Psychosocial Integrity (HESI Compass Practice Questions)

Which brain structure abnormalities would the nurse identify as being seen on imaging among people with schizophrenia spectrum disorders? Select all that apply. One, some, or all responses may be correct. Reduced volume in the right anterior insula Reduced connectivity among various brain regions Excess gray matter in the dorsolateral prefrontal cortex area Reduced volume and changes in the shape of the hippocampus Reduced neuronal growth in some areas due to excess neuronal pruning

Reduced volume in the right anterior insula Reduced connectivity among various brain regions Reduced volume and changes in the shape of the hippocampus Brain images from people with schizophrenia spectrum disorders demonstrate reduced volume in the right anterior insula, reduced connectivity among various brain regions, and reduced volume and changes in the shape of the hippocampus. These individuals will not demonstrate excess gray matter, but gray matter deficits in the dorsolateral prefrontal cortex area, thalamus, and anterior cingulate cortex, as well as the frontotemporal, thalamocortical, and subcortical-limbic circuits. People with schizophrenia spectrum disorders have also proved to have neuronal overgrowth in some areas, believed to be due to inflammation or inadequate neuronal pruning.

Which advice would the school nurse provide to the parent who wants to improve their child's performance on schoolwork? "Praise your child's accomplishments." "Compare your child's work with that of more successful children." "Allow your child to play more and don't focus too much on academics." "Complete some of the harder tasks until your child gains comprehension."

"Praise your child's accomplishments." Praising accomplishments motivates a child to continue to do well because the child associates effort with increased success. Comparing a child with other children may result in decreased self-confidence, which in turn could result in poorer performance. Although it is important to allow children time for play, it is also important that the school-aged child achieve mastery of the tasks necessary for school success. Completing tasks for the child fosters dependence and a sense of inferiority.

When the spouse of a client with chest pain repeatedly expresses concern about the client's pallor, which response by the nurse is best? "Paleness is not always a sign that something is wrong." "Skin color really varies quite a bit from person to person." "We will be drawing blood to check your spouse for anemia." "Tell me why you are concerned about your spouse's paleness."

"Tell me why you are concerned about your spouse's paleness." Because the spouse has repeatedly expressed the concern about the client's skin color, asking about why the spouse is concerned recognizes that this is something of high importance for the spouse and shows that the nurse is listening to the concerns. In addition, it gives the spouse a chance to share information that may be useful to the care of the client, such as usual skin color and any history of anemia or other relevant diagnoses. The statement that paleness is not always a sign that something is wrong is true, but it discourages further sharing of information or concerns by the spouse. It is true that skin color varies from person to person, but this response fails to recognize that the spouse knows this specific client well and has valuable information to share. In telling the spouse that blood will be drawn to check for anemia, the nurse makes a possible false assumption that the spouse is concerned about anemia.

A client who exhibits blurred and double vision and muscular weakness is informed of the diagnosis of multiple sclerosis (MS). The client becomes visibly upset. Which response would the nurse make? "That must have shocked you. Tell me what the health care provider told you about it." "You should see a psychiatrist who will help you cope with this overwhelming news." "Don't worry; early treatment often alleviates the symptoms of the disease." "You should be glad that we caught it early so you can be cured."

"That must have shocked you. Tell me what the health care provider told you about it." The response "That must have really shocked you. Tell me what the health care provider told you about it" acknowledges the effect of the diagnosis on the client and explores what is known. There is no evidence of ineffective coping, so a referral to a psychiatrist is not necessary. The statement "Don't worry; early treatment often alleviates symptoms of the disease" provides false reassurance. The statement "You should be glad we caught it early so it can be cured" does not address the client's current emotional state, and it is inaccurate; MS is a chronic autoimmune disease.

A primipara who was exhausted after a long labor requested time to rest before rooming in with her infant. After awakening and having the infant brought back to her, she asks whether she may undress him. How would the nurse respond? "I'll help you undress the baby." "This is important for you. Of course you can undress your baby." "You should wait a few hours, until your baby's temperature has stabilized." "Let's walk back to the nursery. We'll put the baby in a heated crib so you can undress him."

"This is important for you. Of course you can undress your baby." One aspect of the attachment or bonding process is the parents' need to touch, hold, and observe their newborn; this is facilitated by encouraging the mother to undress, gaze at, and hold her newborn. If not asked for help, the nurse would honor the mother's request and encourage her to undress, touch, and hold her baby. A healthy naked newborn can withstand the temperature variation in the mother's room especially if placed skin to skin with the mother whose body warmth can help maintain the newborn's temperature.

The grieving wife of a client who has just died says, "We should've spent more time together. I always felt that the children's needs came first." Which reflective response will the nurse use? "You feel resentful towards your children because you met their needs first." "You put the children first and your marital relationship suffered." "You feel guilty, but it sounds like you were caring for the family." "Your husband should have spent time helping you with the children."

"You feel guilty, but it sounds like you were caring for the family." The nurse reflects the expected feelings of guilt associated with the death of a loved one; there is initially guilt over what might have been. The nurse might use the other options if there were nonverbal behaviors that indicated resentment or ambivalence towards the children or the deceased spouse.

The nurse is planning a teaching session for the parents of a toddler. Which statement regarding toddler behavior indicative of centration would the nurse include in the session? "Your child may yell at the chair for causing a fall." "Your child may not want to eat certain foods because of its color." "Your child may not be able to understand that others have a different perspective." "Your child may refuse to sleep in the bedroom if the bed is moved to another location."

"Your child may not want to eat certain foods because of its color." Not wanting to eat food because of its color is an example of centration. Yelling at the chair for causing a fall is an example of animism. Refusal to sleep in a bedroom because the bed has been moved to another location is an example of global organization. Egocentrism causes the toddler-age client to be unable to understand a different perspective.

An adult child of a dying client says to the nurse, "I am so upset because my parent is always angry at me." Which would be the correct response by the nurse? "Your parent is frightened by impending death." "Your parent is working through acceptance of the situation." "Your parent is attempting to reduce your need for dependency." "Your parent is hurt that you will not provide physical care at home."

"Your parent is working through acceptance of the situation." Understanding the stages leading to the acceptance of death may help the family member understand the client's moods and anger. The parent may not be frightened unless stated by the client; some clients welcome death as a release from pain. It is unlikely that the parent is attempting to reduce the family member's need for dependency; anger is one of the stages of accepting death. It is an assumption by the nurse that the parent is hurt that the family member will not provide physical care at home unless stated by the client.

A client with generalized anxiety disorder presents with restlessness and fatigue. Which additional clinical manifestation would the nurse monitor for? Hoarding Panic attacks Excessive worry Fear of leaving the house

Excessive worry The nurse would monitor for excessive worry. Generalized anxiety disorder is the manifestation of both physical and cognitive symptoms of chronic or excessive anxiety/worry. Hoarding is a sign of hoarding disorder, not generalized anxiety disorder. Panic attacks occur in panic disorder, not generalized anxiety disorder. Fear of leaving the house is a symptom of agoraphobia, not generalized anxiety disorder.

Which client finding would indicate that the therapy is beginning to be effective in a client with anorexia nervosa? Hides food in clothes pockets States that the hospitalization has been helpful Has gained 6 lb (2.7 kg) since admission 3 weeks ago Remains in the dining room eating for 1 hour after others have left

Has gained 6 lb (2.7 kg) since admission 3 weeks ago Gaining weight is a sign of improvement in a client with anorexia nervosa. Weight gain of 6 lb (2.7 kg) since admission 3 weeks ago is objective proof that the client's eating behaviors have improved. "Stashing" of food is a characteristic of an eating disorder, not a sign of improvement. The statement that the hospitalization has been helpful is subjective information and may be manipulative. "Marathon meals" with little actual food ingestion are common in people with anorexia. Remaining in the dining room eating for 1 hour after others have left is not improvement.

Which goal would the nurse include for a client who is wanting to learn more effective ways to handle stressful situations? Identify unhealthy habits that need to be altered. Determine the benefits of a rehabilitation program. Learn about the benefits of antianxiety medications. Develop a consistent method for performing self-care.

Identify unhealthy habits that need to be altered. The identification of unhealthy habits or specific problems will allow the client to determine which additional coping skills need to be developed and practiced. A rehabilitation program is more appropriate for clients with physical issues, such as strokes, not for clients who are experiencing anxiety. Further assessment is required before initiation of the use of medication, and nonpharmacological strategies are used before pharmacological ones. Although a consistent method for performing self-care is important, it is not the goal of a client wanting to learn effective coping strategies.

After a myocardial infarction, a client asks the nurse, "What's the chance of my having another heart attack if I watch my diet and stress levels carefully?" What is the most appropriate initial response by the nurse? Identifying the concerns and helping the client explore feelings Telling the client that it is important to be especially careful with diet and stress Suggesting that the client discuss the feelings of vulnerability with the primary health care provider Understanding that the client is frightened and suggesting a talk with the psychiatric nurse

Identifying the concerns and helping the client explore feelings The nurse must first analyze the feelings and identify the concerns that are implied in the client's question and reflect these to help the client verbalize and explore them; the focus is on collecting more data. Although telling the client that it is important to be especially careful with diet and stress may be true, it does not respond to the feelings implicit in the client's comment. The suggestion that the client discuss feelings of vulnerability with the primary health care provider avoids responsibility of helping the client explore feelings; it cuts off communication. No data presented at this time suggest that a referral to a psychiatric nurse is warranted. This response also cuts off communication when the client has expressed a need; the nurse is avoiding responsibility to assist the client.

The nurse has learned that infants born to very young mothers are at risk for neglect or abuse, primarily because of which characteristic typical of adolescent mothers? Did not plan for her pregnancy Cannot anticipate her baby's needs Is involved in seeking her own identity Becomes resentful of the need to give constant care to the baby

Is involved in seeking her own identity Adolescent parents are still involved in the developmental stage of resolving their own self-identity; they have not sequentially matured to intimacy and generativity, making nurturing of another difficult. Although adolescents usually do not plan for their pregnancies, it is not the primary reason that their infants are at risk for neglect or abuse. Although adolescents may have difficulty anticipating their infants' needs, it is not the primary reason that their infants are at risk for neglect or abuse. Although adolescents may resent the responsibilities involved in childrearing, it is not the primary reason that their infants are at risk for neglect or abuse. These issues could be problematic for a new mother of any age.

Which feature makes a group setting especially conducive to therapy? It provides a safe arena to practice healthier communication. It decreases the focus on the individual's emotional needs. It fosters development of one-on-one personal relationships. It allows confrontation of members for their shortcomings.

It provides a safe arena to practice healthier communication. The group provides a safe setting where an individual has the opportunity to learn that others share the same problems and needs. The group also provides opportunities to practice communicating with others. The focus is on learning to relate to others. Groups promote interaction among many people rather than one-on-one relationships. Confronting individual members with their shortcomings may happen from time to time, but it is not a main function of the group.

Which gross motor skills would the nurse expect children 3 to 5 years of age to develop? Select all that apply. One, some, or all responses may be correct. Jumping rope Walking stairs Drawing circles Stacking blocks Drawing triangles

Jumping rope Walking stairs Examples of the gross motor skills that a preschooler learns are jumping rope and walking up and down steps with ease. Fine motor capabilities in a toddler include drawing circles and crosses accurately. By 3 years of age, the child draws simple stick people and is usually able to stack a tower of small blocks. Triangles and diamonds are usually mastered between 5 and 6 years of age.

Which assessment data would the nurse find in a client who was recently admitted with a diagnosis of bulimia nervosa? Amenorrhea in postmenarchal female Lack of control over binge-eating episodes Body weight less than 85% of that expected Inability to purge in public places after eating

Lack of control over binge-eating episodes The nurse would find there is a lack of control over binge-eating episodes. Ingestion of an excessive amount of food within a short period of time (e.g., a 2-hour period), accompanied by a feeling that one cannot stop eating or control what or how much one is eating is a diagnostic criterion for bulimia nervosa. Amenorrhea in a postmenarchal female and body weight less than 85% of the expected weight are diagnostic criteria for anorexia nervosa, not bulimia nervosa. In bulimia nervosa, binge eating is normally followed by some type of purging behavior, such as self-induced vomiting or using laxatives, diuretics, etc

Which question would the nurse ask to test the older adult client's capacity for abstract thinking? "How are a television and a radio alike?" "Can you give me today's complete date?" "What would you do if you fell and hurt yourself?" "Repeat the following numbers for me: 8, 3, 7, 1, 5."

"How are a television and a radio alike?" The question, "How are a television and a radio alike?" tests the client's capacity for abstract thinking. This question forces the client to find a characteristic common to two things, an ability that is the criterion for abstract thinking. The question, "Can you give me today's complete date?" tests orientation, not abstract thinking. The question, "What would you do if you fell and hurt yourself?" tests judgment, not abstract thinking. The question, "Repeat the following numbers for me: 8, 3, 7, 1, 5" tests short-term memory, not abstract thinking.

Which statement indicates that the client is experiencing auditory hallucinations? "Get these horrible snakes out of my room!" "I am not the devil! Stop calling me names!" "The food on this plate has poison in it." "I saw an alien spaceship and now I feel sick."

"I am not the devil! Stop calling me names!" The client is responding to messages that she or he is hearing, which are auditory hallucinations. The responses regarding the snakes and the spaceship are examples of visual hallucinations because they describe what the client sees. The accusation of poisoning is the statement of a client who is suspicious and paranoid but not hallucinating.

In comparing assessment findings in clients with vascular dementia and dementia of the Alzheimer type, which factor is unique to vascular dementia? Memory impairment Abrupt onset of symptoms Difficulty making decisions Inability to use words to communicate

Abrupt onset of symptoms The signs and symptoms associated with vascular dementia have an abrupt onset (days to weeks) because of the occlusion of small arteries or arterioles in the cortex of the brain. Dementia of the Alzheimer type is associated with a gradual (years), progressive loss of function. Memory impairment and difficulty making decisions may or may not be a symptom of vascular dementia; it depends on which part of the brain is affected. Alzheimer disease usually results in memory impairment and difficulty with decision-making, but not abruptly. Inability to use words to communicate is a typical symptom of Alzheimer disease, but with vascular dementia, the client may have trouble speaking or understanding speech.

A 20-year-old carpenter with a history of substance abuse falls from a roof and sustains fractures of the right femur and left tibia. Which intervention is the most important? Confronting the client about substance abuse Overlooking the drug problem during hospitalization Assessing for amount and time of last substance use Advocating for adequate dosage of pain medication

Assessing for amount and time of last substance use Determining the amount and last use of the substance is the priority. Nurses would base their treatment of withdrawal symptoms on the time and amount of last use. Confronting the client is not appropriate; helping the client to deal with substance problem will come later. Ignoring the substance abuse puts the client at risk for withdrawal symptoms or undertreatment of pain. Because of cross-tolerance the client may need larger doses of analgesia for pain relief, but this is not the priority.

Which benefit accompanies mild apprehension? Physiological functions are slowed. There is an increased alertness. Behavioral responses become automatic. Ego defense mechanisms are mobilized

There is an increased alertness. A mild level of anxiety can be beneficial because attention becomes focused. Initially anxiety amplifies physiological function; function decreases after prolonged anxiety because of exhaustion. Automatic behavioral responses and ego defense mechanisms may hinder, rather than increase, an individual's awareness.

When the nurse conveys a willingness to listen and a genuine desire to view the client in a respectful manner, which underlying principle is the nurse using to establish a therapeutic nurse-client relationship? Caring is the underlying component of nursing that promotes client care. Understanding the psychosocial effects of a mental illness is vital to client care. Clients have a right to quality care that includes their strengths and weaknesses. The nurse initiates and maintains the therapeutic nurse-client relationship.

Caring is the underlying component of nursing that promotes client care. Caring is essential to promote the therapeutic relationship; assistance is provided with respect and genuineness. Understanding the psychosocial effects of a mental illness, including clients' strengths and weaknesses, and initiating and maintaining the nurse-client relationship are subcomponents of caring.

When the concerned parents come to visit their son who was admitted for drug addiction, the son angrily shouts at them to go away. Which intervention is the most therapeutic after the parents leave? Insisting that the client call his parents and apologize Confronting the client about his behavior and verbal response Explaining why the visit was important to his parents Suggesting that the client go to the gym to work off the anger

Confronting the client about his behavior and verbal response Avoidance is characteristic of the addicted individual, so confronting the client about the behavior prevents him from avoiding responsibility. This approach may also help the client develop some self-awareness. Insisting that he calls and apologizes is giving unsolicited advice; the client would be given positive feedback if he initiates this action on his own. The focus should be on the client, not the parents. A visit to the gym provides an outlet for the anger; this could be suggested if he can't verbalize his feelings. If he goes to the gym, the nurse would initiate a follow-up discussion after his anger has decreased.

While in the postanesthesia care unit after surgery to create a colostomy, a client requests that no one be allowed to visit. To support the client, which action would the nurse take? Give assurance of respect for the client's wishes. Determine the reason that visitors are not wanted. Promote communication by asking how the client really feels. Explain that the surgery is over and everything is going well.

Give assurance of respect for the client's wishes. Giving assurance of respect for the client's wishes meets the client's immediate personal needs; also, it demonstrates respect and concern. Determining the reason that visitors are not wanted may be considered in future planning; it is not the priority at this time. Promoting communication by asking how the client really feels is inappropriate at this time; the client is recovering from anesthesia, and working with the client's feelings requires time. Explaining that the surgery is over and everything is going well provides false reassurances that may block communication; it does not meet the client's immediate need.

Which statement describes how an individual overcomes conflicting thoughts that arise during an Electra complex? Following a proper toilet-training process Identifying with the parent of the same sex Indulging in educational and social activities By experiencing physical and emotional availability of the parents

Identifying with the parent of the same sex A child with an Electra complex fantasizes about the parent of the opposite sex as his or her first love interest. This conflicting thought is overcome by identifying with the parent of the same sex as a way to win recognition and acceptance. Toilet training is related to the anal stage. During the latency stage, a child indulges in education and social activities. Physical and emotional availability of the parents is needed during the oral stage.

A 28-year-old woman is scheduled to undergo a laparoscopic bilateral salpingo-oophorectomy. Which concern would the nurse expect to be the most prominent for the client? Acute pain Risk for hemorrhage Fear of chronic illness Loss of childbearing potential

Loss of childbearing potential Due to the client's young age, the nurse must determine the client's feelings concerning loss of fertility or childbearing potential; if she is childless, the client must cope with the knowledge that unless ova are removed and frozen before the surgery, her genes will not be passed to the next generation, even with in vitro fertilization. Laparoscopic surgery is not usually associated with acute, severe pain. Because the abdominal cavity is not entered, there is minimal risk of hemorrhage. There is no evidence to indicate that a chronic illness is related to the need for the surgery.

Which source of stress would the nurse anticipate in a 5-year-old client? Jealousy Stubbornness Procrastination Companionship

Procrastination Procrastination, or a delay completing chores or activities, is a source of stress for 5-year-old clients. Jealousy, stubbornness, and companionship are sources of stress for 3- and 4-year-old clients.

Which initial treatment would the nurse expect for a preschool-aged child experiencing severe fear of the dark? Prescription medication Mental health counseling Cognitive behavioral therapy Repetition of brave statements

Repetition of brave statements Repetition of brave statements is an effective treatment option for preschool-aged clients who experience a severe fear of the dark. Prescription medication, mental health counseling, and cognitive behavioral therapy are not initial treatment options for fear of the dark.

The parents of a gifted child note that their child has been showing signs of rebellion and acting out. Which is one important thing to teach the parents about gifted children? They need boundaries like any other child. Intense emotions require an outlet, not punishment. All discipline models approve of physical aggression. Gifted children should be allowed to freely express themselves.

They need boundaries like any other child. Gifted children need discipline like any other child to feel loved and safe. Punishment is appropriate for behavior that is unsafe or falls outside set boundaries. Discipline appropriately applied does not lead to physical aggression. Free expression does not mean overstepping the boundaries of appropriate behavior.

Which potential source of stress for a 12-year-old client would the nurse plan to include in a teaching session during the health maintenance visit? Having a fear of getting lost Resenting parental authority Being tempted to drink alcohol Selecting friends of the same sex

Being tempted to drink alcohol' A source of stress for many school-age children between the ages of 10 and 12 years is the temptation to experiment with drugs and alcohol; therefore, this is an important topic to include in the teaching session with the client and his or her parents. Having a fear of getting lost is a source of stress for a 6-year-old school-age client. Resenting parental authority is a common source of stress for an 8-year-old school-age client. Selecting friends of the opposite, not the same, sex is a source of stress for the school-age client who is 10 to 12 years of age.

Which response would the nurse make to a depressed, crying client on the evening of admission? "You're crying. Let's talk about it." "Let me get a cup of coffee; then we can talk." "Visitors will be here soon; you'd better get ready." "You'll feel better soon. Come to the sitting room with me."

"You're crying. Let's talk about it." Noting that the client is crying and suggesting that the nurse and client talk about it addresses the behavior observed, and the offer by the nurse to spend time to help the client implies that the client is worthy. With "Let me get a cup of coffee; then we can talk" the nurse offers to help but places the client second by stating the desire to get coffee first. The nurse denies the client's feelings by focusing on getting ready for visitors. Assuring the client that the client will feel better soon and asking the client to come to the sitting room constitutes false reassurance, ignores the crying, and blocks communication.

Which action would be required of the client with alcohol use disorder who attends Alcohol Anonymous (AA) meetings? Speaking aloud at weekly meetings Maintaining controlled drinking after 6 months Promising to attend at least 12 meetings yearly Acknowledging an inability to control the alcoholism

Acknowledging an inability to control the alcoholism The client would have to acknowledge an inability to control the alcoholism. A major premise of AA is that, to be successful in achieving sobriety, clients with an alcohol use disorder must acknowledge their inability to control the use of alcohol. There are no rules of speaking at meetings or attendance, although both actions are strongly encouraged. Maintaining controlled drinking after 6 months is not part of the AA program; this group strongly supports total abstinence for life.

Three days after having a myocardial infarction, a client displays an outburst of anger and tells the nurse to get out of the room. Which is the most appropriate nursing action? Administer the prescribed "as needed" sedative. Agree to leave and check back with the client later. Point out that directing anger at the nurse is inappropriate. Notify the primary health care provider of the client's behavior.

Agree to leave and check back with the client later. Anger is part of the normal process of adjusting to a new diagnosis like myocardial infarction. Agreeing to leave, then check back later indicates recognition that the client's reaction is understandable; it creates a climate of acceptance and eventually promotes expression of feelings. Administering the prescribed sedative implies that the anger is pathological and needs treatment. Pointing out that this behavior is inappropriate creates a situation in which the client will be hesitant to express any feelings. Notification of the primary health care provider is not needed at this time, because the client's actions are not unusual or inappropriate.

The nurse is assessing a child who is accompanied by a parent and a stepbrother. Which kind of a family does this child belong to? Blended family Extended family Alternative family Single-parent family

Blended family The child belongs to a blended family. Such a family is formed when parents bring unrelated children from prior relationships into a new, joint living situation. Extended family comprises the husband, wife, children, uncles, aunts, cousins, and grandparents. An alternative family may have grandparents caring for grandchildren. It may also be a multi-adult household with cohabiting partners or homosexual couples. A single-parent family is formed when one parent cares for the children after the death, divorce, or desertion of the other parent. A single person may also decide to have or adopt a child.

Which effect of cocaine contributes to substance dependence? Eases pain and discomfort Blurs reality of problems Creates a dreamlike state Decreases motor activity

Blurs reality of problems The addict tries to avoid stress and reality. The drug produces a blurring of these feelings to the point that the addict becomes dependent on it. The psychological effect is usually more important than relief of physical pain or discomfort. Large doses of opioids, not cocaine, can cause a dreamlike state. Cocaine can increase, not decrease, motor activity.

Which statement is accurate for adolescent suicide behavior? Boys account for more attempts compared with girls. Girls use more dramatic methods compared with boys. Girls talk more about suicide before attempting it. Boys are more likely to use lethal methods than are girls.

Boys are more likely to use lethal methods than are girls. The finding that boys are more likely to use lethal methods than are girls is supported by research; girls account for 90% of suicide attempts, but boys are three times more successful because of the methods they use. Statistics do not support the assertion that girls talk more about suicide before attempting it than do boys or that girls use more dramatic methods than do boys.

When a client complains about the nursing care, the nurse replies, "We're doing the best we can; others need attention too." Which type of behavior is the nurse displaying? Impulse control Defensive behavior Reality reinforcement Limit-setting behavior

Defensive behavior The nurse's response is not therapeutic because it does not recognize the client's needs but instead tries to make the client feel guilty for being demanding. Impulse control refers to a sudden driving force being constrained or held back. The nurse is not using reality reinforcement or setting limits.

Which conscious, healthy, coping behaviors would the nurse recommend a client use to reduce anxiety? Select all that apply. One, some, or all responses may be correct. Eating Sublimation Exercise Suppression Rationalization Talking to friends

Exercise Suppression Talking to friends Exercise, suppression, and talking to friends are positive coping behaviors that can be used consciously to promote mental health. Eating, although conscious, is not a healthy coping behavior. Sublimation and rationalization are unconscious coping behaviors.

Which are signs and symptoms of withdrawal that might be seen in a postpartum client with a history of opioid abuse? Paranoia and evasiveness Extreme hunger and thirst Depression and tearfulness Irritability and muscle tremors

Irritability and muscle tremors The earliest sign of opioid withdrawal is central nervous system overstimulation. Paranoia and evasiveness are related to opioid drug abuse, not opioid withdrawal. Extreme hunger and thirst have no relation to opioid withdrawal; most postpartum women are hungry and thirsty. Depression and tearfulness are not specific to people who abuse opioids.

Which assessment findings are suggestive of postpartum depression? Select all that apply. One, some, or all responses may be correct. Lethargy Ambivalence Emotional lability Increased appetite Long periods of sleep

Lethargy Ambivalence Emotional lability Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is also associated with postpartum depression.

The mother who has been separated from her spouse for 6 months reports that her 7-year-old child is falling behind in schoolwork and often cries. Which conclusion about the child would the nurse consider? Is feeling different from classmates May be happier living with the other parent Is working through feelings of shame May be experiencing self-blame for the parents' breakup

May be experiencing self-blame for the parents' breakup The child may be experiencing self-blame for the parents' breakup. Young children usually blame themselves for their parents' marital problems, believing that they are the reason that a parent leaves. No data are presented to indicate that the child feels different from peers, that the child will be happier living with the other parent, or that the child is working through feelings of shame.

Which defense mechanism is the client using when she constantly complains about her health problems and then says, "Those old crabby people just want to talk about their aches and pains and doctor appointments"? Projection Introjection Somatization Rationalization

Projection The client is assigning to others those feelings and emotions that are unacceptable to herself. Introjection is treating something outside the self as if it is inside the self. Somatization is the unconscious transformation of anxiety into a physical symptom that has no organic cause. Rationalization is the use of a socially acceptable logical explanation to justify personally unacceptable behavior.

Which factor would create difficulty in developing insight when helping a client who has embezzled money and says, "I never would have done this if I'd been paid what I am worth"? Feelings of boredom and emptiness Grandiosity related to personal abilities Projection of reasons for difficulties onto others Anger toward those who are in authority positions

Projection of reasons for difficulties onto others The factor that would cause difficulty is projection of reasons for difficulties onto others. The development of insight is impeded by the client's unwillingness or inability to face his or her own contribution to a problem. Feelings of boredom and emptiness will not impede the development of insight. Grandiosity will not impede the development of insight. It is often a cover for feelings of inadequacy, which are threatening to the client; these feelings usually disappear with insight. Anger will not impede the development of insight. It is not the anger itself but instead how the anger contributes to interpersonal difficulty that the client must recognize.

When a client with heart failure is to be discharged and tells the nurse that there are no family members who can help with care at home, which action would the nurse take first? Question the client about current support systems. Ask the health care provider for a home health referral. Suggest short-term placement in a long-term care facility. Recommend that the client consider an assisted living facility.

Question the client about current support systems. The initial action by the nurse would be assessment of the resources that the client is currently using or has available. A home health referral may be needed, but more information about the client's current resources is needed before asking the health care provider for a referral. Short-term placement in a long-term care facility is helpful for many clients to transition from hospital to home, but there is not enough information to determine whether this is a good option for this client. An assisted living facility is appropriate for many clients, but more assessment data are needed to decide whether this client would benefit from an assisted living facility.

Which defense mechanism would be exhibited when a client with alcohol use disorder states, "I function better when I'm drinking than when I'm sober"? Sublimation Suppression Compensation Rationalization

Rationalization The client is using rationalization. The attempt to justify a behavior by giving it acceptable motives is an example of rationalization. Sublimation is the substitution of a maladaptive behavior for a more socially acceptable behavior. Suppression is the intentional exclusion of things, people, feelings, or events from consciousness. Compensation is the attempt to emphasize a characteristic viewed as an asset to make up for a real or imagined deficiency.

The nurse is caring for a client with a new colostomy. Which client outcome is most important for achievement of long-range goals associated with adjusting to a new colostomy? Mastery of techniques of colostomy care Readiness to accept an altered body function Awareness of available community resources Knowledge of necessary dietary modifications

Readiness to accept an altered body function The client must be ready to accept changes in body image and function; this acceptance will facilitate mastery of the techniques of colostomy care and optimal use of community resources. Specific knowledge can be imparted only when an individual is ready to learn; it requires acceptance of a new body image.

Which assessment data would be most important to obtain from an Asian-American client with major depressive disorder who maintains traditional cultural beliefs and values? Dietary practices Concept of space Immigration status Role within the family

Role within the family The role within the family is the most important assessment data. If an Asian-American client adheres to traditional Asian practices, the nurse must recognize that the family is the central and most important social force acting on the individual. Dietary practices, concept of space, and immigration status are not as significant as family dynamics.

Which issue is the main problem for a client who is withdrawn and declines participation in situations that require communication with others? Personal identity Social interaction Sensory perception Verbal communication

Social interaction Characteristics of clients with problems with social interaction include avoidance of others, problematic patterns of interaction, and an inability to establish or maintain stable, supportive relationships. Clients with personal identity issues usually exhibit an inability to distinguish between the self and nonself. A client with impaired sensory perception demonstrates altered processing of sensory stimuli and a distorted or decreased response to stimuli. A client who has problems with verbal communication has a decreased ability to receive, process, or transmit communication.

A primipara about to be discharged with her newborn asks the nurse many questions regarding infant care. Which phase of maternal adjustment does this behavior illustrate? Let-down Taking-in Taking-hold Early parenting

Taking-hold The taking-hold phase, which begins around the second or third postpartum day, involves concern about being a "good" mother; the new mother is most receptive to teaching at this time. The behavior described refers to the taking-hold phase of bonding. Let-down is not related to bonding. The let-down reflex refers to the flow of milk in response to suckling and is caused by the release of oxytocin from the posterior pituitary. The taking-in phase is the first period of adjustment to parenthood. It includes the first 2 postpartum days; the mother is passive, dependent, and preoccupied with her own needs. Early parenting involves many behaviors, of which taking-hold is only one.

Which assessment data are the most important to obtain from a client in crisis? The client's work, recreational, and leisure time habits Any significant physical, surgical, or medication health data A history of emotional or mental health problems in the family The client's perception of the circumstances related to the crisis

The client's perception of the circumstances related to the crisis Knowing the client's perception of the circumstances surrounding the crisis helps the nurse determine what the situation means to the client. Work and lifestyle habits, health information, and family history should be included in a later assessment.

Which response would the nurse make to a client with antisocial personality disorder who kisses the nurse and shouts, "I like you"? "Thank you. I like you, too." "I wish you wouldn't do that." "Don't ever touch me like that again. I don't like it." "Your behavior is inappropriate. Don't do that again."

"Your behavior is inappropriate. Don't do that again." Telling the client that this behavior is inappropriate and instructing the client not to do it again accepts the client while rejecting and setting limits on the behavior the client is using. Thanking the client encourages this type of behavior instead of setting limits. Saying that the nurse wishes the client wouldn't do that or telling the client not to touch the nurse like that again makes it appear that it is the nurse's preference, not the client's behavior, that is the issue.

Which concepts would the nurse include in the education about age-appropriate behavior provided to the parents of a 4-year-old child? Select all that apply. One, some, or all responses may be correct. Animism Superego Imagination Concrete thinking Object permanence

Animism Imagination The nurse will explain animism and imagination to the parents. Animism is when a child believes that inanimate objects have feelings and wishes. The child shows this behavior early in the preoperational stage, according to Piaget. Children have an active imagination, which allows them to further explore their environment. The superego theory was developed by Freud and is not related to a 4-year-old child; rather, it develops later in school-aged children or adolescents. When a child is 7 to 11 years old, he or she develops concrete thinking and starts to think about an act before performing it and understands differences in the perspectives of others. Object permanence develops between birth and 2 years of age. It is a tendency of a child to understand that some things exist even if they are not visible.

Which benefit would a client expect from joining a self-help group after being discharged from a mental health facility? Getting support from group members Learning about confrontation techniques Working on self-awareness exercises Practicing psychotherapy interventions

Getting support from group members Members of a self-help group share similar experiences and can provide valuable understanding and support for each other. Although confrontation and self-awareness may occur, these are not the primary purposes of self-help groups. Self-help groups provide an opportunity for people to interact, but not to engage in professional psychotherapy.

After an unexpected emergency cesarean birth the client tells the nurse, "I failed natural childbirth." Which postpartum phase of adjustment would this statement most closely typify? Taking-in Letting-go Taking-hold Working-through

Taking-in By discussing her birth experience, the client is bringing it into reality; this is characteristic of the taking-in phase. The client is not ready to assume the tasks of the letting-go phase until completing the tasks of the taking-in and taking-hold phases. The taking-hold phase is marked by an increased desire to resume independence; this statement reveals that the client is not ready for this phase. The working-through phase is not a separate phase of adjustment to parenthood; it is not relevant.

A child is undergoing chemotherapy to treat a neuroblastoma, stage IV, and had his first chemotherapy session last week. He arrives with his mother for this week's session. How would the nurse greet the child? "It's time for your next dose." "There are only three more sessions." "Did you get sick to your stomach last time?" "How did you feel after your last treatment?"

"How did you feel after your last treatment?" Asking how the child felt allows the child to volunteer information first and thus feel in control; the nurse can ask validating questions later. "It's time for your next dose" is a flippant, insensitive statement. Stating that there are three more sessions is unfeeling because it reminds the child and mother that there are more sessions in the future. "Did you get sick to your stomach?" focuses the assessment on vomiting, thereby predisposing the child to think about vomiting during this treatment.

Which response would the nurse make when approaching a depressed client who is sitting alone in the dayroom? "May I sit with you for a while?" "Just call me if you'd like to talk." "Do you mind if I sit and talk with you?" "I'll be sitting with you for a while today."

"I'll be sitting with you for a while today." "I'll be sitting with you for a while today," removes from the client the burden of making the decision and demonstrates that the client is worth spending time with. The question, "May I sit with you for a while?" would block communication if the client said no. Saying, "Just call me if you'd like to talk," requires an action that the client may be unable to take. "Do you mind if I sit and talk with you?" requires the client to make a decision that the client may be unable to make; if the client says no, communication is blocked.

The nurse hired to work in a metropolitan hospital provides services for a culturally diverse population. One of the nurses on the unit says it is the nurses' responsibility to discourage these people from bringing all that alternative medicine stuff to their family members. Which response by the nurse is correct? "Hospital policies should put a stop to this." "Everyone should conform to the prevailing culture." "Nontraditional approaches to health care can be beneficial." "You are right because they may have a negative effect on people's health."

"Nontraditional approaches to health care can be beneficial." Studies demonstrate that some nontraditional therapies are effective. Culturally competent professionals should be knowledgeable about other cultures and beliefs. Many health care facilities are incorporating both Western and nontraditional therapies. The statement "Everyone should conform to the prevailing culture" does not value diversity. The statement "You are right because they may have a negative effect on people's health" is judgmental and prejudicial. Some cultural practices may bring comfort to the client and may be beneficial, and they may not interfere with traditional therapy.

A girl arrives at the school health office in tears, telling the nurse that several of her classmates have been teasing her. Which is the most therapeutic response by the nurse? "Tell me more about it." "Has this happened before?" "Was it boys or girls who were teasing you?" "This happens to everyone at some time or another."

"Tell me more about it." The child has not stated why the teasing occurred; asking for clarification in a nonthreatening manner is the first step of the assessment process. "Has this happened before?" is a yes-or-no (closed-ended) question that could be posed as the next question after the situation is clarified. First, the nurse would encourage clarification with an open-ended question. Asking about the sex of the children who teased the child is not relevant to the incident at this time. Minimizing the child's experience with a dismissive statement does not allow for clarification. Assuring the child that being teased is not uncommon may be helpful later.

Which response would the nurse make to help a depressed client who is crying? "Does crying help?" "I know that you're upset." "Tell me what you're feeling now." "Do you want to tell me why you're crying?"

"Tell me what you're feeling now." The nurse would make the response, "Tell me what you're feeling now." This therapeutic response encourages expression of the client's feelings. Asking, "Does crying help?" does not explore feelings, and the client may interpret it as a put-down. Although the statement, "I know that you're upset," appears empathic, it does not encourage expression of feelings and the nurse is making an assumption because crying does not always indicate being upset. Asking, "Do you want to tell me why you're crying?" will elicit a yes or no response rather than encouraging expression of feelings.

The nurse is caring for a client whose mobility is restricted to a wheelchair after a motor vehicle accident. The client has been prescribed physiotherapy as a part of rehabilitation care. Which interventions would the nurse consider when the client is discharged from the health care facility? Select all that apply. One, some, or all responses may be correct. Focus firmly on the challenges faced by the client. Refrain from including children in the support system. Assist the family in identifying community support systems. Encourage the primary caregiver to set a routine time for respite. Consider the primary caregiver's experience in the discharge plan.

Assist the family in identifying community support systems. Encourage the primary caregiver to set a routine time for respite. Consider the primary caregiver's experience in the discharge plan. The nurse would assist the family in identifying support within the community. The family may need assistance with meals, physiotherapy exercises, and care for younger children. The nurse would encourage the primary caregiver to set a routine time for respite. The nurse would consider the primary caregiver's experience and abilities with nursing care while planning client discharge. The nurse would not only focus on the weaknesses and challenges faced by the client but also on the client's strengths. Children should be included in the support system, and the client and family should spend time sharing their stories with each other.

When an uncoordinated person who wishes to be athletic excels in a musical career, which defense mechanism could this be related to? Sublimation Identification Compensation Rationalization

Compensation Compensation is replacing a weak area or trait with a desirable one. Sublimation is rechanneling unacceptable desires and drives into activities that are socially acceptable. Identification is attributing to self or taking on the characteristics of another. Rationalization is the use of justification to make tolerable certain feelings, behaviors, and motives.

Which behavior occurs first in the bulimia nervosa cyclical pattern? Hunger results from food deprivation and physical stress. Dieting is used as an attempt to maintain control over life. Binge eating occurs to numb physical and emotional discomforts. Purging is another attempt to regain control and alleviate guilt.

Dieting is used as an attempt to maintain control over life. Dieting is the first attempt to gain personal control. The body does experience hunger, and binge eating serves as emotional comfort when the person ingests large amounts of calories. Purging is the final phase in this cycle; often individuals are unaware that purging rids fewer than 50% of the calories ingested.

A young female client has an argument with her boyfriend. Which defense mechanism is the client using when she complains that the hospital meals are always late and the food is terrible? Projection Dissociation Displacement Intellectualization

Displacement Displacement reduces anxiety by transferring the emotions associated with an object or person to another emotionally safer object or person. Projection is the attempt to deal with unacceptable feelings by attributing them to another. Dissociation is an attempt to detach emotional involvement or the self from an interaction or the environment. Intellectualization is the use of facts or other logical reasoning rather than feelings to deal with the emotional effect of a problem.

Which assessment finding would the nurse observe in a client who has been found to have an antisocial personality disorder? Pays great attention to detail and demonstrates a high level of anxiety Has scars from self-mutilation and a history of many negative relationships Displays charm, has an above-average intelligence, and tends to manipulate others Demonstrates suspiciousness, avoids eye contact, and engages in limited conversation

Displays charm, has an above-average intelligence, and tends to manipulate others The nurse would observe charm, above-average intelligence, and manipulation of others. A client with an antisocial personality disorder is charming on first contact, but this charm is a manipulative ploy. These clients usually are bright and use their intelligence for self-gain. Paying great attention to detail and demonstrating a high level of anxiety are traits of an individual with an obsessive-compulsive personality disorder. The client with a borderline personality disorder self-mutilates when under stress; there is a fear of abandonment, so any relationship is better than no relationship. Demonstrating suspiciousness, avoiding eye contact, and engaging in limited conversation resembles the behavior of an individual with a paranoid personality, which includes suspiciousness and lack of trust.

The nurse enters the client's room and observes the infant lying quietly in the bassinet with the eyes open wide. Which action would the nurse take in response to the infant's behavior? Brightening the lights in the room Encouraging the mother to talk to her baby Wrapping and then turning the infant to the side Beginning physical and behavioral assessments

Encouraging the mother to talk to her baby A quiet, alert state is an optimal time for infant stimulation. Bright lights are disturbing to newborns and may impede mother-infant interaction. Wrapping and then turning the infant to the side is done for the sleeping infant. Physical and behavioral assessments are not the priorities; they may be delayed.

The care plan for a client with bulimia nervosa includes "observe client after meals"; however, the client managed to purge four times in the past week. Which action would the nurse use first? Tell the client that all privileges are revoked until the purging stops. Confine the client to his or her bedroom with one-on-one observation. Evaluate the factors that are affecting the success of the intervention. Talk to the staff members who failed to prevent the purging.

Evaluate the factors that are affecting the success of the intervention. Observing the client after meals is the only way to ascertain that the client does not engage in purging; however, when a straightforward intervention is not working, the nurse must evaluate factors that are interfering (e.g., staff shortage, client manipulating staff, design of environment prevents observation). Once the constraints are identified, the plan can be revised. Revoking privileges, one-on-one observation, or talking to staff members may be actions that the nurse uses after evaluating the barriers.

Which type of sexual disorder describes a client who has a sexual obsession with shoes? Select all that apply. One, some, or all responses may be correct. Sexual sadism Fetishistic Pedophilic Voyeuristic Frotteuristic Exhibitionistic

Fetishistic Having a fetish is to become sexually aroused by something that would not be typically arousing. A fetishistic disorder is characterized by a sexual focus on objects (such as shoes, gloves, pantyhose, and stockings) that are intimately associated with the human body. Sadism is achievement of sexual satisfaction from the physical or psychological suffering (including humiliation) of a victim. Pedophilic disorder is a predominant or exclusive sexual interest toward prepubescent children. Voyeurism is characterized by seeking sexual arousal through the viewing (usually secret) of other people engaged in intimate situations. Rubbing or touching a non-consenting person is frotteuristic disorder. Exhibitionistic disorder involves the intentional display of the genitals in a public place.

Which action would the nurse take for a female client who has just awakened from her first electroconvulsive therapy (ECT) treatment? Immediately get the client out of bed and back into the unit's routine. Sit the client up and arrange for the dietary staff to deliver a lunch tray. Orient the client to time and place and explain that the treatment is over. Take the client's pulse and blood pressure every 15 minutes after the client is fully awake.

Orient the client to time and place and explain that the treatment is over. The nurse would orient the client to time and place and explain that the treatment is over. Clients are confused when they awaken after ECT. They have loss of recent memory, so it is important to orient them to time, place, and situation. The nurse would not immediately get the client out of bed; this occurs about 1 to 3 hours after the treatment. Sitting the client up may be done later if the client asks for food. Vital signs are monitored before the client is awake; they may become stable before the client is fully awake.

Which information about the client with obsessive-compulsive disorder would best validate the client's improvement at work? States spending less time on ritualistic behaviors while at work Discusses techniques used to provide distraction from obsessive thoughts Reports spending an increased amount of time with friends in pleasurable activities Receives a letter from a supervisor at work stating job performance has improved

Receives a letter from a supervisor at work stating job performance has improved The information that best validates the client's improvement at work is a letter from the supervisor stating job performance has improved. The letter provides objective validation that the client's work performance has improved. Although spending less time at work on ritualistic behavior, coming up with techniques to lessen the need for obsessive thoughts, and spending more time with friends in pleasurable activities are all acceptable outcomes of therapy, they all represent subjective information reported by the client.

In light of the information shown, which nursing intervention would be appropriate for this client? Chart/Exhibit 1 Remaining with the client until the crisis is over Reinforcing for the client that a panic attack is rarely fatal Communicating with the client using detailed sentences Introducing soft, soothing music into the environment to distract the client

Remaining with the client until the crisis is over The nurse would remain with the client until the crisis is over because the chart findings indicate the client is having a panic attack. It is appropriate to remain with the client during a panic attack while being mindful of the need for a low-stimulus environment. The client will not benefit from hearing that a panic attack is rarely fatal because the ability to think rationally may be greatly impaired. The client experiencing a panic attack is not capable of analyzing detailed communication. Additional environmental stimuli are not advisable and are likely to increase the client's anxiety level.

After caring for a terminally ill client, the nurse becomes aware of a need for a respite. Which action would the nurse use? Request a few days' vacation time. Seek support from colleagues on the unit. Ask to be reassigned to a different client. Retain the assignment and suppress feelings.

Seek support from colleagues on the unit. Talking with colleagues who face or who have faced the same problems may provide constructive help with the situation. Requesting vacation time is an avoidance technique; these feelings must be addressed. Reassignment or suppressing feelings does not address the needs of the nurse and interferes with a productive nurse-client relationship.

Which communication technique would the nurse be using when he or she states, "Let's see whether we mean the same thing," to a client who is not making sense? Reflecting feelings Making observations Seeking consensual validation Attempting to place events in sequence

Seeking consensual validation The phrase "Let's see whether we mean the same thing" reflects seeking consensual validation. Seeking consensual validation is a technique that prevents misunderstanding so that both the client and the nurse can work toward a common goal in the therapeutic relationship. Reflection of feelings is used to increase client awareness but would not be used when the nurse is unsure of what the client is saying. Making observations refers more to nonverbal than to verbal communication. Placing events in a sequence helps organize content, but ideas would be clarified first by means of validation if the nurse is unsure of the meaning of what is being said.

After an emergency cesarean birth, the client tells the nurse that she was hoping for a "natural" childbirth but is glad that she and her baby are all right. Which postpartum phase of adjustment does this statement typify? Taking-in Letting-go Taking-hold Working-through

Taking-in By discussing the experience, the client is bringing it into reality; this is characteristic of the taking-in phase. The client is not ready to assume the tasks of the letting-go phase until the tasks of the taking-in and taking-hold phases have been completed. The taking-hold phase is marked by an increased desire to resume independence. The working-through phase is not a separate phase of adjustment to parenthood.

Which behavior indicates that the client has learned the most effective method to cope with anger? Goes for a long jog Talks about the anger Goes outside and screams Focuses on cause of anger

Talks about the anger Talking about angry feelings is better than acting them out; this response indicates that the client has learned a positive coping method. Although taking a long jog or going outside to scream may help, these are isolated activities that do not permit sharing of feelings. Focusing on the cause may result in an escalation of angry feelings.

For a client experiencing a developmental crisis, which rationale supports participation in a crisis group intervention? The client is encouraged to talk about personal problems in the group setting. The crisis group supplies a workable solution to the client's problems. The client is able to consider alternative ways to solve the identified problem. The group is led by a psychologist who has crisis intervention experience.

The client is able to consider alternative ways to solve the identified problem. A crisis intervention group helps clients reestablish psychological equilibrium by assisting in the exploration of new alternatives for coping; realistic situations can be addressed with rational and flexible problem-solving methods. Talking about personal problems is not an immediate goal of crisis intervention. Clients are never given a solution; they are helped to arrive at their own solutions. It is not necessary for the crisis intervention group to be a lead by psychologist.

Which description by a student of the formal operations stage of Piaget's theory of cognitive development indicates a need for further teaching? Select all that apply. One, some, or all responses may be correct. Thinking moves toward abstract theory. There is an absence of egocentric thought. The individual engages in risk-taking behavior. Reversibility in thought is the primary characteristic. The capacity to reason with respect to possibilities is developed.

There is an absence of egocentric thought Reversibility in thought is the primary characteristic. During the formal operations stage, egocentric thought prevails. During the concrete operation stage, reversibility is the primary characteristic of the thought. Reversibility refers to the ability to recognize that numbers or objects can be changed and returned to their original conditions. When the student says that there is no egocentric thought in adolescents and reversibility is the primary characteristic in the formal operation stage, this indicates a need for further teaching. During the formal operations stage, the adolescent is preoccupied by the thought that he or she is invulnerable and engages in risk-taking behavior. As adolescents mature, their thinking moves to abstract and theoretical subjects. During the formal operations stage, individuals develop the capacity to reason with respect to possibilities.

For a client with an obsessive-compulsive disorder, which rationale explains the function of obsessions and compulsions? Unconscious control of unacceptable feelings Intentional act to punish self for shortcomings Obedience to voices that direct behaviors Symbolic reenactment of punishing others

Unconscious control of unacceptable feelings In carrying out the compulsive ritual, the client unconsciously tries to control anxiety by avoiding acting on unacceptable feelings and impulses. The compulsions do not fill the need to punish self or others. Hallucinations are not part of this disorder.

For a client who recently left her husband because of physical abuse, which behaviors indicate that the crisis intervention therapy has been successful? Select all that apply. One, some, or all responses may be correct. Cries frequently throughout the day Sleeps more than half the day Utilizes healthier coping skills Declines a referral to support services Describes the current situation realistically

Utilizes healthier coping skills Describes the current situation realistically Healthier coping provides a repertoire of skills from which to draw in future crisis situations. Being able to be objective and review the situation realistically demonstrates progress as the client moves toward resolution of the crisis. Although crying reflects that the client is expressing her feelings, usually it indicates the presence of anxiety and nonresolution of the crisis, especially if it occurs frequently throughout the day. Sleeping excessively is a maladaptive strategy. Declining referrals to support services may indicate denial. One of the goals of crisis intervention is to develop a stronger support system.

Which common source of stress for a 6-year-old client would the nurse include in the teaching session during a scheduled health maintenance visit? Wanting to be first Demanding privacy Having a desire to be like an idol Being more selective with playmates

Wanting to be first A common source of stress for a 6-year-old school-age client is competition such as wanting to be first or the best (winning); therefore, the nurse would include this in the teaching session during the health maintenance visit. Demanding privacy, the desire to be like an idol, and becoming more selective with playmates is anticipated for the 7-year-old client, not 6-year-old client.

Which questions would allow the nurse to assess a preschool-age child diagnosed with asthma for delayed peer relationships? Select all that apply. One, some, or all responses may be correct. "Can your child independently dress each day?" "Does your child use 'babylike' terms when talking?" "Does your child play with the other children in the playroom?" "Has your child ever thought that the asthma is a punishment?" "Does your child become anxious before respiratory treatments?"

"Does your child use 'babylike' terms when talking?" "Does your child play with the other children in the playroom?" Peer relationships begin to form during the preschool stage of development. This task can be affected by the diagnosis of a chronic illness, such as asthma. The nurse would assess the child for socialization with peers and overprotection by the family by asking if the child uses "baby-like" terms when talking about interactions with other children in the playroom. Information obtained from these questions will allow the nurse to plan care that enhances the child's ability to socialize with other children. Mastery of self-care skills may also be affected; therefore, the nurse would ask the parent if the child is able to independently dress each day. Preschool-age children learn through preoperational thought, which includes magical thinking; therefore, the nurse would assess information related to the child believing the diagnosis is a punishment. The child's body image may also be affected; therefore, the nurse would assess for anxiety before respiratory treatments. However, assessment of these last 3 aspects addresses other concerns than peer relationships.

During the working phase of the nurse-client relationship, which question would the nurse ask the depressed client who has a history of suicide attempts when exploring alternative coping strategies? "How have you managed your problems in the past?" "What do you feel that you've learned from this suicide attempt?" "How will you manage the next time your problems start piling up?" "Were there other things going on in your life that made you want to die?"

"How will you manage the next time your problems start piling up?" The nurse would ask, "How will you manage the next time your problems start piling up?" because this focuses the interaction toward the future and invites the client to explore alternative coping strategies. "How have you managed your problems in the past?" explores past coping strategies and should have been asked as a part of the initial assessment. "What do you feel that you've learned from this suicide attempt?" is an attempt to explore the client's insight into current feelings about the suicide rather than focusing on coping strategies. "Were there other things going on in your life that made you want to die?" asks the client once more to ensure that all the precipitating stressors have been identified but does not focus on future coping strategies.

A newly diagnosed client with human immunodeficiency virus (HIV) comments to the nurse, "There are so many rotten people around. Why couldn't one of them get HIV instead of me?" Which statement is the nurse's best response? "I can understand why you are afraid of dying." "It seems unfair that you contracted this disorder." "Do you really wish this disorder on someone else?" "Have you thought of speaking with your religious adviser?"

"It seems unfair that you contracted this disorder." The client is in the anger or "why me" stage; encouraging the expression of feelings will help the client resolve them and move toward acceptance. The response "I can understand why you're afraid of dying" does not reflect what the client said; introducing the topic of death may not be therapeutic. The response "Do you really wish this disorder on someone else?" is judgmental and may precipitate feelings of guilt and block the nurse-client relationship. The response "Have you thought of speaking with your religious adviser?" abdicates the responsibility of talking with the client; this response ignores the client's present concerns.

An older client who has a fractured femur asks the nurse, "Will I be able to walk again?" Which response would the nurse make? "I have no idea because only time will tell." "You only broke a bone. It could have been worse." "You'll walk again. This is a common issue in older people." "Tell me your concerns about being able to walk."

"Tell me your concerns about being able to walk." The phrase "Tell me more" shows interest in the client's concerns, is nonjudgmental, and encourages expression and exploration of feelings. First the client's feelings must be explored before providing a direct answer that may cut off communication. The responses "I have no idea" and "You only broke a bone. It could have been worse" places the client on the defensive; it is demeaning to the client and discourages further communication. The general response "You'll walk again. This is a common issue in older people" dismisses the client's concerns; the client is not recognized as an individual whose injury is a traumatic and personal event.

A client who recently became blind as a result of an injury responds to the loss of autonomy by being sarcastic. Which response is best? Accepting the behavior Setting limits on the behavior Instituting behavior modification techniques Mentioning how the behavior alienates others

Accepting the behavior The nurse shows acceptance because the client feels a loss of control and is verbally expressing and releasing anger. Setting limits is appropriate when the client is verbally aggressive and the anger is escalating. The client's behavior is serving a useful purpose at this time; attempts at modification should not be made until later. When the client is ready to think about others, then discussions of how his behavior affects others would be appropriate. The client's needs are currently the priority.

Which term would be used to document the client's affect, which was observed during the mental status assessment? Depressed Flat Cooperative Resistive

Flat Affect is the observable outward manifestation of a person's mood, feelings, or tone. Common terms to describe affect include inappropriate, flat, or blunted. Mood is a feeling state reported by the client (e.g., sad, depressed, angry, anxious, happy). Attitude relates to the approach or manner of the client during the interaction with the interviewer (e.g., cooperative, resistive, friendly, ingratiating).

Which initial action would the nurse take for a nursing home resident with moderate Alzheimer disease who begins to engage in numerous acting-out behaviors? Assess the client's level of consciousness Identify the stressors that precipitate the client's behavior Observe the client's performance of activities of daily living Monitor the side effects associated with the client's medications

Identify the stressors that precipitate the client's behavior The nurse would initially identify the stressors that precipitate the client's behavior. If the areas that cause stress can be identified, the client would be better able to control the acting-out behavior. These clients may be confused or disoriented, but they usually do not experience an altered level of consciousness; an altered level of consciousness is associated with delirium, not dementia. Although the client's performance of activities of daily living may be observed, this is only one area of function that should be assessed and it is not the initial action. The initial action would focus on the acting-out behaviors. Although monitoring the side effects associated with the client's medications is important, it is not the initial action.

Which cause would the nurse conclude is the underlying reason a client with conversion disorder is unable to walk? Nondisabling illness Enjoyment of being sick Loss of contact with reality Result of intrapsychic conflict

Result of intrapsychic conflict The underlying cause in conversion disorder is the result of intrapsychic conflict. In situations in which a client may experience a high level of anxiety and psychic pain, a physical reason for not acting may unconsciously be used to limit negative feelings. Conversion disorder is disabling; the client truly cannot walk and the client believes that the symptoms are real. These individuals do not enjoy their illness; their anxiety is relieved by it. These individuals are in contact with reality.

Which primary component of behavior modification verbalized by parents indicates the parents have a correct understanding of their child's therapy for anorexia nervosa? Rewards positive behavior Deconditions fear of weight gain Decreases unnecessary restrictions Reduces anxiety-producing situations

Rewards positive behavior The primary component of behavior modification is rewarding positive behavior. In behavior modification, positive behavior is reinforced and negative behavior is punished or not reinforced. Deconditioning the client's fears, decreasing the number of unnecessary restrictions, and reducing the number of anxiety-causing situations are not primary components of behavior modification.

During the first meeting of a therapy group, members exhibit frequent periods of silence, tense laughter, and nervous movements. Which conclusion would the nurse make? The group requires an active leader who will intervene to relieve signs of obvious stress. The group process is unhealthy and there is unwillingness to openly relate. The members are displaying expected behaviors because relationships are not yet established. The behaviors should be immediately addressed so members will not become too uncomfortable.

The members are displaying expected behaviors because relationships are not yet established. The members have not established trust and are hesitant to discuss problems; the observed behaviors reflect anxiety and insecurity. These behaviors are expected in the early stage of group interaction and are not unhealthy; active leader intervention in not necessary. Calling attention to the behaviors or intervening is not necessary; these behaviors will subside as the group progresses.

Which is the secondary use of data from the 2000 census classification system to identify disparities in mental health care along racial-ethnic lines? To provide culturally relevant care to the required ethnic group To identify all racial and ethnic groups in the United States To identify why there are disparities in the United States To determine when and how the health care needs of the ethnic populations are being met

To determine when and how the health care needs of the ethnic populations are being met The census classification system categorized individuals according to racial and ethnic descriptions. In addition to identifying health disparities, recording these classifications helps determine when and how the health care needs of ethnic populations are being met. Nurses would practice culturally relevant nursing to meet the needs of culturally diverse clients of a specific ethnic group; the census has nothing to do with this. Because each racial group contains multiple ethnic cultures, the census does not succeed in identifying all of them in the United States, and it doesn't include them all as options. Although the census helps identify health disparities, it does not attempt to examine and determine why they exist.

Which defense mechanism would the nurse conclude a female client with obsessive-compulsive disorder who washes her hands more than 20 times a day is using to ease anxiety? Undoing Projection Introjection Displacement

Undoing Undoing is an act that partially negates a previous one; the client is using this defense mechanism to atone for unacceptable acts or wishes. The client is not attributing self-thoughts or impulses to another person or group, which is called projection. The client is not absorbing into the self a hated or loved object (introjection). Displacement is the transferring of feelings from one person, object, or experience onto another, less threatening person, object, or experience. The client is not using displacement when compulsively washing hands.

Which response would the nurse make to an adolescent who is extremely underweight, disappears into the bathroom after meals, and angrily says, "I don't have any problems. Stop watching me"? "I hear how frustrated you are to be here." "If you don't follow the rules, you'll lose your privileges." "Your feelings are part of your illness; later you'll feel better." "I'll get you the medication your primary health care provider prescribed for anxiety."

"I hear how frustrated you are to be here." "I hear how frustrated you are to be here," is the best initial response; it encourages additional expression of feelings. "If you don't follow the rules, you'll lose your privileges," is not necessarily true, and the response is somewhat threatening and nontherapeutic. The response "Your feelings are part of your illness; later you'll feel better," is not therapeutic; also, it is false reassurance because the client may not feel better later. "I'll get you the medication your primary health care provider prescribed for anxiety," is not therapeutic; the client is verbally expressing feelings, and the behavior does not require medication at this time.

Which statement would the nurse expect to hear from a client with an obsessive-compulsive disorder? "I know there's no reason to do these things, but I can't help myself." "I don't know why everyone's upset with me—I'm doing nothing wrong." "The things I do take a little time, but they make me a productive person." "The devil makes me do it—it's not my fault that I constantly act this way."

"I know there's no reason to do these things, but I can't help myself." The nurse would expect the client to say, "I know there's no reason to do these things, but I can't help myself." Intellectually, the person knows that the compulsive acts are senseless but is unable to stop doing them because these acts control anxiety. "I don't know why everyone is upset with me—I'm doing nothing wrong," is an example of denial. Most people with compulsive behaviors are not in denial. "The things I do take a little time, but they make me a productive person," is rationalization; obsessive-compulsive behavior is usually counterproductive and time consuming and interferes with function. "The devil makes me do it—it's not my fault that I constantly act this way," is an example of delusional thinking. Clients with obsessive-compulsive disorder are not delusional.

For a client who has many self-inflicted nonlethal injuries over the preceding month, which level of suicidal behavior is demonstrated? Threats Ideation Gestures Attempts

Gestures A suicidal gesture involves superficial, nonlethal injuries; the client has no intent to die as a result of the injuries. A suicidal threat is a person's verbal statement of intent to commit suicide; there is no action. Suicidal ideation is a person's thoughts regarding suicide; no definitive intent or action is expressed. A suicide attempt is an actual implementation of a severe self-injurious act; there is an attempt to cause serious self-harm or death.

A child is recovering from a diagnosis of meningococcal meningitis and appears sad and cries frequently. How would the nurse help the child verbalize her thoughts and feelings? By telling the child that she seems sad and upset By encouraging the parents to speak with their child By showing the child some photos of hospitalized children and having the child tell stories about them By having the child watch videotapes about sick children and answering any questions that the child might have

By telling the child that she seems sad and upset The child is old enough to respond when a direct question is asked or an open-ended statement of assessment is made. The parents may be too emotionally involved to effectively help their child communicate feelings. Younger children benefit from the projective technique of being shown photos of children in a similar situation and then constructing stories about them. Younger children benefit from the projective technique of watching videos of other sick children and asking questions about them.

A pregnant client with a history of delusions, hallucinations, and suspiciousness tells the nurse she is fearful about the upcoming birth and the health of her baby. Which intervention would the nurse use? Reassure her that she will have help with the birth. Commend her for the ability to express her concerns. Share staff's concerns about how she will handle the infant. Give her a detailed explanation of the birthing process.

Commend her for the ability to express her concerns. Because suspicious clients lack trust and have difficulty sharing feelings, this healthy behavior should be identified as the first step in developing a trusting relationship. If the client's feelings are dismissed and then reassuring blanket statements are given, this responds to only part of the client's concerns. The staff's attitude may decrease the client's self-esteem. A detailed description at this time may increase the client's fears.

Which activity would the nurse working in the fertility clinic perform to help ease the feeling of isolation that infertile couples often experience? Teach them about infertility and its treatment. Identify activities that are interesting and satisfying. Explore ways to promote communication with family and friends. Explain to them that men and women cope differently with stressful situations.

Explore ways to promote communication with family and friends. Couples who are experiencing infertility often distance themselves from family and friends because they find communication painful; improved communication techniques may help them interact with family and friends and reduce the sense of isolation they may feel. Knowledge is power; however, it may not ease the couple's feeling of isolation. Identifying activities that are interesting and satisfying may promote a positive self-image but may not relieve the sense of isolation from others. Explaining to the couple that men and women cope differently with stressful situations may improve communication between the man and the woman but will probably not relieve their sense of isolation from others. Often these couples would benefit from joining a support group where they can communicate with others in a similar situation.

Which clinical manifestations would the nurse observe in a client with opioid withdrawal? Select all that apply. One, some, or all responses may be correct. Muscle twitching Runny nose Tachycardia Flulike symptoms Pinpoint pupils

Muscle twitching Runny nose Tachycardia Flulike symptoms The nurse would observe the following: muscle twitching, runny nose, tachycardia, and flulike symptoms. When opioids, which are central nervous system depressants, are withdrawn initially, the client will experience muscle twitching, a runny nose (rhinorrhea), tearing (lacrimation), diaphoresis, yawning, and tachycardia. Flulike symptoms, such as nausea, vomiting, and diarrhea, also occur. Pinpoint pupils occur with intoxication or overdose, not during withdrawal.

Nursing management of a client with dementia who is disoriented, forgetful, and with inappropriate behaviors would be directed toward which? Restricting gross motor activity to prevent injury Preventing further deterioration in the client's condition Maintaining scheduled activities through behavior modification Rechanneling the client's energies into more appropriate behaviors

Rechanneling the client's energies into more appropriate behaviors The nurse would rechannel the client's energies into more appropriate behaviors. Disoriented clients need assistance in how they direct their energy to limit inappropriate behaviors. The staff cannot prevent all gross motor activity; the client needs to use the muscles, but their use must be controlled. Preventing gross motor activity can increase outbursts from the client. Further deterioration usually cannot be prevented in this disorder; it is a progressive disease. Behavior modification methods do not work well with disoriented, forgetful clients. They do not have the cognitive abilities to remember the awards and consequences of behavior modification to make it an effective strategy.

The therapist suggests response prevention for a client who has an overwhelming impulse to count and arrange the paper clips. Which nursing action supports this behavioral therapy? Coach the client to do deep-breathing and relaxation exercises. Role-model how to minimize handling and storing paper clips. Reinforce saying "Stop" while snapping a rubber band on the wrist. Remind about the set time limits for counting and arranging.

Remind about the set time limits for counting and arranging. In response prevention the therapist prevents the compulsive behavior and the client learns that anxiety can subside. The client then sets time limits and gradually extends the time in between rituals and the time spent in performing rituals. Relaxation exercises, role modeling, and thought blocking ("Stop" with a physical cue such as snapping a rubber band) are other interventions used in behavioral therapy.