment of a person's adaptive behaviors and problem-solving abilities in meeting life's demands; ritualistic behavior fits under this category as a defining characteristic.

A nurse notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers? 1. Lack of honesty 2. Belief in superstitions 3. Show of temper tantrums 4. Constant need for attention

1. Lack of honesty. Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by lying.

Which of the following nursing interventions has priority for a client with borderline personality disorder? 1. Maintain consistent and realistic limits 2. Give instructions for meeting basic self-care needs 3. Engage in daytime activities to stimulate wakefulness 4. Have the client attend group therapy on a daily basis

1. Maintain consistent and realistic limits. Clients with borderline who are needy, dependent, and manipulative will benefit greatly from maintaining consistent and realistic limits. Option 2: They don't tend to have difficulty meeting their self-care needs. Option 3: They don't tend to have sleeping difficulties. Option 4: They enjoy attending group therapy because they often attempt to use the opportunity to become the center of attention.

Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? 1. Over self-centered and exploitative of others. 2. Suspicious and mistrustful of others. 3. Rule conscious and disapproving of change. 4. Anxious and socially isolated.

1. Over self-centered and exploitative of others.

The nurse has experience caring for patients with personality disorders who often rely on immature or primitive defenses or behaviors. Which of the following would the nurse recognize as immature or primitive defenses or behaviors that individuals frequently use with diagnosed personality disorders? (Select all that apply) 1. Splitting 2. Dissociation 3. Lying 4. Altruism 5. Sublimation

1. Splitting 2. Dissociation 3. Lying

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." The nurse understands this defense is known as: 1. Splitting 2. Ambivalence 3. Passive aggression 4. Reaction formation

1. Splitting. Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others.

A client with avoidant personality disorder says occupational therapy is boring and doesn't want to go. Which action would be best? 1. State firmly that you'll escort him to OT. 2. Arrange with OT for the client to do a project on the unit. 3. Ask the client to talk about why OT is boring 4. Arrange for the client not to attend OT until he is feeling better

1. State firmly that you'll escort him to OT. If given the chance, a client with avoidant personality disorder typically elects to remain immobilized. The nurse should insist that the client participates in OT. Options 2 and 4: Arranging for the client to do a project on the unit validates and reinforces the client's desire to avoid getting to OT. Option 3: Addressing an invalid issue such as the client's perceived boredom avoids the real issue: the client's need for therapy.

When assessing a client diagnosed with impulse control disorder, the nurse observes violent, aggressive, and assaultive behavior. Which of the following assessment data is the nurse also likely to find? Select all that apply. 1. The client functions well in other areas of his life. 2. The degree of aggressiveness is out of proportion to the stressor. 3. The violent behavior is most often justified by the stressor. 4. The client has a history of parental alcoholism and chaotic, abusive family life. 5. The client has no remorse about the inability to control his anger.

1. The client functions well in other areas of his life. 2. The degree of aggressiveness is out of proportion to the stressor. 4. The client has a history of parental alcoholism and chaotic, abusive family life. A client with an impulse control disorder who displays violent, aggressive, and assaultive behavior generally functions well in other areas of his life. Option 3: The degree of aggressiveness is typically out of proportion with the stressor. Option 5: Such a client commonly has a history of parental alcoholism and a chaotic family life, and often verbalizes sincere remorse and guilt for the aggressive behavior.

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? 1. "I won't get involved in another relationship." 2. "I'm determined to look for the perfect partner." 3. "I've decided to use better communication skills." 4. "I'm going to be an equal partner in a relationship."

2. "I'm determined to look for the perfect partner." Clients with borderline personality disorder would decide to look for a perfect partner. This characteristic is a result of the dichotomous manner in which these clients view the world. They go from relationship to relationship without taking responsibility for their behavior. Option 1: It's unlikely that an unsuccessful relationship will cause clients to make a change. They tend to be demanding and impulsive in relationships. Option 3: There's no thought given to what one wants or needs from a relationship. Because they tend to blame others for problems, it's unlikely they would express a desire to learn communication skills. Option 4: Because they tend to blame others for problems, it's unlikely they would express a desire to learn communication skills.

A person with antisocial personality disorder has difficulty relating to others because of never having learned to: 1. Count on others 2. Empathize with others 3. Be dependent on others 4. Communicate with others socially

2. Empathize with others. The lack of superego control allows the ego and the id to control the behavior. Self-motivation and self-satisfaction are of paramount concern.

The nurse is aware that the use of psychopharmacology in individuals with personality disorders are true in which of the following statements? *Select all that apply* 1. Are helpful in treating all types of personality disorders. 2. Have no effect in the direct treatment of the disorder itself. 3. Can relieve some symptoms. 4. Must be used with caution in individuals diagnosed with borderline personality disorder due to the potential for overdose.

2. Have no effect in the direct treatment of the disorder itself. 3. Can relieve some symptoms. 4. Must be used with caution in individuals diagnosed with borderline personality disorder due to the potential for overdose.

The client with antisocial personality disorder: 1. Suffers from a great deal of anxiety 2. Is generally unable to postpone gratification 3. Rapidly learns by experience and punishment 4. Has a great sense of responsibility toward others

2. Is generally unable to postpone gratification. Individuals with this disorder tend to be self-centered and impulsive. They lack judgment and self-control and do not profit from their mistakes.

A client with a diagnosis of narcissistic personality disorder has been given a day pass from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30." The nurse would be most therapeutic by telling the client to: 1. Return immediately, to demonstrate control 2. Return on time or restrictions will be imposed 3. Come back at 6:45, as a compromise to set limits 4. Come back as soon as possible or the police will be sent

2. Return on time or restrictions will be imposed. This sets limits, points out reality, and places responsibility for behavior on the client.

Which of the following behaviors by a client with dependent personality disorder shows the client has made progress toward the goal of increasing problem solving skills? 1. The client is courteous 2. The client asks questions 3. The client stops acting out 4. The client controls emotions

2. The client asks questions. The client with a dependent personality disorder is passive and tries to please others. By asking questions, the client is beginning to gather information, the first step of decision making.

A young, handsome man with a diagnosis of antisocial personality disorder is being discharged from the hospital next week. He asks the nurse for her phone number so that he can call her for a date. The nurse's best response would be: 1. "We are not permitted to date clients." 2. "No, you are a client and I am a nurse." 3. "I like you, but our relationship is professional." 4. "It's against my professional ethics to date clients."

3. "I like you, but our relationship is professional." This accepts the client as a person of worth rather than being cold or implying rejection. However, the nurse maintains a professional rather than a social role.

Which of the following statements is typical for a client diagnosed with a paranoid personality disorder? 1. "I understand you're the one to blame." 2. "I must be seen first; it's not negotiable." 3. "I see nothing humorous in this situation." 4. "I wish someone would select the outfit for me."

3. "I see nothing humorous in this situation." Clients with paranoid personality disorder tend to be extremely serious and lack a sense of humor.

A client with antisocial personality is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. Which of the following responses is the most appropriate? 1. "I believe we need to sit down and talk about this." 2. "Don't you know better than to try to bend the rules?" 3. "What you're asking me to do is unacceptable." 4. "Why don't you bring this request to the community meeting?"

3. "What you're asking me to do is unacceptable." These clients often try to manipulate the nurse to get special privileges or make exceptions to the rules on their behalf. By informing the client directly when actions are inappropriate, the nurse helps the client learn to control unacceptable behaviors by setting limits. Option 1: By sitting down to talk about the request, the nurse is telling the client there's room for negotiating when there is none.

A nurse discusses job possibilities with a client with schizoid personality disorder. Which suggestion by the nurse would be helpful? 1. "You can work in a family restaurant part-time on the weekend and holidays." 2. "Maybe your friend could get you that customer service job where you work only on the weekends." 3. "Your idea of applying for the position of filing and organizing records is worth pursuing." 4. "Being an introvert limits the employment opportunities you can pursue."

3. "Your idea of applying for the position of filing and organizing records is worth pursuing." Clients with schizoid personality disorder prefer solitary activities, such as filing, to working with others. Working as a cashier or in customer service would involve interacting with many people.

The nurse is caring for a patient with a personality disorder. The patient has a sense of entitlement, is manipulative, cons others and has a lack of regard for the law and the rights of others with an absence of remorse for hurting others. The nurse suspects that the patient has which of the following diagnosed personality disorders? 1. Borderline personality disorder 2. Avoidant personality disorder 3. Antisocial personality disorder 4. Narcissistic personality disorder

3. Antisocial personality disorder

The nurse is caring for a patient with Borderline Personality Disorder. Which of the following is the priority nursing intervention? 1. Protect other patients from manipulation 2. Respect the patient's need for social isolation 3. Assess for suicidal and self-harm behaviors 4. Provide simple instructions on unit routine.

3. Assess for suicidal and self-harm behaviors

Which of the following conditions is likely to coexist in clients with a diagnosis of borderline personality disorder? 1. Avoidance 2. Delirium 3. Depression 4. Disorientation

3. Depression. Chronic feelings of emptiness and sadness predispose a client to depression. About 40% of the clients with borderline struggle with depression.

Which of the following interventions is important for a client with paranoid personality disorder taking olanzapine (Zyprexa)? 1. Explain effects of serotonin syndrome 2. Teach the client to watch for extrapyramidal adverse reactions 3. Explain that the drug is less effective if the client smokes 4. Discuss the need to report paradoxical effects such as euphoria.

3. Explain that the drug is less effective if the client smokes. Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine doesn't cause euphoria (damn), and extrapyramidal side effects aren't a problem. However, the client should be aware of adverse effects such as tardive dyskinesia.

Which of the following types of behavior is expected from a client diagnosed with a paranoid personality disorder? 1. Eccentric 2. Exploitative 3. Hypersensitive 4. Seductive

3. Hypersensitive. People with paranoid personality disorders are hypersensitive to perceived threats. Option 1: Schizotypal personalities appear eccentric and engage in activities others find perplexing. Option 2: Clients with narcissistic personality disorder are interpersonally exploitative to enhance themselves or indulge in their own desires. Option 4: A client with a histrionic personality disorder can be extremely seductive when in search of stimulation and approval.

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? 1. Antisocial behavior 2. Suspicious behavior 3. Relationship problems 4. Auditory hallucinations

3. Relationship problems. Relationship problems can precipitate a crisis because they bring up issues of abandonment. Clients with borderline personality disorder aren't usually suspicious; they're more likely to be depressed or highly anxious.

When caring for a client with a diagnosis of schizotypal personality disorder, the nurse should: 1. Set limits on manipulative behavior 2. Encourage participation in group therapy 3. Respect the client's needs for social isolation 4. Understand that seductive behavior is expected.

3. Respect the client's needs for social isolation. These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may encourage the eventual development of a therapeutic alliance. Group therapy would increase this client's anxiety; cognitive or behavioral therapy would be more appropriate.

An adult client with a borderline personality disorder become nauseated and vomits immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The most appropriate initial response by the nurse would be to: 1. Promptly notify the attending physician 2. Immediately initiate suicide precautions 3. Sit quietly with the client until nausea and vomiting subsides 4. Assess the client's vital signs and administer syrup of ipecac

3. Sit quietly with the client until nausea and vomiting subside. This intervention demonstrates the nurse's caring presence which is vital for this client. Option 1: Although the treatment team does need to know about the event, notification is not the immediate concern. Option 2: This is premature and it reinforces the client's predisposition to manipulative behavior. Option 4: This medication is inappropriate in this situation; vomiting would be expected after the ingestion of shampoo.

Which of the following is behavioral patterns is characteristic of individuals with schizotypal personality disorder? 1. Belittling themselves and their abilities. 2. A lifelong pattern of socialization. 3. Suspicious or paranoid ideation. 4. Overreacting inappropriately to minor stimuli.

3. Suspicious or paranoid ideation.

A nurse is orienting a new client to the unit when another client rushes down the hallway and asks the nurse to sit down and talk. The client requesting the nurse's attention is extremely manipulative and uses socially acting-out behaviors when demands are unmet. The nurse should: 1. Suggest that the client requesting attention speak with another staff member 2. Leave the new client and talk with the other client to avoid precipitating acting out behavior 3. Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible." 4. Introduce the two clients and suggest that the client join the new client and the nurse on the tour

3. Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible." This sets realistic limits on behavior without rejecting the client

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? 1. The client is overly dramatic after hearing the facts 2. The client focuses on self to not become over-anxious 3. The client responds from a rational, objective point of view 4. The client doesn't spend time thinking about the information.

3. The client responds from a rational, objective point of view. Clients with paranoid personality disorder are affectively restricted, appear unemotional, and appear rational and objective.

A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the unit's rules. This behavior should be confronted because it will help the client: 1. Control anger 2. Reduce anxiety 3. Set realistic goals 4. Become more self-aware

4. Become more self-aware. Client's must first become aware of their behavior before they can change it. Occurs after the client is aware of the behavior and has a desire to change the behavior.

The nurse is caring for a patient diagnosed with Personality Disorder traits, who states they're incapable of surviving if left alone. Which of the following personality disorders would the nurse suspect? 1. Antisocial personality disorder 2. Schizoid personality disorder 3. Avoidant personality disorder 4. Dependent personality disorder

4. Dependent personality disorder

The nurse is caring for a patient who has been diagnosed with borderline personality disorder (BPD). The nurse is aware that which of the following treatment modalities may be effective in the treatment of BPD? 1. Milieu or Group Therapy 2. Psychoanalytical psychotherapy 3. Cognitive Behavioral therapy 4. Dialectical Behavioral therapy

4. Dialectical Behavioral therapy

A client with schizotypal personality disorder is sitting in a puddle of urine. She's playing in it, smiling, and softly singing a child's song. Which action would be best? 1. Admonish the client for not using the bathroom 2. Firmly tell the client that her behavior is unacceptable 3. Ask the client if she's ready to get cleaned up now 4. Help the client to the shower, and change the bedclothes.

4. Help the client to the shower, and change the bedclothes. A client with schizotypal personality disorder can experience high levels of anxiety and regress to childlike behaviors. This client may require help needing self-care needs. The client may not respond to the other options or those options may generate more anxiety.

Which of the following characteristics or client histories substantiates a diagnosis of antisocial personality disorder? 1. Delusional thinking 2. Feelings of inferiority 3. Disorganized thinking 4. Multiple criminal charges

4. Multiple criminal charges. Clients with antisocial personality disorder are often sent for treatment by the court after multiple crimes or for the use of illegal substances.

A nurse is assessing a client diagnosed with dependent personality disorder. Which of the following characteristics is a major component to this disorder? 1. Abrasive to others 2. Indifferent to others 3. Manipulative of others 4. Over-reliance on others

4. Over-reliance on others. Clients with dependent personality disorder are extremely over-reliant on others; they aren't abrasive or assertive. They're clinging and demanding of others; they don't manipulate.

A nurse notices that a client is mistrustful and shows hostile behavior. Which of the following types of personality disorder is associated with these characteristics? 1. Antisocial 2. Avoidant 3. Borderline 4. Paranoid

4. Paranoid. Paranoid individuals have a need to constantly scan the environment for signs of betrayal, deception, and ridicule, appearing mistrustful and hostile. They expect to be tricked or deceived by others.

The nurse is caring for a patient with an antisocial personality disorder who is testing limits. Which of the following is a priority task in working with this patient? 1. Respecting patients need for social isolation 2. Teaching the patient to not be so grandiose 3. Preventing patient from violating the nurse's rights 4. Providing clear limits and boundaries on specific behaviors

4. Providing clear limits and boundaries on specific behaviors

When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: 1. Controlling anxiety 2. Terminating the session on time 3. Accepting the psychiatric diagnosis 4. Setting mutual goals for the relationship

4. Setting mutual goals for the relationship. Clients with borderline personality disorders frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals.

An experienced nurse is working on a unit with patients diagnosed with personality disorders. Which of the following is not a self-care technique for the nurse working on this unit? 1. Acknowledging and accepting their own emotional response 2. Frequent communication among staff 3. Continuous availability of supervision and support 4. Vengefulness

4. Vengefulness

Nurse Arya assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? *Select all that apply.* A. Anhedonia B. Delusions C. Flat affect D. Hallucinations E. Loose associations F. Social withdrawal

Answer: B. Delusions D. Hallucinations E. Loose associations These are considered positive symptoms of schizophrenia. Options A, C, and F are considered negative symptoms.

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? *Select all that apply.* A. Analyzing family issues and past problems B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment E. Treating family members affected by the illness F. Participating in in-depth psychoanalytical counseling

Answer: B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client's development of skills in the here and now; consequently, psychoanalytic counseling is not part of the approach.

Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia? A. Age of onset is typical for schizophrenia. B. Age of onset is later than usual for schizophrenia. C. Age of onset is earlier than usual for schizophrenia. D. Age of onset follows no predictable pattern in schizophrenia.

Answer: A. Age of onset is typical for schizophrenia. The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27). Paranoid schizophrenia may sometimes have a later onset. All of the other options are incorrect.

A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first? A. Ask the client about any previous problems with psychotropic medications. B. Ask the client if an injection is preferable. C. Insist that the client takes medication as prescribed. D. Withhold the medication until the client is less suspicious.

Answer: A. Ask the client about any previous problems with psychotropic medications. The nurse needs to clarify the client's previous experience with psychotropic medication in order to understand the meaning of the client's statement. Option B: Asking the client if an injection is preferable may add to the client;s suspicion and feeling threatened. Option C: Insisting that the client take medication can be a violation of his right to refuse treatment. Option D: Withholding medication prescribed to relieve delusional beliefs will likely intensify paranoid thinking.

Ramsay is diagnosed with schizophrenia paranoid type and is admitted to the psychiatric unit of Nurseslabs Medical Center. Which of the following nursing interventions would be most appropriate? A. Establishing a non-demanding relationship B. Encouraging involvement in group activities C. Spending more time with Ramsay D. Waiting until Ramsay initiates interaction

Answer: A. Establishing a nondemanding relationship A non-threatening, non-demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Options B and C: Encouraging involvement in group activities and spending more time with the client would be threatening for a client who is suspicious of other people's motives. Option D: This client is unlikely to initiate interaction; the nurse is responsible for initiating a relationship with the client.

Nurse Dorothy is evaluating care of a client with schizophrenia; the nurse should keep which point in mind? A. Frequent reassessment is needed and is based on the client's response to treatment. B. The family does not need to be included in the care because the client is an adult. C. The client is too ill to learn about his illness. D. Relapse is not an issue for a client with schizophrenia.

Answer: A. Frequent reassessment is needed and is based on the client's response to treatment. Because client responds to treatment in different ways, the nurse must constantly evaluate the client and his potential. A premorbid adjustment must also be considered. Option B: Most clients with such condition go home, so the family should be involved. Option C: The client can learn about the illness if information is provided gradually. Option D: Relapse is common in schizophrenia.

Nurse Winona educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would Nurse Winona state is helpful? A. Call the therapist to request a medication change. B. Encourage the use of learned relaxation techniques. C. Request that the client be hospitalized until the crisis is over. D. Wait before the anxiety worsens before intervening.

Answer: B. Encourage the use of learned relaxation techniques. The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive and helpful by encouraging the client to use these techniques. Option A: Anxiety is a common experience for everyone, and is no reason to change medication. Handling anxiety is a learned skill that is important to reinforce. Option C: There is no indication that the client is in crisis. Option D: It is much easier to intervene early in anxiety rather than waiting until escalation occurs.

Which of the following client behaviors documented in Gio's chart would validate the nursing diagnosis of Risk for other-directed violence? A. Gio's description of being endowed with superpowers B. Frequent angry outburst noted toward peers and staff C. Refusal to eat cafeteria food D. Refusal to join in group activities

Answer: B. Frequent angry outburst noted toward peers and staff Anger is an important factor that indicated the potential for acting out. Because the client is angry with both peers and staff, any acting out would probably be directed toward others. Options A and C: The client's description of being endowed with superpowers and his refusal to eat cafeteria food indicate that he may have delusional beliefs, but not necessarily a risk for violence. Option D: Refusal to join in group activities indicates discomfort with a group, however, no threat of violence is apparent.

Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been plated in the unit walls. Which action would be the most therapeutic response? A. Confront the delusional material directly by telling Gio that this simply is not so. B. Tell Gio that this must seem frightening to him but that you believe he is safe here. C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions. D. Isolate Gio when he begins to talk about these beliefs.

Answer: B. Tell Gio that this must seem frightening to him but that you believe he is safe here. The nurse must realize that these perceptions are very real to the client. Acknowledging the client's feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation. Option A: Confronting the delusional material directly will not work with this client and may diminish trust. Option C: Telling the client to wait and talk about these beliefs in his one-on-one counseling session will reinforce the delusion. Option D: Isolation will increase anxiety. Distraction with a radio or activities would be a better approach.

The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite? A. Conclusive evidence indicates a specific gene transmits the disorder. B. Incidence of this disorder is variable in all families. C. There is a little evidence that genes play a role in transmission. D. Genetic factors can increase the vulnerability for this disorder.

Answer: D. Genetic factors can increase the vulnerability for this disorder. Research shows that family history statistically increases the risk for development of schizophrenia. Option A: However, no single gene has yet been identified. Options B and C are both incorrect because genetics plays a role in the etiology of schizophrenia.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with: A. Auditory hallucinations. B. Bizarre behaviors. C. Ideas of reference. D. Motivation for activities.

Answer: D. Motivation for activities. In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. Options A, B, and C: All of the other symptoms listed are the positive symptoms of schizophrenia.

Which factor is associated with increased risk for schizophrenia? A. Alcoholism B. Adolescent pregnancy C. Overcrowded schools D. Poverty

Answer: D. Poverty Low socioeconomic status or poverty is an identified environmental factor associated with increased incidence of schizophrenia. Options A, B, and C: Although alcoholism, adolescent pregnancy, and overcrowded schools may be stressful, research does not show they increase the risk of schizophrenia.

Upon Sam's admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time? A. Anxiety B. Decisional conflict C. Self-care deficit D. Social isolation

Answer: D. Social isolation These behaviors indicate the client's withdrawal from others and possible fear or mistrust of relationships. Options A and B: There is no indication of Anxiety or Decisional conflict in the information provided. Option C: Although the client refuses to bathe or dress, Self-care deficit would not be the priority nursing diagnosis in this situation.

Drogo who has had auditory hallucinations for many years tells Nurse Khally that the voices prevent his participation in a social skills training program at the community health center. Which intervention is most appropriate? A. Let Drogo analyze the content of the voices. B. Advise Drogo to participate in the program when the voices cease. C. Advise Drogo to take his medications as prescribed. D. Teach Drogo to use thought stopping techniques.

Answer: D. Teach Drogo to use thought stopping techniques. Clients with long-lasting auditory hallucinations can learn to use thought stopping measures to accomplish tasks. Option A: Analyzing the content of the voices may be indicated when hallucinations first occur to establish whether the voices are threatening to the client or instructing him to harm others. However, focusing on their content at this point would reinforce this symptom. Option B: The voices have lasted many years; the client should participate despite the voices. Option D: There is no indication that the client is not taking medication as prescribed.

Cersei is diagnosed as having disorganized schizophrenia. Which behaviors would Nurse Sansa most likely assess in the client? A. Absence of acute symptoms impaired role function B. Extreme social withdrawal, odd mannerisms, and behavior C. Psychomotor immobility; presence of waxy flexibility D. Suspiciousness toward others increased hostility

B. Extreme social withdrawal, odd mannerisms, and behavior Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms. Option A: The absence of acute symptoms and impaired role function are more characteristic of residual-type schizophrenia. Option C: Psychomotor immobility and presence of waxy flexibility are more indicative of catatonic schizophrenia. Option D: Suspiciousness toward others and increased hostility is more characteristic of paranoid schizophrenia.

Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority

a. Lack of guilt for wrongdoing

Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? a. Overly self-centered and exploitative of others b. Suspicious and mistrustful of others c. Rule conscious and disapproving of change d. Anxious and socially isolated

a. Overly self-centered and exploitative of others

Clint, a client on the psych unit, have been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clints belief is an example of a : a. delusion of persecution b. delusion of reference c. delusion of control or influence d. delusion of grandeur

a. delusion of persecution

Which of the following meds have been indicated or improvement in cognitive functioning in mild to mod AD? *Select all that apply* a. donepezil- aricept b. rivastimine- exelon c. risperidone- risperdal d. galantamine- razadyne

a. donepezil- aricept b. rivastimine- exelon d. galantamine- razadyne

In addition to disturbances in cognition and orientation, individuals with AD may also show changes in which of the following? *Select all that apply* a. personality b. vision c. speech d. hearing e. mobility

a. personality c. speech e. mobility

Kim, a client diagnosed with Borderline Personality Disorder, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: a. refusal to stay in room alone, stating, "It's so lonely." b. asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. c. stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." d. cutting arms with razor blade after discussing dismissal plans with physician.

a. refusal to stay in room alone, stating, "It's so lonely."

Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? a. Belittling themselves and their abilities b. A lifelong pattern of social withdrawal c. Suspicious and mistrustful of others d. Overreacting inappropriately to minor stimuli

b. A lifelong pattern of social withdrawal

Mrs. G who has NCD due to AD, says to the nurse "I have a date tonight. I always have a date on Christmas." Which of the following in the most appropriate response? a. Don't be silly, its not Christmas Mrs. G b. Today is Tuesday, october 21. Mrs. G. We will have supper soon, and then your daughter will come to visit. c. Who is your date with, Mrs. G? d. I think you need some more meds, Mrs. G. I'll bring it to you now.

b. Today is Tuesday, october 21. Mrs. G. We will have supper soon, and then your daughter will come to visit.

Splitting by the client with borderline personality disorder denotes a. evidence of precocious development. b. a primitive defense mechanism in which the client sees objects as all good or all bad. c. a brief psychotic episode in which the client loses contact with reality. d. two distinct personalities within the borderline client.

b. a primitive defense mechanism in which the client sees objects as all good or all bad.

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in mid sentence, and listens intently. The nurse recognizes these behaviors as a symptom of the clients illness. The most appropriate nursing int. for this symptom would be: a. as the client to describe his physical symptoms b. ask the client to describe what he is hearing c. administer a dose of benztropine d. call the physician for additional orders

b. ask the client to describe what he is hearing

The primary goal in working with an actively psychotic, suspicious client would be to a. promote interaction with others b. decrease his anxiety and increase trust c. improve his relationship with his parents d. encourage participation in therapy activities

b. decrease his anxiety and increase trust

Milieu therapy is a good choice for clients with antisocial personality disorder because it a. provides a system of punishment and reward for behavior modification. b. emulates a social community in which the client may learn to live harmoniously with others. c. provides mostly one-to-one interaction between the client and therapist. d. provides a very structured setting in which the clients have very little input into the planning of their care.

b. emulates a social community in which the client may learn to live harmoniously with others.

Tony, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Tony is to a. give him an injection of Thorazine b. ensure a safe environment for him and others. c. place him in restraints d. order him a nutritious diet

b. ensure a safe environment for him and others.

Mrs. G has been diagnosed with NCD due to AD. The primary nursing intervention in working with Mrs. G is which of the following a. ensuring that she receives food she likes to prevent hunger b. ensuring that the environment is safe, to prevent injury c. ensuring that she meets other patients, to prevent social isolation d. ensuring that she takes care of her own ADLs, to prevent dependence

b. ensuring that the environment is safe, to prevent injury

The night nurse finds Mrs. G, with AD, wandering in the hallway at 4 am and trying to open the door to the side yard. Which statement probably reflects the most accurate assessment of the situation? a. "That door leads out to the patio Mrs. G its nighttime. You don't want to go outside now." b. "You look confused Mrs. G, What is bothering you?" c. "This is the patio door Mrs. G. Are you looking for the bathroom?" d. "Are you lonely? Perhaps you'd like go of back to your room and talk a for a while."

c. "This is the patio door Mrs. G. Are you looking for the bathroom?"

In evaluating the progress of Jack, a client diagnosed with Antisocial Personality Disorder, which of the following behaviors would be considered the most significant indication of positive change? a. Jack got angry only once in group this week. b. Jack was able to wait a whole hour for a cigarette without verbally abusing the staff. c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight. d. Jack stated that he would no longer start any more fights.

c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight.

Which of the following interventions is most appropriate in helping a client with AD with her ADLs? *Select all that apply* a. perform all adls for her while she is in the hospital b. provide her with a written list of activities she is expected to perform c. assist her with a step by step instructions d. tell her that if her morning care is not completed by 9am, it will be performed for her by the nurses aide so that she can attend group therapy e. encourage her and give her plenty of time to perform as many of her adls as possible independently

c. assist her with a step by step instructions e. encourage her and give her plenty of time to perform as many of her adls as possible independently

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking and mid sentence and listens intently. The nurse recognized from these signs that they client is likely experiencing: a. somatic delusions b. catatonic stupor c. auditory hallucinations d. pseudoparkinsoisn

c. auditory hallucinations

When a client suddenly becomes aggressive and violent on the unit which of the following approaches would be best for the nurse to use first? a. provide large motor activities to relieve the clients pent-up tension b. administer a dose of pen chlorpromazine to keep the client calm c. call for sufficient help to control the situation d.convey to the client that his behavior is unacceptable and will not be permitted

c. call for sufficient help to control the situation

An example to a treatable form of Non-Communicable Disease (NCD) is one that is caused by which of the following? *Select all that apply.* a. multiple sclerosis b. multiple small brain infarcts c. electrolyte imbalances d. HIV e. folate deficiency

c. electrolyte imbalances e. folate deficiency

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg of chlorpromazine IM stat and then 50 mg PO bid; 2 mg benztropin PO bid prn. Why is the chlorpromazine ordered? a. to reduce extrapyramidal symptoms b. to prevent neuroleptic malignant syndrome c. to decrease psychotic symptoms d. to induce sleep

c. to decrease psychotic symptoms

Mrs. G has NCD due to AD, has trouble sleeping and wanders around at night. Which of the following actions would be best to promote sleep in Mrs. G? a. ask the doctor to prescribe flurazepam (Dalmane) b. ensure that Mrs. G gets an afternoon nap so she will not be overtired at bed time c. make Mrs. G a cup of tea with honey before bedtime d. ensure that Mrs. G gets regular exercise during the day

d

Clint, a client on a phych unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response is: a. Thats ridiculous cling. no one is going to hurt you. b. The CIA isn't intereste in people like you clint c. Why do you think the CIA wants to kill you? d. I know you believe that Clint, but its really hard for me to believe

d. I know you believe that Clint, but its really hard for me to believe

Carol is a new nursing graduate being oriented on a medical/surgical unit by the head nurse, Mrs. Carey. When Carol describes a new technique she has learned for positioning immobile clients, Mrs. Carey states, "What are you trying to do . . . tell me how to do my job? We have always done it this way on this unit, and we will continue to do it this way until I say differently!" This is an example of which type of personality characteristic? a. Antisocial b. Paranoid c. Passive-aggressive d. Obsessive-compulsive

d. Obsessive-compulsive

According to Margaret Mahler, predisposition to borderline personality disorder occurs when developmental tasks go unfulfilled in which of the following phases? a. Autistic phase, during which the child's needs for security and comfort go unfulfilled b. Symbiotic phase, during which the child fails to bond with the mother c. Differentiation phase, during which the child fails to recognize a separateness between self and mother d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence

d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence

1. Kim has a diagnosis of Borderline Personality Disorder. She often exhibits alternating clinging and distancing behaviors. The most appropriate nursing intervention with this type of behavior would be to: a. encourage Kim to establish trust in one staff person, with whom all therapeutic interaction should take place. b. secure a verbal contract from Kim that she will discontinue these behaviors. c. withdraw attention if these behaviors continue. d. rotate staff members who work with Kim so that she will learn to relate to more than one person.

d. rotate staff members who work with Kim so that she will learn to relate to more than one person.

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM stat and then 50 mg po big; 2 mg benztropine po bid pen. Because benztropine was ordered on a pen basis, which of the following assessments by the nurse would convey a need for this med? a. the clients level of agitation increases b. the client complains of a sore throat c. the clients skin has a yellowish cast d. the client develops tremors and a shuffling gait

d. the client develops tremors and a shuffling gait

The primary focus of family therapy for clients with schizophrenia and their families is a. to discuss concrete problem-solving and adaptive behaviors for coping with stress b. to introduce the family to others with the same problem c. to keep the client and family in touch with the health-care system d. to promote family interaction and increase understanding of the illness

d. to promote family interaction and increase understanding of the illness

Mrs. G has been diagnosed with NCD due to Alzheimer's disease. The cause of this disorder is which of the following? a. multiple small brain infarcts b. chronic alcohol abuse c. cerebral abscess d. unknown

d. unknown