PSYCH Unit 4

The nurse is caring for a patient who has been diagnosed with somatic symptom disorder. What teaching about this condition will the nurse provide? A. "Your symptoms are all inside your head" B. "Regular visits with a counselor can be helpful" C. "Certain medications will cure this type of condition" D. "There is no chance you will recover from this disorder"

B. "Regular visits with a counselor can be helpful"

Which assessment findings does the nurse anticipate in a patient with depersonalization disorder? A. Forgetting one's whereabouts B. Reports of feeling in a dreamlike state C. Identifying two or more distinct personalities D. Claiming to be an important historical figure

B. Reports of feeling in a dreamlike state

An older client diagnosed with chronic low back pain with no apparent physical cause receives cooking and cleaning help from her extended family. Which benefit should the mental health nurse conclude is being obtained by the client? A. Malingering B. Secondary gain C. Primary gain D. Attention

B. Secondary gain

A client with somatic symptom disorder has been attending group therapy. Which of the following statements indicates that therapy is having a positive outcome for this client? A. "I feel better physically just from getting a chance to talk." B. "I haven't said much, but I get a lot from listening to others." C. "I shouldn't complain too much; my problems aren't as bad as others'." D. "The other people in this group have emotional problems."

A. "I feel better physically just from getting a chance to talk."

A client treated for a diagnosis of hypochondriasis would demonstrate understanding of the disorder by which statement to the nurse? A. "I know that I don't have a serious illness, even though I still worry about the symptoms." B. "I realize that exposure to toxins can cause significant organ damage." C. "Once my family members realize how severely ill I am, they will be more understanding." D. "I realize that tests and lab results cannot pick up on the seriousness of my illness."

A. "I know that I don't have a serious illness, even though I still worry about the symptoms."

The client has chronic pain to the back and is diagnosed with somatic symptom disorder with predominant pain. Which statement by the client indicates to the nurse that the plan of care has been successful? A. "I realize that my pain can be influenced by stress." B. "I should keep myself pain free by increasing my pain medication as I need it." C. "I should avoid most physical activity." D. "Relaxation techniques only help when I am anxious about my pain."

A. "I realize that my pain can be influenced by stress."

The client is taking alprazolam to reduce anxiety related symptoms. Which statements indicate that the nurse should provide more teaching to the client? Select all that apply. A. "I should stop taking this medication abruptly." B. "I will probably have to take this medication for the rest of my life." C. "I don't need to go to therapy since the medication is working." D. "I might not be able to drive while I am taking this medication." E. "This medication will help alleviate some symptoms of my anxiety."

A. "I should stop taking this medication abruptly." B. "I will probably have to take this medication for the rest of my life." C. "I don't need to go to therapy since the medication is working."

Which medication will the nurse prepare to teach a patient with acute stress disorder? A. Sertraline (Zoloft) B. Fluoxetine (Prozac) C. Prazosin (Minipress) D. Propranolol (Inderal)

D. Propranolol (Inderal)

The nurse is conducting a client teaching session about dissociative disorders. Which client statement indicates to the nurse an understanding of important concepts about the disorder? A. "Dissociative disorders are caused from past use of hallucinogens." B. "People develop dissociative disorders to protect themselves from extreme anxiety." C. "People with dissociative disorder usually have gradual loss of memory for names and phone numbers." D. "Dissociative disorders serve as a means of avoiding adult responsibilities."

B. "People develop dissociative disorders to protect themselves from extreme anxiety."

The nurse has taught a client experiencing dissociative amnesia about therapeutic methods for memory retrieval. The nurse should determine that the instruction has been effective when the client makes which statement? A. "I'm a little uneasy about being hypnotized, but it does help release memories." B. "Even if it does uncover hidden memories, I don't want to have electroconvulsive therapy." C. "Anxiety causes this memory problem, and antianxiety agents will greatly reduce it." D. "If I use relaxation techniques properly, my memories will come back quickly."

A. "I'm a little uneasy about being hypnotized, but it does help release memories."

The spouse of a woman diagnosed with somatic symptom disorder tells the nurse that he "is running out of patience with her" and feels that "she has all of those health problems on purpose." What is the best response by the nurse? A. "She doesn't have the problem on purpose; however, this is probably difficult for both of you." B. "Have you tried asking her? I think she'd tell you the truth." C. "She has some significant emotional problems that she cannot admit." D. "Your wife is trying to gain your attention."

A. "She doesn't have the problem on purpose; however, this is probably difficult for both of you."

The client with OCD has counting and checking rituals that prolong attempts to perform ADLs and get ready for activities of the day. The nurse knows that interrupting the client's ritual to assist in faster task completion will likely result in A. A burst of increased anxiety. B. Gratitude for the nurse's assistance. C. Relief from stopping the ritual. D. Symptoms of depression or suicidality.

A. A burst of increased anxiety.

The client's family asks the nurse, "What is illness anxiety disorder?" The best response by the nurse is, "Illness anxiety disorder is A. A persistent preoccupation with getting a serious disease." B. An illness not fully explained by a diagnosed medical condition." C. Characterized by a variety of symptoms over a number of years." D. The eventual result of excessive worrying about diseases."

A. A persistent preoccupation with getting a serious disease."

The nurse assessing the client in a fugue state should look for which of the following? Select all that apply. A. A recent history of being raped B. Dissociative episodes C. A history of childhood trauma D. Coexisting depression E. Exposure to a major stressor

A. A recent history of being raped E. Exposure to a major stressor

Which of the following would be an appropriate intervention for a client with OCD who has a ritual of excessive, constant cleaning? A. A structured schedule of activities throughout the day B. Intense psychotherapy sessions daily C. Interruption of rituals with distracting activities D. Negative consequences for ritual performance

A. A structured schedule of activities throughout the day

The nurse understands that secondary gain for the client with a somatic symptom illness can include A. Acceptable absence from work. B. Freedom from daily chores. C. Increased attention from family. D. Provision of care by others. E. Resolution of family conflict. F. Temporary relief of anxiety.

A. Acceptable absence from work B. Freedom from daily chores. C. Increased attention from family. D. Provision of care by others.

Clients from other countries who suffered traumatic oppression in their native country may develop PTSD. Which of the following is least helpful in dealing with their PTSD? A. Assimilating quickly into the culture of their current country of residence. B. Engaging in their native religious practices. C. Maintaining a strong cultural identity. D. Social support from an interpreter or fellow countryman.

A. Assimilating quickly into the culture of their current country of residence.

Education for clients with PTSD should include which of the following? A. Avoid drinking alcohol. B. Discuss intense feelings only during counseling sessions. C. Eat well-balanced, nutritious meals. D. Find and join a support group in the community. E. Get regular exercise, such as walking. F. Try to solve an important problem independently.

A. Avoid drinking alcohol. C. Eat well-balanced, nutritious meals. D. Find and join a support group in the community. E. Get regular exercise, such as walking.

A client with OCD is admitted to the hospital due to ritualistic hand washing that occupies several hours each day. The skin on the client's hands is red and cracked, with evidence of minor bleeding. The goal for this client is A. Decreasing the time spent washing hands. B. Eliminating the hand washing rituals. C. Providing milder soap for hand washing. D. Providing good skin care.

A. Decreasing the time spent washing hands.

Interventions for a client with panic disorder would include A. Encouraging the client to verbalize feelings. B. Helping the client to avoid panic-producing situations. C. Reminding the client to practice relaxation when anxiety level is low. D. Teaching the client reframing techniques. E. Teaching relaxation exercises to the client. F. Telling the client to ignore any anxious feelings.

A. Encouraging the client to verbalize feelings. C. Reminding the client to practice relaxation when anxiety level is low. D. Teaching the client reframing techniques. E. Teaching relaxation exercises to the client.

The nurse is working with a client who is severely anxious. The nurse should identify which nursing concern as having highest priority for the client at this time? A. Ensuring the client is safe B. Trying to get the patient to socialize C. Addressing maladaptive coping D. Discussing the denial aspects of the problem

A. Ensuring the client is safe

The client diagnosed with body dysmorphic disorder says to the nurse, "I can't get rid of the idea that my ears are weird-looking." What would be the most appropriate outcome criterion for this client? A. Explore possible explanations for dissatisfaction with body image. B. Consider plastic surgery to reshape the ears. C. List three benefits of having unusual ears. D. Understand how body image is affected by maturation.

A. Explore possible explanations for dissatisfaction with body image.

A client says to the nurse, "I know you think this is in my head, but my pelvic pain is real. I have a serious malignancy and am going to die." The healthcare provider just informed the client that no abnormalities were found after extensive diagnostic testing. What is the nurse's best response? A. "I guess it could be true. Sometimes healthcare providers miss a diagnosis." B. "It must be hard for you to accept the testing results." C. "I realize that you do have pain and hurt a lot." D. "How about resting now and asking your healthcare provider more about it later?"

B. "It must be hard for you to accept the testing results."

Which nursing intervention approaches might be effective for the nurse to take when caring for a client diagnosed with body dysmorphic disorder (BDD) who is preoccupied with a mole on her face? Select all that apply. A. Focus on the client's positive relationships with family members. B. Explain to the client that her perception of the mole is absolutely a misperception, and that it is all "in her head." C. Teach the client meditation and breathing relaxation techniques. D. Respect the client's preoccupation with the perceived physical defect. E. Encourage the client to participate in a self-help group.

A. Focus on the client's positive relationships with family members. C. Teach the client meditation and breathing relaxation techniques. D. Respect the client's preoccupation with the perceived physical defect. E. Encourage the client to participate in a self-help group.

Nursing assessment indicates that a client is experiencing a panic attack shortly after arriving alone to the emergency department. The client states he is afraid, is unable to understand directions from the nurse, and manifests disorganized thinking. Which should be the priority nursing concern? A. Impaired cognition B. Impaired communication C. Flight risk D. Lack of social support systems

A. Impaired cognition

For a client diagnosed with a somatic symptom disorder, the nurse plans to write which priority nursing concerns in the client's plan of care? Select all that apply. A. Inability to cope B. Problems with role performance C. Ineffective oxygenation D. Health-seeking behavior E. Risk for violence inflicted on self

A. Inability to cope B. Problems with role performance

The nurse who is assessing a client with PTSD would expect the client to report which of the following? A. Inability to relax B. Increased alcohol consumption C. Insomnia even when very fatigued D. Suspicion of strangers E. Talking about problems to friends F. Wanting to sleep all the time

A. Inability to relax B. Increased alcohol consumption C. Insomnia even when very fatigued D. Suspicion of strangers

Which of the following characteristics describe the obsessional thoughts experienced by client's with OCD? A. Intrusive B. Realistic C. Recurrent D. Uncontrollable E. Unwanted F. Voluntary

A. Intrusive C. Recurrent D. Uncontrollable E. Unwanted

A hospitalized client diagnosed with a somatic symptom disorder asks for as needed (prn) medication for complaints of abdominal pain. What is the nurse's best response? A. Matter-of-factly assess the pain and administer prn medication. B. Teach the client to take slow, deep breaths. C. Delay fulfilling request for medication to see if the pain subsides first. D. Inform the client of negative gastroscopy findings.

A. Matter-of-factly assess the pain and administer prn medication.

The nurse has established the following long term goal for a client who has chronic anxiety: "The client will learn new ways of coping with anxiety." For which level of anxiety is this goal most appropriate? A. Moderate B. Severe C. Panic D. Mild

A. Moderate

Flashbacks of an unpleasant, terrifying, or painful experience are associated with which trauma- and stressor-related disorder? A. PTSD B. RAD C. AID D. DSED

A. PTSD

The nurse should select which nursing concerns as appropriate priorities for a client experiencing a fugue state? Select all that apply. A. Posttraumatic stress syndrome B. Impaired self-esteem C. Disruption of family processes D. Anxiety E. Relocation-related stress

A. Posttraumatic stress syndrome D. Anxiety

The nurse is caring for a 6-year-old patient with new-onset OCD-type behaviors after a strep infection. What will the nurse teach the family? A. The behavior may have been triggered by an immune response B. OCD is harmless and will go away quickly C. There is a concern that this condition may be contagious D. Medication therapy is required for the child to recover

A. The behavior may have been triggered by an immune response

Which of the following is true about clients with illness anxiety disorder? A. They may interpret normal body sensations as signs of disease. B. They often exaggerate or fabricate physical symptoms for attention. C. They do not show signs of distress about their physical symptoms. D. All the above are true statements.

A. They may interpret normal body sensations as signs of disease.

The client is experiencing a panic attack. Which actions by the nurse would be appropriate at this time? Select all that apply. A. Use short simple sentences. B. Speak loudly and firmly. C. Teach cognitive restructuring skills. D. Restrict the client's physical activity. E. Remain calm and serene.

A. Use short simple sentences. E. Remain calm and serene.

Clients with OCD often have exposure/response prevention therapy. Which of the following statements by the client would indicate positive outcomes for this therapy? A. "I am able to avoid obsessive thinking." B. "I can tolerate the anxiety caused by obsessive thinking." C. "I no longer have any anxiety when I have obsessive thoughts." D. "I no longer feel a compulsion to perform rituals."

B. "I can tolerate the anxiety caused by obsessive thinking."

The nurse has been caring for a client with posttraumatic stress disorder (PTSD). Which statement by the client would indicate the most improvement? A. "I am responsible for what happened to me." B. "I enjoy being back at work with my friends." C. "I like to stay awake all night." D. "I can't relax. I stay alert all the time."

B. "I enjoy being back at work with my friends."

A client diagnosed with a somatic symptom disorder has been attending group therapy on a regular basis. Which client statement suggests to the nurse that the therapy has been effective? A. "I think I'd better get some pain pills. My back hurts from sitting in group." B. "I feel better physically just from getting a chance to talk." C. "The other people in the group have mental problems!" D. "I haven't said much, but I get a lot out of listening."

B. "I feel better physically just from getting a chance to talk."

The nurse is caring for a patient being evaluated for body dysmorphic disorder (BDD). Which statement requires immediate attention? A. "I am worried that I might have cancer" B. "I lift for 3 hours a day because my body is never big enough" C. "I think i could lose a few pounds before the end of the year" D. "My breasts cause me back pain; I would like a reduction"

B. "I lift for 3 hours a day because my body is never big enough"

The nurse has taught an anxious client a relaxation technique. The nurse should evaluate the effect of the instruction on which client goals? Select all that apply. A. "The client will keep a journal of times anxiety is experienced." B. "The client will experience anxiety without feeling overwhelmed." C. "The client will work through problems without being devastated."D. "The client will confront the source of the anxiety." E. "The client will suppress anxious feelings."

B. "The client will experience anxiety without feeling overwhelmed." C. "The client will work through problems without being devastated."

The spouse of a client who is experiencing a fugue state asks the nurse if the spouse will be able to remember what happened during the time of the fugue. What is the nurse's best response? A. "Avoid mentioning it, or your spouse may start alternating old and new identities." B. "Your spouse will probably have no memory of events during the fugue." C. "Your spouse will be able to tell you —if you can gently encourage talking." D. "It is not possible to predict whether your spouse will remember the fugue state."

B. "Your spouse will probably have no memory of events during the fugue."

When caring for a client diagnosed with hypochondriasis, the nurse should take which of the following actions? A. Encourage the client to seek second opinions about the symptoms experienced. B. Assist the client to identify relationships between life events and physical symptoms. C. Explore the details and history of the client's early life and illnesses. D. Have the spouse encourage the client to talk more about the symptoms.

B. Assist the client to identify relationships between life events and physical symptoms.

Which risk factor does the nurse identify that may contribute to DID? Select all that apply. A. History of seizures B. Emotional, physical, or sexual abuse C. Genetic predisposition D. Extreme stress and trauma E. Cardiac structural anomalies

B. Emotional, physical, or sexual abuse C. Genetic predisposition D. Extreme stress and trauma

When planning care for a client with somatic symptom disorder, the nurse would include the following interventions: A. Confront the client with negative results from diagnostic testing. B. Encourage the client to participate in daily routine activities. C. Help the client see the relationship between physical symptoms and life stress/events. D. Provide additional 1:1 attention when the client discusses physical symptoms. E. Refuse to discuss or listen to any physical complaints the client may express. F. Validate the client's physical and emotional distress.

B. Encourage the client to participate in daily routine activities. C. Help the client see the relationship between physical symptoms and life stress/events. F. Validate the client's physical and emotional distress.

The best goal for a client learning a relaxation technique is that the client will A. Confront the source of anxiety directly. B. Experience anxiety without feeling overwhelmed. C. Report no episodes of anxiety. D. Suppress anxious feelings.

B. Experience anxiety without feeling overwhelmed.

The nurse is caring for a patient recently diagnosed with OCD. Which first line of treatment does the nurse anticipate will be prescribed? A. Duloxetine B. Fluvoxamine C. Alprazolam D. Clomipramine

B. Fluvoxamine

Emotion-focused coping strategies are designed to accomplish which of the following outcomes? A. Helping the client manage difficult situations more effectively. B. Helping the client manage the intensity of symptoms. C. Teaching the client the relationship between stress and physical symptoms. D. Relieving the client's physical symptoms.

B. Helping the client manage the intensity of symptoms.

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal? A. Suppressing feelings of anxiety B. Identifying anxiety-producing situations C. Continued contact with a crisis counselor D. Eliminating all anxiety from daily situations

B. Identifying anxiety-producing situations

The nurse formulates which priority nursing concern for a client experiencing amnesia associated with high levels of anxiety? A. Confusion B. Inability to cope C. Impaired sensory perception D. Powerlessness

B. Inability to cope

Which of the following is the most appropriate priority nursing concern for a client with somatic symptom disorder with predominant pain who is homebound and unable to work in his previous profession for the past two years? A. Risk of sustaining injury B. Inability to perform role C. Impaired sensory perception D. Anxiety

B. Inability to perform role

The nurse assessing a client with dissociative identity disorder (DID) expects to note which of the following manifestations? Select all that apply. A. Elated mood B. Irritable bowel syndrome C. History of headaches D. Intact memory for recent and remote events E. Asthma

B. Irritable bowel syndrome C. History of headaches E. Asthma

When completing the nursing history, what should the nurse expect the client who is diagnosed with somatic symptom disorder to reveal? A. Ignoring physical symptoms until role performance was altered B. Numerous physical symptoms in many organ systems C. Episodes of personality dissociation D. Abrupt onset of physical symptoms at menopause

B. Numerous physical symptoms in many organ systems

A client is brought to the emergency room after a brutal physical assault. Although oriented and coherent, the client cannot remember the assault or events surrounding it. Which nursing intervention should be the priority of the nurse? A. Referral to a community support group B. Physical comfort and safety C. Thoughtful questioning for the police report D. Frequent reality orientation

B. Physical comfort and safety

Which statement describes the etiology of somatization disorder from a learning theory perspective? A. Studies have shown that there is an increase in the predisposition of somatization disorder in first-degree relatives B. Positive reinforcement of somatic symptoms encourages behaviors to continue. C. A client views self as "bad" and considers physical suffering as deserved and required atonement D. The use of physical symptoms is a response to repressed severe anxiety

B. Positive reinforcement of somatic symptoms encourages behaviors to continue

What would be the best nursing action for the nurse to implement for a client who is having a panic attack? A. Instruct the client to remain alone until the symptoms subside. B. Remain with the client. C. Ask the client to describe what was happening before the anxiety began. D. Teach the client to recognize signs of a panic attack.

B. Remain with the client.

During client assessment, the nurse finds that the client is trembling and restless, blood pressure and pulse are elevated, heart is pounding. The client reports nausea, headache, and dizziness. His behavior is highly disorganized. The nurse should conclude that this client is experiencing which level of anxiety? A. Mild B. Severe C. Panic D. Moderate

B. Severe

During an assessment interview the client says, "I can't stop worrying about my makeup. I can't go anywhere nor do anything unless my makeup is fresh and perfect. I wash my face and put on fresh makeup at least once and sometimes twice an hour." The nurse's priority should be to adjust the client's plan of care so that which of the following will happen? A. The client will be asked to keep a diary of feelings experienced if unable to groom self at will. B. The client will be given advance notice of approaching time for all group therapy sessions. C. The client will be required to spend daytime hours out of own room. D. The client will be allowed to use own cosmetics and grooming products.

B. The client will be given advance notice of approaching time for all group therapy sessions.

The nurse should conclude that client education to manage dissociative episodes is effective if the client states to do which of the following if he starts to dissociate? A. "Begin my relaxation technique." B. "Focus on my internal feelings." C. "Focus on what I can see and hear externally." D. "Immediately take my antianxiety medication."

C. "Focus on what I can see and hear externally."

Which of the following statements would indicate that teaching about somatic symptom disorder has been effective? A. "The doctor believes I am faking my symptoms." B. "If I try harder to control my symptoms, I will feel better." C. "I will feel better when I begin handling stress more effectively." D. "Nothing will help me feel better physically."

C. "I will feel better when I begin handling stress more effectively."

A client treated for a diagnosis of hypochondriasis has an upsetting phone conversation with her husband and subsequently requests an analgesic. The client states, "My head is killing me, and I know there is a tumor in there somewhere, or it wouldn't hurt like this." What is the nurse's best response? A. "You must try not to rely on the pain pills so much since they are addictive." B. "I'll get your vital signs and then call your healthcare provider if they are abnormal." C. "I'll get your medication and then let's talk about what just happened." D. "You have no brain tumor. It is just your anger toward your husband."

C. "I'll get your medication and then let's talk about what just happened."

Signs and symptoms of dissociative amnesia with dissociated fugue are most pronounced.... A. Weeks before the fugue episode B. During the fugue episode C. After the fugue episode D. Moments before the onset of the fugue episode

C. After the fugue episode

When communicating with a client in a panic state, the nurse should ensure that statements made to the client have which characteristics? A. Are avoided until the client brings up the subject B. Are abstract and nonthreatening C. Are short, firm, and simple D. Are avoided until the anxiety disappears

C. Are short, firm, and simple

The nurse should prioritize which nursing intervention for a client recently admitted to an inpatient unit with a dissociative disorder? A. Increasing sensory stimulation B. Working through past trauma C. Creation of a calm, safe environment D. Promoting social skills

C. Creation of a calm, safe environment

A client is diagnosed with depersonalization/derealization disorder. Which client data is the nurse likely to gather during the assessment? Select all that apply. A. Amnesia about the event B. Indifference to the symptoms C. Feelings like "being in a dream" D. Feeling like a robot E. Two or more personalities

C. Feelings like "being in a dream" D. Feeling like a robot

When working with a client with moderate anxiety, the nurse would expect to see A. Inability to complete tasks. B. Failure to respond to redirection. C. Increased automatisms or gestures. D. Narrowed perceptual field. E. Selective attention. F. Inability to connect thoughts independently.

C. Increased automatisms or gestures. D. Narrowed perceptual field. E. Selective attention. F. Inability to connect thoughts independently.

Which of the following interventions would be most helpful for a client with dissociative disorder having difficulty expressing feelings? A. Distraction B. Reality orientation C. Journaling D. Grounding techniques

C. Journaling

Which of the following does the nurse expect to assess when taking the history of a client with a diagnosis of somatic symptom disorder with predominant pain? A. Insight into relationship between stress and pain B. Good responses to past pharmacological treatment C. Pain does not respond well to medication D. Indifference to the discomfort of pain

C. Pain does not respond well to medication

A client who developed numbness in the right hand could not play the piano at a scheduled recital. The consequence of the symptom, not having to perform, is best described as A. Emotion-focused coping B. Phobia C. Primary gain D. Secondary gain

C. Primary gain

Before a newly admitted anxious client begins treatment with benzodiazepines, it is most important for the nurse to make which client assessment? A. Situational and social support B. Stressors and use of coping mechanisms C. Recent use of alcohol or other depressants D. Level of motivation for treatment

C. Recent use of alcohol or other depressants

Which of the following would be the best intervention for a client having a panic attack? A. Involve the client in a physical activity. B. Offer a distraction such as music. C. Remain with the client. D. Teach the client a relaxation technique.

C. Remain with the client.

While taking the nursing history, a client with body dysmorphic disorder says, "After three surgeries, my jaw line still isn't right. Plus, it took five surgeries before my nose was finally fixed." What would be the most appropriate priority nursing concern? A. Changes in sense of identity B. Potential for self-harm C. Self-consciousness regarding body image D. Interest in improving health behaviors

C. Self-consciousness regarding body image

The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as A. Mild B. Moderate C. Severe D. Panic

C. Severe

A client with GAD states, "I have learned that the best thing I can do is to forget my worries." How would the nurse evaluate this statement? A. The client is developing insight. B. The client's coping skills have improved. C. The client needs encouragement to verbalize feelings. D. The client's treatment has been successful.

C. The client needs encouragement to verbalize feelings.

Which of the following is true about touching a client who is experiencing a flashback? A. The nurse should stand in front of the client before touching. B. The nurse should never touch a client who is having a flashback. C. The nurse should touch the client only after receiving permission to do so. D. The nurse should touch the client to increase feelings of security.

C. The nurse should touch the client only after receiving permission to do so.

A client who has refused to take the regular prescribed dose of clonazepam reports irritability, insomnia, tremors, and agitation. The nurse should conclude that the client is most likely experiencing symptoms associated with which of the following? A. Anxiety B. Manipulation C. Withdrawal D. Overdose

C. Withdrawal

A client with dissociative identity disorder (DID) suddenly has a change in voice quality and sentence structure. What is the most therapeutic response by the nurse? A. "This behavior keeps you from working on your problems." B. "I wonder why you're not acting your age." C. "You must be feeling very needy." D. "Can you tell me what is happening?"

D. "Can you tell me what is happening?"

A client has obsessive-compulsive disorder (OCD). Which statement made by the client to the nurse would be the best indicator of improvement? A. "I know that my thoughts and behaviors are not normal." B. "I only do my ritual to reward myself when I have been good." C. "My friends don't know about my disorder." D. "I have more control over my thoughts and behaviors."

D. "I have more control over my thoughts and behaviors."

A female client with an eight-year history of a diagnosis of somatic symptom disorder is to be discharged from the first psychiatric hospitalization. Which client statement indicates that nursing care has been effective for the client? A. "What I have is called a factitious disorder." B. "I need to make sure that all of my medications are sent home with me." C. "My family is so good to me when I am sick like this." D. "I see now that when I get stressed, my 'body' speaks for me."

D. "I see now that when I get stressed, my 'body' speaks for me."

A nursing assistant (NA) asks for advice about talking with a client recently diagnosed with dissociative identity disorder (DID). What would be the nurse's best response when the NA asks, "Should I talk about her childhood abuse?" A. "You will need to really push her to get it all out." B. "Ask her to discuss this only with her therapist." C. "Remind her that sometimes adults exaggerate their childhood experiences." D. "If she brings up the abuse, listen to her and be supportive."

D. "If she brings up the abuse, listen to her and be supportive."

The client who has dissociative identity disorder (DID) is now 20 minutes late for cognitive therapy group. The client says, "I was never told to go to that group." What is the nurse's best response? A. "Have you thought about just why you might be resisting treatment?" B. "You can't get out of group that easily." C. "People with dissociative identity disorder forget quite a bit." D. "It is possible that you were not aware of group time."

D. "It is possible that you were not aware of group time."

A client states, "I am always late for everything because I can't leave my room without checking every drawer and door to make sure they are locked. If I don't do that, I get so worried that I have to go back. I can't seem to stop my behavior." The nurse should take which action at this time? A. Explore childhood experiences that may have led to the behavior. B. Encourage the client to remain in the room until the urge to recheck has decreased. C. Remind the client that the staff will not allow others to enter the room. D. Allow the client adequate time to carry out the ritual.

D. Allow the client adequate time to carry out the ritual.

A client with dissociative identity disorder (DID) suddenly begins to speak with a child's vocabulary and voice. The nurse should interpret this as which of the following? A. An attempt to gain attention B. Malingering C. A state of depersonalization D. Changing to a child alter

D. Changing to a child alter

The nurse is caring for a patient who reports having six different personalities. The nurse associates this assessment finding with which disorder? A. Dissociative fugue B. Depersonalization disorder C. Dissociative amnesia D. DID

D. DID

Which therapy technique has been found to be useful in the treatment of OCD? A. Aversion therapy B. Guided self-help therapy C. Rapid eye movement therapy D. Exposure and response prevention (ERP)

D. Exposure and response prevention (ERP)

The nurse working with a client during a flashback says, "I know you're scared, but you're in a safe place. Do you see the bed in your room? Do you feel the chair you're sitting on?" The nurse is using which of the following techniques? A. Distraction B. Reality orientation C. Relaxation D. Grounding

D. Grounding

A client who is receiving an anxiolytic medication is reluctant to participate in group therapy. The client states, "The pills I am taking will take care of my stress. I don't need to talk about my problems." What explanation should the nurse include in a response to the client's statement? A. The client will need to attend group therapy only until the medication becomes effective. B. The medications will not work unless the client participates in group therapy. C. Many anxiolytics are habituating. D. Medications relieve symptoms but do not change the source of the anxiety.

D. Medications relieve symptoms but do not change the source of the anxiety.

Paroxetine (Paxil) has been prescribed for a client with a somatic symptom illness. The nurse instructs the client to watch out for which of the following side effects? A. Constipation B. Increased appetite C. Increased flatulence D. Nausea

D. Nausea

Interventions for a client with OCD would include A. Encouraging the client to verbalize feelings. B. Helping the client to avoid obsessive thinking. C. Interrupting rituals with appropriate distractions. D. Planning with the client to limit rituals. E. Teaching relaxation exercises to the client. F. Telling the client to tolerate any anxious feelings.

D. Planning with the client to limit rituals. E. Teaching relaxation exercises to the client. F. Telling the client to tolerate any anxious feelings.

A client with dissociative identity disorder (DID) is admitted after an overdose of alcohol and benzodiazepines, claiming that "another alter did it." The nurse should formulate which of the following as the priority nursing concern? A. Anxiety B. Posttraumatic stress syndrome C. Personal identity disturbance D. Risk for violence inflicted on self

D. Risk for violence inflicted on self

Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiologic dependence? A. Benzodiazepines B. Tricyclics C. Monoamine oxidase inhibitors D. Selective serotonin reuptake inhibitors

D. Selective serotonin reuptake inhibitors

When assessing a client with anxiety, the nurse's questions should be A. Avoided until the anxiety is gone. B. Open ended. C. Postponed until the client volunteers information. D. Specific and direct.

D. Specific and direct.

A client with generalized anxiety disorder states, "I now know the best thing for me to do is just to try to forget my worries." How should the nurse evaluate this statement? A. The client is developing insight. B. The nurse-client relationship should be terminated. C. The client's coping skills are improving. D. The client needs to be encouraged to verbalize feelings.

D. The client needs to be encouraged to verbalize feelings.

A client reports episodic depersonalization experiences to the nurse. Which of the following would be an appropriate goal of care? A. The client will state five personal strengths by day two. B. The client will create a chart of all personalities by week one. C. The client will report no suicidal thoughts by week one. D. The client will describe three stress management techniques by day two.

D. The client will describe three stress management techniques by day two.

The nurse should formulate which goal as most appropriate for a client who has been diagnosed as having generalized anxiety disorder (GAD)? A. The client will relive the traumatic event. B. The client will describe dissociative experiences. C. The client will verbalize a sense of control over ritualistic behaviors. D. The client will display the ability to cope with mild anxiety.

D. The client will display the ability to cope with mild anxiety.

A client with anxiety is beginning treatment with lorazepam (Ativan). It is most important for the nurse to assess the client's A. Motivation for treatment. B. Family and social support. C. Use of coping mechanisms. D. Use of alcohol.

D. Use of alcohol.

Nursing interventions for hospitalized clients with PTSD include A. Encouraging a thorough discussion of the original trauma. B. Providing private solitary time for reflection. C. Time-out during flashbacks to regain self-control. D. Use of deep breathing and relaxation techniques.

D. Use of deep breathing and relaxation techniques.