psych exam 3
13. When planning care for a client diagnosed with BPD, which self-harm behavior should the nurse expect the client to exhibit? 1. The use of highly lethal methods to commit suicide 2. The use of suicidal gestures to evoke a rescue response from others 3. The use of isolation and starvation as suicidal methods 4. The use of self-mutilation to decrease endorphins in the body
2
14. The director of nursing (DON) sets up a meeting with the newly appointed nurse manager who has been doing an excellent job. The DON anticipates that the nurse manager plans to resign. Which is the best description of the DON's cognitive error? 1. Thinking from an all-or-nothing perspective 2. Always thinking the worst will occur without considering positive outcomes 3. Viewing only selected negative evidence while editing out positive aspects 4. Undervaluing the positive significance of an event
2
16. Using a behavioral approach, which nursing intervention is most appropriate when caring for a client diagnosed with BPD? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Contract with the client to reinforce positive behaviors with unit privileges. 3. Teach the purpose of antianxiety medications to improve medication compliance. 4. Encourage the client to journal feelings to improve awareness of abandonment issues.
2
4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. Which statement is true regarding what the milieu provides that may be missing in the home environment? 1. Peer pressure 2. Structured programming 3. Visitor restrictions 4. Mandated activities
2
5. A client diagnosed with borderline personality disorder (BPD) brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. Which approach is best for the nursing staff to implement? 1. Allow the clients to apply the democratic process when developing unit rules. 2. Maintain consistency of care by open communication to avoid staff manipulation. 3. Allow the client spokesperson to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of autocratic leadership.
2
6. A client treated for symptoms of PTSD following a shooting incident at a local elementary school reports, "I feel like there's no reason to go on living when so many others are dead." Which is the most appropriate response by the nurse now? 1. "You have lots of reasons to go on living." 2. "Are you having thoughts of hurting or killing yourself?" 3. "You're just experiencing survivor guilt." 4. "There must be something that gives you hope."
2
28. Exposure to trauma has been associated with hyperarousal of the sympathetic nervous system, excessive amygdala activity, and decreased volume of the ____________________.
hippocampus
30. The client is diagnosed with PTSD and informs the nurse that she is experiencing nightmares. The pharmacological intervention that will most benefit this client is ____________________.
prazosin (Minipress)
1. Which of the following best defines the basis of cognitive behavior therapy? 1. Cognitive behavior therapy is based on the concept that distorted thoughts are the foundation of many emotional, mental, and behavioral disorders. 2. Cognitive behavior therapy is based on the concept that higher education can prevent emotional, mental, and behavioral disorders. 3. Cognitive behavior therapy is based on the concept that a contingency contract can help a client develop adaptive behaviors. 4. Cognitive behavior therapy is based on a reward system of positive reinforcement of positive self-statements.
1
10. Beck's original concept for cognitive behavior therapy has been expanded by many theorists, but the foundation remains. Which of the following best describes the historical foundation of cognitive behavior therapy? 1. Rejection of passive listening used in psychoanalysis in favor of active, direct dialogues with clients. 2. Utilization of the psychoanalytic view of seeing depression as "anger turned inward." 3. Recognition that cognitive behavior therapy works for depression but not for other emotional disorders. 4. Cognitive behavior therapy has been the forefront of the Freudian framework of psychoanalysis.
1
10. The nurse manager has set a new policy on the unit to facilitate effective collaboration and locate referrals for clients who require mental health services. Which of the following is an appropriate resource to locate resources? 1. Online treatment map provided by the Substance Abuse and Mental Health Services Administration 2. Nonsuicidal self-injuring behavioral screening tool 3. Screen for adverse childhood events 4. SBIRT
1
11. A high-school basketball player sustains a serious knee injury and states to the school nurse, "I will never get into college if I don't receive a basketball scholarship." Which nursing reply would assist the student to see a broader range of possibilities? 1. "Let's look at the alternatives for funding your college education." 2. "I know you are feeling helpless now, but you are looking at this from only one perspective." 3. "Can your family afford knee surgery?" 4. "You now need to prioritize your academics and not focus on basketball."
1
12. The psychiatric-mental health nurse understands the goal of milieu therapy is which of the following? 1. To structure the environment to ensure a therapeutic experience 2. To demand clients to be active participants in their therapy 3. To provide spontaneous opportunities for therapeutic interactions 4. To design a homelike atmosphere that encourages communication
1
15. A nursing instructor is teaching about dichotomous thinking. Which student statement indicates learning has occurred? 1. "Dichotomous thinking is when an individual views a situation as being good or bad or black or white." 2. "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances." 3. "Dichotomous thinking is when an individual exaggerates the negative significance of an event." 4. "Dichotomous thinking is when an individual undervalues the positive significance of an event."
1
15. Which is the priority nursing diagnosis when providing care to a client diagnosed with paranoid personality disorder? 1. Risk for violence: directed toward others R/T suspicious thoughts 2. Risk for suicide R/T altered thought processes 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others
1
17. Which statement does the nurse recognize as exemplifying the level of cognitive function of a client experiencing mild anxiety? 1. "Right now I feel as sharp as a tack." 2. "I'm having a tough time focusing." 3. "Sometimes I feel like I'm having an out-of-body experience." 4. "All I seem to focus on is my anger."
1
19. Using a cognitive approach, which intervention would the nurse choose to assist clients in managing anger without the use of violence? 1. Assist the client in identifying thoughts that trigger anger and substitute reality-based thinking. 2. Provide consequences, such as removal from group therapy, in response to angry outbursts. 3. Administer antipsychotic medications and use limit setting, such as a room restriction. 4. Administer antianxiety medication, and encourage participation in a group on medication actions.
1
2. The client arrives to the ED complaining of severe abdominal pains. The attending health-care provider determines that the client is in labor. Upon further investigation, the nurse discovers that the client uses illegal substances and did not seek prenatal care. Which of the following would best explain this lack of prenatal care? 1. Many states consider substance use during pregnancy as child abuse. 2. The client was never educated about the need for prenatal care. 3. The client had children at home and considered prenatal care unnecessary. 4. The client did not have the financial resources to obtain prenatal care.
1
3. A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which reply by the nurse is appropriate? 1. "Group therapy provides the opportunity to learn and practice new coping skills." 2. "Group therapy is mandatory. All clients must attend." 3. "Group therapy is optional. You can go if you find the topic helpful and interesting." 4. "Group therapy is an economical way of providing therapy to many clients concurrently."
1
3. A successful business executive continually thinks her job accomplishments are not adequate. The nurse recognizes the client's thinking reflects which cognitive error? 1. Minimization 2. Dichotomous thinking 3. Arbitrary inference 4. Personalization
1
3. The client with a myocardial infarction tells the intensive care nurse, "You won't have to care for me pretty soon. I will not be a burden to you or others." Which initial action should the nurse take? 1. Screen the client for suicide. 2. Transfer the client to the medical unit. 3. Allow the client some private, quiet time. 4. Reinforce independence with self-care.
1
4. A military veteran who recently returned from active duty in a Middle Eastern country and suffers from PTSD states that he will not allow the laboratory technician, who is Iranian, to draw his blood. The client states, "He'll probably use a contaminated needle on me." Which of these is the most appropriate nursing response by the nurse? 1. "Let me see if I can arrange for a different technician to draw your blood." 2. "Let me help you overcome your cultural bias by letting him draw your blood." 3. "There is no other technician, so you're just going to have to let him draw your blood." 4. "I don't think the technician is really Middle Eastern."
1
5. The family practice clinic nurse is triaging clients. The nurse should require which client with nonsuicidal self-injuring behavior to be seen immediately? 1. The patient who is self-cutting in response to command hallucinations 2. The patient who has a history of borderline personality disorder 3. The patient who has recently retired from the military 4. The patient who has thoughts of being detached from the body
1
5. To promote self-reliance, how would a psychiatric-mental health nurse best conduct medication administration? 1. Encourage clients to request their medications at the appropriate times. 2. Refuse to administer medications unless clients request them at the appropriate times. 3. Allow the clients to determine appropriate medication times. 4. Take medications to the clients' bedsides at the appropriate times.
1
6. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with BPD? 1. Being firm, consistent, and empathetic while addressing specific client behaviors 2. Promoting client self-expression by implementing laissez-faire leadership 3. Using authoritative leadership to help clients learn to conform to societal norms 4. Overlooking inappropriate behaviors to avoid promoting secondary gains
1
7. An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client's concerns. What is the purpose of this nursing intervention? 1. To identify important areas needing concentration during therapy 2. To increase self-esteem and decrease feelings of helplessness 3. To modify maladaptive behaviors using role-play 4. To divert away from intrusive thoughts and depressive ruminations
1
7. The nurse discovers that the client who has been admitted to the facility with depression has been a victim of childhood trauma. The nurse reports this discovery to the health-care provider and the staff. What is the rationale for the nurse to inform the staff of the trauma? 1. Interventions that may mimic the childhood trauma may retraumatize the adult client. 2. The client may start to act out during group sessions. 3. The client may have other underlying health concerns. 4. This should be a part of the family therapy session.
1
9. A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of examining the evidence. Which response by the nursing instructor exemplifies this technique? 1. "Let's look at the potential reasons why your partner has not participated." 2. "How do you define irresponsibility?" 3. "Has it occurred to you that your partner may be working on the project at home?" 4. "Are you telling me that you feel totally responsible for this project?"
1
9. Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply? 1. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone." 2. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, whereas clients diagnosed with avoidant personality disorder do not." 3. "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant." 4. "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, whereas clients diagnosed with avoidant personality disorder remain based in reality."
1
19. The client being treated for PTSD tells the nurse that their therapist is recommending cognitive behavior therapy. The client asks the nurse how that is supposed to help with nightmares. Which of these responses by the nurse provides accurate information about the benefits of this type of therapy? Select all that apply. 1. "The nightmares may be related to troubling thoughts and feelings; cognitive behavior therapy will help you explore and modify those thoughts and feelings." 2. "It is designed to help you cope with anxiety, anger, and other feelings that may be related to your symptoms." 3. "It is designed to repeatedly expose you to the trauma you experienced so you can regain a sense of safety." 4. "Once you learn to repress these troubling feelings, the nightmares should cease." 5. "Cognitive behavior therapy will help distract you from the issues."
1, 2
14. A military veteran is assessed for outpatient therapy after he reports having problems at home and at work. Which of the symptoms that he describes is commonly associated with PTSD? Select all that apply. 1. "I've been drinking and smoking pot daily." 2. "I've been having trouble sleeping and been having nightmares but I can't remember them." 3. "I slapped my wife when she was trying to hug me." 4. "I've been having intense pain in the leg where I sustained a combat wound." 5. "I realize now that I was just a kid in the war and could not control what happened."
1, 2, 3
20. The client recently moved into a dormitory to begin their first year in college. The dormitory supervisor reprimanded the client for not disposing of food items properly, and the client responded by throwing all their belongings from a second-story window while shouting obscenities. The campus police escorted the client to campus health services, where the client was diagnosed with an adjustment disorder with disturbance of conduct. Which of the following items in the client's history reflects a predisposition to this disorder? Select all that apply. 1. The client reports that they have no friends in the dormitory. 2. The client's family currently lives out of the country and is often difficult to reach. 3. The client was notified the same day that they would have to withdraw from one of their classes due to poor grades. 4. The client has a higher-than-average grade point average and is a member of the National Honor Society. 5. The client has a scholarship due to excellent grades and athletic ability on the field.
1, 2, 3
21. The client recently experienced surviving a plane crash and is assessed by the nurse. Which client statements indicate that they may be experiencing PTSD? Select all that apply. 1. "I keep having these thoughts about the crash that just pop into my mind at random times." 2. "I am so afraid that I will never be able to fly again. I worry about it constantly." 3. "I have nightmares every night about the crash where I picture myself dying." 4. "I believe that I was meant to survive this accident so that I can focus on the important things in life." 5. "I have started going to church to show gratitude for surviving the crash."
1, 2, 3
24. A nurse practitioner uses cognitive behavior therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts (DRDT). Which of the following are appropriate nursing replies to a client asking about the purpose of this exercise? Select all that apply. 1. "The purpose of this exercise is to identify automatic thoughts." 2. "The purpose of this exercise is to identify rational alternatives." 3. "The purpose of this exercise is to modify cognitive errors." 4. "The purpose of this exercise is to eliminate irrational beliefs." 5. "The purpose of this exercise is to monitor thoughts related to self-esteem."
1, 2, 3
12. The nurse is preparing a staff development presentation to improve the screening, intervention, and referral process for clients in the geriatric community center. Which information should the nurse identify as barriers to this initiative? Select all that apply. 1. Client privacy concerns 2. Competing workload demands 3. Novice nurses 4. Staff attitude 5. Changing screening requirements
1, 2, 3, 4
14. The clinic nurse is caring for a client with ulcerative colitis who has signs of depression. Which additional conditions should the nurse assess for in this client? Select all that apply. 1. Mania 2. Cardiovascular disease 3. Metabolic syndrome 4. Diabetes 5. Emphysema
1, 2, 3, 4
13. The nurse is a manager of a unit in an acute care setting. Which actions should the nurse manager take to equip staff to address neuropsychiatric symptoms in the clients? Select all that apply. 1. Encourage the use of screening tools. 2. Provide education of staff members. 3. Keep referrals to a minimum. 4. Increase social contact with individuals with mental illness. 5. Promote defensive medicine.
1, 2, 4
22. The client is a Marine who has recently returned from a military battle in the Middle East. The nurse is assessing him to develop a plan of care and evaluates the data to determine the variables associated with his response to trauma. Which variables should the nurse consider to make this determination? Select all that apply. 1. The resources the client uses to cope with trauma 2. The outcomes the client previously experiences with trauma. 3. The location and duration of the traumatic event experienced by the client 4. The temperament the client displays in the presence of trauma 5. The client's childhood, specifically any history of childhood trauma
1, 2, 4, 5
15. A client's wife reports to the nurse that she was told her husband's PTSD may be related to cognitive problems. She is asking the nurse to explain what that means. Which of the following are accurate statements about cognitive theory as it applies to PTSD? Select all that apply. 1. People are vulnerable to trauma-related disorders when their fundamental beliefs are invalidated. 2. Cognitive theory addresses the importance of how people think (or cognitively appraise) events. 3. Dementia is a common symptom of PTSD. 4. Amnesia is the biggest cognitive problem in PTSD and is the primary cause of trauma-related disorders. 5. Cognitive behavior therapy not only works with how individuals think but also with how their body responds.
1, 2, 5
17. A client admitted to the hospital with PTSD is ordered the following medications. Which of these medications has a direct use in treating symptoms that are common in PTSD? Select all that apply. 1. Alprazolam (Xanax) 2. Propranolol (Inderal) 3. Docusate sodium (Colace) 4. Docusate (Dulcolax) 5. Prazosin (Minipress)
1, 2, 5
17. Therapeutic community is based on which of Skinner's assumptions? Select all that apply. 1. Every interaction is an opportunity for therapeutic intervention. 2. Social interactions and group activities foster behavior change. 3. Peer pressure is a useful and powerful tool. 4. Inappropriate behaviors are dealt with as they occur. 5. Physical facilities enhance adaptive coping skills.
1, 3, 4
23. The client recently lost his spouse and two small children in a house fire. He did not return to work after the trauma and thus lost his job. He also withdrew from family and friends. His pastor reached out and encouraged him to seek psychiatric help, which he did. The client is currently a client at a psychiatric facility. The nurse assigned to him is evaluating the plan of care. Which statements made by the client would require the nurse to reevaluate his 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." 5. "I have decided to do more physical work to help me get rid of this tension."
1, 3, 4
13. A client is admitted to the community mental health center for outpatient therapy with a diagnosis of adjustment disorder. Which of the following subjective statements by the client supports this diagnosis? Select all that apply. 1. "I was divorced 3 months ago, and I can't seem to cope." 2. "I was a victim of date rape 15 years ago when I was in college." 3. "My partner came home last week and told me he just didn't love me anymore." 4. "I failed one of my classes last month and I can't get motivated to register for my next semester." 5. "I can't go back to work; my new boss constantly bullies me and enjoys it when I cry."
1, 3, 4, 5
18. A client who is being seen in the community mental health center for PTSD is being considered for EMDR. The nurse is asked to conduct an assessment to validate the client's appropriateness for this treatment. Which of the following data, collected by the nurse, are most important to document when determining appropriateness for treatment with EMDR? Select all that apply.
1, 3, 4, 5
16. The nurse who works on an inpatient psychiatric unit is working on developing a treatment plan for a client admitted with PTSD. The client, a military veteran, reports that sometimes he thinks he sees bombs exploding and the enemy rushing toward him. He has had aggressive outbursts and was hospitalized after assaulting a coworker during one of these episodes. Which of these nursing interventions are evidence-based responses? Select all that apply. 1. Collaborate with the client about how he would like staff to respond when he has episodes of reexperiencing traumatic events. 2. Tell the client it is not appropriate to hit other clients or staff and if that occurs, he will have to be discharged from the hospital. 3. Contact the doctor and recommend that the client be ordered an antipsychotic medication. 4. Refer the client to a peer-advocate support group with other military veterans. 5. Request antidepressant medications when he starts to experience a flashback of the trauma.
1, 4
1. A client presents in the emergency department with a friend who reports that the client has been sitting in her apartment "staring off into space" and doesn't seem interested in doing anything. During the assessment, the client reveals, with little emotion, that she was raped 4 months ago. Which of these is the most appropriate interpretation of the client's lack of emotion? 1. The client is probably hearing voices telling her to be emotionless. 2. The client is experiencing a common symptom of numbing of emotional response. 3. The client is attempting to be secretive and lying, which are common symptoms in posttraumatic stress disorder (PTSD). 4. The client is having a dissociative episode and revisiting the traumatic event.
2
1. During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior? 1. "You are very disrespectful. You need to learn to control yourself." 2. "I understand that you are angry, but this behavior will not be tolerated." 3. "What behaviors could you modify to improve this situation?" 4. "What antisocial personality disorder medications have helped you in the past?"
2
10. The client's 8-year-old child went missing 1 year ago. The police have few leads and have lost interest in the case. The client visits an outpatient mental health clinic to determine the treatment options available to help cope with the grief. The client begins to sob uncontrollably when attempting to speak to the nurse. Which statement made by the nurse demonstrates support of the client? 1. "Please don't cry. It will make me cry to see you so upset." 2. "I'll be right back with some tissues and a glass of water." 3. "Kidnapping is a terrible thing, but maybe your child will be returned home." 4. "I think you need a long vacation to help you forget all about this situation."
2
11. A client is diagnosed with PTSD. Which treatment modality exposes the client to repeated and prolonged mental recounting of the traumatic event? 1. Cognitive behavior therapy 2. Prolonged exposure therapy 3. Group therapy 4. Eye movement desensitization and reprocessing (EMDR)
2
11. A nursing instructor is teaching students about clients diagnosed with HPD 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."
2
13. A client tells the nurse she is anxious and loudly demands the nurse give her lorazepam right now. The nurse replies, "I understand you are having anxiety; however, demanding medication in a loud voice is unacceptable behavior." Which type of intervention is the nurse implementing? 1. Establishing trust 2. Limit setting 3. Validating feelings 4. Client teaching
2
8. A pessimistic client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which underlying cause of this client's personality disorder should the nurse recognize? 1. Nurturance was provided from many sources, and independent behaviors were encouraged. 2. Nurturance was provided exclusively from one source, and independent behaviors were discouraged. 3. Nurturance was provided exclusively from one source, and independent behaviors were encouraged. 4. Nurturance was provided from many sources, and independent behaviors were discouraged.
2
8. The client is an 18-year-old college student being treated in the community mental health clinic for an adjustment disorder after receiving news of her parents' impending divorce. While talking about her feelings, she becomes angry and starts shouting and crying. She screams, "I wish they would both die!" Which of these is the most appropriate nursing response? 1. Contact the parents and the police to report that the client is expressing homicidal ideation. 2. Encourage the client to talk more about her anger. 3. Instruct the client that it is not acceptable to talk that way about her parents. 4. Assess the client for harming herself or others.
2
9. The adult client is diagnosed with a trauma disorder and is being treated at an inpatient psychiatric unit. Which nursing short-term goal is most appropriate for this client? 1. The client resolves all feelings of survivor's guilt within 1 week. 2. The client demonstrates three relaxation techniques upon discharge. 3. The client moves through all stages of grief within 1 month. 4. The client agrees to seek community resources upon admission.
2
24. The client is a 19-year-old high school student who has been admitted to the psychiatric unit with a diagnosis of adjustment disorder with disturbance of conduct. The client assaulted a teacher after being informed of imminent detentions for a pattern of tardiness. The nurse, while completing rounds, finds the client in their room crying, and one of their wrists is bleeding from a self-inflicted cut made by a piece of metal from an unknown source. Prioritize each of the following nursing interventions from 1 to 5, with 1 being the highest priority. ___ 1. Obtain the client's vital signs. ___ 2. Assess the wound site. ___ 3. Contact the health-care provider. ___ 4. Discuss with the client what precipitated this event. ___ 5. Cleanse and treat the wound site to prevent infection.
2, 1, 5, 3, 4
12. A mother brings her son to the emergency department and tells the nurse that her son must have PTSD because he witnessed a car accident 2 days ago in which there were fatalities. She is convinced that her son has PTSD because he has been crying when he talks about the incident. She believes that boys are at greater risk for PTSD because they don't typically cry. She read on the Internet that PTSD can have dangerous consequences, so she wants her son to get some medication "to cure the PTSD before it gets too bad." Which of these statements by the nurse would accurately correct this mother's misunderstanding about PTSD? Select all that apply. 1. "There are no long-term or dangerous consequences from PTSD." 2. "Women appear to be at greater risk of this disorder than are men." 3. "Medications have been found to be effective in treating symptoms but do not cure the disorder." 4. "Fewer than 10% of trauma victims develop PTSD." 5. "PTSD occurs when there are other underlying mental health issues, such as depression."
2, 3, 4
14. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? Select all that apply. 1. Respiratory therapist 2. Occupational therapist 3. Recreational therapist 4. Psychiatric social worker 5. Mental health technician
2, 3, 4, 5
23. A nursing instructor is lecturing about cognitive behavior therapy. Which of the following are objectives of implementation of this therapy? Select all that apply. 1. To modify automatic thoughts to promote minimization of negative cognitions 2. To apply a variety of methods to create change in an individual's thinking 3. To apply cognitive principles to change an individual's basic schema 4. To modify belief systems to bring about emotional change 5. To modify belief systems to bring about behavioral change
2, 4, 5
15. Which descriptors are true regarding a therapeutic community? Select all that apply. 1. The unit schedule includes unlimited free time for personal reflection. 2. Unit responsibilities are assigned according to client capabilities. 3. A flexible schedule is determined by client needs. 4. The individual is the sole focus of therapy. 5. A democratic form of government exists.
2, 5
1. An angry client on an inpatient unit approaches a nurse, stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? 1. Conflict should be avoided at all costs on inpatient psychiatric units. 2. Conflict should be resolved by the nursing staff. 3. Every interaction is an opportunity for therapeutic intervention. 4. Conflict resolution should be addressed only during group therapy.
3
11. Which client would benefit most from working with a dietitian? 1. A client with anxiety 2. A client with schizophrenia 3. A client with pica 4. A client with bipolar disorder
3
12. A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-lb baby. Which statement by the mother indicates to the nurse the use of the cognitive error of selective abstraction? 1. "My baby is refusing to nurse, and I know it's because she already 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 had my heart set on having twins." 4. "My baby has an elevated bilirubin; I know it will get worse, and she will die."
3
18. Which statement demonstrates that the nurse is using a cognitive approach when teaching a client about panic disorder? 1. "You might want to stay in the house when you notice the symptoms beginning." 2. "Medications such as lorazepam (Ativan) should be taken when symptoms start." 3. "Remind yourself that symptoms of a panic attack are time limited and will end." 4. "Keep a journal to note feelings surrounding the panic attacks."
3
2. A client diagnosed with antisocial personality disorder comes to the nurses' station at 11:00 p.m., requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate? 1. "Go ahead and use the phone. I know this pending divorce is stressful." 2. "You know better than to break the rules. I'm surprised at you." 3. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." 4. "The decision to divorce should not be considered until you have had a good night's sleep."
3
2. Studies have suggested that reexperiencing a traumatic event can become an addiction of sorts. The evidence suggests that the reason for this is which of the following? 1. Those with addictive personalities tend to experience PTSD more often. 2. Perpetuating the traumatic experience yields secondary gains. 3. The reexperiencing of trauma enhances production of endogenous opioid peptides. 4. Concurrent substance abuse issues are symptoms of PTSD.
3
20. A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? 1. "I can't give up alcohol right now because I just gave up smoking." 2. "I just read that red wine has health benefits." 3. "I may have a minor problem, but I can handle it." 4. "I don't drink as much as my spouse, and nobody thinks she has a problem."
3
22. 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?"
3
3. A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? 1. Provide objective evidence that violence is unwarranted. 2. Initially restrain the client to maintain safety. 3. Use clear, calm statements and a confident physical stance. 4. Empathize with the client's paranoid perceptions.
3
3. The client, a rape survivor, is being treated for PTSD. Which of these statements is a good indication that the client is beginning to recover from PTSD? 1. "I still have nightmares every night, but I don't always remember them anymore." 2. "I'm not drinking as much alcohol as I had been over the past several months." 3. "This traumatic event immobilized me for a while, but I have found imagery helpful in reducing my anxiety." 4. "Whenever I am reminded of the rape, I have to hide until the memory goes away."
3
4. A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should the nurse associate with these assessment data? 1. Compulsive personality disorder 2. Schizotypal personality disorder 3. Histrionic personality disorder (HPD) 4. Manic personality disorder
3
4. 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
3
4. The nurse is providing care for clients in a free community clinic. Which technique should the nurse use to conduct a trauma screening? 1. Perform a general environmental survey. 2. Implement a thorough head-to-toe assessment. 3. Interview in a secluded area. 4. Use empathy with the family members.
3
6. The nurse is working in an ED. With which client should the nurse use the screening, brief intervention, and referral to treatment approach (SBIRT)? 1. The patient who has suicidal thoughts 2. The patient who has nonsuicidal self-injuring behavior 3. The patient who has an opioid addiction 4. The patient who has been sexually assaulted
3
7. What is the first step the nurse should take to reduce the stigmatization of mental health clients? 1. Increase social contact with mental health clients. 2. Attend on-the-job training about mental health clients. 3. Have a willingness to interact with mental health clients. 4. Understand the person as a mental health client.
3
7. Which adult client should the nurse recognize as exhibiting the characteristics of a dependent personality disorder? 1. A physically healthy client who is dependent on meeting social needs by having contact with 15 cats 2. A physically healthy client who has a history of depending on intense relationships to meet basic needs 3. A physically healthy client who lives with parents and relies on public transportation 4. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security
3
8. The nurse is providing care to a depressed, introverted client who is recovering from surgery for a fractured hip. Which action should the nurse take to provide client-centered care? 1. Refer the client for involuntary hospitalization. 2. Allow the client plenty of solitude during the day. 3. Involve the client in choosing a blue or green gown to wear. 4. Develop a partnership with the spouse who is not withdrawn.
3
8. The student comes in to the instructor's office and reports that they wish to drop out of nursing school due to the overwhelming work. The instructor advises the student to write assignments and due dates on a calendar to help break down what needs to be done and when. What technique is the instructor using? 1. Activity scheduling 2. Distraction 3. Graded task assignments 4. Behavioral rehearsal
3
9. A client has undergone psychological testing. With which member of the interdisciplinary team would a nurse collaborate to review these results? 1. Psychiatrist 2. Psychiatric social worker 3. Clinical psychologist 4. Clinical nurse specialist
3
9. In which setting should the nurse be aware that the client with a substance use disorder would most likely seek initial treatment? 1. Psychiatric hospital 2. Addiction treatment center 3. Urgent care clinic 4. Inpatient psychiatric unit
3
25. Which of the following statements regarding role-playing is correct? Select all that apply. 1. Role-playing is a type of distractor from negative thinking. 2. The client assumes the role of the antagonist that produces the maladaptive response. 3. The situation is played out to help the client recognize their automatic thinking. 4. Role-play is limited to strong relationships between client and therapist. 5. Role-play teaching increases awareness of controlled breathing.
3, 4
16. Which responsibilities describe those of the psychiatric-mental health nurse on the interdisciplinary treatment team? Select all that apply. 1. Present educational programs for nursing staff. 2. Perform in-depth psychosocial history. 3. Develop one-to-one relationships with clients. 4. Manage the therapeutic milieu on a 24-hour basis. 5. Provide input during the development of the treatment plan.
3, 4, 5
1. The nurse in the emergency department (ED) is assessing a client with a long history of depression. The nurse finds that the client has gained weight, has dry skin, and has cold sensitivity. The nurse determines the client's depression is exacerbating; further examination and testing reveal the client has hypothyroidism. Which phenomenon occurred? 1. Depression screening 2. Social distancing 3. Trauma-informed caring 4. Diagnostic overshadowing
4
10. During an interview, which client statement indicates to the nurse that a potential diagnosis of schizotypal personality disorder should be considered? 1. "I really don't have a problem. My family is inflexible, and every relative is out to get me." 2. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses?'" 3. "I spend all my time tending my bees. I know a whole lot of information about bees." 4. "I am getting a message from the beyond that we have been involved with each other in a previous life."
4
10. Which dining arrangement would the nurse use to best promote a sense of community? 1. Arrange tables for two around the dining room 2. Allow clients to take their meals to their rooms 3. Set up rectangular tables in the shape of a large square around the room to seat everyone 4. Arrange tables seating 5 or 6 clients around the dining room
4
11. A home care nurse notices the client who startles easily is exhibiting signs of posttraumatic stress disorder. The nurse asks, "Have you ever made a suicide attempt?" to which the client responds, "Yes, I have." Which response should the nurse make next? 1. Immediately notify the primary care provider. 2. Gently touch the client's arm. 3. Ask "Why would you do that?" 4. Ask "Are you having thoughts of suicide now?"
4
12. Which nursing diagnosis should the nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? 1. Altered thought processes related to (R/T) increased stress 2. Risk for suicide R/T loneliness 3. Risk for violence: directed toward others R/T paranoid thinking 4. Social isolation R/T inability to relate to others
4
13. A client admitted to a Veterans Administration hospital with a diagnosis of major depressive disorder tells the nurse, "I failed my battalion by giving the wrong order. Fortunately, no one was injured." Which nursing diagnosis will the nurse assign this client? 1. Chronic low self-esteem 2. Risk for self-directed violence 3. Powerlessness 4. Situational low self-esteem
4
14. Which client situation 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."
4
16. A client states, "I keep having horrible nightmares about the car accident that killed my child. I shouldn't have taken her with me to the store." Using a cognitive approach, which nursing reply is most therapeutic? 1. "Are other issues from your past affecting your ability to move on?" 2. "Describe your current feelings about your loss." 3. "Let's talk about something that will help you move on." 4. "Can anyone predict when a car accident will happen?"
4
2. A client on an inpatient unit angrily states to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which response by the nurse is appropriate? 1. "I'll talk to Peter and present your concerns." 2. "Why are you overreacting to this issue?" 3. "You should bring this to the attention of your treatment team." 4. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."
4
2. A psychiatric-mental health nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. Which assessment data will the nurse document? 1. "Thought patterns are triggered by specific stressful stimuli." 2. "Thought patterns contain the client's fundamental beliefs and assumptions." 3. "Thought patterns are flexible and based on personal experience." 4. "Thought patterns include a predominance of automatic thoughts."
4
21. A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of the following? 1. "Try singing 'Happy Birthday' until the voices are gone." 2. "Document what the voices are saying to note cause and effect." 3. "Try listening to music using headphones for distraction." 4. "Remind yourself that the voices are symptoms of your disease."
4
5. An advanced practice nurse recommends that a client participate in cognitive behavior therapy. The client asks, "What's cognitive behavior therapy, and how can it help me?" Which is the nurse's best reply? 1. "It is a system of techniques in which you use positive thinking to improve your mood." 2. "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences." 3. "It is an interpersonal treatment approach that specifically targets magical thinking." 4. "It is a focused treatment for the modification of distorted thinking and maladaptive behaviors."
4
5. The nurse is conducting a grief counseling session for those who have survived a national disaster. Which of the following group member statements shows effective resolution of their complicated grief? 1. "Had I not taken that phone call away from them, I could have saved them." 2. "I only wish I did not call in sick so I could have died with them." 3. "I cannot drive past the building without crying." 4. "I have started to jog every day to help get rid of this tense energy."
4
6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. Which activity would the nurse identify as an appropriate group topic? 1. Dream analysis 2. Creative cooking 3. Paint by number 4. Stress management
4
6. A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. Which is the best technique for the employee health nurse to use to help the employee request the promotion? 1. Socratic questioning 2. Activity scheduling 3. Distraction 4. Cognitive rehearsal
4
7. Which statement made by the nursing student indicates an understanding regarding the role of the social worker? 1. "The social worker can encourage a client to express their feelings through the use of music." 2. "My client has been eating drywall, so I have contacted the social worker to come speak to them." 3. "I have asked the social worker to organize a game of volleyball this weekend." 4. "My client cannot afford medications when they are discharged, so the social worker is arranging some assistance."
4
8. Which statement describes the development of trust between the nurse and client? 1. "You cannot draw a picture until you take your medication." 2. "I am sorry you are angry." 3. "I am going to teach you how to change your dressing." 4. "I will listen if you would like to tell me about your day."
4
25. The client is a 38-year-old Army sergeant who has been admitted to the psychiatric unit with a diagnosis of PTSD. The client witnessed combat partner step on an explosive device that caused the combat partner's body to explode. The client tells the nurse that they have a headache and are going to stay in their room instead of going to the dining room for dinner. When the nurse later checks on the client, the nurse finds them hanging from a fixture in the bathroom. The nurse quickly determines that the client is not conscious. Prioritize each of the following nursing interventions from 1 to 5, with 1 being the highest priority. ___ 1. Begin cardiopulmonary resuscitation (CPR). ___ 2. Assess airway, breathing, and circulation. ___ 3. Notify the client's family. ___ 4. Cut down the client. ___ 5. Call for help.
4, 2, 5, 1, 3
26. According to NANDA International (2012), a disorder that occurs after the death of a significant other or any loss perceived as significant to the individual in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment is referred to as ____________________.
complicated grieving
