Dunphy Psychosocial Part 2

The nurse is assessing a client who has borderline personality disorder. Which of the following would be a priority? A) Nutrition patterns B) Personal hygiene practices C) Physical functioning D) Somatic complaints

A) Nutrition patterns

The nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of which of the following? A) Panic disorder B) Schizophrenia C) Delusional disorder D) Posttraumatic stress disorder

A) Panic disorder

A nursing instructor is preparing a teaching plan for a class of nursing students about antisocial personality disorder. Which of the following would the nurse include as a term often used to describe the behaviors associated with this condition? Select all that apply. A) Psychopath B) Manipulator C) Criminality D) Sociopath E) Psychotic

A) Psychopath D) Sociopath

A nurse is assessing a client diagnosed with avoidant personality disorder. Which of the following would the nurse most likely expect to find? Select all that apply. A) Shyness B) Feelings of inadequacy C) Feelings of superiority D) Perfectionism E) Detail oriented

A) Shyness B) Feelings of inadequacy

The nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder and his family. The nurse determines that the client and family have understood the instructions when they state which of the following? A) The disorder may be caused by increased serotonin activity. B) The disorder is caused by decreased dopamine activity in my brain. C) A frontal lobe dysfunction may be causing this condition. D) A decrease in hormonal substances increases the risk for this illness.

C) A frontal lobe dysfunction may be causing this condition.

A young man with malaria spikes a temperature of 105 F and begins to hallucinate. How should the nurse assess this? a. Delirium b. Psychotic break c. Possible stroke d. Anxiety disorder

a. Delirium Delirium is an organic mental disorder that is frequently brought on by a severe physical illness, such as fever.

The nurse is told that a patient believes he was born into the wrong body. What is the correct terminology for the desire to have the body of the opposite sex? a. Homosexuality b. Transsexualism c. Heterosexuality d. Bisexuality

b. Transsexualism Transsexualism is a persistent desire to be the opposite sex and to have the body of the opposite sex.

The home health nurse assesses a patient who creates elaborate excuses for not leaving home. Further questioning reveals the patient had not left home for 6 months. How should this be documented? a. Mania b. Depression c. Agoraphobia d. Anxiety

c. Agoraphobia Agoraphobia is a high level of anxiety in which an anxiety attack could occur in individuals who avoid other people, places, or events.

The nurse is assessing a female patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. What type of anxiety should the nurse conclude that the patient is exhibiting? a. Signal anxiety b. General anxiety c. Anxiety traits d. Panic disorder

c. Anxiety traits An individual with anxiety traits has anxious reactions to relatively nonstressful events. Signal anxiety is a learned response to an event such as test taking. An individual with general anxiety worries over many things. A panic attack occurs suddenly and typically peaks within 10 minutes.

17.The nurse recognizes that researchers have identified that hereditary factors account for what percentage of mood disorders? a. 10% to 15% b. 20% to 30% c. 35% to 50% d. 60% to 80%

d. 60% to 80% Research indicates that hereditary factors account for 60% to 80% of mood disorders.

A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the clients blood level for this drug, which level would alert the nurse to the need to change the dosage? A) 30 ng/mL B) 55 ng/mL C) 75 ng/mL D) 115 ng/mL

A) 30 ng/mL

A nurse is reading a journal article about the various theories associated with the development of antisocial personality disorder. The article mentions difficult temperament as a possible theory. The nurse demonstrates understanding of this concept when identifying which of the following as a key behavior associated with a difficult temperament? Select all that apply. A) Aggression B) Inattention C) Hyperactivity D) Impulsivity E) Depression F) Paranoia

A) Aggression B) Inattention C) Hyperactivity D) Impulsivity

The nurse is preparing to assess a client with a paranoid personality trait. The nurse integrates knowledge of this condition, anticipating that the clients affect and behavior will most likely be which of the following? A) Angry and hostile B) Flirtatious and seductive C) Fearful and anxious D) Friendly and open

A) Angry and hostile

A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? Select all that apply. A) Childhood sexual abuse B) Parental loss C) Substance abuse D) Family history E) Genetics

A) Childhood sexual abuse B) Parental loss

A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be prescribed? Select all that apply. A) Clomipramine B) Lithium C) Sertraline D) Fluvoxamine E) Paroxetine F) Alprazolam

A) Clomipramine C) Sertraline D) Fluvoxamine E) Paroxetine

A nurse is developing a teaching plan for a client with generalized anxiety disorder, focusing on nutrition. Which of the following would the nurse encourage the client to avoid? Select all that apply. A) Coffee B) Ginseng C) Milk products D) Citrus juices E) Aged cheese

A) Coffee B) Ginseng

A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which of the following would the nurse most likely include? Select all that apply. A) Developing a therapeutic relationship B) Bargaining about the unit rules C) Holding the client responsible for behavior D) Discouraging client from discussing thoughts E) Using a firm, lecture-like approach for teaching

A) Developing a therapeutic relationship C) Holding the client responsible for behavior

After teaching a class about the biochemical theories associated with panic disorder, the instructor determines a need for additional teaching when the students identify which neurotransmitter as being implicated? A) Dopamine B) Serotonin C) Norepinephrine D) Gamma-aminobutyric acid (GABA)

A) Dopamine

A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for the nurse to do? A) Tell the client firmly that she must take her medication. B) Allow the client to participate in the treatment decision. C) Restrain the client before administering the medication. D) Notify the physician about the clients refusal of the medication.

B) Allow the client to participate in the treatment decision.

A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which of the following would be most important for the nurse to focus on when teaching the family about this disorder? A) Anger management B) Boundary setting C) Medication therapy D) Self-responsibility

B) Boundary setting

A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitive behavioral concepts associated with panic disorders, which of the following would the nurse expect to address? A) Personal losses B) Conditioned response C) Early separation D) Dysfunctional family communication

B) Conditioned response

A nurse is working with a client who is a compulsive gambler. Which of the following would the nurse emphasize as crucial for relapse prevention? Select all that apply A) Medication therapy B) Family involvement C) Identification of triggers D) Anger management E) Milieu management

B) Family involvement C) Identification of triggers

A group of students is reviewing the signs and symptoms associated with anxiety. The students demonstrate an understanding of the information when they identify which of the following as cognitive symptoms? Select all that apply. A) Edginess B) Feelings of unreality C) Difficulty concentrating D) Tunnel vision E) Apprehensiveness F) Speech dysfluency

B) Feelings of unreality C) Difficulty concentrating D) Tunnel vision

A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer? A) Lithium carbonate (Lithium) B) Haloperidol lactate (Haldol) C) Fluoxetine (Prozac) D) Paroxetine (Paxil)

B) Haloperidol lactate (Haldol)

A nurse is assessing a client with borderline personality disorder. Which question would be most appropriate to assess the clients level of impulsivity? A) What things bother you and make you feel happy? B) Have you ever felt sorry after acting as you did on the spur of the moment? C) How do you view other people around you? D) Have you ever felt like you were separated from your body?

B) Have you ever felt sorry after acting as you did on the spur of the moment?

A client with bipolar disorder has had a history of multiple episodes and states, Im so frustrated with whats happened because of these episodes. Which of the following would the nurse encourage to help support this clients recovery? A) Codependence B) Hope C) Self-control D) Independent decision making

B) Hope

A nursing instructor is describing depressive and negativistic personality traits to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as characteristic of negativistic personality traits? Select all that apply. A) Anhedonia B) Hostility C) Pessimism D) Oppositionality E) Guilt

B) Hostility D) Oppositionality E) Guilt

The nurse explains that an alternative therapy that uses essential oils and scented candles to help a patient relax and focuses on the atmosphere of the moment is ___________________.

aromatherapy Aromatherapy uses essential oils and scented candles to soothe the senses and make people aware of the here and now of the pleasant environment.

What disorder is a severe form of self-starvation that can lead to death? a. Bulimia nervosa b. Anorexia nervosa c. Teenage nervosa d. Obesity nervosa

b. Anorexia nervosa Anorexia nervosa is a severe form of self-starvation that can lead to death.

9.A patient believes himself to be the president of the United States and that terrorists are trying to kidnap him. The nurse records these observations as which type of behavior? a. Absent behavior b. Positive behavior c. Negative behavior d. False behavior

b. Positive behavior The behaviors of schizophrenic individuals can be categorized as positive (or excessive) or negative (or absent). Examples of positive behaviors include hallucinations, delusions, and disordered thinking. Examples of negative behaviors include apathy, social withdrawal, and flat affect.

A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent? a. Phobia b. Post-traumatic stress disorder c. Obsessive-compulsive disorder d. Disordered thinking

b. Post-traumatic stress disorder Post-traumatic stress disorder describes a response to an intense traumatic experience that is beyond the usual range of human experience.

A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent? a. Phobia b. Post-traumatic stress disorder c. Obsessive-compulsive disorder d. Disordered thinking

b. Post-traumatic stress disorder Post-traumatic stress disorder describes a response to an intense traumatic experience that is beyond the usual range of human experience.

8.A profound, disabling mental illness is characterized by bizarre, nonreality thinking. What is the illness? a. Manic depressive b. Schizophrenia c. Paranoia d. Bipolar

b. Schizophrenia Schizophrenia, a thought process disorder, is one of the most profoundly disabling mental illnesses.

A patient who is taking a monoamine oxidase inhibitor (MAOI) asks the nurse about the addition of St. Johns wort to help with his depression. What would be the best response of the nurse? a. That is a great idea. Alternative therapies can be very helpful. b. You will feel better sooner if you include phenylalanine. c. Did you know that St. Johns wort can raise your blood pressure dramatically? d. You will need to drink lots of water.

c. Did you know that St. Johns wort can raise your blood pressure dramatically? St. Johns wort can raise blood pressure dramatically in people who are also taking MAOIs.

What is the prognosis for a schizophrenic patient who is exhibiting positive behaviors? a. Guarded b. Poor c. Good d. Repeatable

c. Good Prognosis for schizophrenic patients who are exhibiting positive behavior patterns is good.

The nurse alters the care plan for a patient with depression to include what type of activity? a. Domino game with three other patients b. Ping-Pong game with one other patient c. Group outing to view wildflowers d. Magazine to read alone

c. Group outing to view wildflowers The quiet, noncompetitive trip to view wildflowers would be the best option. Depressed people should not be put in situations where they must concentrate or compete.

The patient talks with his dead brother and arranges furniture so that his brother will have a place to sit. How should the nurse document this behavior? a. Disordered thinking b. Anhedonia c. Hallucination d. Alogia

c. Hallucination A hallucination is a sensory experience without a stimulus trigger. Disordered thinking occurs when the individual is not able to interpret information being received in the brain. Anhedonia describes lack of expressed feelings. Alogia is reduced content of speech.

A home health nurse has a patient who is taking lithium. What should be included in the teaching plan? a. Examine her skin closely for eruptions b. Take her blood pressure twice a day to check for hypertension c. Have her drug blood level checked every month d. Avoid aged cheese and red wine

c. Have her drug blood level checked every month ANS: C Lithium has a very narrow therapeutic window. The drug blood levels should be closely monitored.

4.When all five axes of the Diagnostic and Statistical Manual of Psychiatric Disorders, V, are used, it provides what type of assessment approach to comprehensive care? a. Personalized b. Individualized c. Holistic d. Organic

c. Holistic Using all five axes of the DSM-V provides a holistic assessment.

3.The Diagnostic and Statistical Manual of Psychiatric Disorders, V (DSM-V), is used by most hospitals and is the current tool used to examine mental health and illness. What approach does the DSM-V use to classify mental disorders? a. Holistic system b. Hierarchical system c. Multiaxial system d. Evaluation system

c. Multiaxial system The DSM-V is a multiaxial system.

A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent? a. Senseless behavior b. Controlled repetition c. Obsessive-compulsive d. Anxiety tension

c. Obsessive-compulsive Obsessive-compulsive disorders have two features: thoughts that are recurrent, intrusive, and senseless; and behaviors that are performed repeatedly and ritualistically.

A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent? a. Senseless behavior b. Controlled repetition c. Obsessive-compulsive d. Anxiety tension

c. Obsessive-compulsive Obsessive-compulsive disorders have two features: thoughts that are recurrent, intrusive, and senseless; and behaviors that are performed repeatedly and ritualistically.

31.What is the term for a long-term and intense form of psychotherapy developed by Sigmund Freud that allows a patients unconscious thoughts to be brought to the surface? a. Adjunctive b. Behavior c. Psychoanalysis d. Cognitive

c. Psychoanalysis Psychoanalysis technique was developed by Sigmund Freud and is a long-term and intense therapy.

The patient complains of recurrent, multiple physical ailments for which there is no organic cause. How should the nurse assess this? a. Obsessive-compulsive disorder b. Phobia anxiety disorder c. Somatoform disorder d. Delusional disorder

c. Somatoform disorder Somatoform disorder is characterized by recurrent, multiple physical complaints for which there is no organic cause.

The nurse is caring for a patient with a diagnosis of catatonic schizophrenia. What behavior is consistent with this diagnosis? a. Talks excitedly about going home b. Suspiciously watches the staff c. Stands on one foot for 15 minutes d. States he has a cat under his bed that talks to him

c. Stands on one foot for 15 minutes Maintaining a rigid pose for long periods of time is an example of behavior expected with catatonic schizophrenia.

The nurse instructs a patient who has just been prescribed a protocol of fluoxetine HCl (Prozac) that the drug takes ___________ to __________ weeks to take effect.

two, four Antidepressants of this type take 2 to 4 weeks before any effect is felt by the patient.

A group of students is reviewing information about social phobia in preparation for an oral class presentation on this topic. Which of the following would the students expect to include when describing a person with this condition? Select all that apply. A) Fear that others will judge them negatively B) Openly speak up in crowds to reduce fear C) Are insensitive to others criticism D) Demonstrate a distorted view of their own strengths E) Exaggerate personal flaws

A) Fear that others will judge them negatively D) Demonstrate a distorted view of their own strengths E) Exaggerate personal flaws

A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which client statement would help support the nurses suspicions? A) I have a very important position in life; everyone I know wants to be like me. B) My wife is poisoning my food so she can get rid of me and marry her boss. C) I like to work alone because then I can let my thoughts wander. D) Im always the life of the party, making new friends all the time.

A) I have a very important position in life; everyone I know wants to be like me.

The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior? A) I have felt so down lately. I dont enjoy doing anything anymore. B) I do what I do because others tell me to do so. C) When I feel extremely anxious, it is like my mind goes somewhere else. D) It is almost as if as soon as I think of doing something, I immediately do it.

A) I have felt so down lately. I dont enjoy doing anything anymore.

A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the teaching was successful when the client states which of the following? A) I need to notify my physician if I develop a skin rash. B) I need to have my blood tested about once a month. C) I have to watch how much salt I use every day. D) This drug can affect my liver function.

A) I need to notify my physician if I develop a skin rash.

The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following? A) I should start by stating my feelings as an I statement. B) Maybe I should start by describing the situation that has me upset. C) I should first tell the other person what Id like to be different about the situation. D) I should begin by telling the other person what has triggered my emotion.

A) I should start by stating my feelings as an I statement.

A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate? A) Increase your salt intake if an activity causes you to perspire heavily. B) Wear sunscreen when you are going to be outdoors in the summer time. C) Drink less fluid than usual now because you are taking this drug. D) No changes are necessary for strenuous activities you do outdoors.

A) Increase your salt intake if an activity causes you to perspire heavily.

The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which of the following would the nurse include when describing panic disorder? A) Individuals may believe they are having a heart attack when a panic attack occurs. B) People with panic attacks often have fewer attacks if they also have agoraphobia. C) Typically, individuals experience this disorder after the age of 30 years. D) Persons rarely have an underlying comorbid condition of depression.

A) Individuals may believe they are having a heart attack when a panic attack occurs.

A nursing instructor is preparing a class discussion on personality disorders and characteristics. Which term would the instructor include to differentiate personality disorders from normal personality? Select all that apply. A) Inflexible B) Short term C) Pervasive D) Unstable over time E) Distressing

A) Inflexible C) Pervasive D) Unstable over time E) Distressing

A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the clients medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? Select all that apply. A) Lisinopril B) Hydrochlorothiazide C) Indomethacin D) Caffeine E) Aspirin

A) Lisinopril B) Hydrochlorothiazide C) Indomethacin

A client is brought into the emergency department because of complaints from the neighbors that the client was acting strangely. The nurse assesses the client and suspects schizotypal personality disorder based on assessment of which of the following? Select all that apply. A) Magical beliefs B) Hallucinations C) Paranoia D) Avoidance of eye contact

A) Magical beliefs C) Paranoia D) Avoidance of eye contact

A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired. Which of the following would alert the nurse to suspect possible withdrawal? Select all that apply. A) Metallic taste B) Irritability C) Dry, flushed skin D) Tremor E) Muscle flaccidity

A) Metallic taste B) Irritability D) Tremor

A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the nurse expect to assess? Select all that apply. A) Metallic taste B) Ataxia C) Diarrhea D) Slurred speech E) Fasciculations F) Muscle weakness

A) Metallic taste C) Diarrhea F) Muscle weakness

The nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse most likely identify as a priority? A) Risk for Other-Directed Violence B) Risk for Self-Injury C) Risk for Suicide D) Risk for Self-Directed Violence

A) Risk for Other-Directed Violence

The nurse is caring for a client with schizoid personality trait. When developing the plan of care for the client, which of the following would the nurse most likely include? A) Social skills training B) Anger management training C) Relaxation techniques D) Coping skills training

A) Social skills training

A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The clients sister is visiting, and the sister asks the nurse to explain why her sister sometimes does this to herself. Which response by the nurse would be most appropriate? A) Sometimes the self-injurious behavior is undertaken to relieve stress. B) Self-injurious behavior often calms and sedates people with this diagnosis. C) Sometimes they do it to avoid the onslaught of delusional thinking. D) The self-mutilation often slows the mood swings your sister experiences.

A) Sometimes the self-injurious behavior is undertaken to relieve stress.

A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, Im so nervous. My hands are shaking, and Im sweating. I feel as if Im having a stroke right now. Which of the following would the nurse do first? A) Stay with the client while remaining calm. B) Move the client to a safe environment. C) Tell the client that the attack will soon pass. D) Teach the client deep breathing techniques to calm her.

A) Stay with the client while remaining calm.

A client with obsessive-compulsive disorder (OCD) is using cue cards to help restructure thought patterns. Which statements would be appropriate to include on a cue card? Select all that apply. A) These are the OCD thoughts. B) Trust myself. C) Keep on checking. D) Safety is the key. E) I did it right the first time.

A) These are the OCD thoughts. B) Trust myself. E) I did it right the first time.

The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack? A) I am feeling very nervous right now. B) I can handle this anxiety; it will be over shortly. C) I am taking medication to eliminate these symptoms. D) Relax your muscles, relax your muscles.

B) I can handle this anxiety; it will be over shortly.

A nurse is assisting a client with borderline personality disorder in how to manage transient psychotic episodes that involve auditory hallucinations. The teaching is planned for times when the client is free of these symptoms. Which of the following would the nurse instruct the client to do first? A) Use skills to tolerate painful feelings. B) Practice deep abdominal breathing. C) Identify early internal cues of distress. D) Refer to cards listing potential symptoms.

B) Practice deep abdominal breathing.

A client with borderline personality disorder has difficulty maintaining boundaries of the professional relationship. Which of the following would be most effective for the nurse to do? Select all that apply. A) Punish the client with seclusion for violating established boundaries. B) Respond to the clients arrogance in a neutral, nonconfrontational manner. C) Discuss the purpose of the limits in the therapeutic relationship. D) State the parameters of the limits and boundaries clearly. E) Ensure that any established limits are maintained consistently.

B) Respond to the clients arrogance in a neutral, nonconfrontational manner. C) Discuss the purpose of the limits in the therapeutic relationship. D) State the parameters of the limits and boundaries clearly. E) Ensure that any established limits are maintained consistently.

A nurse is developing the plan of care for a client with panic disorder that will include pharmacologic therapy. Which of the following would the nurse most likely expect to administer? A) Benzodiazepine B) Selective serotonin reuptake inhibitor (SSRI) C) Monoamine oxidase inhibitor (MAOI) D) Tricyclic antidepressant (TCA)

B) Selective serotonin reuptake inhibitor (SSRI)

A nurse is developing a teaching plan for a client with an impulse-control disorder. The nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the individual commits the act? A) Remorse B) Tension C) Regret D) Pleasure

B) Tension

A woman diagnosed with obsessive-compulsive disorder comes to the clinic with her husband. During the visit, the husband states, Shes always checking and rechecking to make sure that all of the appliances are turned off before we go out. Its nerve-wracking. We can never get out of the house on time. Isnt checking once enough? An understanding of which of the following would the nurse need to incorporate into the response? A) The client is attempting to exert control over the situation. B) The client performs the ritual to relieve anxiety temporarily. C) The womans behavior reflects a need for safety. D) The woman is attempting to use thought stopping to decrease her behavior.

B) The client performs the ritual to relieve anxiety temporarily.

A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state which of the following? A) The disorder occurs more frequently in women. B) The individual must be at least 18 years of age. C) The disorder is found primarily in Asian individuals. D) Alcohol abuse disorder rarely accompanies this disorder.

B) The individual must be at least 18 years of age.

A nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. The girl would pull out hair over several hours to relieve tension and anxiety and then eat the hair. The nurse most likely is reading an article about which of the following? A) Kleptomania B) Trichotillomania C) Pyromania D) Intermittent explosive disorder

B) Trichotillomania

A nurse is engaged in role-playing with a client with borderline personality disorder to assist the client in learning how to communicate effectively. Which of the following would the nurse encourage the client to use? Select all that apply. A) Me statements B) Validating perceptions with others C) Paraphrasing before responding D) Listening passively E) Compromising

B) Validating perceptions with others C) Paraphrasing before responding D) Listening passively E) Compromising

A client with borderline personality disorder tells the nurse, Im afraid to get on a train because well probably get into a wreck. Which response by the nurse would be most appropriate? A) Have you had a bad experience riding a train? B) What are the chances of that actually happening? C) Now you know that wont happen. D) Have you thought about going by automobile?

B) What are the chances of that actually happening?

A client comes to the emergency department because he thinks he is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to use? A) Are you feeling much better now that you are lying down? B) What did you experience just before and during the attack? C) Do you think you will be able to drive home? D) What do you think caused you to feel this way?

B) What did you experience just before and during the attack?

A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the clients therapy has been effective when the client states which of the following? A) I am still experiencing quite a bit of stress at home and at work; things are different at home than they were in the hospital. B) When my mother-in-law comes over now, I go out to my workshop and work on one of my projects. C) Im still drinking coffee; I cant quit after drinking it all these years. D) Ive learned having a beer after I get home from work helps me relax.

B) When my mother-in-law comes over now, I go out to my workshop and work on one of my projects.

A client with a panic disorder has been prescribed a benzodiazepine medication. Which of the following would the nurse emphasize as a risk associated with using this medication? A) Dietary restrictions B) Withdrawal symptoms C) Agitation D) Fecal impaction

B) Withdrawal symptoms

A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state which of the following? A) Anxiety disorders rank second to depression in psychiatric illnesses being treated. B) Women experience anxiety disorders more often than do men. C) Most anxiety disorders tend to be short term with individuals achieving full recovery. D) Anxiety disorders are more common in children than in adolescents.

B) Women experience anxiety disorders more often than do men.

When planning care for a female patient diagnosed with obsessive and compulsive behavior, Nurse Barbara and case manager Marc must recognize that the ritual: A. Assists the patient to understand their inability to deal with reality. B. Helps the patient to be in control of their anxiety. C. Helps the patient control the obsessive and compulsive behavior. D. Is used to manipulate others.

B. Helps the patient to be in control of their anxiety. The rituals performed by the patient with obsessive-compulsive disorder are a substitute for the cause of the anxiety.

A client is diagnosed with generalized anxiety disorder and is prescribed medication therapy. Which agent would the nurse expect to administer to the client to obtain the quickest relief from anxiety symptoms? A) Buspirone B) Venlafaxine C) Alprazolam D) Imipramine

C) Alprazolam

While interviewing a client, the client reports an intense fear of spiders, stating, I cant be near them. I get so upset. I start to sweat and hyperventilate if I see one. The nurse documents this finding as which of the following? A) Algophobia B) Entomophobia C) Arachnophobia D) Cynophobia

C) Arachnophobia

A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate? A) Immediately obtain a specimen to determine the clients blood drug level. B) Suggest that the client take the medication with meals or snacks. C) Assist the client in minimizing exposure to stressors. D) Encourage the client to elevate the affected hand on a pillow.

C) Assist the client in minimizing exposure to stressors.

A group of nursing students is reviewing information about schizoid personality trait. The students demonstrate understanding of the information when they identify which disorder as the most common comorbid disorder? A) Depression B) Substance abuse C) Avoidant personality disorder D) Anxiety

C) Avoidant personality disorder

The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, Im just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood? A) Irritable B) Elevated C) Expansive D) Euphoric

C) Expansive

The nurse is assessing a client with posttraumatic stress disorder (PTSD). Which of the following would the nurse categorize as reflecting intrusion? Select all that apply. A) Irritability B) Difficulty sleeping C) Flashbacks D) Short-term memory deficits E) Dissociation

C) Flashbacks D) Short-term memory deficits

A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of which of the following? Select all that apply. A) Tachypnea B) Bradycardia C) Hypotension D) Nystagmus E) Vomiting

C) Hypotension D) Nystagmus E) Vomiting

A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale? A) It requires the client to develop attachments. B) It sets up specific boundaries for the client. C) It helps reinforce self-responsibility. D) It avoids confrontation about dysfunctional patterns.

C) It helps reinforce self-responsibility.

A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note? A) Actively participating in several different groups B) Openly verbalizing feelings C) Participating in relationships in which the client has control D) Adhering to the personal boundaries of others

C) Participating in relationships in which the client has control

A nurse determines that a client who is experiencing anxiety is using relief behaviors. The nurse determines that the client is experiencing which degree of anxiety? A) Mild B) Moderate C) Severe D) Panic

C) Severe

The nurse is preparing a teaching plan for the family of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the teaching was effective when they identify which of the following as suggesting mania? Select all that apply. A) Avoiding people B) Sleeping more than usual C) Talking faster than usual D) Being hungry all the time E) Reading several books at once

C) Talking faster than usual D) Being hungry all the time E) Reading several books at once

A nurse is developing a presentation for families who have members that have been diagnosed with bipolar disorders. When describing this condition to the group, which of the following would the nurse most likely include? A) As the person ages, the episodes tend to decrease over time. B) Environmental stressors are a key cause of these disorders. C) The risk for suicide is high with either depression or mania. D) Risk-taking behaviors are more common with a depressive episode.

C) The risk for suicide is high with either depression or mania.

A client diagnosed with borderline personality disorder tells the nurse that she frequently spaces out. Which response by the nurse would be most appropriate? A) Do you feel stressed most of the time? B) Does this frighten you when it happens? C) Whats happening around you when this occurs? D) Do you feel as if you are out of your body?

C) Whats happening around you when this occurs?

A clients blood level of carbamazepine is increased. When reviewing the clients medication history, which of the following would alert the nurse to a possible interaction? A) Phenobarbital B) Primidone C) Phenytoin D) Diltiazem

D) Diltiazem

As part of a clients treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills? A) Emotion regulation skills B) Mindfulness skills C) Distress tolerance skills D) Self-management skills

D) Self-management skills

A female client is diagnosed with panic disorder. The client tells the nurse that she hasnt left her house in more than a month because she was afraid of another attack. She visited the mental health clinic today only because her son brought her. Which nursing diagnosis would be a priority for this client? A) Powerlessness related to symptoms of anxiety B) Decisional Conflict related to fear of leaving the house C) Ineffective Family Coping related to symptoms of anxiety D) Social Isolation related to fear of recurrence of anxiety symptoms

D) Social Isolation related to fear of recurrence of anxiety symptoms

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which of the following nursing interventions would be most appropriate? A) Demonstrate empathy for the client by trying to mimic the clients state of anxiety. B) Tell the client that you must leave to go report his symptoms to the psychiatrist on duty. C) Tell the client this is an acute exacerbation with a positive prognosis and low morbidity. D) Stay with the client, emphasizing that he is safe and that you will remain with him.

D) Stay with the client, emphasizing that he is safe and that you will remain with him.

A client with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, These pills are making me sick. I think Im getting a brain tumor because of the headaches. Which response by the nurse would be most appropriate? A) Lets talk about how often you have been performing the rituals lately. B) Tell me how many times you have washed your hands today. C) Have you been practicing your deep breathing and relaxation exercises? D) These medications have side effects that can cause increased headaches.

D) These medications have side effects that can cause increased headaches.

A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which of the following as representing the psychoanalytic theory for this disorder? A) Inaccurate environmental danger assessment B) Exposure to multiple stressful life events C) Kindling caused by overstimulation D) Unresolved unconscious conflicts

D) Unresolved unconscious conflicts

The nurse has identified a nursing diagnosis of disturbed thought processes for a patient with obsessive-compulsive disorder. What abilities displayed by the patient would be related to an appropriate outcome for this problem? Select all that apply. a. Can identify when obsessions are worsening b. Speaks of obsessions as being embarrassing behaviors c. Describes lessening anxiety when compulsive rituals are interrupted d. Plans to ignore obsessive thoughts and so minimizes resulting stress e. Limits time focusing on obsessive thoughts to 15 minutes, 4 times a day

a. Can identify when obsessions are worsening c. Describes lessening anxiety when compulsive rituals are interrupted e. Limits time focusing on obsessive thoughts to 15 minutes, 4 times a day It is desirable for the patient to experience a sense of being able to identify and control the obsessive thinking and the resulting anxiety. Identifying the behaviors as embarrassing is not showing control nor is ignoring the behaviors.

The patient is concerned about confidentiality and asks the nurse not to tell anyone what is said. What is the best response by the nurse? a. I am required to report any intent to hurt yourself or others. b. Conversations between patient and nurse are confidential. c. What we say can be secret. What I write in the chart is available to the health team. d. I cant help you unless you trust me.

a. I am required to report any intent to hurt yourself or others. No secrets are allowed to be kept by a member of the health care team.

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a. I check where my car keys are eight times. b. My legs often feel weak and spastic. c. Im embarrassed to go out in public. d. I keep reliving a car accident.

a. I check where my car keys are eight times. Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Stating My legs feel weak most of the time is more in keeping with a somatic disorder. Being embarrassed to go out in public is associated with an avoidant personality disorder. Reliving a traumatic event is associated

2.When the patient with a psychosis is thought to be a danger to self or others, by what method should the patient be admitted to the hospital? a. Probating b. Nurses request c. Physicians order d. Family request

a. Probating Probating can be done if the individual is thought to be a danger to self or others.

What are considered warning signs of suicide? (Select all that apply.) a. Talking about suicide b. Increased interactions with friends and family c. Drug or alcohol abuse d. Difficulty concentrating on work or school e. Personality changes

a. Talking about suicide c. Drug or alcohol abuse d. Difficulty concentrating on work or school e. Personality changes Warning signs of suicide include talking about suicide, decreased interactions with friends and family, drug/alcohol abuse, difficulty concentrating on work or school, and personality changes.

The nurse cautions a patient to watch his step. What response indicates concrete thinking? a. The patient fixedly begins to watch his feet. b. The patient immediately examines his watch. c. The patient begins to watch the nurses feet. d. The patient stands rigidly in one place without moving.

a. The patient fixedly begins to watch his feet. Concreteness is an indication of disordered thinking. The patient is unable to translate any words except by a very concrete definition.

Adjunctive therapies are used for which reasons? (Select all that apply.) a. To increase self-esteem b. To promote positive interaction c. To enhance reality orientation d. To stimulate communication e. To increase energy

a. To increase self-esteem b. To promote positive interaction c. To enhance reality orientation The purpose of adjunctive therapies is to increase self-esteem, promote positive interaction, and enhance reality orientation.

The nurse is discussing the differences between a patient with a neurosis and one with a psychosis. What is true of the patient experiencing a neurosis? a. The patient experiences a flight from reality. b. The patient usually needs hospitalization. c. The patient has insight that there is an emotional problem. d. The patient has severe personality deterioration.

c. The patient has insight that there is an emotional problem. An individual with a neurosis has insight that he has an emotional problem. A person with psychosis is out of touch with reality and has severe personality deterioration. Treatment for neurosis is usually completed in the outpatient setting, while treatment for psychosis often requires hospitalization.

4. The nurse is working with the family of a patient with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan? a. The thoughts, images, and impulses are voluntary. b. The family should pay immediate attention to symptoms. c. The thoughts, images, and impulses tend to worsen with stress. d. OCD is a chronic disorder that does not respond to treatment.

c. The thoughts, images, and impulses tend to worsen with stress. Stress is known to increase the intensity of OCD symptoms. Families should be taught this relationship and the need to reduce stress in the patients life as much as possible. The symptoms are not under the patients voluntary control. It is nontherapeutic to immediately focus on the symptoms, since to do so contributes to secondary gain. OCD responds well to medication and therapy.

32.What is the typical schedule for electroconvulsive therapy (ECT)? a. 3 treatments over 2 weeks b. 6 treatments over 2 months c. 8 treatments over several weeks d. 10 treatments over several weeks

d. 10 treatments over several weeks ECT is done as a treatment for depression, mania, and schizoaffective disorders that have not responded to other treatments. The usual protocol is 10 treatments over several weeks.

26.What should the nurse preparing a patient for a scheduled appointment for electroconvulsive therapy (ECT) remind the patient to do? a. Drink plenty of fluids before ECT to ensure adequate hydration. b. Bring a change of clothes in case of incontinence. c. Be prepared for visual disturbances after the treatment. d. Arrange for transportation to and from the appointment.

d. Arrange for transportation to and from the appointment. If the patient has not arranged for adequate transportation to and from the appointment, the treatment will be canceled because driving after ECT is dangerous. The patient is typically NPO before the procedure. Incontinence and visual disturbances are not common following the procedure.

For the past 3 weeks, the nurse has observed a patient interacting with staff and other patients, helping decorate the dining room for a party, and leading the singing in the activity room. Today, the patient tearfully refuses to dress or get out of bed. The nurse recognizes these behaviors as evidence of which psychiatric disorder? a. Unipolar depression b. Dysthymic disorder c. Hypomanic episode d. Bipolar disorder

d. Bipolar disorder Bipolar disorder can cause the patient to experience a sudden shift in emotion from one extreme to the other.

Dementia is an organic mental disease secondary to what problem? a. Chemical imbalance b. Emotional problems c. Circulatory impairment d. Cerebral disease

d. Cerebral disease Dementia describes an altered mental state secondary to cerebral disease.

When a patient is experiencing a panic attack, how should the nurse best assist the patient? a. Assist with reality orientation b. Aid in decision making c. Assist with rational thought d. Coach in deep breathing

d. Coach in deep breathing Coaching in relaxation techniques such as deep breathing is an effective intervention for a patient who is experiencing a panic attack.

When a patient demonstrates accelerated heart rate, trembling, choking, and chest pain along with acute, intense, and overwhelming anxiety, the nurse should recognize that the patient is most likely experiencing what condition? a. Terror b. Fright c. Fear d. Panic

d. Panic Panic can be defined as an attack of acute, intense, and overwhelming anxiety.

What is the term used for the beginning stage of schizophrenia, characterized by a lack of energy and complaints of multiple physical problems? a. Prepsychotic b. Residual c. Acute d. Prodromal

d. Prodromal The prodromal phase is the beginning stage of schizophrenia. Hallucinations and delusions sometimes occur in the prepsychotic stage. In the acute phase, individuals often lose touch with reality. The residual phase follows the acute phase and the symptoms of that phase are similar to those of the prodromal stage.

A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. What is the term applied to this type of delirium? a. Disordered thinking b. Schizophrenia c. Dementia d. Sundowning syndrome

d. Sundowning syndrome A patient with sundowning syndrome displays increased disorientation and agitation only during evening and nighttime. Disordered thinking occurs when an individual is not able to interpret information being received in the brain. Disordered thinking is one characteristic of schizophrenia, which is a large group of psychotic disorders that includes nonreality-based thinking. Dementia is an altered mental state secondary to cerebral disease.

The nurse asks a patient with schizophrenia if he had any visitors on Sunday. Which response indicates loose association? a. No. b. Yes! I had 90 visitors who came from every state in the union. c. Sunday is the Sabbath. Do we have visitors on the Sabbath? d. We visited Yellowstone Park last summer

d. We visited Yellowstone Park last summer. Loose association is a type of disordered thinking that occurs when the individual cannot interpret information and the conversation does not flow.

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of: a. flooding. b. relaxation technique. c. desensitization. d. cognitive restructuring.

d. cognitive restructuring. Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions. Desensitization involves graduated exposure to a feared object. Relaxation training teaches the patient to produce the opposite of the stress response. Flooding exposes the patient to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response.

36.The nurse recognizes that a woman who has experienced physical abuse and has inadequate income to care for herself and her family would be categorized under Axis __________.

four Axis 4 queries the environmental and psychosocial information of a patient.