unit 3

Which slogans would be used in a 12-step program? Select all that apply. A) ìPull yourself together.î B) ìGet control of your problem.î C) ìOne day at a time.î D) ìEasy does it.î E) ìLet go and let God.î

c, d, e

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first? A) Decrease the client's environmental stimuli. B) Give the client feedback about his behavior. C) Introduce the client to other staff on the unit. D) Tell the client about hospital rules and policies.

A

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time? A) Accompany the client to his or her room to get dressed. B) Put the client in seclusion for his or her own protection. C) Tell other clients to ignore the behavior because it is harmless. D) Tell the client that the behaviors have to stop right now.

A

The client with mania attempts to hit the nurse. Which is the best response by the nurse? A) ìDo not swing at me again. If you cannot control yourself, we will help you.î B) ìIf you do that one more time, you will be put in seclusion immediately.î C) ìStop that. I didn't do anything to provoke an attack.î D) ìWhy do you continue that kind of behavior? You know I won't let you do it.î

A

Which of the following is a psychosocial explanation for the development of personality disorders? A) Highly self-directed people reflect uncooperativeness and intolerance. B) Cooperative people become increasingly helpless over time. C) Failure to complete a developmental task jeopardizes future personality development. D) Self-transcendence contributes to self-consciousness and materialism

c

Upon admission, a client with a personality disorder identified the following as areas of concern for which the client would like help. According to studies, which will most likely be addressed by the health-care team? A) Psychological distress B) Self-care C) Sexual expression D) Budgeting

a

Which term describes the extent to which a person considers himself to be an integral part of the universe? A) Cooperativeness B) Self-directedness C) Self-transcendence D) Character

c

A client who is manic states, ìWhat time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?î Which would be the most appropriate response by the nurse? A) ìPlease slow down. I'm not sure what you need first.î B) ìYou will have to be quiet and have breakfast after the doctor comes.î C) ìAre you hungry?î D) ìYour thoughts seem to be racing this morning.î

A

Which individual is at highest risk for committing suicide? A) A 71-year-old male, alcohol user, independent minded B) A 16-year-old female, diabetic, two best friends C) A 47-year-old male, schizophrenic, unemployed D) A 57-year-old female, depression, active in church

a

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? A) Insisting that others follow the rules of the unit B) Wondering why others are being friendly to her C) Having a tantrum if not getting enough attention D) Getting others to make decisions for her

c

A client who is depressed begins to cry and states, ìI'm just really sick of feeling this way. Nothing ever seems to go right in my life.î Which would be the most appropriate response by the nurse? A) ìDon't cry. Try to look at the positive side of things.î B) ìYou are feeling really sad right now. It's a hard time.î C) ìHang in there. Your medication will start helping in a few days.î D) ìNothing ever goes right?î

B

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale? A) As soon as lunch is over, the client will calm down. B) Other clients need to be protected from the intrusive behavior. C) The client's behavior is not an imminent threat to anyone's physical safety. D) The client needs food and fluids in any way possible.

B

The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, ìI saw you sitting alone and thought I might keep you company.î The client turns away from the nurse. Which would be the most therapeutic nursing intervention? A) Move to another chair closer to the client and say, ìThe staff is here to help you.î B) Move to a chair a little further away and say, ìWe can just sit together quietly.î C) Remain in place and say, ìHow are you feeling today?î D) Say, ìI'll visit with you a little later,î and leave the client alone for a while

B

At 1 AM, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response? A) ìGo to the day room and wait while I call your psychiatrist.î B) ìDon't be unreasonable. I can't call the psychiatrist at this time of night.î C) ìI can't call the psychiatrist now, but you and I can talk about your request for a pass.î D) ìYou must really be upset to want a pass immediately; I'll give you some medication.î

C

During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse? A) ìDo you think you could sit still for a few minutes so we can talk?î B) ìHow are you ever going to get any rest if you keep that music on?î C) ìLet's go to the conference room and talk for a while.î D) ìTurn the radio down so we can hear ourselves talk.î

C

The nurse is planning care for a client with major depression. Which is an appropriate expected outcome? A) The client will avoid causing harm to others. B) The client will be free from stress. C) The client will independently carry out activities of daily living. D) The client will not experience agitation

C

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? A) Peanut butter sandwich, chips, cola B) Fried chicken, mashed potatoes, milk C) Ham sandwich, cheese slices, milk D) Spaghetti, garlic bread, salad, tea

C

A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm? A) Immediately after a family visit B) On the anniversary of significant life events in the client's life C) During the first few days after admission D) Approximately 2 weeks after starting antidepressant medication

D

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior? A) Administering a sedative that has been prescribed to be used PRN. B) Insisting the client take a ìtime-outî in his room C) Clearing the area of all other clients D) Setting limits on aggressive and intimidating behavior

D

A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate? A) Allowing the client to direct her participation at her own pace B) Giving the client several choices of projects, so she can choose her favorite C) Staying away from the client during the session to encourage free expression D) Structuring the activity to facilitate completion of one specific task

D

A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit ìcold turkey.î What would be the best response by the nurse? A) ìIt is not safe to stop drinking suddenly without medicine.î B) ìYou sound really motivated. Come in and we will help you find a treatment center.î C) ìAfter a few days of rest, you should feel much better as long as you do not drink anything.î D) ìYou will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest, and come in if they do not get better in 3 to 5 days.î

a

A client is admitted for major depression. What should the nurse expect to find during assessment? A) Anhedonia, feelings of worthlessness, and difficulty focusing B) Depressed mood, guilt, and pressured speech C) Changes in sleep pattern, tired, and grandiose mood D) Difficulty focusing, feelings of helplessness, and flight of ideas

a

A client is readmitted to the detox unit for the fourth time in 3 years. The nurse states in the morning report, ìNot again! Why should we keep trying to help this guy? He obviously doesn't want it.î What does this statement reflect? A) The nurse lacks the self-awareness to work effectively with this addicted client. B) The nurse understands the cycle of remission and relapse characteristic of addiction. C) The nurse has repressed negative emotions from past experiences with addiction. D) The nurse is trying to conceal his or her own addictions.

a

A client who is depressed states, ìI think my family would be better off without me. They don't need to worry.î Which would be the most appropriate response by the nurse? A) ìAre you planning to commit suicide?î B) ìWhat do you think they are worried about?î C) ìWhere are you going?î D) ìYou don't mean that. Your family loves you.î

a

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which of the following is typical of these symptoms? A) Alcohol withdrawal syndrome B) Continuing intoxication C) Delirium tremens D) WernickeñKorsakoff syndrome

a

A client with dependent personality disorder has a goal to increase her problem-solving skills. Which client behavior would indicate progress toward meeting that goal? A) Asking questions B) Being polite C) Controlling emotional outbursts D) Requesting assistance appropriately

a

A concerned family member tells the nurse, ìI am concerned about my brother. He has been acting very different lately.î Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder? A) Taking unnecessary risks B) Sleeping more C) Intense focus D) Showing low self-esteem

a

Chapter 18 Which disorder is characterized by pervasive mistrust and suspiciousness of others? A) Paranoid personality disorder B) Schizoid personality disorder C) Histrionic personality disorder D) Dependent personality disorder

a

The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristics would the nurse identify as a significant risk factor? A) One parent who is an alcoholic B) Parents who practiced strict discipline C) Overprotective parents D) Being raised in an urban area

a

The nurse is coleading a family therapy group with a client addicted to alcohol. Which statement made by the wife indicates the need for additional education regarding alcoholism as a family illness? A) ìI have to call in sick for my husband when he is too hung over to go to work.î B) ìLast time he got arrested, I just let him sit in jail.î C) ìWe have separated our finances so that I will not go broke.î D) ìI take my kids with me to Al-anon meetings every week.î

a

The nurse is discussing the principles of 12-step programs for recovery with a client. Which statement is consistent with the principles of 12-step programs? A) The client will need to abstain from all substances for successful recovery. B) Once sober, the person can safely return to life as it was before becoming addicted. C) The prognosis for recovery is enhanced with the aid of maintenance medications. D) Recovery requires adherence to a plan of achieving long-term goals.

a

The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action on him. Which is the best rationale for this intervention? A) It will assist the client to start basing decisions and actions on reality. B) It will help the client understand the origins of his or her paranoid thinking. C) It will help the client learn to trust other people. D) It will teach the client to differentiate when his or her suspicions are true.

a

The nurse is teaching a client with schizoid personality to function more comfortably with others in the community. Which nursing intervention would be effective to improve the client's social skills? A) Teach the client to make necessary requests in writing or over the phone. B) Accompany the client during initial interactions in the community. C) Suppress the display of any unusual behaviors in public. D) Assist in developing an explanation for bizarre behaviors to offer to others in the community.

a

Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide? A) The relative's suicide offers a sense of ìpermissionî or acceptance of suicide as a method of escaping a difficult situation. B) Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation. C) Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation. D) The relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.

a

Which of the following groups could benefit most from prevention programs? A) Children, prior to first use B) Adults who have already engaged in substance abuse C) Older adults D) Infants

a

Which are important in the limit-setting technique to deal with manipulative behavior? Select all that apply. A) Stating the behavioral limit B) Identifying the consequences if the limit is exceeded C) Identifying the expected or desired behavior D) Providing choices E) Allowing flexibility

a, b, c

Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply. A) Negative societal view of suicide B) Feeling inadequate and anxious about suicide and/or his or her own mortality C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety D) Being unaware of his or her own feelings and beliefs about suicide E) Implementing nursing interventions to decrease the risk of suicide

a, b, c, d

Which reasons make it necessary for the nurse to examine his or her beliefs and attitudes about substance abuse? Select all that apply. A) The nurse may be overly harsh and critical of the client. B) The nurse may unknowingly act out old family roles and engage in enabling behavior. C) The nurse or close friends and family of the nurse may abuse substances. D) The nurse may have different attitudes about various substances of abuse. E) The nurse is not likely to have had any experience with substance abuse.

a, b, c, d

Which statements are important reasons for why the problem of substance abuse must be addressed? Select all that apply. A) Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. B) Chemical abuse results in increased violence. C) Drug abuse costs business and industry an estimated $102 billion annually. D) Alcohol abuse is a too frequent cause of or contributor to death. E) Substance abuse is decreasing.

a, b, c, d

Which are general warning signs of substance abuse that a nurse should be alert for in coworkers? Select all that apply. A) Poor work performance B) Frequent absenteeism C) Unusual behavior D) Slurred speech E) Isolation from peers F) Substance abuse is not a problem in health professionals

a, b, c, d, e

The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply. A) Paranoid B) Antisocial C) Schizotypal D) Narcissistic E) Avoidant

a, b, d

The nurse is coleading a family therapy group for clients and families of drug-addicted individuals. The family of a cocaine addict is angry and cannot understand why the client cannot just stop using. The nurse guides the group to discuss their understanding of the nature of addiction. Which statements would the nurse identify as an accurate understanding of the nature of addiction? Select all that apply. A) It is a medical illness that is progressive. B) The client will eventually be cured. C) Relapses and remissions are part of the illness. D) Clients can learn to get control over the substance

a, c

Which nursing interventions are most important in a plan of care for a client with histrionic personality disorder? Select all that apply. A) Teach social skills. B) Assist the client to eliminate passive behavior. C) Provide factual feedback about behavior. D) Try to meet the client's needs for attention. E) Acceptance of the behavior.

a, c

Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? Select all that apply. A) Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings. B) Considering the client to be a personal friend. C) Employ ongoing communication with team members to remain firm and consistent about expectations for clients. D) Solving the problems of the client. E) Understanding that behavior changes in clients with personality disorders can occur quickly.

a, c

Of the following personality disorders, which are most likely related to lack of caring about others? Select all that apply. A) Schizotypal personality disorder B) Borderline personality disorder C) Antisocial personality disorder D) Narcissistic personality disorder E) Obsessiveñcompulsive personality disorder

a, c, d

Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply. A) After starting antidepressant therapy but not having reached the therapeutic level B) After having reached the therapeutic level of antidepressants and maintained it for several years C) If the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed D) If the client does not adhere to the medication regimen and takes antidepressant medications irregularly E) Prior to initiating antidepressant therapy but before the depression results in lack of energy

a, c, d, e

Which client is at highest risk for carrying out a suicide plan? A) A client who plans to take a bottle of sleeping pills. B) A client who says, ìMy life is over.î C) A client who has a private gun collection. D) A client who says, ìI'm going to jump off the next bridge I see.î

c

A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention? A) Stating, ìThe effects of medications will not last forever. You will need to eventually learn to function without them.î B) Stating, ìMedications help your brain function better, but the therapy helps you achieve lasting behavior change.î C) Stating, ìBoth are recommended. Since your insurance covers both, that is the best plan for you.î D) Asking, ìDo you have reservations about going to therapy?î

b

A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse? A) ìI am going to take up a new hobby. It's time to start something new.î B) ìI can still hang out with my old friends. I am just not going to use.î C) ìI'm not very comfortable with being alone yet.î D) ìShooting baskets helps me not think about getting high.î

b

A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, ìI am so ashamed.î What should the nurse reply? A) ìI really thought you would make it.î B) ìTell me what has happened since your last admission.î C) ìYou have nothing to be ashamed of.î D) ìWhy did you start drinking again?î

b

A client who has been discharged home on Celexa (citalopram) calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions? A) Make an appointment to change to a different medication. B) Take the medication at night. C) Be patient while this early side effect subsides. D) Skip a dose if drowsiness is excessive

b

A client with alcohol dependence is admitted to the hospital with pancreatitis. Which intervention should be included in the client's plan of care? A) Fluid restriction of 1000 mL per 24 hours B) Glucometer checks b.i.d. C) High-protein diet D) Protective isolation precautions

b

A client with borderline personality disorder says to the nurse, ìI feel so comfortable talking with you. You seem to have a special way about you that really helps me.î Which would be the most appropriate response by the nurse? A) ìI'm glad you feel comfortable with me.î B) ìI'm here to help you just as all the staffs are.î C) ìYou feel others don't understand you?î D) ìI cannot be your friend. We need to be clear on that.î

b

A community health nurse is planning a substance abuse prevention program. Which group would be the best target audience for the nurse to plan a program? A) Teenagers in a high school health class B) School-age children in an after-school program C) Parents attending a parentñteacher association meeting D) Elementary school teachers and counselors

b

A female client with borderline personality was formerly cooperative with the treatment regimen. Suddenly, the client believes the staff is working against her and is refusing all interaction and participation in treatment. The nurse feels very frustrated by this client's behavior. What is the best action for the nurse to take regarding personal frustration with this client? A) Discuss the feelings of frustration with the client in a one-to-one interaction. B) Discuss the frustration with a colleague or supervisor in a private setting. C) Set aside the frustration and focus on reassessing the client's needs. D) Research the client's diagnosis further to better understand the client's behaviors

b

A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include? A) Unlike heroin, methadone is nonaddicting. B) Methadone will meet the physical need for opiates without producing cravings for more. C) Methadone will produce a high similar to heroin. D) People taking methadone run the same risks associated with IV drug use as those taking heroin

b

A nurse suspects a coworker is signing out narcotics for clients and is using them herself. Which action should be taken by the nurse who has these suspicions? A) Ignore suspicions and leave it to the supervisor to intervene. B) Report the observations to the supervisor. C) Follow behind the coworker to ensure client comfort and safety. D) Confront the coworker about suspicions

b

A peer reports for work looking unkempt and disheveled. Her movements are uncoordinated, and her breath smells like mouthwash. Another nurse suspects this peer is intoxicated. What should be the action of the nurse who suspects that a peer is intoxicated? A) Immediately call the supervisor to report the peer's behavior. B) Ask the peer if she feels alright and express concern. C) Give the peer some information about the hospital's employee assistance program. D) Ignore the situation until someone else validates the observations.

b

A person with temperament traits of high harm avoidance would most likely suffer from which personality disorder? A) Schizoid B) Avoidant C) Narcissistic D) Antisocial

b

A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at his time? A) Confiscate the soda can as a restricted item. B) Pour the soda into a plastic cup. C) Ask the visitor to place the soda can at the nurse's desk until he or she leaves. D) Ask the visitor not to bring outside items on the unit in the future.

b

The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that his relationship with the client was codependent and enabling. Which is an example of codependent behavior? A) The friend called Alcoholics Anonymous when the client expressed a need to stop drinking. B) The friend called the client every night to make sure he got home safely and went looking for him if he was not at home. C) The friend confronted the client on the effect of his drinking on their relationship. D) The friend refused to go out drinking with the client to celebrate the client's birthday.

b

The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which is the best action for the nurse to take? A) Ask other nurses if they have noticed anything unusual. B) Call the manager and report the observations. C) Observe the nurse as injections are prepared and administered. D) Tell the nurse, ìI know you've been stealing Valium.î

b

The nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. Which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal? A) ìI just don't understand why anyone would want to kill themselves.î B) ìI think suicide is wrong and selfish.î C) ìI get frustrated when my client negates all the positives I try to point out.î D) ìI can see how much my client is hurting inside.î

b

When interviewing the family members of a client being treated for substance abuse problems, which behavior would alert the nurse to the possibility of codependency? A) Being flexible but angry B) Blaming themselves for the family's problems C) Expressing thoughts and feelings openly D) Taking pleasure in self-accomplishments

b

Which characteristic of the 12-step program distinguishes it from other programs? A) The philosophy that it is possible to reduce the use of substances without abstaining. B) It is a self-help group that does not necessarily use health professionals as leaders. C) Persons who use this program are independent in their sobriety. D) Infrequent attendance is usually successful.

b

A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply. A) Weigh self weekly at the same time of day. B) Drink a 2-L bottle of decaffeinated fluid daily. C) Do not alter dietary salt intake. D) See the doctor if you get the flu. E) Restrict involvement in intense exercise.

b, c, d

Which challenges are posed when working with clients with personality disorders? Select all that apply. A) Clients with personality disorders are obviously unable to function more effectively. B) It can take a long time to change their behaviors, attitudes, or coping skills. C) The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. D) Clients with personality disorders challenge the ability of therapeutic staff to work as a team. E) Team members may have differing opinions about individual clients.

b, c, d, e

Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply. A) Norepinephrine levels may be increased in mania. B) Manic episodes are a ìdefenseî against underlying depression. C) Acetylcholine seems to be implicated in mania. D) The id takes over the ego and acts as an undisciplined hedonistic being (child).

b, d

Which variables represent the highest risk for developing major depressive disorder? Select all that apply. A) Male gender B) Mood disorder in first-degree relatives C) Substance abuse D) Divorced E) Older adult

b, d

A client is being discharged on disulfiram (Antabuse). Which instruction for Antabuse should the client receive? A) Take disulfiram with food to avoid stomach upset. B) Skip the daily dose of disulfiram on days when consumption of alcoholic beverages is likely. C) Read products labels carefully to avoid all products containing alcohol. D) Disulfiram will prevent the desire to drink alcoholic beverages.

c

A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least six drinks with every episode in order to ìhave a good time.î Which term would best describe this phenomenon? A) Dependence B) Intoxication C) Tolerance D) Withdrawal

c

A client will be taking disulfiram (Antabuse) after discharge from an alcohol treatment program. Which statement would indicate that teaching has been effective? A) ìAntabuse is safe to take with any over-the-counter cold medication.î B) ìAntabuse will block my cravings for alcohol, so I'll have less desire to drink.î C) ìDrinking alcohol while taking Antabuse can cause dangerous symptoms.î D) ìIf I drink while taking Antabuse, it will make me vomit before the alcohol affects me.î

c

A client with antisocial personality disorder is begging to use the phone to call his wife, even though it is against the unit rules. The client begs, ìIt is just this once, and she will be so hurt if I don't call her.î Which would be the most appropriate response by the nurse? A) ìOnly to help your wife, you can call this time.î B) ìI will get in trouble with my supervisor if I let you call.î C) ìYou may not use the phone to call your wife.î D) ìYou cannot call because you need to focus on your recovery while you are here, not your wife.î

c

A nurse is teaching a client with borderline personality disorder to reshape thinking patters. Which is an example of a cognitive restructuring technique that would be helpful for this client? A) When negative thoughts begin, tell yourself ìstop.î B) Learn to look at situations realistically rather than assuming the worst. C) Recognize negative thoughts and replace them with positive ones. D) Express needs using ìIî statements.

c

A nurse is working with a couple seeking counseling for marital discord. The history indicates the husband was treated for substance abuse 4 years ago and attends AA meetings occasionally. Which statement made by the recovering husband should alert the nurse for the need for further education? A) ìI still need to go to AA meetings even though I have been sober for years.î B) ìAfter all these years, I just don't have the will power to stop if I started using again.î C) ìShe gets upset when I hang out with my old buddies on the weekends.î D) ìI wish I could be able to handle just one beer with dinner.î

c

The nurse is assessing the drinking history of a client being admitted for alcohol abuse. Which statement would the nurse expect the client to make? A) ìI really need some help. My drinking is tearing my family apart.î B) ìI have tried so many times to stop drinking. It is so hard.î C) ìI don't really have a problem with alcohol. I've just been having a streak of bad luck lately.î D) ìI have no intention to stop drinking. I like the way it makes me feel.î

c

The nurse is teaching a 70-year-old man about his depression. Which statement by the client would indicate that teaching has been effective? A) ìAll old people get depressed at times.î B) ìI'm glad I'll feel better in 2 or 3 days.î C) ìI never knew depression could just happen for no specific reason.î D) ìWhen I reduce the stress in my life, the depression will go away.î

c

What would the nurse expect to assess in a client with narcissistic personality disorder? A) Genuine concern for others B) Mistrust of others C) Grandiose and superior self-concept D) Dependence on others for decision making

c

When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do? A) Aggressively confront the client about boundary violations. B) Limit interactions to 10 minutes at a time. C) Respect the client's boundaries at all times. D) Tell the client the relationship will last as long as the client wishes.

c

Which best explains the neurochemical processes responsible for depression? A) Increased activity of dopamine B) Decreased glucocorticoid activity C) Decreased serotonin and norepinephrine activity D) Potentiating of the kindling process

c

. The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of her husband. The nurse suggests the wife implement the limitsetting skills she has learned in family therapy. In this instance, the nurse's action would be considered A) inappropriate; the nurse should not give advice to the wife. B) inappropriate; the husband has the legal right to spend personal money. C) appropriate; the wife is responsible for the husband's actions since he has a mental illness. D) appropriate; the wife needs support in setting boundaries.

d

A client has been admitted to the inpatient unit after using inhalants recently. Which is an antidote to treat inhalant toxicity? A) Ativan B) Narcan C) Antabuse D) There is no antidote

d

A client in treatment for drug abuse makes the statement, ìI am a winner. You all are the losers because you can't beat this on your own.î What common characteristic of persons addicted to drugs is revealed in this statement? A) Realistic understanding of successful recovery of drug addiction B) Indication of an underlying personality disorder C) Brain damages resulting from chronic drug use D) Defending against a negative self-concept

d

A client is admitted for a drug overdose with a Barbiturate? Which is the priority nursing action when planning care for this client? A) Check the client's belongings for additional drugs. B) Pad the side rails of the bed because seizures are likely. C) Prepare a dose of ipecac, an emetic. D) Monitor respiratory function.

d

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority? A) Hopelessness related to recent divorce B) Ineffective coping related to inadequate stress management C) Spiritual distress related to conflicting thoughts about suicide and sin D) Risk for suicide related to a highly lethal plan

d

A nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then display negativity. The nursing student may be showing signs of which personality disorder or behavior? A) Paranoid B) Borderline C) Narcissistic D) Passive-aggressive behavior

d

An unconscious client is admitted to the emergency department after a motor vehicle accident. The client's blood alcohol level upon admission was 1.7. The client's family soon arrives, reporting that the client is an uncle who is visiting from out of town. They cannot give much more history other than that he is a ìsocial drinker.î After being transported to the unit, the client starts sweating and has elevated vital signs. What information should the nurse request of the family? A) Who is the next of kin? B) For what occasion is the uncle visiting from out of town? C) Does the uncle have a history of any sort of anxiety disorder? D) Are there other indications that the client may be a heavy drinker?

d

The client asks the nurse, ìWhat will happen if I drink while taking Antabuse?î What should be the nurse's reply? A) ìYou will not want to drink while taking Antabuse. It reduces the cravings.î B) ìYou will not get any effect from the alcohol you drink.î C) ìAntabuse will reverse the effects of alcohol.î D) ìYou will experience a severe reaction, including a throbbing headache and vomiting.î

d

The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful? A) ìBeing a loner really limits your employment opportunities.î B) ìMaybe your friend could see if there is a night position available at the convenience store.î C) ìPerhaps working part-time at a fast-food restaurant would be something you could do.î D) ìThere is a job posting at the hospital for a file clerk in medical records.î

d

The nurse teaches an antisocial client to take a time-out in his room when challenged by another person instigating an argument. What is the main reason for the time-out? A) It allows time for the instigator to leave the area. B) It allows adequate space between the client and the instigating individual. C) It prevents the client from experiencing negative consequences of behavior. D) It allows an opportunity for the client to regain control of emotions.

d

The wife of a client who is alcoholic asks the nurse how to respond to him in a helpful way when he is disruptive in family life. Which is the nurse's best response? A) ìHelp him avoid embarrassment by supporting him when he makes excuses for failing to meet obligations.î B) ìInclude him in family outings even when he is drinking.î C) ìSearch the house regularly for alcohol.î D) ìTry to maintain a normal home environment for yourself and the children.î

d

When planning care for a client with passive-aggressive personality disorder, the nurse will need to include interventions for which behavior? A) Avoidance of anxiety-provoking situations B) Compulsive needs for perfection and praise C) Dependence on others for decisions D) Procrastination and intentional inefficiency

d

Which is a freudian explanation of the etiology of depression? A) Depression is a reaction to a distressing life experience. B) Depression results from being raised by rejecting or unloving parents. C) Depression results from cognitive distortions. D) Depression is anger turned inward.

d

Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality? A) The team needs to consider updating treatment recommendations as the client improves. B) Rotating team members need to be apprised of the care planned for the client. C) Staff frustrations in caring for the client need to be processed. D) Team consistency is important to prevent manipulation by the client.

d

Which of the following is a realistic outcome for the care of a person with a personality disorder? A) Outcomes that focus on satisfaction with daily life B) Outcomes that focus on the client's perception of others C) Outcomes that focus on increased client insight D) Outcomes that focus on change in behavior

d

Which of the following neurochemical influences is a probable cause of substance abuse? A) Imbalances of serotonin and norepinephrine in the brain B) Inhibition of GABA in the brain C) Excessive serotonin activity in the CNS D) Stimulation of dopamine pathways in the brain

d

Which thought process would cause a client with antisocial personality disorder to want to do everything for himself? A) Belief in his own self-worth B) Inability to delay gratification C) Rewards for competitive behavior D) Sense of mistrust of others

d