Mental Health Final

In studying for the National Council of State Boards (NCLEX) exam, the student concludes that psychiatric nursing is accountable to which of the following ethical codes or guidelines? Select all that apply. 1) American Nurses Association Code of Ethics for Nurses 2) American Hospital Association Patients' Bill of Rights 3) Bill of Rights for Psychiatric Patients 4) American Nurses Association Nurses' Bill of Rights 5) American Medical Association Code of Medical Ethics

1: Psychiatric nursing is accountable to the American Nurses Association Code of Ethics for Nurses. 2: Psychiatric nursing is accountable to the American Hospital Association Patients' Bill of Rights. 3: Psychiatric nursing is accountable to the Bill of Rights for Psychiatric Patients. Feedback 4: Psychiatric nursing is accountable to the American Nurses' Association Nurses' Bill of Rights.

The nurse is teaching a student about the human limbic system. Which student response demonstrates that teaching about the function of the limbic system has been effective? 1) "It helps stabilize emotional behavior." 2) "It helps maintain balance and muscle tone." 3) "It helps with visual perception and spatial relationships." 4) "It helps with muscular coordination."

1: The limbic system is the "emotional brain." It is associated with fear, anxiety, anger, aggression, love, joy, hope, sexuality, and social behavior.

The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night b. Risk for injury related to manic hyperactivity c. Impaired social interaction evidenced by manipulation of others d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor

1. B 2. D 3. A 4. C

A 30-year-old continually changes jobs and has difficulty establishing long-term relationships. According to Erikson's psychosocial theory, this client is having difficulty successfully completing which development task conflict? 1) Industry versus inferiority 2) Intimacy versus isolation 3) Generativity versus stagnation 4) Ego integrity versus despair

2: Intimacy versus isolation takes place in early adulthood (ages 18 to 40). The goal of successful completion for this conflict is finding oneself, and cultivating/maintaining an effective loving relationship. This young man has moved from job to job, seeking his own identification, and has not yet been able to establish a meaningful long-term relationship. Therefore, he has not successfully completed this stage and is in the negative stage of Erikson's intimacy versus isolation psychosocial stage of personality development.

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist is using an interpersonal approach. 2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest. 4. The client is susceptible to illness because of effects of stress on the immune system.

ANS: 4 Rationale: The therapist's recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoimmunology.

A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? 1. A client makes inappropriate sexual innuendos to a staff member. 2. A client constantly demands attention from the nurse by begging, "Help me get better." 3. A client physically attacks another client after being confronted in group therapy. 4. A client refuses to bathe or perform hygienic activities.

A client physically attacks another client after being confronted in group therapy.

Which situation reflects violation of the ethical principle of veracity? 1. A nurse discusses with a client another client's impending discharge. 2. A nurse refuses to give information to a physician who is not responsible for the client's care. 3. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. 4. A nurse does not treat all of the clients equally, regardless of illness severity.

A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room.

Guidelines relating to "duty to warn" state that a therapist should consider taking action to warn a third party when his or her client (select all that apply) a. threatens violence toward another individual. b. identifies a specific intended victim. c. is having command hallucinations. d. reveals paranoid delusions about another individual.

A, B

Annie has hair-pulling disorder. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? Select all that apply. a. Awareness training b. Competing response training c. Social support d. Hypnotherapy e. Aversive therapy

A, B, C

Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? Select all that apply. a. Unresolved grief over loss of her husband b. Loss of several relatives and friends over the last few years c. Repressed feelings of guilt over the way in which Lucky died d. Inability to prepare in advance for the loss

A, B, C, D

An individual may be considered gravely disabled for which of the following reasons? Select all that apply. a. A person, because of mental illness, cannot fulfill basic needs. b. A mentally ill person is in danger of physical harm based on inability to care for self. c. A mentally ill person lacks the resources to provide the necessities of life. d. A mentally ill person is unable to make use of available resources to meet daily living requirements.

A, B, D

A client with erectile disorder has a new prescription for sildenafil. The nurse who is providing education about this medication tells the client that which of the following are common side effects of this medication. Select all that apply. a. Headache b. Facial flushing c. Constipation d. Nasal congestion e. Indigestion

A, B, D, E

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply. a. Olanzepine (Zyprexa) b. Paroxetine (Paxil) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) e. Tranylcypromine (Parnate)

A, C, D

Which of the following symptoms should a nurse associate with the development of increased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.) 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

ANS: 1, 2 Rationale: The nurse should associate depression and fatigue with increased levels of TSH. TSH is only increased when thyroid levels are low, as in the diagnosis of hypothyroidism. In addition to depression and fatigue, other symptoms, such as decreased libido, memory impairment, and suicidal ideation are associated with chronic hypothyroidism.

A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span

ANS: 1, 2, 4 Rationale: The nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with mental illness unless there is significant impairment in other areas of daily functioning. Other indicators of more serious anxiety are restlessness, difficulty concentrating, muscle tension, and sleep disturbance.

Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) 1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. 2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. 3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is a possible correlation between increased levels of prolactin and anorexia nervosa. 5. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

ANS: 1, 3 Rationale: The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones and gonadotropin. Anorexia nervosa has also been correlated with increased cortisol levels.

An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? 1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission

ANS: 2 Rationale: The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse.

A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? 1. Bipolar disorder: mania 2. Schizophrenia spectrum disorder 3. Generalized anxiety disorder 4. Major depressive episode

ANS: 4 Rationale: The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client's chart was clearly stamped "Allergic HALDOL." The client suffered anaphylactic shock and died. Which would describe this nurse's actions? 1) Intentional tort 2) Negligence 3) Battery 4) Assault

2: The nursing action was an unreasonable or careless act. In this case, the nurse is negligent and could be held liable for the client's death.

A client's husband died 23 years ago. She has not changed a thing in their house since that time. His slippers are still beside the bed. The nurse identifies that the client is exhibiting which pathological grief response? 1) Inhibited grief response 2) Prolonged grief response 3) Delayed grief response 4) Distorted grief response

2: The prolonged grief response is characterized by intense preoccupation with memories of the lost person years after the loss has occurred. This is how the client in the question has responded to her husband's death.

Psychoanalytically, the theory of obesity relates to the individual's unconscious equation of food with a. nurturance and caring. b. power and control. c. autonomy and emotional growth. d. strength and endurance.

A

Which of the following hormones has been implicated in the etiology of mood disorder with seasonal pattern? a. Increased levels of melatonin b. Decreased levels of oxytocin c. Decreased levels of prolactin d. Increased levels of thyrotropin

A

A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred? A. "Dichotomous thinking is when an individual views situations as being 'good or bad' or 'black or white.'" B. "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances." C. "Dichotomous thinking is when an individual exaggerates the negative significance of an event." D. "Dichotomous thinking is when an individual undervalues the positive significance of an event."

ANS: A An individual who is using dichotomous thinking views situations in terms of "all or nothing," "good or bad," or "black or white." KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety? A. "Right now I feel as sharp as a tack." B. "I'm having a tough time focusing." C. "Sometimes I feel like I'm having an out-of-body experience." D. "All I seem to focus on is my anger."

ANS: A Cognitive ability will be enhanced with mild anxiety. Mild anxiety prepares the individual for heightened responses to environmental stimuli. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client's concerns. What is the purpose of this nursing intervention? A. To identify important areas needing concentration during therapy B. To increase self-esteem and decrease feelings of helplessness C. To modify maladaptive behaviors by the use of role-play D. To divert away from intrusive thoughts and depressive ruminations

ANS: A In activity scheduling, the client is asked to keep a daily log of activities and rate them for mastery and pleasure in order to identify recurring daily patterns that may need to be addressed in therapy. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the client's thinking is reflective of which cognitive error? A. Minimization B. Dichotomous thinking C. Arbitrary inference D. Personalization

ANS: A Minimization is the cognitive error that undervalues positive events and experiences. The client cannot give credit for personal strengths. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

20. A client is recovering from abdominal surgery. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse? A. Assessing the client's level of pain B. Assessing and documenting the client's vital signs C. Assessing skin turgor and hydration status D. Assessing incisional site for serosanguineous drainage

ANS: A Pain will distract the client and interfere with the learning process. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

26. According to Peplau, treatment of client symptoms should involve which nursing action? A. Establishing a therapeutic nurse-client relationship B. Using the technique of desensitization C. Challenging clients' negative thoughts D. Uncovering clients' past experiences

ANS: A Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Implementation

3. A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care? A. Northern European Americans B. Native Americans C. Latino Americans D. African Americans

ANS: A The community health nurse should anticipate that Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this group's educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices. PTS: 1 REF: 106 KEY: Cognitive Level: Comprehension | Integrated Process: Assessment

6. A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior? A. Families are male dominated with clear male-female role distinctions. B. Religious tenets support the use of violence in a marital context. C. The nuclear family is female dominated and the mother possesses ultimate authority. D. Marriage dynamics are controlled by dominant females in the family.

ANS: A The nurse should associate the cultural belief that families are male dominated with clear male-female role distinctions with the client's abusive behavior. The father in the Latin American family usually possesses the ultimate authority. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Assessment

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of "examining the evidence." Which response exemplifies this technique? A. "Let's look at the potential reasons why your partner has not participated." B. "How would you define irresponsibility?" C. "Has it occurred to you that your partner may be working on the project at home?" D. "Are you telling me that you feel totally responsible for this project?"

ANS: A When using the technique of examining the evidence, the student and nurse review automatic thoughts and study the evidence to support or counter the belief. KEY: Cognitive Level: Application | Integrated Processes: Implementation | Client Need: Psychosocial Integrity

34. Which of the following individuals are communicating a message? (Select all that apply.) A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal. PTS: 1 REF: 151 KEY: Cognitive Level: Application | Integrated Process: Assessment

21. A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

27. During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

ANS: B The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior. PTS: 1 REF: Pages: 331-336 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

The director of nursing (DON) sets up a meeting with the newly appointed nurse manager, who, to this point, has done an excellent job. The nurse manager anticipates job termination. What is the best description of the cognitive error being employed by the nurse manager? A. Thinking from an "all-or-nothing" perspective B. Always thinking the worst will occur without considering positive outcomes C. Viewing only selected negative evidence while editing out positive aspects D. Undervaluing the positive significance of an event

ANS: B Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. The nurse manager has quickly jumped to the conclusion that the meeting will result in job termination. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

21. A 29-year-old client living with parents has few interpersonal relationships. The client states, "I have trouble trusting people." Based on Erikson's developmental theory, which should the nurse recognize as a true statement about this client? A. The client has not progressed beyond the trust versus mistrust developmental stage. B. Developmental deficits in earlier life stages have impaired the client's adult functioning. C. The client cannot move to the next developmental stage until mastering all earlier stages. D. The client's developmental problems began in the intimacy versus isolation stage.

ANS: B Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to complete these tasks and move on to a higher developmental level. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

22. Which statement is most likely to be made by a nurse practitioner who shares the philosophy of an interpersonal theorist? A. "Let's discuss your use of defense mechanisms." B. "We need to examine how your relationships affect your ability to cope." C. "It is important that you take the medications that I have prescribed for you." D. "Your genetic background is a factor in your predisposition to mental illness."

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Intervention

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, "Have you ever felt that certain objects or persons have control over your behavior?" For which type of thought disruption is the nurse assessing? A. Delusion of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of behavior. Delusions of control or influence occur when the client believes that behavior is being controlled. An example would be if a client believes that a hearing aid receives transmissions that control thoughts and behaviors. PTS: 1 REF: Page: 327 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Assessment

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, "Have you ever felt that certain objects or persons have control over your behavior?" The nurse is assessing for which type of thought disruption? A. Delusions of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of the client's behavior. Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors.

7. When working with clients of a particular culture, which action should a nurse avoid? A. Maintaining eye contact based on cultural norms B. Assuming that all individuals who share a culture or ethnic group are similar C. Supporting the client in participating in cultural and spiritual rituals D. Using an interpreter to clarify communication

ANS: B The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals. PTS: 1 REF: 104 KEY: Cognitive Level: Application | Integrated Process: Implementation

3. Which nursing diagnosis should a nurse identify as being correctly formulated? A. Schizophrenia R/T biochemical alterations AEB altered thought B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance C. Depressed mood R/T multiple life stressors D. Developmental disability R/T early-onset schizophrenia AEB hallucinations

ANS: B The nurse should determine that the correctly written diagnosis would be Self-care deficit: hygiene R/T altered thought AEB disheveled appearance. The nursing diagnosis should describe the client's condition, facilitating the choice of interventions. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

18. When interviewing a client of a different culture, which of the following questions should a nurse consider asking? (Select all that apply.) A. Would using perfume products be acceptable? B. Who may be expected to be present during the client interview? C. Should communication patterns be modified to accommodate this client? D. How much eye contact should be made with the client? E. Would hand shaking be acceptable?

ANS: B, C, D, E When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview, modifications of communication patterns, amount of eye contact, and hand-shaking acceptability. Given that cultural influences affect human behavior, its interpretation, and another person's response, it is important for nurses to understand the effects of these cultural influences to work effectively with diverse populations. PTS: 1 REF: 119 KEY: Cognitive Level: Application | Integrated Process: Implementation

17. Which cultural group is correctly matched with the disease process for which this group is most susceptible? A. African Americans are susceptible to lactose intolerance. B. Western European Americans are susceptible to malaria. C. Arab Americans are susceptible to sickle cell disease. D. Jewish Americans are susceptible to thalassemia.

ANS: C A number of genetic diseases are more common in the Arab American population, including sickle cell disease, tuberculosis, malaria, trachoma, typhus, hepatitis, typhoid fever, dysentery, parasitic infestations, thalassemia, and cardiovascular disease. PTS: 1 REF: 112 KEY: Cognitive Level: Application | Integrated Process: Assessment

A newly admitted client has taken thioridazine (Mellaril) for 2 years with good symptom control. Symptoms exhibited on admission included paranoid delusions and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.

ANS: C Altered thinking can affect a client's insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.

25. A client diagnosed with major depressive disorder states, "Why should I keep trying to get a job? I mess up everything I do." Which correctly written nursing diagnosis best reflects the content and mood themes in this client's statement? A. Hopelessness R/T poor job performance B. Risk for impaired adjustment R/T inadequate social skills AEB isolation C. Altered role performance R/T the fear of failure AEB not seeking employment D. Chronic low self-esteem R/T major depressive disorder AEB self-hatred

ANS: C An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem, it doesn't as of yet exist. The client's statement indicates that role performance is altered due to the fact that fear of failure prevents seeking employment. PTS: 1 REF: 172 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

28. The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview? A. "Appears uncooperative. Exhibits characteristics of depression." B. "Maintains poor eye contact throughout interview process. Unable to answer interview questions due to depression." C. "States, 'I don't need to be here.' when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission." D. "Unwilling to respond openly during interview."

ANS: C Documentation occurs in the implementation phase of the nursing process. All charting entries to the client's legal record should be objective and based on assessed data. Implications and generalizations should be avoided. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nursing student states, "The instructor gave me a failing grade on my research paper. I know it's because the instructor doesn't like me." Which cognitive error does a nurse recognize in this student's statement? A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization

ANS: C In magnification, negative events are exaggerated. It is irrational to assume that there is a relationship between failing a paper and being personally disliked by the instructor. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? A. "My baby is refusing to nurse, and I know it's because she hates me." B. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me." C. "My baby is wonderful, but I'm depressed because I wanted twins." D. "My baby has an elevated bilirubin, and I know it will get worse and she will die."

ANS: C In selective abstraction the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred. KEY: Cognitive Level: Application | Integrated Processes: Assessment | Client Need: Psychosocial Integrity

16. A nurse is preparing to establish a therapeutic relationship with a grieving family from China. Which nursing intervention would be considered most appropriate? A. Touch each member lightly as this enhances the communication process. B. Direct questions to the young males of the family as they maintain positions of authority. C. Avoid direct eye contact as it implies rudeness. D. Remain objective and empathetic as Asians express feelings freely.

ANS: C In the Asian culture, eye contact is often avoided as it connotes rudeness and lack of respect. PTS: 1 REF: 109 KEY: Cognitive Level: Application | Integrated Process: Implementation

12. During family counseling a child states, "I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young." The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize? A. Multigenerational transmission B. Disengagement C. Mother-child subsystem D. Emotional cutoff

ANS: C In this situation, the mother and child have formed a subsystem in which they have aligned themselves against the father. PTS: 1 REF: 210 | 213 KEY: Cognitive Level: Application | Integrated Process: Assessment

17. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which reply by the instructor most accurately answers the student's question? A. "Use the Nursing Interventions Classification (NIC) as a reference for nursing outcomes." B. "Look at your client's problems and set a realistic, achievable goal." C. "Use the Nursing Outcomes Classification (NOC) as a reference for nursing outcomes." D. "Copy your standard outcomes from a nursing care plan textbook."

ANS: C NOC is a comprehensive, standardized classification of client outcomes developed to evaluate the effects of nursing interventions. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

5. Which task should the nurse recognize as appropriate to stage IV of the family life cycle? A. Making adjustments within the marital system to meet the responsibilities of parenthood B. Establishing a new identity as a couple by realigning relationships with extended family C. Redefining the level of dependence so that adolescents are provided with greater autonomy D. Reestablishing the bond of the dyadic marital relationship

ANS: C Stage IV of the family life cycle is described as the "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs. PTS: 1 REF: 203 KEY: Cognitive Level: Application | Integrated Process: Assessment

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension. PTS: 1 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

10. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? A. Mood B. Perception C. Orientation D. Affect

ANS: C The nurse should ask the client to identify name, date, residential address, and situation to assess the client's orientation. Assessment of the client's orientation to reality is part of a mental status evaluation. PTS: 1 REF: 172 KEY: Cognitive Level: Comprehension | Integrated Process: Assessment

10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being "taken-down" after a violent outburst? A. To reinforce unit rules with the client population B. To create protocols for the future release of tensions associated with anger C. To process feelings and concerns related to the witnessed intervention D. To discuss the client problems that led to inappropriate expressions of anger

ANS: C The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients have witnessed a peer being "taken-down" after a violent outburst is to process feelings and concerns related to the witnessed intervention. PTS: 1 REF: 244 KEY: Cognitive Level: Application | Integrated Process: Implementation

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom. B. Clonazepam (Klonopin) to address the positive symptom. C. Risperidone (Risperdal) to address the positive symptom. D. Clozapine (Clozaril) to address the negative symptom.

ANS: C The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbance in conduct of thought (delusions), form of thought (neologisms), or perception (hallucinations). PTS: 1 REF: Page: 337 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Planning

5. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client's decision? A. Future orientation causes the client to devalue assertiveness skills. B. Decreased emotional expression makes it difficult to be assertive. C. Assertiveness techniques may not be aligned with the client's definition of the female role. D. Religious prohibitions prevent the client's participation in assertiveness training.

ANS: C The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the family which is male dominated. The father usually possesses the ultimate authority. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Evaluation

18. A father of a 5-year-old demeans and curses at his child for disobedience. In turn, when upset, the child uses swear words in kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development according to Peplau? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: C The nurse should identify that the child using swear words in kindergarten has not successfully completed the "Identifying oneself" stage according to Peplau's interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her. PTS: 1 REF: 47 KEY: Cognitive Level: Application | Integrated Process: Assessment

12. A 6-year-old boy uses his father's flashlight to explore his 3-year-old sister's genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal? A. Oral B. Anal C. Phallic D. Latency

ANS: C The nurse should identify this behavior as normal because the 6-year-old client who focuses on genital organs is in the phallic stage of Freud's stages of psychosexual stages of development. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identification with the same-sex parent also occurs at this stage. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Assessment

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

ANS: C The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness.

6. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? A. The role of technical expert B. The role of resource person C. The role of surrogate D. The role of leader

ANS: C The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate according to Peplau's interpersonal theory. A surrogate serves as a substitute for another person—in this case, the child's parent. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Implementation

1. An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? A. Conflict should be avoided at all costs on inpatient psychiatric units. B. Conflict should be resolved by the nursing staff. C. Every interaction is an opportunity for therapeutic intervention. D. Conflict resolution should only be addressed during group therapy.

ANS: C The nurse's response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve psychological health and functioning. PTS: 1 REF: 227 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Yes, I see. Go on." D. "Can you chronologically order the events that led to your admission?"

ANS: C The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

15. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this client's problem? A. The client will avoid daytime napping and attend all groups. B. The client will exercise, as needed, before bedtime. C. The client will sleep 7 uninterrupted hours by day four of hospitalization. D. The client's sleep habits will improve during hospitalization.

ANS: C The outcome "The client will sleep 7 uninterrupted hours by day four of hospitalization." is accurately written and an appropriate outcome to address the client problem of insomnia. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. PTS: 1 REF: 173 KEY: Cognitive Level: Analysis | Integrated Process: Planning

11. During family counseling a husband states, "Every time my wife and I discuss child discipline, we get into shouting matches." The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. What intervention is the nurse using? A. Reframing B. Restructuring the family C. Expressive psychotherapy D. Paradoxical intervention

ANS: D In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This removes control over the behavior from the family to the therapist. Clients are made more aware of the defeating behavior and this can lead to behavioral change. PTS: 1 REF: 215 KEY: Cognitive Level: Application | Integrated Process: Implementation

23. An instructor overhears a student say, "That family seems to disagree more than agree. The family seems to be dysfunctional." To further assess the family's situation, which would be an appropriate instructor reply? A. "Families who disagree can be a challenge to the treatment team." B. "You seem very critical of the family. Do you believe that you are unable to help them?" C. "Let's bring the family in for an educational session to improve their communication." D. "What appears to trigger family disagreements?"

ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. In this situation, prior to intervening with this family, the nurse needs further information about the cause of family conflicts. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

26. During an intake interview, which question would assist the nurse in gathering data about the client's judgment? A. "What brought you to the hospital? Do you know what day and season it is now?" B. "On a scale of 1 to 10, how would you rate your stress level?" C. "What does the phrase 'a rolling stone gathers no moss' mean to you?" D. "If you found a stamped, addressed envelope in the street, what would you do?"

ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. The nurse presents a situation that requires the client to make a judgment call and can assess appropriate judgment based on the client's action choice. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

When a client's husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husband's tardiness. What technique is the nurse using? A. Examination of the evidence B. Decatastrophizing C. Generating alternatives D. Reattribution

ANS: C Using the technique of generating alternatives will assist the client to recognize a wider range of possible explanations for her husband's behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

19. A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse address first? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104°F (40°C) D. Excessive salivation

ANS: C When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104?F (40?C). A temperature this high places the client at risk for febrile seizure and is the most life-threatening finding. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Assessment

14. When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R). PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Implementation

7. A 30-year-old client seeking therapy states, "My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems? A. The boundaries are rigid. B. The boundaries are restructured. C. The boundaries are enmeshed. D. The boundaries are disengaged.

ANS: C With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The client's mother is trying to prevent independence by generating feelings of guilt. PTS: 1 REF: 213 KEY: Cognitive Level: Application | Integrated Process: Assessment

25. A nursing instructor is teaching about the application of Peplau's theory to nursing care. Which student statement indicates that learning has occurred? A. "The nurse assumes the role of a parenting figure instructing the client in good health practices." B. "The nurse is concerned more about psychosocial functioning than physiological functioning." C. "The nurse bases the client care plan on standardized nursing approaches and physician orders." D. "The nurse applies principles of human relations to the problems that arise at all levels of experience."

ANS: D Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Evaluation

32. Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) A. Client outcomes are specifically formulated by nurses. B. Client outcomes are not restricted by time frames. C. Client outcomes are specific and measurable. D. Client outcomes are realistically based on client capability. E. Client outcomes are formally approved by the psychiatrist.

ANS: C, D The nurse should identify that client outcomes should be specific, measurable, and realistically based on client capability. Outcomes should be derived from the diagnosis and should include a time estimate for attainment. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, client, and significant others. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" For which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoid delusions C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client that believes that he or she receives messages through the radio is experiencing delusions of reference. These delusions involve the client referring to events within the environment to him- or herself. PTS: 1 REF: Page: 327 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Assessment

A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" Which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoid delusions C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

1. Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

ANS: D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Evaluation

10. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish? A. Establishing the ability to control emotional reactions B. Establishing a strong sense of ethics and character structure C. Establishing and maintaining self-esteem D. Establishing a career, personal relationships, and societal connections

ANS: D The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, non-achievement in the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

7. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? A. "You've really been helpful. Can I count on you for continued support?" B. "I work out in the college gym rather than jogging outdoors." C. "I'm really glad I didn't go home. It would have been hard to come back." D. "I carry mace when I jog. It makes me feel safe and secure."

ANS: D The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. PTS: 1 REF: 244-245 KEY: Cognitive Level: Analysis | Integrated Process: Evaluation

A 60-year-old client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? A. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications. B. Agranulocytosis treated by administration of clozapine (Clozaril). C. Extrapyramidal symptoms treated by administration of benztropine (Cogentin). D. Tardive dyskinesia treated by discontinuing antipsychotic medications.

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medication. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be a side effect of typical antipsychotic medications. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Planning

7. A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau's framework for psychodynamic nursing, what therapeutic role is this nurse assuming? A. The role of technical expert B. The role of resource person C. The role of teacher D. The role of leader

ANS: D The nurse who directs client interaction and plans for interventions is assuming the role of leader. According to Peplau, a leader directs the nurse-client interaction and ensures that actions are taken to achieve goals. PTS: 1 REF: 45 KEY: Cognitive Level: Application | Integrated Process: Implementation

A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? A. "I can't give up alcohol right now because I just gave up smoking." B. "I just read that red wine has health benefits." C. "I may have a minor problem, but I can handle it." D. "I don't drink as much as my wife, and nobody thinks she has a problem."

ANS: C The statement "I may have a minor problem, but I can handle it" is an example of the use of the cognitive distortion of minimization. Minimization is the undervaluing of the positive significance of an event. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

The neurotransmitter most strongly associated with panic disorder is:

Increased levels of Norepinephrine. It's known to mediate arousal, and it causes hyperarousal and anxiety. Seratonin and GABA are believed to be decreased in panic disorder as well.

A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory? 1. Industry versus inferiority 2. Identity versus role confusion 3. Intimacy versus isolation 4. Generativity versus stagnation

Industry versus inferiority

A client diagnosed with alcohol use disorder experiences a first relapse. During an Alcoholics Anonymous (AA) meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? 1. Imparting of information 2. Instillation of hope 3. Catharsis 4. Universality

Instillation of hope

A jilted college student is admitted to a hospital following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize that this patient has a deficit in which developmental stage? 1. Trust versus mistrust 2. Initiative versus guilt 3. Intimacy versus isolation 4. Ego integrity versus despair

Intimacy versus isolation

A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson's developmental theory? 1. Industry versus inferiority 2. Identity versus role confusion 3. Intimacy versus isolation 4. Generativity versus stagnation

Intimacy versus isolation

Which nursing statement about the concept of neurosis is most accurate? 1. An individual experiencing neurosis is unaware that he or she is experiencing distress. 2. An individual experiencing neurosis feels helpless to change his or her situation. 3. An individual experiencing neurosis is aware of the psychological causes of his or her behavior. 4. An individual experiencing neurosis has a loss of contact with reality.

An individual experiencing neurosis feels helpless to change his or her situation.

Adam has Antisocial Personality Disorder. He says to the nurse, "I'm not crazy. I'm just fun-loving. I believe in looking out for myself. Who cares what anyone thinks? If it feels good, do it!" Which of the following describes the psychoanalytical structure of Adam's personality? a. Weak id, strong ego, weak superego b. Strong id, weak ego, weak superego c. Weak id, weak ego, punitive superego d. Strong id, weak ego, punitive superego

B

Anna is diagnosed with Major Depressive Disorder. She is most likely fixed in which stage of the grief process? a. Denial b. Anger c. Depression d. Acceptance

B

From which of the following symptoms might the nurse identify a chronic cocaine user? a. Clear, constricted pupils b. Red, irritated nostrils c. Muscle aches d. Conjunctival redness

B

In an effort to help the child with mild to moderate intellectual disability develop satisfying relationships with others, which of the following nursing interventions is most appropriate? a. Interpret the child's behavior for others. b. Set limits on behavior that is socially inappropriate. c. Allow the child to behave spontaneously, for he or she has no concept of right or wrong. d. This child is not capable of forming social relationships.

B

Jane is hospitalized on the psychiatric unit. She has a history and current diagnosis of Bulimia Nervosa. Which of the following symptoms would be congruent with Jane's diagnosis? a. Binging, purging, obesity, hyperkalemia b. Binging, purging, normal weight, hypokalemia c. Binging, laxative abuse, amenorrhea, severe weight loss d. Binging, purging, severe weight loss, hyperkalemia

B

Janet has a diagnosis of Generalized Anxiety Disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? a. "Xanax is not effective for generalized anxiety disorder." b. "Buspirone must be taken daily in order to be effective." c. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." d. "Your friend really should be taking the Xanax every day."

B

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? *A.* "Xanax is not effective for generalized anxiety disorder." *B.* "Buspirone must be taken daily to be effective." *C.* "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." *D.* "Your friend really should be taking the Xanax every day."

B

John is on the Alcohol Treatment Unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel, saying, "That's a stupid program! I want to watch something else!" In what stage of development is John fixed according to Sullivan's interpersonal theory? a. Juvenile. He is learning to form satisfactory peer relationships. b. Childhood. He has not learned to delay gratification. c. Early adolescence. He is struggling to form an identity. d. Late adolescence. He is working to develop a lasting relationship.

B

John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John? a. Repressed anger b. Survivor's guilt c. Intrusive thoughts d. Spiritual distress

B

Larry, who has Antisocial Personality Disorder, feels no guilt about violating the rights of others. He does as he pleases without thought to possible consequences. In which of Peplau's stages of development would you place Larry? a. Learning to count on others b. Learning to delay gratification c. Identifying oneself d. Developing skills in participation

B

Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the ED by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of a a. delusion of grandeur. b. delusion of persecution. c. delusion of reference. d. delusion of control or influence.

B

Milieu therapy is a good choice for clients with antisocial personality disorder because it a. provides a system of punishment and reward for behavior modification. b. emulates a social community in which the client may learn to live harmoniously with others. c. provides mostly one-to-one interaction between the client and therapist. d. provides a very structured setting in which the clients have very little input into the planning of their care.

B

Nurse Jones decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. Which of the following ethical theories is considered in this decision? a. Kantianism b. Christian ethics c. Natural law theories d. Ethical egoism

B

Nurse Jones is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen." d. "You don't have to eat if you don't want to. It is your choice."

B

Splitting by the client with borderline personality disorder denotes a. evidence of precocious development. b. a primitive defense mechanism in which the client sees objects as all good or all bad. c. a brief psychotic episode in which the client loses contact with reality. d. two distinct personalities within the borderline client.

B

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? *A.* Keep the ct's bathroom locked so she can't wash her hands all the time. *B.* Structure the ct's schedule so that she has plenty of time for washing her hands. *C.* Place the ct in isolation until she promises to stop washing her hands so much. *D.* Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.

B

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? a. Keep the client's bathroom locked so she cannot wash her hands all the time. b. Structure the client's schedule so that she has plenty of time for washing her hands. c. Place the client in isolation until she promises to stop washing her hands so much. d. Explain the client's behavior to her, since she is probably unaware that it is maladaptive.

B

The nurse assists the physician with electroconvulsive therapy on his client who has refused to give consent. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality

B

The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with Major Depressive Disorder. The nurse says to Nancy, "Some changes will have to be made in your behavior. I care about what happens to you." Which nursing role described by Peplau is the nurse fulfilling in this instance? a. Counselor b. Surrogate c. Technical expert d. Resource person

B

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to: a. ask the client to describe his physical symptoms. b. ask the client to describe what he is hearing. c. administer a dose of benztropine. d. call the physician for additional orders.

B

The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with Major Depressive Disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a. "Cheer up, Margaret. You have so much to be happy about." b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. "I'll report that to the physician, Margaret. Maybe he will order something different." d. "Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"

B

The primary goal in working with an actively psychotic, suspicious client would be to a. promote interaction with others. b. decrease his anxiety and increase trust. c. improve his relationship with his parents. d. encourage participation in therapy activities.

B

Tim, age 18, babysits for his 11-year-old neighbor, Jeff. Six months ago, Tim began fondling Jeff's genitals. They now engage in mutual masturbation each time they are together. This is an example of which pedophilic disorder? a. Fetishistic disorder b. Pedophilic disorder c. Exhibitionistic disorder d. Voyeuristic disorder

B

Tom watches his neighbor through her window each night as she undresses for bed. Later he fantasizes about having sex with her. This is an example of which paraphilic disorder? a. Exhibitionistic disorder b. Voyeuristic disorder c. Frotteuristic disorder d. Pedophilic disorder

B

Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? a. Temporal lobe b. Thalamus c. Limbic system d. Hypothalamus

B

Theresa, who's been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is most appropriate in this instance. A. Obtain an order to place Theresa in restraints to prevent any attempts to harm herself. B. Check on Theresa q 15 minutes or assign a staff person to stay with her on a one-to one basis. C. Obtain an order to give Theresa a sedative to calm her and reduce suicide ideas. D. Do not allow Theresa to participate in any unit activities while she is on suicide precautions.

B. Check on Theresa q 15 minutes or assign a staff person to stay with her on a one-to one basis.

Twins Jan and Jean still dress alike even though they are grown and married. This is an example of which of the following? A. Rigid boundary B. Enmeshed boundary C. A boundary violation D. Boundary pliancy

B. Enmeshed boundary is the correct answer because when two people's boundaries are so blended together that neither can be sure where one stops and the other begins. They may be unable to differentiate his or her feelings, wants, and needs from the other person's. This does not only apply to twins. Boundary pliancy refers to a boundary being either rigid, flexible or enmeshed. A boundary violation would be an unwanted intrusion of anothers personal or psychological space.

Jermaine scores a 7 on the SAD PERSONS scale. What action needs to be taken? A. Closely follow up; consider hospitalization. B. Hospitalize or commit. C. Send home with follow-up. D. Strongly consider hospitalization.

B. Hospitalize or commit. A score of 7 to 10 on the SAD PERSONS scale indicates hospitalization or commitment because the person would be considered high risk for suicide. Closely follow up refers to a score of 3 to 4. Send home with follow-up refers to a score of 0 to 2. Strongly consider hospitalization refers to a score of 5 to 6.

A suicidal individual calls a suicide hot line. This represents the level of intervention classified as A. primary. B. secondary. C. tertiary. D. quaternary.

B. secondary Secondary prevention is essentially treatment.

After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department. The client threatens suicide. Which of the following criteria would enable a physician to consider involuntary commitment? (Select all that apply.) 1. Being dangerous to others 2. Being homeless 3. Being disruptive to the community 4. Being gravely disabled and unable to meet basic needs 5. Being suicidal

Being dangerous to others Being gravely disabled and unable to meet basic needs Being suicidal

What is a biochemical abnormality associated with panic disorder?

Blood elevations of lactate. Pg 533

After receiving three ECT treatments, a client says to the nurse, "I feel so much better, but I'm having trouble remembering some things that happened this last week." The nurse's best response would be: a. "Don't worry about that. Nothing important happened." b. "Memory loss is just something you have to put up with in order to feel better." c. "Memory loss is a side effect of ECT, but it is only temporary. Your memory should return within a few weeks." d. "Forget about last week, Mr. C. You need to look forward from here."

C

At a synapse, the determination of further impulse transmission is accomplished by means of a. potassium ions. b. interneurons. c. neurotransmitters. d. the myelin sheath.

C

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to a. administer alprazolam as ordered prn for anxiety. b. call the physician and report the incident. c. stay with John and reassure him of his safety. d. have John listen to a tape of relaxation exercises.

C

Lucky sometimes refused to obey Anna and indeed did not come back to her when she called to him on the day he was killed. But Anna continues to insist, "He was the very best dog. He always minded me. He always did everything I told him to do." This represents the defense mechanism a. sublimation. b. compensation. c. reaction formation. d. undoing.

C

Mr. J. has been diagnosed with Schizophrenia. He refuses to eat, and told the nurse he knew he was "being poisoned." According to Erikson's theory, in what developmental stage would you place Mr. J.? a. Intimacy vs. isolation b. Generativity vs. self-absorption c. Trust vs. mistrust d. Autonomy vs. shame and doubt

C

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Why is chlorpromazine ordered? a. To reduce extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep

C

Which of the following parts of the brain deals with sensory perception and interpretation? a. Hypothalamus b. Cerebellum c. Parietal lobe d. Hippocampus

C

Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. Tachycardia, hypertension, hyperthermia b. Bradycardia, hypertension, hyperthermia c. Bradycardia, hypotension, hypothermia d. Tachycardia, hypotension, hypothermia

C

Which statement is true? A. "Women are more successful at suicide attempts." B. "Men attempt suicide more often than women." C. "Adolescent girls are most likely to suffocate themselves." D. "Adolescent boys most often choose hanging."

C. "Adolescent girls are most likely to suffocate themselves." Women attempt suicide more often than men using drug overdose as their method, but men are more successful when they attempt suicide and they most often use firearms. Adolescent boys most often complete suicide with a firearm. Page 276

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. She says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which if the best response by the nurse? A. "You're safe here. We will make sure nothing happens to you." B. "You're just lucky your roommate came home when she did." C. "What exactly do you plan to do?" D. "I don't understand. You have so much to live for."

C. "What exactly do you plan to do?"

Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10 mg Valium qid B. Group therapy with other agoraphobics C. Facing her fear in gradual step progression D. Hypnosis

C. Facing her fear in gradual step progression

The husband says to the wife, "What do you want to do tonight?" and the wife responds, "Whatever you want to do." This is an example of which of the following? A. Rigid boundary. B. A boundary violation C. Too flexible boundary. D. Showing respect for the boundary of another.

C. Too flexible boundary is the correct answer because the wife is too flexible, she is allowing her husband to make her choices and direct her behavior. People with rigid boundaries often have a hard time trusting others, keep others at a distance and are difficult to communicate with. They are often withdrawn emotionally and physically. Telling his wife what they would do without asking would be a boundary violation.

In determining the degree of suicidal risk with a suicidal client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily liver, no close support systems. The nurse identifies the client's risk for suicide as: A. Low B. Moderate C. High D. Unable to determine

C. high

The suicide intervention that has the greatest impact on a client's safety is A. educating visitors about potentially dangerous gifts. B. restricting the client from potentially dangerous areas of the unit. C. one-on-one observation by the staff. D. removal of personal items that might prove harmful.

C. one-on-one observation by the staff. Correct One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm.

John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every three days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes to the clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change? a. The sertraline is finally taking effect. b. He is no longer in need of antidepressant medication. c. He has completed the grief response over loss of his wife. d. He may have decided to carry out his suicide plan.

D

Kim has a diagnosis of Borderline Personality Disorder. She often exhibits alternating clinging and dis tancing behaviors. The most appropriate nursing intervention with this type of behavior would be to a. encourage Kim to establish trust in one staff person, with whom all therapeutic interaction should take place. b. secure a verbal contract from Kim that she will discontinue these behaviors. c. withdraw attention if these behaviors continue. d. rotate staff members who work with Kim so that she will learn to relate to more than one person.

D

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? *A.* Ms. T. experiences panic anxiety when she encounters snakes. *B.* Ms. T refuses to fly in an airplane. *C.* Ms. T. Will not eat in public places. *D.* Ms. T. stays in her home for fear of being in a place from which she cannot escape.

D

Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent-child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems

D

Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system? It also regulates appetite and temperature. a. Temporal lobe b. Parietal lobe c. Cerebellum d. Hypothalamus

D

Which of the following parts of the brain is associated with multiple feelings and behaviors and is some- times referred to as the emotional brain? a. Frontal lobe b. Thalamus c. Hypothalamus d. Limbic system

D

Which of the following parts of the brain is concerned with visual reception and interpretation? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe

D

With implosion therapy, a client with phobic anxiety would be a. taught relaxation exercises. b. subjected to graded intensities of the fear. c. instructed to stop the therapeutic session as soon as anxiety is experienced. d. presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D

The nurse proposes that a suicidal client enter into a no-suicide contract. Such a contract would contain a provision that the client promises A. never to attempt suicide. B. to alert someone if he or she has made an attempt. C. not to consider suicide for 72 hours. D. not to attempt suicide in the next 24 hours.

D. not to attempt suicide in the next 24 hours. A no-suicide contract is quite straightforward in seeking a client's promise not to attempt to harm oneself within a specified period. When that time expires, a new contract is negotiated.

A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of dopamine 3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine

Decreased levels of acetylcholine

A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

Defense mechanisms can be appropriate responses to stress and need not be eliminated.

During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? 1. Democratic 2. Autocratic 3. Laissez-faire 4. Bureaucratic

Democratic

What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place in an inpatient unit? 1. Reinforce unit rules with the client population. 2. Create protocols for the future release of tensions associated with anger. 3. Process client feelings and alleviate fears of undeserved seclusion and restraint. 4. Discuss the situation that led to inappropriate expressions of anger.

Discuss the situation that led to inappropriate expressions of anger.

A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

Dopamine

"Promiscuity can be very dangerous." According to Sigmund Freud, this client statement reflects the predominance of the __________ structure of the personality.

Ego

Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.) 1. Meeting the psychological needs of the nurse and the client 2. Ensuring therapeutic termination 3. Promoting client insight into problematic behavior 4. Collaborating to set appropriate goals 5. Meeting both the physical and psychological needs of the client

Ensuring therapeutic termination Promoting client insight into problematic behavior Collaborating to set appropriate goals Meeting both the physical and psychological needs of the client

A client is diagnosed with major depressive episode. Which of the following laboratory results would the nurse expect if an alteration in the endocrine system was associated with this condition? Select all that apply. 1) Elevated serum cortisol 2) Decreased thyroid-stimulating hormone 3) Elevated melatonin levels 4) Decreased serum cortisol 5) Increased thyroid-stimulating hormone

Feedback 1: Clients experiencing depression have hormonal inhibition failure resulting in hypersecretion of cortisol. Feedback 3: Elevated melatonin levels are associated with depression in some individuals during the fall and winter months when the amount of daylight decreases. Feedback 5: Increased levels of thyroid-stimulating hormone are associated with hypothyroidism and often result in symptoms of depression.

A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? 1. S 2. O 3. L 4. E 5. R

O

What is the priority nursing intervention before starting ECT therapy? a. Take vital signs and record b. Have the patient void c. Administer succinylcholine d. Ensure that the consent form as been signed

d. Ensure that the consent form as been signed

Nurse Jones is working with Kim, a client in the anger-management program. Which of the following identifies actions associated with the working phase of the therapeutic relationship? a. Kim tells Nurse Jones she wants to learn more adaptive ways to handle her anger. Together they set some goals. b. The goals of therapy have been met, but Kim cries and says she has to keep coming to therapy in order to be able to handle her anger appropriately. c. Nurse Jones reads Kim's previous medical records. She explores her feelings about working with a woman who has abused her child. d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

The most common side effects of ECT are: a. Permanent memory loss and brain damage b. Fractured and dislocated bones c. Myocardial infarction and cardiac arrest d. Temporary memory loss and confusion

d. Temporary memory loss and confusion

Hildegard Peplau identified seven subroles within the role of the nurse. She believed the emphasis in psychiatric nursing was on which of the subroles? a. The resource person b. The teacher c. The surrogate d. The counselor

d. The counselor

In the _______________________ stress response, the individual becomes fixed in the denial stage of the grieving process.

delayed or inhibited

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be: a. imbalanced nutrition; less than body requirements b. complicated grieving c. risk for suicide d. social isolation

risk for suicide

A nurse who is helping a client int eh preparation stage of the Psychological Recovery Model might include which of the following interventions? a. teach about effects of the illness and how to recognize, monitor, and manage symptoms b. help the client identify "triggers" that cause distress or discomfort c. help the client establish a daily maintenance list d. listen actively while the client composes his or her personal story

teach about effects of the illness and how to recognize, monitor, and manage symptoms

A nurse is assisting an individual with mental illness recovery using the Psychological Recovery Model. The client says to the nurse, "I have schizophrenia. Nothing can be done. I might as well die." In which stage of the Psychological Recovery model would the nurse assess the individual to be? a. the awareness stage b. the preparation stage c. the rebuilding stage d. the moratorium stage

the moratorium stage

Already in Order: Order the stages of the general adaptation syndrome according to Hans Selye. Alarm Reaction Stage Stage of Resistance Stage of Exhaustion

Selye called the general reaction of the body to stress the general adaptation syndrome. He described the reaction in three distinct stages: 1. Alarm Reaction Stage: During this stage, the physiological responses of the fight-or-flight syndrome are initiated. 2. Stage of Resistance: The individual uses the physiological responses of the first stage as a defense in the attempt to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear. 3. Stage of Exhaustion: This stage occurs when there is prolonged exposure to the stressor to which the body has become adjusted. The adaptive energy is depleted, and the individual can no longer draw from the resources for adaptation described in the first two stages.

A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder? 1. Altered communication R/T feelings of worthlessness AEB anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

Social isolation R/T poor self-esteem AEB secluding self in room

client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? 1. Peer pressure 2. Structured programming 3. Visitor restrictions 4. Mandated activities

Structured programming

According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? 1. Technical expert 2. Resource person 3. Surrogate 4. Leader

Surrogate

Which part of the nervous system should a nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

Sympathetic nervous system

A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior? 1. That families are male-dominated, with clear male-female role distinctions 2. That religious tenets support the use of violence in a marital context 3. That the nuclear family is female-dominated and the mother has ultimate authority 4. That marriage dynamics are controlled by dominant females in the family

That families are male-dominated, with clear male-female role distinctions

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? 1. Imparting of information 2. Instillation of hope 3. Altruism 4. Universality

Universality

What is the goal of cognitive therapy with depressed clients? a. identify and change dysfunctional pattern of thinking b. resolve the symptoms and initiate or restore adaptive family functioning c. alter the neurotransmitters that are creating the depressed mood d. provide feedback from peers who are having similar experiences

a

Elisa says to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which of the following is an empathetic response by the nurse?" a. "You are very angry now. This is a normal response to your loss." b. "I know what you mean. Men can be very insensitive." c. "I understand completely. My husband divorced me, too." d. "You are depressed now, but you will better in time."

a. "You are very angry now. This is a normal response to your loss."

Black box warning

a. All antidepressants carry an FDA black box warning for increased risk of suicidality in children and adolescents.

Sam has a diagnosis of major depression. After an unsuccessful trial of antidepressant medication, Same's physician has hospitalized him for a course of ECT treatments. Same says to the nurse on the admission, "I don't want to end up like McMurphy in 'One Flew Over the Cuckoo's Nest' ! I'm scared!" What is Sam's priority nursing diagnosis at this time? a. Anxiety related to deficient knowledge about ECT b. Risk for injury related to risks associated with ECT c. Deficient knowledge related to negative media presentation of ECT d. Acute confusion related to side effects of ECT

a. Anxiety related to deficient knowledge about ECT

Which of the following conditions increases the risk of adverse events associate with ECT? (Select all that apply). a. Increased intracranial pressure b. Recent myocardial infarction c. Severe underlying hypertension d. Congestive heart failure e. Breast Cancer

a. Increased intracranial pressure b. Recent myocardial infarction c. Severe underlying hypertension d. Congestive heart failure

Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shared the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation.

a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shared the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment.

An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?"

b

The physician orders sertraline 50 mg PO bid for Margaret, a68-year-old women with MDD. After 3 days of taking the medication, Margaret says to the nurse "I don't think this medicine is doing any good. I don't feel a bit better". What is the most appropriate response by the nurse? a. Cheer up, Margaret. You have so much to be happy about b. Sometimes it takes a few weeks for the medication to bring an improvement in symptoms c. I'll report that to the physician. Maybe he will order you something different d. Try not to dwell on you symptoms. Why don't you join the others down in the dayroom

b

Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the client's insight and perception of reality b. Creating an environment for the establishment of trust and rapport c. Using the problem-solving model toward goal fulfillment d. Obtaining available information about the client from various sources e. Formulating nursing diagnoses and setting goals

b. Creating an environment for the establishment of trust and rapport e. Formulating nursing diagnoses and setting goals

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? (select all that apply) a. Don't eat chocolate while taking this medication b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect c. Don't take this medication with the migraine drugs "triptans" d. Go to the lab each week to have your blood drawn for therapeutic level of this drug e. This drug causes a high degree of sedation, so take it just before bedtime

b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect c. Don't take this medication with the migraine drugs "triptans"

When the nurse shows unconditional acceptance of an individual as a worthwhile and unique human being, he or she is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

b. Respect

Atropine sulfate is administered to a client receiving ECT for what purpose? a. To alleviate anxiety b. To decrease secretions c. To relax muscles d. As a short-acting anesthetic

b. To decrease secretions

A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b. "I can understand how you must feel." c. "Those feelings are a normal part of the grief response." d. "Just think about the good times that you had while he was alive."

c

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be: a. imbalanced nutrition; less than body requirements b. complicated grieving c. risk for suicide d. social isolation

c

Nurse Mary has been providing care for Tom during his hospital stay. On Tom's day of discharge, his wife brings a bouquet of flowers and a box of chocolates to his room. He presents these gifts to Nurse Mary, saying, "Thank you for taking care of me." What is a correct response by the nurse? a. "I don't accept gifts from patients." b. "Thank you so much! It is so nice to be appreciated." c. Thank you. I will share these with the rest of the staff." d. "Hospital policy forbids me to accept gifts from patients."

c. Thank you. I will share these with the rest of the staff."

Succinylcholine is administered to a client receiving ECT for what purpose? a. To alleviate anxiety b. To decrease secretions c. To relax muscles d. As a short-acting anesthetic

c. To relax muscles

A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

Autonomy

Alternative approaches refer to interventions that are used instead of conventional treatment. A client asks a nurse to explain the difference between alternative and complementary medicine. Which is an appropriate nursing response? 1. "Alternative medicine is a more acceptable practice than complementary medicine." 2. "Alternative and complementary medicine are terms that essentially mean the same thing." 3. "Complementary medicine disregards traditional medical approaches." 4. "Complementary therapies partner alternative approaches with traditional medical practice."

"Complementary therapies partner alternative approaches with traditional medical practice."

You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment? A. "I know a lot of people care about me and want me to get better." B. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." C. "I don't have a good support system, but I am planning on joining a recovery group." D. "I think things will be better soon."

"I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

Which client statement reflects an understanding of circadian rhythms in psychopathology? 1. "When I dream about my mother's horrible train accident, I become hysterical." 2. "I get really irritable during my menstrual cycle." 3. "I'm a morning person. I get my best work done before noon." 4. "Every February, I tend to experience periods of sadness."

"I'm a morning person. I get my best work done before noon."

A mother who is notified that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy? 1. "This situation is very sad, but time is a great healer." 2. "You are sad, but you must be strong for your other children." 3. "Once you cry it all out, things will seem so much better." 4. "It must be horrible to lose a child, and I'll stay with you until your husband arrives."

"It must be horrible to lose a child, and I'll stay with you until your husband arrives."

A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? 1. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." 2. "It is important for you to discontinue these ritualistic behaviors." 3. "Why are you asking for help, if you won't participate in unit therapy?" 4. "Let's figure out a way for you to attend unit activities and still wash your hands."

"Let's figure out a way for you to attend unit activities and still wash your hands."

A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? 1. "Medications only address biological factors. Environmental and interpersonal factors must also be considered." 2. "Because biological factors are the sole cause of depression, medications will improve your mood." 3. "Environmental factors have been shown to exert the most influence in the development of depression." 4. "Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."

"Medications only address biological factors. Environmental and interpersonal factors must also be considered."

An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? 1. "Why did you use the client's name on your clinical worksheet?" 2. "You were very careless to refer to your client by name on your clinical worksheet." 3. "Surely you didn't do this deliberately, but you breeched confidentiality by using names." 4. "It is disappointing that after being told you're still using client names on your worksheet."

"Surely you didn't do this deliberately, but you breeched confidentiality by using names."

A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing response is most appropriate? 1. "I'm confident you know what's best for you." 2. "This may not be the best time for you to make such an important decision." 3. "Your children will be terribly disappointed." 4. "Tell me why you want to make this change."

"This may not be the best time for you to make such an important decision."

A client diagnosed with posttraumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of "broad openings"? 1. "What occurred prior to the rape, and when did you go to the emergency department?" 2. "What would you like to talk about?" 3. "I notice you seem uncomfortable discussing this." 4. "How can we help you feel safe during your stay here?"

"What would you like to talk about?"

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so mad that the children and I had to put up with him as long as we did." 3. "Yes, it was a difficult relationship, but I think I have learned from the experience." 4. "I still don't have any appetite and continue to lose weight."

"Yes, it was a difficult relationship, but I think I have learned from the experience."

A nurse encourages a client to tell his or her story, actively listens to the account of the resulting distress, and assists the client to record the story in his or her own words. This nurse is employing which commitment in the "Tidal Model of Recovery?" 1) Value the Voice. 2) Respect the Language. 3) Develop Genuine Curiosity. 4) Become the Apprentice.

1 A nurse committed to Valuing the Voice encourages the client to tell his or her story. The person's story represents the beginning and endpoint of the helping encounter, embracing not only an account of the person's distress but also the hope for its resolution. The nurse in the question is employing this commitment.

A client diagnosed with a thought disorder lists previously successful strategies and skills used when disturbing auditory hallucinations have occurred. What step of the Wellness Recovery Action Plan (WRAP) recovery model is this client employing? 1) Developing a Wellness Toolbox 2) Daily Maintenance List 3) Triggers 4) Early Warning Signs

1 In the first step (Developing a Wellness Toolbox), a client creates a list of tools, strategies, and skills that he or she has used in the past to assist in relieving disturbing symptoms. The client in the question is employing this step. Developing a Daily Maintenance List is the second step in the WRAP model. The list is divided into three parts. In Part 1, the individual writes a description of how he or she feels (or would like to feel) when experiencing wellness. This is used as a reference point. In Part 2, using the wellness toolbox as a reference, the individual makes a list of things he or she needs to do every day to maintain wellness. In Part 3 of this step, the individual keeps a list of things that need to be done. The individual reads this list daily as a reminder, and items may be considered for accomplishment on any given day at the individual's discretion. Recognizing Triggers is the third step in the WRAP model. This step is divided into two parts. In Part 1, the individual lists events or circumstances that, should they occur, would cause distress or discomfort. In Part 2, the individual uses items from the wellness toolbox to develop a plan for "what to do" if triggers interfere with wellness. Recognizing Early Warning Signs is the fourth step in the WRAP model. This step is divided into two parts. Part 1 involves identification of subtle signs that indicate a possible worsening of the situation. In Part 2, the individual develops a plan for responding to the early warning signs that result in relief or preventing them from escalating.

Group therapy is strongly encouraged, but not mandatory, in an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve? 1. Justice 2. Autonomy 3. Veracity 4. Beneficence

Autonomy

Which of the following nursing statements or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.) 1. "Tell me what happened." 2. "What coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened." 4. "Let's focus on the current problem." 5. "I'll assist you in selecting functional coping strategies."

1. "Tell me what happened." 2. "What coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened."

A client diagnosed with a thought disorder lists previously successful strategies and skills used when disturbing auditory hallucinations have occurred. What step of the Wellness Recovery Action Plan (WRAP) recovery model is this client employing? 1) Developing a Wellness Toolbox 2) Daily Maintenance List 3) Triggers 4) Early Warning Signs

1: In the first step (Developing a Wellness Toolbox) a client creates a list of tools, strategies, and skills that he or she has used in the past to assist in relieving disturbing symptoms. The client in the question is employing this step.

A neighbor asks a psychiatric nurse, "How can you work with the mentally ill day in and day out?" The nurse replies, "It's just the right thing to do." The nurse is operating from which ethical framework? 1) Kantianism 2) Christian ethics 3) Ethical egoism 4) Utilitarianism

1: Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse's response indicates a Kantian perspective.

Which of the following procedures would be used to detect altered brain function? Select all that apply. 1) Magnetic resonance imaging (MRI) 2) Electroencephalography (EEG) 3) Positron emission tomography (PET) 4) Endoscopy 5) Gastroscopy

1: Magnetic resonance imaging is a type of diagnostic radiography that is valuable in providing soft-tissue images of the brain and can be used to detect altered brain function. 2: Electroencephalography is a diagnostic technique used to diagnose epilepsy, brain lesions, and convulsive disorders, and it can be used to detect altered brain function. 3: Positron emission tomography imaging is used to determine blood flow and metabolic activity of the brain and can be used to detect altered brain function.

A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client? a. Stay with the client and reassure of safety. b. Administer a dose of diazepam. c. Leave the client alone in a quiet room so that she can calm down. d. Encourage the client to talk about what triggered the attack.

A

A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? *A.* Stay with the client and reassure the client of her safety *B.* Administer a dose of diazepam *C.* Leave the client alone in a quiet room so that she can calm down. *D.* Encourage the client to talk about what triggered the attack.

A

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it a. relieves her anxiety. b. reduces the probability of infection. c. gives her a feeling of control over her life. d. increases her self-concept.

A

A client with OCD spends many hours each day washing her hands. What is the most likely reason she washes her hands so much? *A.* To relieve her anxiety *B.* To reduce the probability of infection *C.* To gain a feeling of control over her life *D.* To Increase her self-concept

A

Because of cultural inhibitions, a client is reluctant to verbalize spiritual concerns. Understanding this, the nurse implements which nursing intervention? 1) Reassure the client that it is acceptable to talk about spiritual concerns. 2) Question the client about why religious orientation is important. 3) Refer the client to a nondenominational group. 4) Discuss the nurse's personal spiritual beliefs.

1: A holistic approach to nursing care is provided when the framework of the nurse-client relationship includes spiritual health. Reassuring the client that it is acceptable to verbalize spiritual concerns communicates that the nurse values the client's spirituality and opens, rather than blocks, the lines of communication.

A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? a. Blue cheese, red wine, raisins b. Black beans, garlic, pears c. Pork, shellfish, egg yolks d. Milk, peanuts, tomatoes

A

A nurse who is helping a client in the preparation stage of the Psychological Recovery Model might include which of the following interventions? a. Teach about effects of the illness and how to recognize, monitor, and manage symptoms. b. Help the client identify "triggers" that cause distress or discomfort. c. Help the client establish a daily maintenance list. d. Listen actively while the client composes his or her personal story.

A

A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? a. The client abuses amphetamines and anxiolytics. b. The client abuses alcohol and cocaine. c. The client is psychotic. d. The client abuses narcotics and marijuana.

A

Anna, who is 72 years old, is of the age when she may have experienced many losses coming close together. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity

A

Clint, a client on the psychiatric unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint's belief is an example of a a. delusion of persecution. b. delusion of reference. c. delusion of control or influence. d. delusion of grandeur.

A

Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? a. "They claim they will help me stay sober." b. "I'll dry out in AA, then I can have a social drink now and then." c. "AA is only for people who have reached the bottom." d. "If I lose my job, AA will help me find another."

A

Compared with the general population, which psychopathology is more common among Native Americans? 1) Schizophrenia 2) Alcohol use disorder 3) Post-traumatic stress disorder 4) Impulse control disorder

2: Alcohol abuse and dependence are more common among Native Americans than the general population. This may be due to a variety of physical, sociocultural, and environmental causes.

A nursing instructor is teaching about the guiding principles of the recovery model as described by the Substance Abuse and Mental Health Services Administration (SAMHSA). Which student statement indicates that further teaching is needed? 1) "Recovery emerges from hope." 2) "Recovery is specifically focused on symptom reduction." 3) "Recovery is person-driven." 4) "Recovery is supported by addressing trauma."

2: Because recovery is holistic, it is not specifically focused on symptom reduction. This student statement indicates that further teaching is needed.

A Spanish client is uncooperative and confused because of difficulty responding to the nursing staff. What would initially help the nurse facilitate this client's care? 1) Leading a reminiscence group 2) Understanding the norms of the client's culture 3) Leading a re-socialization group 4) Encouraging open expression of feelings

2: Caregivers must have an understanding of the norms of other cultures in order to accept the client and provide professional care. With this knowledge, the nursing staff can better relate to this client.

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is: a. denial. b. projection. c. displacement. d. rationalization.

A

Danny has been diagnosed with Schizophrenia. On the unit he appears very anxious, paces back and forth, and darts his head from side to side in a continuous scanning of the area. He has refused to eat, making some barely audible comment related to "being poisoned." In planning care for Danny, which of the following would be the primary focus for nursing? a. To decrease anxiety and develop trust b. To set limits on his behavior c. To ensure that he gets to group therapy d. To attend to his hygiene needs

A

A homeless client, diagnosed with schizophrenia, has been admitted to an inpatient unit. The client refuses to go to group therapy and hordes multiple pantry items. According to Maslow's theory, how would the nurse interpret this client's needs? 1) Group therapy sessions will help with self-esteem and should be prioritized. 2) This client's need for self-actualization is much stronger than basic needs for rest and safety. 3) Self-actualization can be addressed only after physiological needs have been met. 4) Psychological health should be prioritized over physical health.

3: Maslow's theory creates a hierarchy of needs. Primary needs for food and safety must be met in order to achieve secondary needs such as self-actualization.

A client diagnosed with a thought disorder volunteers at a homeless shelter's soup kitchen. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in which dimension of recovery is this client participating? 1) Health 2) Home 3) Purpose 4) Community Test-Taking Tip: SAMHSA suggests that a life in recovery is supported by four major dimensions.

3: Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. This client is participating in the purpose dimension of recovery.

A client hates her mother because her mother paid little attention to her when she was growing up. Which client statement represents the defense mechanism of reaction formation? 1) "I don't like to talk about my relationship with my mother." 2) "It's my mother's fault that I feel this way." 3) "I have a wonderful mother whom I love very much." 4) "My mom always loved my sister more than she loved me."

3: The client hides her negative unacceptable feelings by an exaggerated expression of positive feelings. This is an example of reaction formation.

Which statement best explains the etiology of anxiety from a biological perspective? 1) Dysregulation of the limbic system 2) Decreased levels of neurotransmitters, such as serotonin, dopamine, and norepinephrine 3) Decreased amounts of inhibitory amino acids, such as gamma-aminobutyric acid (GABA) 4) Hypothyroidism

3: Decreased levels of GABA contribute to anxiety, movement, and seizure disorders. This explains the etiology of anxiety from a biological perspective.

Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority

A

A client admitted to the emergency department after being mugged while crossing the street cannot remember anything about the incident. The nurse recognizes the use of which defense mechanism? 1) Isolation 2) Displacement 3) Compensation 4) Repression

4: The client in the question is using the defense mechanism of repression. Repression is the unconscious, involuntary blocking of unpleasant feelings and experiences from one's own awareness. The client remembers nothing about the mugging and is therefore unconsciously repressing these memories.

Which of the following are effective interventions that a nurse should utilize when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.) A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. C. Use therapeutic touch to convey empathy. D. Set limits on the behavior. E. Teach the client to avoid "I" statements related to expression of feelings.

A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. D. Set limits on the behavior.

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa C. Weight loss with a diagnosis of anorexia nervosa D. Amenorrhea with a diagnosis of anorexia nervosa E. Emaciation with a diagnosis of bulimia nervosa

ANS: A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa The nurse should identify that topiramate (Topamax) is the drug of choice when treating binge eating with obesity and bingeing and purging with a diagnosis of bulimia nervosa. Topiramate (Topamax) is a novel anticonvulsant used in the long-term treatment of binge-eating disorder with obesity. The use of Topamax results in a significant decline in mean weekly binge frequency and significant reduction in body weight. With the use of this medication, episodes of bingeing and purging were decreased in clients diagnosed with bulimia nervosa.

Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? 1. Major depressive episode 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

ANS: 2 Rationale: Although the exact mechanism is unknown, there may be some correlation between decreased levels of the hormone prolactin and schizophrenia.

Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

ANS: 2 Rationale: The limbic system is often referred to as the "emotional brain." The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior.

When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!"

ANS: 4 Rationale: The client's statement "I don't drink too much!" alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.

6. A clinic nurse is caring for a 40-year-old client who lives with his parents. The client's mother continues to do the client's laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize? A. Taking over B. Communicating indirectly C. Belittling feelings D. Making assumptions

ANS: A Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth. By doing the client's laundry and managing finances, the mother is fostering the client's dependence. PTS: 1 REF: 207 KEY: Cognitive Level: Application | Integrated Process: Assessment

8. The nurse should recognize which acronym as representing problem-oriented charting? A. SOAPIE B. APIE C. DAR D. PQRST

ANS: A The acronym SOAPIE represents problem-oriented charting which reflects the subjective, objective, assessment, plan, implementation, and evaluation format. This type of charting identifies nursing diagnoses (client problems) on a written plan of care with appropriate nursing interventions described for each. PTS: 1 REF: 181 KEY: Cognitive Level: Comprehension | Integrated Process: Implementation

10. An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement? A. An adult child considers, but is not governed by, the advice of his or her parents. B. An adult child appears to listen, but ignores, the advice of his or her parents. C. An adult child respects and is governed by the wishes of his or her parents. D. An adult child never requests advice or feedback from his or her parents.

ANS: A The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed. PTS: 1 REF: 210 KEY: Cognitive Level: Application | Integrated Process: Assessment

2. Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting

ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Evaluation

16. The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. B. The client has a history of four suicide attempts in adolescence. C. The client expresses hopelessness and helplessness and isolates self. D. The client has disorganized thought processes and delusional thinking.

ANS: A The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury due to confusion and potential for falls. History of suicide and hopelessness would lead to the development of a risk for suicide nursing diagnosis. Disorganized thoughts and delusional thinking would lead to the development of an altered thought process nursing diagnosis. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients' bedside at the appropriate times.

ANS: A The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units; however, nurses must work with clients to foster independence and provide experiences that would foster increased self-esteem. PTS: 1 REF: 232 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? A. The teenager is attempting to differentiate self. B. The teenager is triangulating self. C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits.

ANS: A The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence. PTS: 1 REF: 210 KEY: Cognitive Level: Application | Integrated Process: Evaluation

24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. PTS: 1 REF: 151 KEY: Cognitive Level: Application | Integrated Process: Implementation

15. A couple is in counseling related to their dysfunctional relationship. Their daughter has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept? A. Triangulation B. Pseudohostility C. Double-bind communication D. Pseudomutuality

ANS: A Triangulation occurs when a relationship between two people is dysfunctional. A third person is brought into the relationship to help stabilize it. The couple is triangulating with their daughter. The threatened daughter draws attention from her parent's interpersonal conflicts by her own dysfunctional behavior. PTS: 1 REF: 210 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? Select all that apply. A. "The purpose of this exercise is to identify automatic thoughts." B. "The purpose of this exercise is to identify rational alternatives." C. "The purpose of this exercise is to modify cognitive errors." D. "The purpose of this exercise is to eliminate irrational beliefs." E. "The purpose of this exercise is to monitor thoughts related to self-esteem."

ANS: A, B, C In a daily record of dysfunctional thoughts, clients (1) identify automatic thoughts and (2) generate a more rational response. In this way, the tool serves to help them (3) modify or make changes in their thinking. A daily record of dysfunctional thoughts does not eliminate the occurrence of irrational beliefs or monitor thoughts solely related to self-esteem. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

12. Which of the following are effective interventions that a nurse should utilize when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.) A. Maintain a calm demeanor. B. Clearly delineate the consequences of the behavior. C. Use therapeutic touch to convey empathy. D. Set limits on the behavior. E. Teach the client to avoid "I" statements related to expression of feelings.

ANS: A, B, D The nurse should determine that when working with an inpatient client who expresses anger inappropriately, it is important to maintain a calm demeanor, clearly define the consequences, and set limits on the behavior. The use of therapeutic touch may not be appropriate and could escalate the client's anger. PTS: 1 REF: 244 KEY: Cognitive Level: Application | Integrated Process: Implementation

31. Which of the following nursing interventions fall within the standards of psychiatric-mental health clinical nursing practice for a nurse generalist? (Select all that apply.) A. Assist clients to perform activities of daily living. B. Consult with other clinicians to provide services for clients and effect system change. C. Encourage clients to discuss triggers for relapse. D. Use prescriptive authority in accordance with state and federal laws. E. Educate families about signs and symptoms of alcohol dependence and withdrawal.

ANS: A, C, E Assisting clients to perform daily living activities, encouraging clients to discuss triggers, and educating families are nursing interventions that fall within the standards of psychiatric clinical nursing practice for a nurse generalist. Psychiatric-mental health advanced practice registered nurses can consult with other clinicians and use prescriptive authority. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries.

ANS: A. The emesis produced during purging is acidic and corrodes the tooth enamel. The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.

19. A nurse is evaluating the effectiveness of teaching after instructing a group of clients on joint replacement. In the evaluation step of the nursing process, which learning domain is the most difficult to measure? A. Normative domain B. Affective domain C. Cognitive domain D. Psychomotor domain

ANS: B Affective knowledge is the most difficult to evaluate because of differences in values, cultures, and attitudes. PTS: 1 REF: 174 KEY: Cognitive Level: Application | Integrated Process: Evaluation

15. A nursing instructor is teaching about cultural characteristics. Which statement by the student indicates the need for further instruction? A. "All cultures communicate freely within their group." B. "All cultures embrace light therapeutic touch." C. "All cultures view the importance of timeliness differently." D. "All cultures display biological variations."

ANS: B All cultures do not embrace light therapeutic touch. In the Native American culture, if a hand is offered to another it may be accepted with a light touch; however, in the Asian culture, touching during communication has been historically considered unacceptable. This student statement indicates the need for further instruction. PTS: 1 REF: 104 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

ANS: B B. Note escalating behaviors and intervene immediately The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

17. A nursing instructor is teaching about the importance of healthy family member expectations for newly blended families. Which student statement indicates a need for further instruction? A. "Healthy family member expectations should be flexible." B. "Healthy family member expectations should be conforming." C. "Healthy family member expectations should be individual." D. "Healthy family member expectations should be realistic."

ANS: B Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations. This student statement indicates a need for further instruction. Realism, flexibility, and individuality are all characteristics of healthy family member expectations. PTS: 1 REF: 207 KEY: Cognitive Level: Application | Integrated Process: Evaluation

13. During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement? A. The husband is expressing an emotional cutoff. B. The husband is expressing double-bind communication. C. The husband is expressing indirect messages. D. The husband is expressing avoidance behaviors.

ANS: B Double-bind communication sets up no-win situations. The husband has created a situation in which no matter what the wife does, she is wrong. PTS: 1 REF: 214 KEY: Cognitive Level: Application | Integrated Process: Assessment

23. A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking. PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nursing assistant has failed a prerequisite course toward admission to nursing school and states, "I will always be only a nursing assistant and never an RN." Her nursing advisor understands this is an example of which automatic thought? A. Arbitrary inference B. Overgeneralization C. Dichotomous thinking D. Personalization

ANS: B Overgeneralization occurs when sweeping conclusions are made on the basis of one incident. Because the student failed a prerequisite nursing course, the student overgeneralizes that the goal of being an RN will never be attained. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

21. During the implementation phase of the nursing process, a nurse is teaching an adult with a cochlear implant about medications. Which modification in the teaching plan would be the most appropriate for this client? A. Using repetition B. Speaking directly face-to-face C. Employing the use of sign language D. Providing large-print materials

ANS: B Speaking face-to-face is an appropriate way to teach individuals with alterations in hearing. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

6. Within the nurse's scope of practice, which function is exclusive to the advance practice psychiatric nurse? A. Teaching about the side effects of neuroleptic medications B. Using psychotherapy to improve mental health status C. Using milieu therapy to structure a therapeutic environment D. Providing case management to coordinate continuity of health services

ANS: B The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. It is within the scope of practice of a registered psychiatric mental health nurse generalist to provide education, case management, and milieu therapy. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

11. What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis.

ANS: B The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client including information collected from the client, significant others, and health-care providers. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Implementation

8. To effectively care for Asian American clients, a nurse should be aware of which cultural norm? A. Obesity and alcoholism are common problems. B. Older people maintain positions of authority within the culture. C. "Tai" and "chi" are the fundamental concepts of Asian health practices. D. Asian Americans are likely to seek psychiatric help.

ANS: B To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. The balance of "yin" and "yang," not "tai" and "chi," is the fundamental concept of Asian health practices. In the Asian culture, psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families. PTS: 1 REF: 109 KEY: Cognitive Level: Application | Integrated Process: Assessment

9. After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept? A. Differentiation of self B. Triangulation C. Fusion D. Emotional cutoff

ANS: B Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couple's marital problems. PTS: 1 REF: 210-211 KEY: Cognitive Level: Application | Integrated Process: Evaluation

11. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.) A. Respiratory therapist and psychiatrist B. Occupational therapist and psychologist C. Recreational therapist and art therapist D. Social worker and hospital volunteer E. Mental health technician and chaplain

ANS: B, C, E The interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. In addition, a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, psychodramatist, and dietician participate in the interdisciplinary treatment team. PTS: 1 REF: 230-231 KEY: Cognitive Level: Application | Integrated Process: Implementation

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? 1. Clarify personal attitudes, values, and beliefs. 2. Obtain thorough assessment data. 3. Determine the client's length of stay. 4. Establish personal goals for the interaction.

Clarify personal attitudes, values, and beliefs.

8. How does a democratic form of self-government in the milieu contribute to client therapy? A. By setting punishments for clients who violate the community rules B. By dealing with inappropriate behaviors as they occur C. By setting community expectations wherein all clients are treated on an equal basis D. By interacting with professional staff members to learn about therapeutic interventions

ANS: C A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input. PTS: 1 REF: 228 KEY: Cognitive Level: Application | Integrated Process: Planning

A client states, "I hear voices that tell me that I am evil." Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge? A. The client will verbalize the reason the voices make derogatory statements. B. The client will not hear auditory hallucinations. C. The client will identify events that increase anxiety and illicit hallucinations. D. The client will positively integrate the voices into the client's personality structure.

ANS: C It is unrealistic to expect the client to completely stop hearing voices. Even when compliant with antipsychotic medications, clients may still hear voices. It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. By this recognition the client can anticipate symptoms and initiate appropriate coping skills.

3. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing.

ANS: C The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture. PTS: 1 REF: 205 KEY: Cognitive Level: Application | Integrated Process: Evaluation

9. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? A. CIWA scale B. GGT C. MMSE D. CAPS scale

ANS: C The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdrawal from substances such as alcohol. The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD. The GGT test is used to assess gamma-glutamyl transferase levels which may be an indication of alcoholism. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Assessment

9. An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

ANS: C The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Implementation

7. A nurse charts "Verbalizes understanding of the side effects of Prozac." This is an example of which category of focused charting? A. Data B. Problem C. Action D. Response

ANS: D "Verbalizes understanding of the side effects of Prozac." is an example of the response category of focused charting. The response is a description of the client's reaction to any part of medical or nursing care. PTS: 1 REF: 182 KEY: Cognitive Level: Application | Integrated Process: Implementation

14. A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session, the nurse documents "Marital schism." What does the nurse mean by this documentation? A. The couple has a compatible marriage relationship. B. The husband has a dominant relationship over the wife. C. The couple has an enmeshed relationship. D. The couple has an incompatible marriage relationship.

ANS: D A marital schism is a state of chronic disequilibrium and discord. This describes this couple's marriage. PTS: 1 REF: 215 KEY: Cognitive Level: Application | Integrated Process: Assessment

A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion? A. Socratic questioning B. Activity scheduling C. Distraction D. Cognitive rehearsal

ANS: D Cognitive rehearsal allows the employee to uncover potential automatic thoughts in advance of his or her meeting to request a promotion. This allows the employee to develop strategies to modify any dysfunctional thinking. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, "I failed my battalion by giving the wrong order. Fortunately, no one was injured." Which nursing diagnosis should the nurse assign to this client? A. Chronic low self-esteem B. Risk for self-directed violence C. Powerlessness D. Situational low self-esteem

ANS: D Emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues. The nursing diagnosis of situational low self-esteem is used for individuals who have a negative perception of self-worth in response to a current situation. This client's cognitive appraisal of the situation has led to the diagnosis of major depressive disorder and low self-esteem. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

4. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message—a double-bind communication. PTS: 1 REF: 206 KEY: Cognitive Level: Application | Integrated Process: Evaluation

10. In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects

ANS: D The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the client's safety and physiological needs are met within the milieu. PTS: 1 REF: 228 KEY: Cognitive Level: Analysis | Integrated Process: Planning

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

What is a nurse's purpose for providing appropriate feedback? 1. To give the client good advice 2. To advise the client on appropriate behaviors 3. To evaluate the client's behavior 4. To give the client critical information

To give the client critical information

11. What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the client's behavior D. To give the client critical information

ANS: D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Evaluation

4. Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days.

ANS: D The statement "Client will initiate interaction with one peer during free time within 2 days." is an example of a correctly formulated expected outcome. Outcomes should be measurable, realistic, client-focused goals that include a time frame. Appropriate nursing interventions are guided by client outcomes. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

A client states, "I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store." Using a cognitive approach, which nursing reply would be most therapeutic? A. "Are other issues from your past affecting your ability to move on?" B. "Describe your current feelings about your loss." C. "Let's talk about something that will help you move on." D. "Can anyone predict when a car accident will happen?"

ANS: D When the nurse attempts to encourage the client to reframe thoughts, the nurse is using a cognitive approach. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects the underlying etiology of this disorder? A. "Skaters need to be thin to improve their daily performance." B. "All the skaters on the team are following an approved 1,200-calorie diet." C. "When I lose skating competitions, I also lose my appetite." D. "I am angry at my mother. I can only get her approval when I win competitions."

ANS: D. "I am angry at my mother. I can only get her approval when I win competitions." This client statement reflects the underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family member's development of anorexia nervosa.

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

ANS: D. "I don't know why people are worried. I need to lose this weight." When the client states, "I don't know why people are worried. I need to lose this weight," the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.

ANS: D. These programs allow clients to maintain control. Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight.

A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home-health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? 1. Allow the client to decline the medication and document the decision. 2. Tell the client that if the medication is refused, hospitalization will occur. 3. Arrange with a relative to add the medication to the client's morning orange juice. 4. Call for help to hold the client down while the injection is administered.

Allow the client to decline the medication and document the decision.

The following outcome was developed for a client: "Client will list five personal strengths by the end of day one." Which correctly written nursing diagnostic statement most likely generated the development of this outcome? 1. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements 2. Self-care deficit R/T altered thought process 3. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 4. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements

A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to affect this client's decision? 1. Future orientation causes the client to devalue assertiveness skills. 2. Decreased emotional expression makes it difficult to be assertive. 3. Assertiveness techniques may not be aligned with the client's definition of the female role. 4. Religious prohibitions prevent the client's participation in assertiveness training.

Assertiveness techniques may not be aligned with the client's definition of the female role.

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? Select all that apply. a. Don't eat chocolate while taking this medication. b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect. c. Don't take this medication with the migraine drugs "triptans." d. Go to the lab each week to have your blood drawn for therapeutic level of this drug. e. This drug causes a high degree of sedation, so take it just before bedtime.

B, C

How does a democratic form of self-government in the milieu contribute to client therapy? 1. By setting punishments for clients who violate the community rules 2. By dealing with inappropriate behaviors as they occur 3. By setting expectations wherein all clients are treated on an equal basis 4. By interacting with professional staff members to learn about therapeutic interventions

By setting expectations wherein all clients are treated on an equal basis

A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition. b. Medication would be given for both conditions simultaneously. c. The bipolar condition would be stabilized first before medication for the ADHD would be given. d. The ADHD would be treated before consideration of the bipolar disorder.

C

An involuntarily committed client is verbally abusive to the staff, repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? 1. Verbally redirect the client, and then refuse one-on-one interaction. 2. Involve the hospital's security division as soon as possible. 3. Notify the client that documenting personal staff information is against hospital policy. 4. Continue professional attempts to establish a positive working relationship with the client.

Continue professional attempts to establish a positive working relationship with the client.

96. Carol is a new nursing graduate being oriented on a medical/surgical unit by the head nurse, Mrs. Carey. When Carol describes a new technique she has learned for positioning immobile clients, Mrs. Carey states, "What are you trying to do . . . tell me how to do my job? We have always done it this way on this unit, and we will continue to do it this way until I say differently!" This is an example of which type of personality characteristic? a. Antisocial b. Paranoid c. Passive-aggressive d. Obsessive-compulsive

D

According to Margaret Mahler, predisposition to borderline personality disorder occurs when develop- mental tasks go unfulfilled in which of the following phases? a. Autistic phase, during which the child's needs for security and comfort go unfulfilled b. Symbiotic phase, during which the child fails to bond with the mother c. Differentiation phase, during which the child fails to recognize a separateness between self and mother d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence

D

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? a. Increased heart rate and blood pressure b. Tremors, insomnia, and seizures c. Incoordination and unsteady gait d. Nausea and vomiting, diarrhea, and diaphoresis

D

Anna's dog Lucky got away from her while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember any of these circumstances of his death. This is an example of what defense mechanism? a. Rationalization b. Suppression c. Denial d. Repression

D

Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders: A. Increased seratonin, decreased norepinephrine, and decreased GABA. B. Increased seratonin, decreased norepinephrine, and increased GABA. C. Decreased seratonin, decreased norepinephrine, and decreased GABA. D. Decreased seratonin, increased norepinephrine, and decreased GABA.

D. Decreased seratonin, increased norepinephrine, and decreased GABA. pg. 530

According to Erikson's developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client? A.To develop a basic trust in others B.To achieve a sense of self-confidence and recognition from others C.To reflect back on life events to derive pleasure and meaning D.To achieve established life goals and consider the welfare of future generations

To achieve established life goals and consider the welfare of future generations

What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? 1. Acknowledge the client's actions, and generate alternative behaviors. 2. Establish rapport and develop treatment goals. 3. Attempt to find alternative placement. 4. Explore how thoughts and feelings about this client may adversely impact nursing care.

Establish rapport and develop treatment goals.

A physically healthy, 35-year-old, single client lives with his parents, who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish? 1. Establishing the ability to control emotional reactions 2. Establishing a strong sense of ethics and character structure 3. Establishing and maintaining self-esteem 4. Establishing a career, personal relationships, and societal connections

Establishing a career, personal relationships, and societal connections

A branch of philosophy that addresses methods for determining the rightness or wrongness of one's actions is defined as __________.

Ethics

The term __________ relates to people who identify with each other because of a shared heritage.

Ethnicity

A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the pre interaction phase of the nurse/patient relationship, which interaction should the nurse employ? a) Acknowledging the client's actions and encouraging alternative behaviors b) Establishing rapport and developing treatment goals c) Providing community resources on aggression management d) Exploring personal thoughts and feelings that may adversely impact the provision of care

Exploring personal thoughts and feelings that may adversely impact the provision of care

A client diagnosed with Schizophrenia was hospitalized due to physical aggression. The staff applied four-point restraints. The client yells that the nurses will be sued for assault and battery. The nurses are protected under which of the following conditions? Select all that apply. 1) The client is voluntarily committed and poses no danger to self or others. 2) The client is voluntarily committed and poses a danger to self or others. 3) The client is involuntarily committed but poses no danger to self or others. 4) The client is involuntarily committed and poses a danger to self or others. 5) The Good Samaritan Law applies.

Feedback 2: As a threat to self or others, the client can be restrained despite objections even if voluntarily committed. Nurses would be protected from liability in this situation. Feedback 4: As a threat to self or others, the client can be restrained despite commitment status. Nurses would be protected from liability in this situation.

Which therapeutic communication technique is being used in the following nurse-client interaction?Client: "When I am anxious, the only thing that calms me down is alcohol."Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" 1. Reflecting 2. Making observations 3. Formulating a plan of action 4. Giving recognition

Formulating a plan of action

Panic disorder and GABA

GABA prevents postsynaptic excitation.

When an individual is "two-faced," which characteristic—essential to the development of a therapeutic relationship—should a nurse identify as missing? 1. Respect 2. Genuineness 3. Sympathy 4. Rapport

Genuineness

If a client demonstrates transference toward a nurse, how should the nurse respond? 1. Promote safety and immediately terminate the relationship with the client. 2. Encourage the client to ignore these thoughts and feelings. 3. Immediately reassign the client to another staff member. 4. Help the client to clarify the meaning of the relationship, based on the present situation.

Help the client to clarify the meaning of the relationship, based on the present situation.

A father of a 5-year-old demeans and curses his child for disobedience. In turn, when upset, the child uses swear words at kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development, according to Peplau? 1. Learning to count on others 2. Learning to delay satisfaction 3. Identifying oneself 4. Developing skills in participation

Identifying oneself

A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites 2. Axons 3. Neurotransmitters 4. Synapses

Neurotransmitters

Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? 1. CIWA scale 2. GGT 3. MMSE 4. CAPS scale

MMSE

In the Psychological Recovery Model in relation to the concept of Hope, mobilization of resources is to the Preparation stage as hopelessness and despair is to the __________ stage.

Moratorium

In the Psychological Recovery Model, a person who senses no hope for recovery is in the recovery stage called ____________.

Moratorium The Psychological Recovery Model (Andresen et al., 2011) identifies stages of recovery on four components: hope, responsibility, self and identity, and meaning/purpose. In Stage 1 (Moratorium), a sense of hopelessness prevails.

A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

Pepperoni pizza and red wine

A nurse is performing a mental health assessment on an adult client. According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? 1. Maintaining a long-term, faithful, intimate relationship 2. Achieving a sense of self-confidence 3. Possessing a feeling of self-fulfillment and realizing full potential 4. Developing a sense of purpose and the ability to direct activities

Possessing a feeling of self-fulfillment and realizing full potential

Which statement should a nurse identify as correct regarding a client's right to refuse treatment? 1. Clients can refuse pharmacological but not psychological treatment. 2. Clients can refuse any treatment at any time. 3. Clients can refuse only electroconvulsive therapy (ECT). 4. Professionals can override treatment refusal by an actively suicidal or homicidal client.

Professionals can override treatment refusal by an actively suicidal or homicidal client.

Which therapeutic communication technique is being used in the following nurse-client interaction?Client: "My father spanked me often."Nurse: "Your father was a harsh disciplinarian." 1. Restatement 2. Offering general leads 3. Focusing 4. Accepting

Restatement

An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? 1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission

Reuptake

The nurse should recognize which acronym as representing problem-oriented charting? 1. SOAPIE 2. APIE 3. DAR 4. PQRST

SOAPIE

A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Body dysmorphic disorder 4. Parkinson's disease

Schizophrenia spectrum disorder

A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation

Reaction Formation

A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents? 1. Reactions to stress are relative rather than absolute; individual responses to stress vary. 2. It is abnormal for identical twins to react differently to similar stressors. 3. Identical twins should share the same temperament and respond similarly to stress. 4. Environmental influences to stress weigh more heavily than genetic influences.

Reactions to stress are relative rather than absolute; individual responses to stress vary.

A set of beliefs, values, rites, and rituals adopted by a group of people can be defined as __________.

Religion

Which situation exemplifies both assault and battery? 1. The nurse becomes angry, calls the client offensive names, and withholds treatment. 2. The nurse threatens to "tie down" the client and then does so, against the client's wishes. 3. The nurse hides the client's clothes and medicates the client to prevent elopement. 4. The nurse restrains the client without just cause and communicates this to family.

The nurse threatens to "tie down" the client and then does so, against the client's wishes.

A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's situation, in which phase of development, according to Mahler's theory, should a nurse expect to see a potential deficit? 1. The symbiotic phase 2. The autistic phase 3. The consolidation phase 4. The rapprochement phase

The autistic phase

Which client action should a nurse expect during the working phase of the nurse-client relationship? 1. The client gains insight and incorporates alternative behaviors. 2. The client establishes rapport with the nurse and mutually develops treatment goals. 3. The client explores feelings related to reentering the community. 4. The client explores personal strengths and weaknesses that impact behavioral choices.

The client gains insight and incorporates alternative behaviors.

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist is using an interpersonal approach. 2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest. 4. The client is susceptible to illness because of effects of stress on the immune system.

The client is susceptible to illness because of effects of stress on the immune system.

When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!"

The client says to the spouse, "I don't drink too much!"

Which potential client should a nurse identify as a candidate for involuntarily commitment? 1. The client living under a bridge in a cardboard box 2. The client threatening to commit suicide 3. The client who never bathes and wears a wool hat in the summer 4. The client who eats waste out of a garbage can

The client threatening to commit suicide

A client is to undergo psychological testing. Which member of the interdisciplinary team should a nurse consult for this purpose? 1. The psychiatrist 2. The psychiatric social worker 3. The clinical psychologist 4. The clinical nurse specialist

The clinical psychologist

A female complains that her husband only satisfies his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband's actions? 1. The id 2. The superid 3. The ego 4. The superego

The id

A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? 1. The nurse refuses to give any information to the caller, citing rules of confidentiality. 2. The nurse hangs up on the caller. 3. The nurse confirms that the person has been at the facility but adds no additional information. 4. The nurse suggests that the caller speak to the client's therapist.

The nurse refuses to give any information to the caller, citing rules of confidentiality.

During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? 1. The nurse mandates that all group members reveal an embarrassing personal situation. 2. The nurse asks for a show of hands to determine group topic preference. 3. The nurse sits silently as the group members stray from the assigned topic. 4. The nurse shuffles through papers to determine the facility policy on length of group.

The nurse sits silently as the group members stray from the assigned topic.

When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? 1. A possible genetic basis for the client's problems 2. The structure and dynamics of the personality 3. Behavioral responses to stressors 4. Maladaptive cognitions

The structure and dynamics of the personality

A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? 1. They are experiencing problems with termination, leading to feelings of abandonment. 2. They did not think any new material would be covered at the last session. 3. They were angry with the leader for not extending the length of the group. 4. They were bored with the material covered in the group.

They are experiencing problems with termination, leading to feelings of abandonment.

Within the nurse's scope of practice, which function is exclusive to the advanced practice psychiatric nurse? 1. Teaching about the side effects of neuroleptic medications 2. Using psychotherapy to improve mental health status 3. Using milieu therapy to structure a therapeutic environment 4. Providing case management to coordinate continuity of health services

Using psychotherapy to improve mental health status

A model of recovery that focuses on the client monitoring and planning responses (such as developing a wellness toolbox) to reduce, modify, or eliminate disturbing symptoms of mental illness is called the____________ model.

WRAP Nurses, when working with individuals who have severe or persistent mental illness, are in a unique position to instill hope and encourage a recovery focus through the use of models such as WRAP, which actively engages the client in planning how to respond to the symptoms of the illness.

An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior? 1. Initiate forced medication protocol. 2. Help the client to explore the source of anger. 3. Ignore the act to avoid reinforcing the behavior. 4. With staff support and a show of solidarity, set firm limits on the behavior.

With staff support and a show of solidarity, set firm limits on the behavior.

Which situation should a nurse identify as an example of an autocratic leadership style? 1. The president of Sigma Theta Tau assigns members to committees to research problems. 2. Without faculty input, the dean mandates that all course content be delivered via the Internet. 3. During a community meeting, a nurse listens as clients generate solutions. 4. The student nurses' association advertises for candidates for president.

Without faculty input, the dean mandates that all course content be delivered via the Internet.

A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? a. Blue cheese, red wine, raisins b. Black beans, garlic, pears c. Pork, shellfish, egg yolks d. Milk, peanuts, tomatoes

a

A client has just been admitted to the psychiatric unit with a diagnosis of MDD. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply a. slumped posture b. delusional thinking c. feelings of despair d. feels best early in the morning e. anorexia

a b c e

Sally is admitted to the hospital with Major Depressive Disorder and repeatedly makes negative statements about herself. Which of the following interventions is identified as an approach that promotes positive self-esteem in the patient? Select all that apply. a. Teach assertive communication skills. b. Make observations to Sally when she completes a goal or task. c. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend time with Sally using a nonjudgmental, accepting approach.

a b d

Sam has a diagnosis of major depression. After an unsuccessful trial of antidepressant medication, Sam's physician has hospitalized him for a course of ECT treatments. Same says to the nurse on the admission, "I don't want to end up like McMurphy in 'One Flew Over the Cuckoo's Nest' ! I'm scared!" Which of the follow statements would be most appropriate by the nurse in response to Sam's expression of concern? a. "I guarantee you won't end up like McMurphy, Sam." b. "The doctor knows what he is doing. There's nothing to worry about." c. "I know you are scared, Sam, and we're going to talk about what you can expect from the therapy." d. "I'm going to stay with you as long as you are scared."

c. "I know you are scared, Sam, and we're going to talk about what you can expect from the therapy."

When there is congruence between what is felt and what is expressed, the nurse is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

c. Genuineness

Electroconvulsive therapy is most commonly prescribed for which of the following? a. Bipolar disorder, manic b. Paranoid schizophrenia c. Major depression d. Obsessive-compulsive disorder

c. Major Depression

Prayer group members at a local Baptist church are meeting with a poor, homeless family whom they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? 1. "Social services might be able to help you find a job." 2. "The last time we helped a family, they got back on their feet and prospered." 3. "I can give you all of my baby clothes for your little one." 4. "I can appreciate your situation. I had to declare bankruptcy last year."

"I can give you all of my baby clothes for your little one."

A client on an inpatient unit angrily says to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response?1. "I'll talk to Peter and present your concerns." 2. "Why are you overreacting to this issue?" 3. "You should bring this to the attention of your treatment team." 4. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

"I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

According to Freud, which statement should a nurse associate with predominance of the superego? 1. "No one is looking, so I will take three cigarettes from Mom's pack." 2. "I don't ever cheat on tests; it is wrong." 3. "If I skip school, I will get into trouble and fail my test." 4. "Dad won't miss this little bit of vodka."

"I don't ever cheat on tests; it is wrong."

During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? 1. "I found a Web site explaining the different types of brain tumors and their treatment." 2. "My brother also had a brain tumor and now is completely cured." 3. "I understand your fear and will be by your side during this time." 4. "My mother was also diagnosed with cancer of the brain."

"I found a Web site explaining the different types of brain tumors and their treatment."

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? 1. "I can't bear the thought of leaving here and failing." 2. "I might have a hard time working with you, because you remind me of my mother." 3. "I really don't want to talk any more about my childhood abuse." 4. "I'm not sure that I can count on you to protect my confidentiality."

"I really don't want to talk any more about my childhood abuse."

During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? 1. "It's hard for me to tell my story when I'm not sure about the reactions of others." 2. "I think Joe's Antabuse suggestion is a good one and might work for me." 3. "My situation is very complex, and I need professional, not peer, advice." 4. "I am really upset that you expect me to solve my own problems."

"I think Joe's Antabuse suggestion is a good one and might work for me."

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It is just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section."

"Psychological factors, like excessive stress, have been found to affect medical conditions."

The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68 year old woman with Major Depressive Disorder. After 3 days of taking the medication, Margaret says to the nurse: "I don't think this medicine is doing any good. I don't feel better." What is the most appropriate response by the nurse? a. "Cheer up, Margaret. You have so much to be happy about" b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. I'll report that to the physician, Margaret. Maybe he will order you something different. d. "Try not to dwell on your symptoms, Margaret. Why don't you join the others in the dayroom."

"Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms."

Callie, a 50-year-old woman addicted to heroin, is in treatment for substance use disorder and reveals a history of sexual abuse during her childhood. Which of the following interventions by the nurse is consistent with the recovery model? 1) The nurse recommends that Callie consider treatment for PTSD in addition to her current treatment for heroin addiction. 2) The nurse encourages Callie to not involve the family in treatment since they are drug users, too. 3) The nurse instructs Callie that she is breaking the law and should be prosecuted. 4) The nurse tells Callie that she will need to confront the perpetrator of sexual abuse in order to recover from this trauma.

1 One of SAMHSA's principles for recovery is that recovery is supported by addressing trauma. The nurse's intervention in this example supports this principle and respects that it is the client's decision since the nurse has made a recommendation rather than an edict. This response negates a principle of recovery that identifies family as important in recovery. Engaging family in treatment may provide an opportunity for the family to participate in recovery and provide support to the client. This response by the nurse suggests lack of acceptance and a value judgment that the client should be prosecuted. One of SAMHSA's principles of recovery is that it is based on respect. This response by the nurse takes a directive approach and negates the principle that recovery is client driven as well as the principle that recovery occurs via many pathways.

The binging episode is thought to involve a. a release of tension, followed by feelings of depression. b. feelings of fear, followed by feelings of relief. c. unmet dependency needs and a way to gain attention. d. feelings of euphoria, excitement, and self-gratification.

A

Lamar, who has been attending day treatment through county mental health services for the past two years, tells the nurse he's been hearing about a recovery model for mental illness and asks what that means. Which of the following teaching points are accurate about recovery models? Select all that apply. 1) People with mental illness can improve their health and wellness. 2) People with mental illness can live self-directed lives. 3) People with mental illness can strive to reach their full potential. 4) People with mental illness no longer need to take medication. 5) People with mental illness who are empowered to make their own decisions about illness management don't need support or intervention from others.

1,2,3 Feedback 1: This concept, which is incorporated in the SAMHSA definition of recovery, shifts from traditional ideas that people with mental illness maintain or deteriorate to one in which clients are recognized as being able to improve their health and wellness. Feedback 2: This concept, which is incorporated in the SAMHSA definition of recovery, shifts from the traditional idea that people with mental illness need constant direction from others to a model that empowers their ability to be self-directed. Feedback 3: This concept, which is incorporated in the SAMHSA definition of recovery, shifts from a traditional philosophy that focuses on limitations imposed by illness to one in which clients are empowered to strive toward their full potential. Feedback 4: The recovery model does not dictate that clients will or will not need to take medication. Instead, it empowers the client to make fully informed decisions about medication and other aspects of treatment. Feedback 5: The recovery model does not dictate whether support is needed but rather empowers the client to make those decisions.

The nurse is assisting a client to develop a recovery plan using principles from the WRAP (Wellness Recovery Action Plan) model. Which of the following are aspects of WRAP that the nurse should include? Select all that apply. 1) Assisting the client to develop a wellness tool box. 2) Assisting the client to identify things that make symptoms worse. 3) Helping the patient to recognize the importance of complying with medication prescriptions. 4) Facilitating development of a plan for how to respond in crisis situations.

1,2,4 Feedback 1: Developing a wellness tool box is a principle from the WRAP model that encourages the client to identify strategies for reducing, modifying, or eliminating disturbing symptoms when they occur. Feedback 2: Assisting the client to identify situations that trigger an exacerbation of symptoms is an aspect of WRAP that precedes identifying plans for how to respond to them. Feedback 3: Directing the client toward medication compliance suggests that the client is not empowered to make those decisions. This is not an aspect of the WRAP model or of the recovery model in general. Feedback 4: Crisis planning is an aspect of the WRAP model in which clients identify symptoms that they believe warrant intervention by others when they are unable to make decisions for themselves.

The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to a. increase energy and elevate mood. b. stimulate the central nervous system. c. prevent psychotic symptoms. d. produce a calming effect.

A

The category of adjustment disorder with disturbance of conduct identifies the individual who a. violates the rights of others to feel better. b. expresses symptoms that reveal a high level of anxiety. c. exhibits severe social isolation and withdrawal. d. is experiencing a complicated grieving process.

A

A nurse encourages a client to tell his or her story, actively listens to the account of the resulting distress, and assists the client to record the story in his or her own words. This nurse is employing which commitment in the "Tidal Model of Recovery?" 1) Value the Voice. 2) Respect the Language. 3) Develop Genuine Curiosity. 4) Become the Apprentice. Test-Taking Tip: Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments upon which the Tidal Model is based. They include Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change is Constant, and Be Transparent.

1: During the Value the Voice commitment, the person is encouraged to tell his or her story. The person's story represents the beginning and endpoint of the helping encounter, embracing not only an account of the person's distress, but also the hope for its resolution. The nurse in the question is employing this commitment.

An inpatient client diagnosed with antisocial personality disorder states, "When I am discharged, I am going to cut my mother-in-law's throat." Which legal principle applies to this situation? 1) Duty to warn 2) Maintenance of confidentiality 3) False imprisonment 4) Least restrictive interventions

1: Duty to warn is the responsibility of a treating mental health professional to notify an intended, identifiable victim. This client has made a verbal threat toward the identifiable mother-in-law and therefore the legal principle of "duty to warn" would apply.

A client has been suffering from sweaty palms, palpitations, shortness of breath, and dizziness for the past year. After the client has been medically cleared, which would potentially cause these symptoms? 1) Pathophysiological changes of the temporal cortex 2) Decreased levels of gamma-aminobutyric acid (GABA) 3) Decreased levels of prolactin 4) Decreased levels of norepinephrine

1: The symptoms presented in the question are indicative of an anxiety disorder. Pathophysiological changes of the temporal cortex have been implicated in anxiety disorders.

A nursing instructor is teaching about the guiding principles of the recovery model as described by the Substance Abuse and Mental Health Services Administration (SAMHSA). Which student statement indicates that further teaching is needed? 1) "Recovery emerges from hope." 2) "Recovery is specifically focused on symptom reduction." 3) "Recovery is person-driven." 4) "Recovery is supported by addressing trauma."

2 "Recovery emerges from hope" is listed by SAMHSA as a guiding principle for the recovery model. Because recovery is holistic, it is not specifically focused on symptom reduction. This student statement indicates that further teaching is needed. "Recovery is person-driven" is listed by SAMHSA as a guiding principle for the recovery model. "Recovery is supported by addressing trauma" is listed by SAMHSA as a guiding principle for the recovery model. SAMHSA also lists the following guiding principles of the recovery model: "recovery occurs via many pathways," "recovery is holistic," "recovery is supported by peers and allies," "recovery is supported through relationship and social networks," "recovery is culturally-based and influenced," "recovery involves individual, family, and community strengths and responsibility," and "recovery is based on respect."

Arthur, who has been diagnosed with schizoaffective disorder, has been engaged with the nurse in a recovery-focused care plan. Which of the following statements by the client is an indication of a successful outcome in this type of care plan? 1) "I don't need treatment because I've never had a mental illness." 2) "I don't want to take medication but my brother has agreed to help me get to the emergency room if my symptoms get to the point where I can't make decisions for myself and I am in danger of hurting myself." 3) "I understand now that people with my illness can't manage higher education degrees because hallucinations prohibit learning." 4) "I understand now that I have to comply with the psychiatrist's orders."

2 This response indicates lack of insight about the presence of schizophrenia. It does not indicate that the client has adopted a recovery focus in treatment. This response indicates that the client has made decisions about his treatment and has engaged the support of others to help him manage according to his wishes. This is consistent with a recovery model focus. This response is inaccurate and suggests that the client is sensing hopelessness about recovery as an option. This response indicates a traditional belief about management of mental illness: that decisions about treatment are solely in the hands of health care professionals. This is not consistent with the recovery model.

Which of the following accurately describes components of William A. Anthony's definition of Recovery? Select all that apply. 1) Recovery follows a predictable pattern of behavioral change. 2) Recovery is a way of living a satisfying, hopeful, and contributing life. 3) Recovery involves the development of meaning and purpose in one's life. 4) Recovery is growth beyond the effects of mental illness. 5) Recovery is a change in one's attitudes, values, feelings, goals, skills, and/or roles.

2,3,4,5 Feedback 1: Recovery is described as a deeply personal, unique process, not a predictable pattern of behavioral change. Feedback 2: Recovery is a way of living a satisfying, hopeful, and contributing life, even with limitations caused by illness. Feedback 3: Recovery involves the development of meaning and purpose in one's life. Feedback 4: Recovery involves growing beyond the catastrophic effects of mental illness. Feedback 5: Recovery involves changing one's attitudes, values, feelings, goals, skills, and/or roles.

Marla has arrived at the inpatient psychiatric unit proclaiming to be the first female president of the United States. She is diagnosed with Bipolar I Disorder, manic episode. As the nurse is conducting the admission assessment, which of these responses are consistent with the recovery model? Select all that apply. 1) "We will not be discussing your delusions about being the President since this will not support your recovery." 2) "Tell me what you would like to get from this hospitalization." 3) "What are your thoughts about the medication you've been prescribed?" 4) "You will need to go to group therapy each morning and afternoon." 5) "Tell me more about what was happening when you began to believe you were the President of The United States."

2,3,5 Feedback 1: Even in traditional models, it is not recommended to tell a person he or she is delusional; in addition, this response does not respect listening to the person's story, which is foundational to recovery model approaches. Feedback 2: This response demonstrates respect for the client's input in treatment and is consistent with the recovery model approach. Feedback 3: This response demonstrates respect for the client's viewpoint and right to decision making about medications. This is consistent with a recovery model approach. Feedback 4: Although in some cases a client may need more direction to ensure that basic care needs are met, dictating the care plan in an initial assessment suggests that client involvement in decision making has been overlooked. Feedback 5: This response respects that listening to the client's story and encouraging discussion of associated events, thoughts, and feelings can provide valuable information in identifying problems and potential solutions, which is foundational to recovery models. Furthermore, this is an example of encouraging discussion without reinforcing a delusion.

Angela is admitted to a partial hospitalization treatment program with depression and a history of suicidal attempts, and she has admitted to recent physical abuse from her husband. Which of these responses by the nurse are consistent with recovery model approaches to treatment? 1) "You need to leave your husband now, for your personal safety." 2) "What would you like to do next in response to this abuse?" 3) "What can you do differently to decrease your husband's anger toward you?" 4) "Are you having any thoughts of suicide?" 5) "Let's discuss strategies that may be options for you to use to protect your safety."

2,4,5 Feedback 1: This approach is directive and suggests that the nurse makes the decisions about client response. This is not consistent with the recovery model. Feedback 2: This response respects that the client is empowered to make decisions about her life and about problem solving. Feedback 3: This response sends the message that the client is responsible for her husband's abuse and suggests that she can control another person's behavior. Both are inappropriate messages. In the recovery model the nurse facilitates clients' exploration of problem solving about their own goals, decisions, and behavior. Feedback 4: Assessing for this client's risk of suicide is essential, especially because of her history of depression and suicide attempts. It is consistent with the recovery model that the nurse facilitates identification of priority problems. Feedback 5: This response is consistent with the recovery model, as it encourages the client to explore and identify safety plans that she finds suitable.

Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? a. Overly self-centered and exploitative of others b. Suspicious and mistrustful of others c. Rule conscious and disapproving of change d. Anxious and socially isolated

A

Which of the following is least likely to predispose a child to Tourette's disorder? a. Absence of parental bonding b. Family history of the disorder c. Abnormalities of brain neurotransmitters d. Structural abnormalities of the brain

A

The nursing staff of an inpatient psychiatric unit failed to run the regularly scheduled groups because of staffing problems. The unit manager determines that this action impacts which client right? 1) Right to respectful care 2) Right to receive treatment 3) Right to reasonable continuity of care 4) Right to review the treatment plan

2: The principle of beneficence states there is a duty to promote the good of clients. By not providing scheduled therapy groups, the staff did not respect the client's right to treatment.

Which of the following medications may be prescribed for early ejaculation? a. Paroxetine b. Tadalafil c. Diazepam d. Imipramine

A

Which of the following accurately describes components of William A. Anthony's definition of Recovery? Select all that apply. 1) Recovery follows a predictable pattern of behavioral change. 2) Recovery is a way of living a satisfying, hopeful, and contributing life. 3) Recovery involves the development of meaning and purpose in one's life. 4) Recovery is growth beyond the effects of mental illness. 5) Recovery is a change in one's attitudes, values, feelings, goals, skills, and/or roles. Test-Taking Tip: William A. Anthony, Executive Director of the Center for Psychiatric Rehabilitation at Boston University, offers this definition of recovery.

2: Recovery is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. 3: Recovery involves the development of meaning and purpose in one's life. 4: Recovery involves growing beyond the catastrophic effects of mental illness. 5: Recovery involves changing one's attitudes, values, feelings, goals, skills, and/or roles.

A client states, "I am really focused on learning about my illness and want to be able to recognize, monitor, and manage my symptoms." The nurse recognizes that this client is in which stage of the Psychological Recovery Model? 1) Moratorium 2) Awareness 3) Preparation 4) Rebuilding

3 Moratorium. This stage is identified by dark despair and confusion. It is called moratorium because it seems life is on hold. Awareness. In this stage, the individual comes to a realization that a possibility for recovery exists. In the Preparation stage the client resolves to begin the work of recovery. The client takes responsibility for learning about the effects of the illness and how to recognize, monitor, and manage symptoms. The client in the question is in the Preparation stage. Rebuilding. The hard work of recovery takes place in the rebuilding stage. The individual takes the necessary steps to work toward his or her goals in rebuilding a meaningful life.

30. Which concepts should a nurse identify as being included in the DSM-IV-TR definition of personality? (Select all that apply.) A. Personality is an enduring pattern of perceiving. B. Personality is influenced by relationships between the environment and self. C. Personality is developed in sporadic stages that vary from person to person. D. Personality is influenced by a wide range of social and personal contexts. E. Personality is inborn and cannot be influenced by developmental progression.

30. ANS: A, B, D The nurse should identify that the following concepts are included in the DSM-IV-TR definition of personality: Personality is an enduring pattern of perceiving, a wide range of social and personal contexts influences it, and it is inborn. Personality disorders are coded on Axis II of the DSM-IV-TR multiaxial diagnosis and include disorders organized into three clusters: odd and eccentric disorders (cluster A); dramatic, emotional, or erratic disorders (cluster B); and anxious or fearful disorders (cluster C). PTS: 1 REF: 32 KEY: Cognitive Level: Application | Integrated Process: Assessment

A suicidal college student is admitted to a psychiatric unit. Family members describe a punitive mother who expected perfection. The student states, "Wow, that's right! I never thought about that connection." Where would Freud postulate that these client memories were stored? 1) In the conscience 2) In the conscious 3) In the preconscious 4) In the unconscious

3: Freud believed that the preconscious included all memories that may have been forgotten or were not in present awareness but, if prompted, could be readily recalled. The situation presented in the question indicates that memories of the student's childhood, of which the student was not currently aware, were prompted into awareness. These memories were stored in the preconscious.

A client states, "I am really focused on learning about my illness and want to be able to recognize, monitor, and manage my symptoms." The nurse recognizes that this client is in which stage of the Psychological Recovery Model? 1) Moratorium 2) Awareness 3) Preparation 4) Rebuilding Test-Taking Tip: Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include Stage 1: Moratorium, Stage 2: Awareness, Stage 3: Preparation, Stage 4: Rebuilding, and Stage 5: Growth.

3: In the Preparation stage the client resolves to begin the work of recovery. The client takes responsibility for learning about the effects of the illness and how to recognize, monitor, and manage symptoms. The client in the question is in the Preparation stage.

Robert, who is diagnosed with schizophrenia, attends social activities offered by NAMI (National Alliance for Mental Illness), where he has developed supportive friendships. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in which dimension of recovery is this client participating? 1) Health 2) Home 3) Purpose 4) Community

4 SAMHSA suggests that a life in recovery is supported by four major dimensions. The dimension of health relates to overcoming or managing one's disease as well as living in a physically and emotionally healthy way. The dimension of recovery related to home addresses whether or not the client has a stable and safe place to live. The purpose dimension of recovery identifies the importance of meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. The community dimension recognizes that relationships and social networks that provide support, friendship, love, and hope are important to recovery. This client is engaging in community.

The goal of cognitive therapy with depressed clients is to a. identify and change dysfunctional patterns of thinking. b. resolve the symptoms and initiate or restore adaptive family functioning. c. alter the neurotransmitters that are creating the depressed mood. d. provide feedback from peers who are having similar experiences.

A

The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with Major Depressive Disorder. The nurse says to Nancy, "What questions do you have about being here on the unit?" Which nursing role described by Peplau is the nurse fulfilling in this instance? a. Resource person b. Counselor c. Surrogate d. Technical expert

A

A client is admitted to the emergency department with a diagnosis of panic-level anxiety. The nurse charts which symptoms that describe the characteristics of panic-level anxiety? 1) "Experiencing decreased attention span and diminished perceptual fields." 2) "Experiencing increased motivation and enhanced awareness of surroundings." 3) "Experiencing greatly narrowed perceptual field, headaches, insomnia, and confusion." 4) "Has decreased reality orientation and refuses to leave bedroom."

4: At a panic level of anxiety, clients can experience decreased reality orientation, which may include hallucinations or delusions. These individuals can also experience either extreme withdrawal behaviors or wild and desperate actions.

A 68-year-old woman with a history of multiple divorces is admitted after phoning her daughter stating, "I have nothing to live for and am going to swallow a bottle of sleeping pills." This woman is struggling with which of Erikson's developmental task conflicts? 1) Trust versus mistrust 2) Industry versus inferiority 3) Generativity versus stagnation 4) Ego integrity versus despair

4: Ego integrity versus despair occurs in the last years of life (ages 65 and older). The older adult reflects back on life and either derives pleasure and meaning from past events or feels self-contempt, anger, and depression when focusing on past failures. When the mother states, "I have nothing left to live for," she is demonstrating despair in the self-assessment of her life.

A single man lives with his mother. His father died when he was 6 years old. Using psychoanalytic theory, the nurse determines that the timing of this man's father's death may have caused problems with which developmental response? 1) Resolution of an Electra complex 2) Resolution of the oral stage 3) Resolution associated with latency 4) Resolution of an Oedipus complex

4: Freud describes the Oedipus complex, which occurs during the phallic stage of development. The male child experiences an unconscious desire to eliminate the parent of the same gender and to possess the parent of the opposite gender for himself. Resolution of this internal conflict occurs when the child develops a strong identification with the parent of the same gender. At the age of 6 years, the death of this man's father could have negatively affected his identification with the same-sex parent.

The emergency department physician tells a mother that her child has died as the result of drowning. She shows no emotional reaction to this message. The mother is demonstrating the use of which defense mechanism? 1) Undoing 2) Rationalization 3) Suppression 4) Isolation

4: The mother in the question is using the defense mechanism of isolation. Isolation is the separation of thought or memory from the feeling, tone, or emotion associated with the memory or event. The mother shows no emotion because she has isolated her unbearable feelings and reaction to her child's death.

The nurse is preparing a patient for an electroconvulsive therapy (ECT) treatment. About 30 minutes prior to the treatment the nurse administers atropine sulfate 0.4 mg IM. Rationale for this order is a. to decrease secretions and increase heart rate. b. to relax muscles. c. to produce a calming effect. d. to induce anesthesia.

A

When planning client care, what is the best reason for including favorite ethnic foods in the diets of clients from other cultures? 1) It prevents malnutrition. 2) It prevents clients from becoming agitated. 3) It ensures the client's cooperation with scientifically based treatment. 4) It conveys acceptance of the client's beliefs and identity.

4: When the nurse includes favorite ethnic foods in the diets of clients from other cultures, the nurse shows respect for a client's cultural differences and accepts the client's beliefs and identity. This will promote dietary intake and enhance therapeutic relationship rapport.

What is the most important reason for nurses to explore their own culture, as well as the cultures of their clients? 1) To recognize that cultural customs and beliefs are resistant to change 2) To anticipate the client's dietary preferences and other personal care practices 3) To understand that cultures have little diversity within and among themselves 4) To understand and respond appropriately to diverse human behaviors

4: Within our American "melting pot," any or all characteristics could apply to individuals within any or all of the cultural groups represented. To work effectively with diverse populations, nurses must understand their own culture as well as the cultures of their clients.

The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is a. 1.0 to 1.5 mEq/L. b. 10 to 15 mEq/L. c. 0.5 to 1.0 mEq/L. d. 5 to 10 mEq/L.

A

Kim, a client diagnosed with Borderline Personality Disorder, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except a. refusal to stay in room alone, stating, "It's so lonely." b. asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. c. stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." d. cutting arms with razor blade after discussing dismissal plans with physician.

A

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for a number of years. Lab reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addictions unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink. b. 2 to 3 days after the last drink. c. 4 to 5 days after the last drink. d. 6 to 7 days after the last drink.

A

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. Paroxetine and group therapy b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive therapy

A

Nurse Jones decides to respect family wishes and not tell the client of his terminal status because that would bring the most happiness to the most people. Which of the following ethical theories is considered in this decision? a. Utilitarianism b. Kantianism c. Christian ethics d. Ethical egoism

A

Psychotropic medications that block the acetylcholine receptor may result in which of the following side effects? a. Dry mouth b. Sexual dysfunction c. Nausea d. Priapism

A

Which of the following nursing diagnoses would be considered the priority in planning care for the child with autism spectrum disorder? a. Risk for self-mutilation evidenced by banging head against wall b. Impaired social interaction evidenced by unresponsiveness to people c. Impaired verbal communication evidenced by absence of verbal expression d. Disturbed personal identity evidenced by inability to differentiate self from others

A

Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe

A

Which of the following parts of the brain is concerned with hearing, short-term memory, and sense of smell? a. Temporal lobe b. Parietal lobe c. Cerebellum d. Hypothalamus

A

A client comes to the mental health clinic with a complaint of lack of sexual desire. In the initial interview, what assessments would the nurse make? Select all that apply. a. Mood b. Level of energy c. Medications being taken d. Previous level of sexual activity

A, B, C, D

A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply. a. Slumped posture b. Delusional thinking c. Feelings of despair d. Feels best early in the morning and worse as the day progresses e. Anorexia

A, B, C, E

A nurse is preparing a client who is a potential candidate for ECT and providing information about the treatments. The nurse may do which of the following? Select all that apply. a. Encourage the client to express fears about getting ECT. b. Discuss with the client and family the possibility of short-term memory loss. c. Remind client and family that injury from the induced seizure is common. d. Monitor for any cardiac alterations (current and past) to avoid possible negative outcomes. e. Ensure the client that he will be awake during the entire procedure.

A, B, D

Annie has Hair pulling disorder. She is receiving treatment at the mental health clinic with HRT. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy

A,B,C

A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) A. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." B. "In this disorder, binge eating occurs, on average, at least once a week for three months." C. "In this disorder, binge eating occurs, on average, at least two days a week for six months." D. "In this disorder, distress regarding binge eating is present." E. "In this disorder, distress regarding binge eating is absent."

A. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." C. "In this disorder, binge eating occurs, on average, at least two days a week for six months." E. "In this disorder, distress regarding binge eating is absent." According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. The new time frame criteria in the DSM-5 states that binge eating must occur, on average, at least once a week for three months not two days a week for six months. The DSM-5 criteria states that distress regarding binge eating would be present.

Which of the following would contribute to a client's excessive weight gain? (Select all that apply.) A. A hypothalamus lesion B. Hyperthyroidism C. Diabetes mellitus D. Cushing's disease E. Low levels of serotonin

A. A hypothalamus lesion C. Diabetes mellitus D. Cushing's disease Lesions in the appetite and satiety centers in the hypothalamus may contribute to overeating and lead to obesity. Hypothyroidism, not hyperthyroidism, is a problem that interferes with basal metabolism and may lead to weight gain. Weight gain can also occur in response to the decreased insulin production of diabetes mellitus and the increased cortisone production of Cushing's disease. New evidence also exists to indicate that low levels of the neurotransmitter serotonin may play a role in compulsive eating.

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy

A. Awareness training, B. Competing response training, C. Social support

The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol

A. Clomipramine, a tricyclic antidepressant, as well as SSRIs such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox) have been approved for treatment of OCD. Clonidine and propranolol, are anthypertensives that have been used used successful to treat anxiety disorders. Clonazepam and other benzodiazepines are used to treat social anxiety disorder.

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? A. Constant 24-hour, one-to-one observation at arm's length B. One-to-one observation while client is awake C. Every 15-minute observation around the clock D. Seclusion with 15-minute observation

A. Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch.

A nursing school graduate failing the NCLEX exam and a 15-year-old high school girl not being selected for the cheer leading squad are examples of which of the following? A. Focal stimuli B. Contextual stimuli C. Residual stimuli D. Spatial stimuli

A. Focal stimuli is the correct answer because not being selected for the cheer leading squad is the immediate concern. Contextual stimuli are present in the environment and contribute to the behavior being caused by the focal stimuli. Residual stimuli are factors that may influence maladaptive behavior in response to focal and contextual stimuli. Spatial stimuli isn't even in the book.

Some biological factors may be associated with the predisposition to suicide. Which of the following biological factors have been implicated? A. Genetics and decreased levels of serotonin B. Heredity and increased levels of norepinepherine C. Temporal lobe atrophy and decreased levels of acetylcholine D. Structural alterations of the brain and increased levels of dopamine.

A. Genetics and decreased levels of serotonin

If a suicidal client is to be treated outside the hospital, which intervention would be of high priority? A. Have the client identify three people to call if he is overwhelmed by hopelessness. B. Make sure the client has food enough to last for 2 to 3 days. C. Arrange for a police visit every 24 hours. D. Provide a 1-week supply of antidepressant medication.

A. Have the client identify three people to call if he is overwhelmed by hopelessness. For suicidal clients treated in the community, establishing a network of individuals to whom the client may turn if the suicidal urge becomes great is important.

The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.) A. Hyperthyroidism B. Hypothyroidism C. Hyperadrenalism D. Hypoadrenalism E. Hyperaphia

A. Hyperthyroidism B. Hypothyroidism C. Hyperadrenalism D. Hypoadrenalism The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders (e.g., hepatic encephalopathy, hypo- and hyperthyroidism, hypo- and hyperadrenalism, and vitamin B12 deficiency) and neurological conditions (e.g., epilepsy, tumors, cerebrovascular disease, head trauma, and encephalitis). Hyperaphia is an excessive sensitivity to touch.

Which of the following outcome criteria would be most appropriate for the client described in question 1? A. Karen is able to express positive aspects about herself and her life situation. B. Karen is able to accept constructive criticism without becoming defensive. C. Karen is able to develop positive interpersonal relationships. D. Karen is able to accept positive feedback from others.

A. Karen is able to express positive aspects about herself and her life situation is the correct answer from the back of the book and the first listed in the criteria. However, it is just one of the outcome criteria for situational low self-esteem. Other outcomes are ability to accept positive feedback from others, able to attempt new experiences, able to accept personal responsibility for own problems, able to accept constructive criticism withoth becoming defensive. uses good eye contact, is able to make independent decisions about life situations, is able to develop positive interpersonal relationships and able to communicate needs and wants to others assertively.

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduced her probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept

A. Relieves her anxiety

Which of the following interventions are appropriate for a client on suicide precautions? Select all that apply. A. Remove all sharp objects, belts, and other potentially dangerous articles from their environment B. Accompany the client to off-unit activities C. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours. D. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

A. Remove all sharp objects, belts, and other potentially dangerous articles from their environment B. Accompany the client to off-unit activities C. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours.

Tommy says to his friend, "I can't even talk to my Daddy until after he has read his newspaper." This is an example of which of the following? A. Rigid boundary B. A boundary violation C. Enmeshed boundary. D. Too flexible boundary

A. Rigid boundary is the correct answer. The father has set rigid boundaries to keep others out of his personal space.

A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? A. Stay with the client and reassure safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down. D. Encourage the client to talk about what triggered the attack.

A. Stay with the client and reassure safety

The nurse identifies the primary nursing dx for Theresa as Risk for Suicide r/t feelings of hopelessness from loss of relationship. Which is the outcome criterion that would most accurately measure achievement of this dx? A. The client has experienced no physical harm to herself. B. The client sets realistic goals for herself. C. The client expresses some optimism and hope for the future. D. The client has reached a stage of acceptance in the loss of the relationship with her boyfriend.

A. The client has experienced no physical harm to herself.

The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should A. allow him to use the razor under staff supervision. B. tell him he must use a safety razor provided by the unit. C. suggest that this would be a good time to grow a beard. D. give him the razor and ask him to return it when he is finished.

A. allow him to use the razor under staff supervision. Because the razor is cordless, independent use is relatively safe.

Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by A. having a staff member sit at the door and check packages as visitors enter. B. having a staff member make frequent rounds during visiting hours to inspect gifts. C. asking all visitors to report to the nurse's station before visiting a client. Incorrect D. asking clients to give staff any unsafe item that might have been left by a visitor.

A. having a staff member sit at the door and check packages as visitors enter. Correct A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety.

Jermaine attempted suicide while intoxicated by using a gun, although the bullet missed when he staggered. Jermaine's method of using a gun to attempt suicide is considered: A. high risk, or a hard method. B. low risk, or a soft method. C. not an actual suicide attempt because he was intoxicated. D. a nonlethal means.

A. high risk, or a hard method. Higher-risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

An identical twin recently committed suicide. The parent tells the nurse, "Thank heavens suicide does not run in families. I won't have to worry about my other son." The nurse's response will be based on the understanding that this optimism is A. not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. B. justified because twin studies suggest no genetic factor is involved in suicide. C. unjustified because the parent has failed to consider the importance of the "copycat" factor. D. likely evidence of her denying the possibility of a parental role in the causation of the suicide.

A. not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. Correct Twin studies, in fact, show that a genetic component of suicide may be present.

The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder: A. Psychoeducation about their disorder B. Ordering neuroimaging to determine activity in the cingulate cortex. C. Psychopharmacology including an SSRI D. Cognitive-behavioral therapy

A. psychoeducation about their disorder. This is the most likely INITIAL intervention. Treatment for hoarding disorder is most commonly a combination of cognitive-behavioral therapy and SSRIs. Decreased activity in the cingulate cortex IS associated with hoarding disorder (pg 540) but neuroimaging of the client's brain is unlikely to be ordered to diagnose/treat this disorder.

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should A. say "I understand" and allow the client to close the door. B. keep the door open, but step to the side out of the client's view. C. leave the client's room and wait outside in the hall. D. say "For your safety I can be no more than an arm's length away."

A. say "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate.

a. A client has just been admitted to the psychiatric unit with a diagnosis of MDD. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply A. slumped posture B. delusional thinking C. Feelings of despair D. Feels best early in the morning and worse as day progresses E. Anorexia

A. slumped posture B. delusional thinking C. Feelings of despair E. Anorexia

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? A. How long the client has been suicidal B. Whether the plan has specific details C. Whether the method is one that causes death quickly D. Whether the client has the means to implement the plan

A.How long the client has been suicidal Lethality refers to how deadly a plan is. The length of time a client has been suicidal has nothing to do with the lethality of the plan.

A client tells the nurse that he believes his situation is intolerable. The nurse assesses that the client is isolating socially. A nursing diagnosis that should be considered is A. hopelessness. B. deficient knowledge. C. chronic low self-esteem. D. compromised family coping.

A.hopelessness. The defining characteristics are present for the nursing diagnosis of hopelessness.

2. A nurse is working with a client diagnosed with SSD. What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)? 1. The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not. 2. The client diagnosed with SSD experiences a change in the quality of self-awareness, and the client diagnosed with IAD does not. 3. The client diagnosed with SSD disorder has a perceived disturbance in body image or appearance, and the client diagnosed with IAD does not. 4. The client diagnosed with SSD only experiences anxiety about the possibility of illness, and the client diagnosed with IAD does not.

ANS: 1 Rationale: Individuals experiencing somatic symptoms without corroborating pathology are considered to have SSD, and those with minimal or no somatic symptoms would be diagnosed with IAD, a diagnosis new to the DSM-5. Clients diagnosed with IAD have minimal or no somatic complaints, but present with intense anxiety and suspiciousness of the presence of an undiagnosed, serious medical illness. Cognitive Level: Analysis Integrated Process: Assessment

A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? 1."Medications only address biological factors. Environmental and interpersonal factors must also be considered." 2."Because biological factors are the sole cause of depression, medications will improve your mood." 3."Environmental factors have been shown to exert the most influence in the development of depression." 4."Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."

ANS: 1 Rationale: The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression.

Which client should the nurse anticipate to be most receptive to psychiatric treatment? 1. A Jewish, female social worker. 2. A Baptist, homeless male. 3. A Catholic, black male. 4. A Protestant, Swedish business executive.

ANS: 1 Rationale: The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important as physical health. Women are also more likely to seek treatment for mental health problems than men.

12. Which combination of diagnoses and appropriate pharmacological treatments are correctly matched? 1. SSD: predominantly pain; treated with venlafaxine (Effexor) 2. IAD; treated with cefadroxil (Duricef) 3. Conversion disorder; treated with cyclobenzaprine (Flexeril) 4. Depersonalization-derealization disorder; treated with mometasone (Elocom)

ANS: 1 Rationale: The nurse should anticipate that the diagnosis of SSD: predominantly pain can be effectively treated with venlafaxine. Antidepressants are often used with somatic symptom disorder when the predominant symptom is pain. They have been shown to be effective in relieving pain, independent of influences on mood. Cognitive Level: Analysis Integrated Process: Implementation

11. Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which nursing care should be included for this client? 1. Deal with physical symptoms in a detached manner. 2. Challenge the validity of physical symptoms. 3. Meet dependency needs until the physical limitations subside. 4. Encourage a discussion of feelings about the lower-extremity problem.

ANS: 1 Rationale: The nurse should assist the client in dealing with physical symptoms in a detached manner. This client should be diagnosed with a conversion disorder in which symptoms affect voluntary motor or sensory functioning with or without apparent impairment of consciousness. Examples include paralysis, aphonia, seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia, and hallucinations. Cognitive Level: Application Integrated Process: Implementation

A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

ANS: 1 Rationale: The nurse should determine that defense mechanisms can be appropriate during times of stress. The client with no defense mechanisms may have a lower tolerance for stress, thus leading to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills.

A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Body dysmorphic disorder 4. Parkinson's disease

ANS: 1 Rationale: The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia spectrum disorder. Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania.

A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents? 1. Reactions to stress are relative rather than absolute; individual responses to stress vary. 2. It is abnormal for identical twins to react differently to similar stressors. 3. Identical twins should share the same temperament and respond similarly to stress. 4. Environmental influences to stress weigh more heavily than genetic influences.

ANS: 1 Rationale: The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress. Mental health is a state of being that is relative to the individual client. Environmental influences and temperament can affect stress reactions.

16. A client is diagnosed with functional neurological symptom disorder (FNSD). Which of the following symptoms is the client most likely to exhibit? (Select all that apply.) 1. Anosmia 2. Anhedonia 3. Akinesia 4. Aphonia 5. Amnesia (multiple response)

ANS: 1, 3, 4 Rationale: FNSD can also be termed conversion disorder. Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. Examples include paralysis, aphonia, seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia, loss of pain sensation, and hallucinations. Cognitive Level: Application Integrated Process: Assessment

....17. A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis? (Select all that apply.) 1. "Have you taken any new medications recently?" 2. "Have you recently traveled away from home?" 3. "Have you recently experienced any traumatic event?" 4. "Have you ever felt detached from your environment?" 5. "Have you had any history of memory problems?" (multiple response)

ANS: 1, 3, 5 Rationale: The nurse should assess the client for possible causes of amnesia, which may include side effects of new medications, experiencing a traumatic event, or having a history of memory problems. Three types of disturbance in recall are identified in the DSM-5: localized, selective, and generalized. In the generalized type, the individual has amnesia for his or her identity and total life history. Cognitive Level: Application Integrated Process: Assessment

15. A client is diagnosed with IAD. Which of the following symptoms is the client most likely to exhibit? (Select all that apply.) 1. Obsessive-compulsive behaviors 2. Pseudocyesis 3. Anxiety 4. Flat affect 5. Depression (multiple response)

ANS: 1, 3, 5 Rationale: The nurse should expect that a client diagnosed with IAD would exhibit obsessive-compulsive behaviors, anxiety, and depression. Hypochondriasis involves an unrealistic or inaccurate interpretation of physical symptoms or sensations that can lead to preoccupation and fear of having a serious disease. Cognitive Level: Application Integrated Process: Assessment

9. According to the DSM-5 diagnostic criteria for dissociative amnesia (DA), what symptom would be essential to meet the criteria for the subcategory of dissociative fugue? 1. An inability to recall important autobiographical information 2. Clinically significant distress in social and occupational functioning 3. Sudden unexpected travel or bewildered wandering 4. "Blackouts" related to alcohol toxicity

ANS: 2 Rationale: An inability to recall important autobiographical information and clinically significant distress in social and occupational functioning are basic criteria for the diagnosis of DA. A specific subtype of dissociative amnesia is with dissociative fugue. Dissociative fugue is characterized by a sudden, unexpected travel away from customary place of daily activities, or by bewildered wandering, with the inability to recall some or all of one's past. The DSM-5 also states that symptoms cannot be attributable to the direct physiological effects of a substance (e.g., alcohol, a drug of abuse, a medication). Cognitive Level: Application Integrated Process: Assessment

13. A nurse is reviewing progress notes on a newly admitted client. One progress note reveals that the client purposefully inserted a contaminated catheter into urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder? 1. Illness anxiety disorder 2. Factitious disorder 3. Functional neurological symptom disorder 4. Depersonalization-derealization disorder

ANS: 2 Rationale: Factitious disorders involve conscious, intentional feigning of physical or psychological symptoms. Individuals with factitious disorder pretend to be ill in order to receive emotional care and support commonly associated with the role of "patient." Individuals become very inventive in their quest to produce symptoms. Examples include self-inflicted wounds, injection or insertion of contaminated substances, manipulating a thermometer to feign a fever, urinary tract manipulation, and surreptitious use of medications. Cognitive Level: Application Integrated Process: Assessment

Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? 1. Neuroendocrinology 2. Psychoimmunology 3. Diagnostic technology 4. Neurophysiology

ANS: 2 Rationale: Psychoimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli.

Which nursing statement about the concept of neurosis is most accurate? 1. An individual experiencing neurosis is unaware that he or she is experiencing distress. 2. An individual experiencing neurosis feels helpless to change his or her situation. 3. An individual experiencing neurosis is aware of psychological causes of his or her behavior. 4. An individual experiencing neurosis has a loss of contact with reality.

ANS: 2 Rationale: The nurse should define the concept of neurosis with the following characteristics: The client feels helpless to change his or her situation, the client is aware that he or she is experiencing distress, the client is aware the behaviors are maladaptive, the client is unaware of the psychological causes of the distress, and the client experiences no loss of contact with reality.

3. Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with SSD? 1. The client will admit to fabricating physical symptoms to gain benefits by day three. 2. The client will list three potential adaptive coping strategies to deal with stress by day two. 3. The client will comply with medical treatments for physical symptoms by day three. 4. The client will openly discuss physical symptoms with staff by day four.

ANS: 2 Rationale: The nurse should determine that an appropriate outcome for a client diagnosed with SSD would be for the client to list three potential adaptive coping strategies to deal with stress by day two. Because the symptoms of SSD are associated with psychosocial distress, increased coping skills may help the client reduce symptoms. Cognitive Level: Application Integrated Process: Planning

At what point should the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection.

ANS: 2 Rationale: The nurse should determine that the client is at risk for mental illness when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental illness, daily functioning must be significantly impaired. The client's ability to communicate distress would be considered a positive attribute.

A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

ANS: 2 Rationale: The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.

According to Maslow's hierarchy of needs, which situation on an in-patient psychiatric unit would require priority intervention by a nurse? 1. A client rudely complaining about limited visiting hours. 2. A client exhibiting aggressive behavior toward another client. 3. A client stating that no one cares. 4. A client verbalizing feelings of failure.

ANS: 2 Rationale: The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslow's hierarchy of needs and must be fulfilled before other higher-level needs can be met. Clients who complain, have feelings of failure, or state that no one cares are struggling with higher-level needs such as the need for love and belonging or the need for self-esteem.

Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality.

ANS: 2 Rationale: The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. The client with psychosis is unaware that his or her behavior is maladaptive or that he or she has a psychological problem.

10. Which situation is an example of selective amnesia? 1. A client cannot relate any lifetime memories. 2. A client can describe driving to Ohio but cannot remember the car accident that occurred. 3. A client often wanders aimlessly after sunset. 4. A client cannot provide personal demographic information during admission assessment.

ANS: 2 Rationale: Three types of disturbance in recall are identified in the DSM-5: localized, selective, and generalized. Localized and selective amnesia are related to a specific stressful event that has occurred. In selective amnesia, the individual can recall only certain incidents associated with a stressful event for a specific period after the event. In the generalized type, the individual has amnesia for his or her identity and total life history. Cognitive Level: Application Integrated Process: Assessment

How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflects a disturbance in the 1. psychosocial, biological, or developmental process underlying mental functioning." 2. psychological, cognitive, or developmental process underlying mental functioning." 3. psychological, biological, or developmental process underlying mental functioning." 4. psychological, biological, or psychosocial process underlying mental functioning."

ANS: 3 Rationale: "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflects a disturbance in the psychological, biological, or developmental process underlying mental functioning", is the new DSM 5 definition of a mental disorder.

Which client statement reflects an understanding of circadian rhythms in psychopathology? 1."When I dream about my mother's horrible train accident, I become hysterical." 2."I get really irritable during my menstrual cycle." 3."I'm a morning person. I get my best work done before noon." 4."Every February, I tend to experience periods of sadness."

ANS: 3 Rationale: By stating, "I am a morning person," the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness.

1. A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which personality disorder characteristics? 1. Experiences intense and chaotic relationships with fluctuating attitudes toward others. 2. Socially irresponsible, exploitative, guiltless, and disregards rights of others. 3. Self-dramatizing, attention seeking, overly gregarious, and seductive. 4. Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange.

ANS: 3 Rationale: The nurse should anticipate that a client diagnosed with SSD would be self-dramatizing, attention seeking, and overly gregarious. It has been suggested that, in somatic symptom disorder, there may be some overlapping of personality characteristics and features associated with histrionic personality disorder. These symptoms include heightened emotionality, impressionistic thought and speech, seductiveness, strong dependency needs, and a preoccupation with symptoms and oneself. Cognitive Level: Analysis Integrated Process: Assessment

7. A client diagnosed with DID switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function? 1. It is a means to attain secondary gain. 2. It is a means to explore feelings of excessive and inappropriate guilt. 3. It serves to isolate painful events so that the primary self is protected. 4. It serves to establish personality boundaries and limit inappropriate impulses.

ANS: 3 Rationale: The nurse should anticipate that a client who switches personalities when confronted with destructive behavior is dissociating in order to isolate painful events so that the primary self is protected. The transition between personalities is usually sudden, dramatic, and precipitated by stress. Cognitive Level: Application Integrated Process: Assessment

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It's just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section."

ANS: 3 Rationale: The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. It is not appropriate to skip physiological and psychosocial questions, as this would lead to an inaccurate assessment.

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so mad that the children and I had to put up with him as long as we did." 3. "Yes, it was a difficult relationship, but I think I have learned from the experience." 4. "I still don't have any appetite and continue to lose weight."

ANS: 3 Rationale: The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life.

An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? 1. The employee assertively confronts the boss. 2. The employee leaves the staff meeting to work out in the gym. 3. The employee criticizes a coworker. 4. The employee takes the boss out to lunch.

ANS: 3 Rationale: The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutral or less-threatening target.

A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation

ANS: 3 Rationale: The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Projection refers to the attribution of unacceptable feelings or behaviors to another person. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities.

A nurse is performing a mental health assessment on an adult client. According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? 1. Maintaining a long-term, faithful, intimate relationship. 2. Achieving a sense of self-confidence. 3. Possessing a feeling of self-fulfillment and realizing full potential. 4. Developing a sense of purpose and the ability to direct activities.

ANS: 3 Rationale: The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslow's hierarchy of needs.

Which part of the nervous system should a nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

ANS: 3 Rationale: The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

6. An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority? 1. Encourage exploration of sexual abuse. 2. Encourage guided imagery. 3. Establish trust and rapport. 4. Administer antianxiety medications.

ANS: 3 Rationale: The nurse should prioritize establishing trust and rapport when beginning to work with a client diagnosed with DID. DID was formerly called multiple personality disorder. Trust is the basis of every therapeutic relationship. Each personality views itself as a separate entity and must be treated as such to establish rapport. Cognitive Level: Analysis Integrated Process: Implementation

A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites 2. Axons 3. Neurotransmitters 4. Synapses

ANS: 3 Rationale: The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications.

A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? 1. Acute mania 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

ANS: 3 Rationale: The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.

14. A nursing instructor is teaching about the DSM-5 diagnosis of depersonalization-derealization disorder (D-DD). Which student statement indicates a need for further instruction? 1. "Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time." 2. "Clients with this disorder can experience unreality or detachment with respect to their surroundings." 3. "During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted." 4. "During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning."

ANS: 4 Rationale: D-DD is characterized by a temporary change in the quality of self-awareness, which often takes the form of feelings of unreality, changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body. Depersonalization (a disturbance in the perception of oneself) is differentiated from derealization, which describes an alteration in the perception of the external environment. The DSM-5 states that during the depersonalization and/or derealization experiences, reality testing remains intact. This student statement indicates a need for further instruction. Cognitive Level: Application Integrated Process: Evaluation

8. A client is diagnosed with DID. What is the primary goal of therapy for this client? 1. To recover memories and improve thinking patterns. 2. To prevent social isolation. 3. To decrease anxiety and need for secondary gain. 4. To collaborate among sub-personalities to improve functioning.

ANS: 4 Rationale: The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among sub-personalities to improve functioning. Some clients choose to pursue a lengthy therapeutic regimen to achieve integration, a blending of all the personalities into one. The goal is to optimize the client's functioning and potential. Cognitive Level: Application Integrated Process: Planning

A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

ANS: 4 Rationale: The nurse should assess that the client's daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without significant impairment, the client's distress does not indicate a mental illness.

A nurse concludes that a restless, agitated client is manifesting a fight- or-flight response. The nurse should associate this response with which neurotransmitter? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine

ANS: 4 Rationale: The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of dopamine 3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine

ANS: 4 Rationale: The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major effector chemical of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? 1."The occipital lobe governs perceptions, judging them as positive or negative." 2."The parietal lobe has been linked to depression." 3."The medulla regulates key biological and psychological activities." 4."The limbic system is largely responsible for one's emotional state."

ANS: 4 Rationale: The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system if often called the "emotional brain" and is associated with feelings, sexuality, and social behavior. The occipital lobes are the area of visual reception and interpretation. Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. The medulla contains vital centers that regulate heart rate and reflexes.

4. Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain, may experience? 1. Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications 2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor 3. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion 4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

ANS: 4 Rationale: The nurse should identify that primary gains are those that allow the client to avoid an unpleasant activity (stressful family reunion) and that secondary gains are those in which the client receives emotional support or attention (get-well cards). Cognitive Level: Analysis Integrated Process: Evaluation

5. A nursing instructor is teaching about the etiology of IAD from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred? 1. "They tend to have a familial predisposition to this disorder." 2. "When the sick role relieves them from stressful situations, their physical symptoms are reinforced." 3. "They misinterpret and cognitively distort their physical symptoms." 4. "They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems."

ANS: 4 Rationale: The nurse should understand that from a psychoanalytical perspective, IAD occurs because physical problems are more acceptable than psychological problems. Psychodynamicists view IAD as a defense mechanism. Cognitive Level: Application Integrated Process: Evaluation

Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? 1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy. 2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill. 3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents. 4. Studies in which monozygotic twins were raised together by mentally ill biological parents. 5. All of the above.

ANS: 5 Rationale: The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.

Using a cognitive approach, a nurse would choose which intervention for assisting clients to manage their anger without the use of violence? A. Assist the client to identify thoughts that trigger anger and substitute reality-based thinking. B. Provide consequences, such as removal from group therapy, in response to angry outbursts. C. Administer antipsychotic medications and use limit-setting such as a room restriction. D. Administer anti-anxiety medication and encourage participation in a group on medication actions.

ANS: A By assisting the client to identify thoughts that trigger anger and encourage the substitution of more reality-based thinking, the nurse can help the client to alter dysfunctional beliefs that predispose the client to distort experiences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

28. Which is a nursing intervention to assist a client to achieve Erikson's developmental task of ego integrity? A. Encourage a life review of triumphs and disappointments B. Provide opportunities for success experiences C. Focus on embracing the future D. Foster the development of creativity

ANS: A Erikson believed that between the age of 65 years and death, the goal is to review one's life and derive meaning from both positive and negative events, while achieving a positive sense of self. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Implementation

27. An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals? A. "What do you think needs to change about how you express anger?" B. "How did you feel after attending the anger management session?" C. "On a scale of 1 to 10, please rate your current level of anger." D. "What bothers you about the actions of others when you get angry?"

ANS: A In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client or to the situation. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

10. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

ANS: A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client. PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Evaluation

23. Which statement describes achievement of Erikson's generativity versus stagnation developmental stage? A. "I've been a girl scout leader for troop 259 for 7 years." B. "I feel great that I could pay for my bike with my paper route money." C. "My parents are so pleased that John and I are going to be married." D. "I've had a very full life. I'm not afraid to leave this world."

ANS: A The major task of generativity versus stagnation is to achieve the life goals established for oneself while also considering the welfare of future generations. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Evaluation

9. A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? A. Try to locate a shaman that will agree to come to the ED. B. Explain to the client that "voodoo" medicine will not heal the ulcerated toe. C. Ask the client to explain what the shaman can do that the physician cannot. D. Inform the client that refusing treatment is a client's right.

ANS: A The most appropriate nursing intervention would be to try to locate a shaman who will agree to come to the ED. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients. PTS: 1 REF: 108 KEY: Cognitive Level: Analysis | Integrated Process: Implementation

7. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. "You appear to be talking to someone I do not see." B. "Please describe what you are seeing." C. "Why do you continually look in the corner of this room?" D. "If you hum a tune, the voices may not be so distracting."

ANS: A The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

9. Which underlying concept should a nurse associate with interpersonal theory when assessing clients? A. The effects of social processes on personality development B. The effects of unconscious processes and personality structures C. The effects on thoughts and perceptual processes D. The effects of chemical and genetic influences

ANS: A The nurse should associate interpersonal theory with the underlying concept of effects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Assessment

13. The following outcome was developed for a client: "Client will list five personal strengths by the end of day 1." Which correctly written nursing diagnostic statement most likely generated the development of this outcome? A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements B. Self-care deficit R/T altered thought processes C. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 D. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

ANS: A The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day 1. Self-care deficit, disturbed body image, and risk for disturbed self-concept would generate specific outcomes in accordance with specific needs and goals. The self-care deficit and risk for disturbed self-concept nursing diagnoses are incorrectly written. PTS: 1 REF: 172 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

If clozapine (Clozaril) therapy is being considered, which laboratory test should a nurse review to establish a baseline for comparison to evaluate a potentially life-threatening side effect? A. While blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

ANS: A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine (Clozaril) can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. PTS: 1 REF: Page: 345 KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Assessment

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

ANS: A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in white blood cells can occur.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5?C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? A. Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium). B. Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication. C. Dystonia treated by administering trihexyphenidyl (Artane). D. Dystonia treated by administering bromocriptine (Parlodel).

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risk. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Planning

11. In what probable way should a nurse expect an Asian American client to view mental illness? A. Mental illness relates to uncontrolled behaviors that bring shame to the family. B. Mental illness is a curse from God related to immoral behaviors. C. Mental illness is cured by home remedies based on superstitions. D. Mental illness is cured by "hot and cold" herbal remedies.

ANS: A The nurse should expect that many Asian Americans are most likely to view mental illness as uncontrolled behavior that brings shame to the family. It is often more acceptable for mental distress to be expressed as physical ailments. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Assessment

A 16-year-old-client diagnosed with paranoid schizophrenia experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing response? A. "Your child has a chemical imbalance of the brain, which leads to altered thoughts." B. "Your child's hallucinations are caused by medication interactions." C. "Your child has too little serotonin in the brain, causing delusions and hallucinations." D. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client hearing voices is experiencing an auditory hallucination

A 16-year-old-client diagnosed with paranoid schizophrenia experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing reply? A. "Your child has a chemical imbalance of the brain which leads to altered thoughts." B. "Your child's hallucinations are caused by medication interactions." C. "Your child has too little serotonin in the brain causing delusions and hallucinations." D. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client who hears voices is experiencing an auditory hallucination.

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

ANS: A The nurse should recognize that a client who claims that an alien is inside the body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background. PTS: 1 REF: Page: 318 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis

3. A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing reply? A. "Group therapy provides the opportunity to learn and practice new coping skills." B. "Group therapy is mandatory. All clients must attend." C. "Group therapy is optional. You can go if you find the topic helpful and interesting." D. "Group therapy is an economical way of providing therapy to many clients concurrently."

ANS: A The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention. PTS: 1 REF: 227 KEY: Cognitive Level: Application | Integrated Process: Implementation

5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? A. "Are you currently thinking about harming yourself?" B. "Why do you want to harm yourself?" C. "Have you thought about the consequences of your actions?" D. "Who is your emergency contact person?"

ANS: A The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should prioritize safety by assessing the client for thoughts of self-harm. PTS: 1 REF: 242 KEY: Cognitive Level: Analysis | Integrated Process: Assessment

12. Which cultural considerations should a nurse identify with Western European Americans? A. They are present-time oriented and perceive the future as God's will. B. They value youth, and older adults are commonly placed in nursing homes. C. They are at high risk for alcoholism due to a genetic predisposition. D. They are future oriented and practice preventive health care.

ANS: A The nurse should identify that most Western European Americans are present oriented and perceive the future as God's will. Older adults are held in positions of respect and are often cared for in the home instead of nursing homes. PTS: 1 REF: 111 KEY: Cognitive Level: Application | Integrated Process: Assessment

17. A female complains that her husband only meets his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband's actions? A. The id B. The superid C. The ego D. The superego

ANS: A The nurse should identify that the husband's actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identified as the pleasure principle. The id is the locus of instinctual drives. PTS: 1 REF: 33 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine (Clozaril) can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. PTS: 1 REF: Pages: 345-346 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

14. A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: A The nurse should recognize that a 10-year-old child who is successful in school both academically and socially has successfully accomplished the industry versus inferiority developmental stage of Erikson's psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 to 12 years of age, at which time individuals achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from others. PTS: 1 REF: 39 KEY: Cognitive Level: Application | Integrated Process: Assessment

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

ANS: A The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background.

14. During the first interview with a man from Syria who has just lost his son in a car accident, in sympathy for the man's loss, the female nurse reaches out and hugs him. Which is an accurate evaluation of the nurse's action? A. The nurse's action should be evaluated as unacceptable due to breech of cultural norms. B. The nurse's action should be evaluated as empathetic; encouraging expressions of feelings. C. The nurse's action should be evaluated as the technique of offering self. D. The nurse's action should be evaluated as inappropriate due to poor timing.

ANS: A The nurse's action should be evaluated as unacceptable due to breech of cultural norms. During communication, Arab Americans stand close together, maintain steady eye contact, and may touch the other's hand or shoulder but only between members of the same sex. PTS: 1 REF: 111 KEY: Cognitive Level: Application | Integrated Process: Evaluation

17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

A high school basketball player sustains a serious knee injury and states to the school nurse, "I will never get to college if I don't receive a basketball scholarship." Which nursing reply would assist the student to see a broader range of possibilities? A. "Let's look at the alternatives for funding your college education." B. "I know you are feeling helpless now, but you are looking at this from only one perspective." C. "Can your family afford knee surgery?" D. "You now need to prioritize your academics and not focus on basketball."

ANS: A When the nurse helps the student to see a broader range of possibilities, the nurse is using the cognitive technique of generating alternatives. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

11. Which of the following nursing statements and/or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.) A. "Tell me what happened." B. "What coping methods have you used, and did they work?" C. "Describe to me what your life was like before this happened." D. "Let's focus on the current problem." E. "I'll assist you in selecting functional coping strategies."

ANS: A, B, C In the assessment phase, the nurse should gather information regarding the precipitating stressor and the resulting crisis. Focusing on the current problem and selecting functional coping strategies are nursing interventions rather than assessments. PTS: 1 REF: 243 KEY: Cognitive Level: Application | Integrated Process: Assessment

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, which symptoms should a nurse expect to observe?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia D. Auditory hallucinations E. Delusions

ANS: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression which would result in the above symptoms.

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. Which client symptoms should a nurse expect to observe during assessment?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia. D. Auditory hallucinations E. Delusions

ANS: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression, which would result in the above symptoms. PTS: 1 REF: Page: 343 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Assessment

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.

Which components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part of rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort. PTS: 1 REF: Pages: 338-340 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Planning

Which of the following client statements would indicate that teaching about benzodiazepines has been successful? Select all that apply. A. "I can't drink alcohol when taking lorazepam (Ativan)." B. "If I abruptly stop taking buspirone (BuSpar), I may have a seizure." C. "Valium can make me drowsy, so I shouldn't drive for awhile." D. "My new diet cannot include aged cheese or pickled herring." E. "When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax)."

ANS: A, C When a nurse teaches about medications, he or she is using a cognitive approach. A core concept of cognitive theory relates to the mental process of thinking and reasoning. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

19. A female nurse is caring for an Arab American male client. When planning effective care for this client, the nurse should be aware of which of the following cultural considerations? (Select all that apply.) A. Limited touch is acceptable only between members of the same sex. B. Conversing individuals of this culture stand far apart and do not make eye contact. C. Devout Muslim men may not shake hands with women. D. The man is the head of the household and women take on a subordinate role. E. Men of this culture are responsible for the education of their children.

ANS: A, C, D When planning effective care for this client, the nurse should be aware that limited touch within this culture is acceptable only between members of the same sex, that devout Muslim men may not shake hands with women, and that women are subordinate to the man, who is the head of household. Conversing individuals of this culture stand close together and maintain eye contact. Arab American women are responsible for the education of the children. PTS: 1 REF: 111-112 KEY: Cognitive Level: Application | Integrated Process: Assessment

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. Which symptoms should a nurse expect the therapeutic effect of this medication to address? (Select all that apply.) A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

ANS: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone (Risperdal) is an atypical antipsychotic that has been effective in the treatment of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms. PTS: 1 REF: Page: 337 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? (Select all that apply.) A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

ANS: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." B. "Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not." C. "Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not." D. "Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not."

ANS: A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food followed by purging.

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

ANS: A. The client will identify two alternative methods of dealing with isolation by day 3. The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content? A. "The therapist provides information about the process of cognitive therapy." B. "The therapist uses guided imagery in an effort to elicit automatic thoughts." C. "The therapist provides information about how cognitive therapy works." D. "The therapist uses reading assignments to reinforce learning."

ANS: B Cognitive therapy prepares the client to become his or her own cognitive therapist. The didactic portion of the therapy provides educational material to reinforce learning about the therapy and how it affects psychiatric disorders. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

8. A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing reply is most appropriate? A. "I'm confident you know what's best for you." B. "This may not be the best time for you to make such an important decision." C. "Your children will be terribly disappointed." D. "Tell me why you want to make this change."

ANS: B During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. The nurse should also assist the client in determining whether any changes are realistic and if timing of change is appropriate. PTS: 1 REF: 244 KEY: Cognitive Level: Application | Integrated Process: Implementation

29. A client is assigned the nursing diagnosis of impaired social interaction R/T socio-cultural differences AEB client stating, "Although I'd like to, I don't join in because I don't speak the language so good." Which correctly written outcome addresses this client's problem? A. The client will collaborate with nursing staff to set specific goals by day 3. B. The client will participate in one group activity of choice by day 2. C. The client will express a desire to interact with others. D. The client will become increasingly independent by discharge.

ANS: B In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client need or to the situation. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Planning

24. A psychiatric nurse uses Sullivan's theories in group and individual therapy. According to Sullivan and other theorists like him, how are client symptoms viewed? A. Client symptoms are viewed as learned behaviors that are maintained because they are reinforced. B. Client symptoms are viewed as responses to anxiety arising from interpersonal relationships. C. Client symptoms are viewed as internal conflicts arising from early childhood trauma. D. Client symptoms are viewed as the misinterpretations of experiences.

ANS: B Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the development of serious difficulty in living. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Evaluation

29. From an interpersonal theory perspective, which intervention would a nurse use to assist a client diagnosed with major depressive disorder? A. Encourage discussion of feelings B. Offer family therapy sessions C. Discuss childhood events D. Teach alternate coping skills

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. Family therapy would assist the client to deal with relationships within the family system. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client including biopsychosocial aspects. C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations.

ANS: B The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

15. A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

ANS: B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? A. Peer pressure B. Structured programming C. Visitor restrictions D. Mandated activities

ANS: B The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups. PTS: 1 REF: 229 KEY: Cognitive Level: Application | Integrated Process: Evaluation

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

ANS: B The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior.

9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should alert a nurse to escalating anger and aggression? A. The client requests prn medications. B. The client has a tense facial expression and body language. C. The client refuses to eat lunch. D. The client sits in group therapy with back to peers.

ANS: B The nurse should assess that tense facial expressions and body language may indicate that a client's anger is escalating. The nurse should conduct a thorough assessment of the client's past and current violent behaviors, and develop interventions for deescalation. PTS: 1 REF: 243 KEY: Cognitive Level: Application | Integrated Process: Assessment

19. A nurse is caring for a hospitalized client who is quarrelsome, opinionated, and has little regard for others. According to Sullivan's interpersonal theory, the nurse should associate the client's behaviors with a previous deficit in which stage of development? A. Infancy B. Childhood C. Early adolescence D. Late adolescence

ANS: B The nurse should associate the client's behavior with a deficit in the childhood stage of Sullivan's interpersonal theory. The childhood stage in Sullivan's interpersonal theory typically occurs from the ages of 18 months to 6 years of age, during which the child learns to experience a delay in personal gratification without undue anxiety. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Evaluation

16. According to Freud, which statement should a nurse associate with predominance of the superego? A. "No one is looking, so I will take three cigarettes from Mom's pack." B. "I don't ever cheat on tests. It is wrong." C. "If I skip school I will get in trouble and fail my test." D. "Dad won't miss this little bit of vodka."

ANS: B The nurse should associate the statement "I don't ever cheat on tests. It is wrong." as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the "perfection principle." PTS: 1 REF: 33 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

ANS: B The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly.

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

ANS: B The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly. PTS: 1 REF: Page: 328 KEY: Cognitive Level: Comprehension | Integrated Process: Communication/Documentation

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis

ANS: B The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility. PTS: 1 REF: 242 KEY: Cognitive Level: Application | Integrated Process: Assessment

3. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: B The nurse should determine that this client has completed the "Learning to delay satisfaction" stage of development according to Peplau's interpersonal theory. This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others. PTS: 1 REF: 47 KEY: Cognitive Level: Application | Integrated Process: Assessment

11. A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's history, in which phase of development according to Mahler's theory, should a nurse expect to see a potential deficit? A. The symbiotic phase B. The autistic phase C. The consolidation phase D. The rapprochement phase

ANS: B The nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation, and is malnourished would not meet the autistic phase of development. The autistic phase of development usually occurs from birth to 1 month, at which time the infant's focus is on basic needs and comfort. PTS: 1 REF: 41 KEY: Cognitive Level: Application | Integrated Process: Assessment

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

ANS: B The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

1. An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth's choices? A. Most African American homes are headed by strong, dominant father figures. B. Most African Americans choose to remain within their own social organization. C. Most African Americans are uncomfortable expressing emotions and need group affiliations. D. Most African Americans have limited religious beliefs which contribute to criminal activity.

ANS: B The nurse should identify that a tendency to remain within one's own social organization may have played a role in this youth's choice to join a black gang. African Americans who have assimilated into the dominant culture are likely to be well educated and future focused. Those who have not assimilated may be unemployed or have low-paying jobs, and view the future as hopeless given their previous encounters with racism and discrimination. PTS: 1 REF: 106 KEY: Cognitive Level: Application | Integrated Process: Assessment

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

ANS: B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R). PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Evaluation

7. What is the best rationale for including the client's family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors

ANS: B The nurse should include the client's family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment. PTS: 1 REF: 229 KEY: Cognitive Level: Application | Integrated Process: Implementation

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance. B. Note escalating behaviors and intervene immediately. C. Interpret attempts at communication. D. Assess triggers for bizarre, inappropriate behaviors.

ANS: B The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe. PTS: 1 REF: Page: 324 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Implementation

14. How should a nurse prioritize nursing diagnoses? A. By the established goal of care B. By the life-threatening potential C. By the physician's priority of care D. By the client's preference

ANS: B The nurse should prioritize nursing diagnoses related to life-threatening potential. Safety is always the nurse's first priority. PTS: 1 REF: 178 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? A. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a decrease or loss of normal functions.

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? A. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a diminution or loss of normal functions. PTS: 1 REF: Page: 319 | Page: 324 | Pages: 328-330 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

8. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? A. A possible genetic basis for the client problems B. The structure and dynamics of the personality C. Behavioral responses to stressors D. Maladaptive cognitions

ANS: B The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, ego, and superego. PTS: 1 REF: 33 KEY: Cognitive Level: Application | Integrated Process: Assessment

6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"

ANS: B The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

18. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this client's problem? A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion

ANS: B The nursing diagnosis altered sensory perception accurately reflects the client's symptoms of hearing things that others do not. A nursing diagnosis describes a client's condition and facilitates the prescription of interventions. Delusional thinking, confusion, and disorientation are problems associated with the nursing diagnosis of altered thought processes. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

A college student has quit attending classes, isolates self due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

ANS: B The nursing diagnosis that must be prioritized in this situation should be risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized.

32. Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self. PTS: 1 REF: 153 KEY: Cognitive Level: Application | Integrated Process: Implementation

31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

33. A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

33. After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? (Select all that apply.) A. Medical judgments related to the psychiatric disorder B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis D. Outcomes that will be targets for nursing interventions E. Statements of client problems of a functional nature

ANS: B, C, E A nursing diagnosis is a statement of a client's functional problem. An actual nursing diagnosis must include related to (R/T) and as evidenced by (AEB) statements. A risk for diagnosis does not contain AEB because there is only a potential for the problem, it does not as yet exist. PTS: 1 REF: 172 KEY: Cognitive Level: Application | Integrated Process: Diagnosis

A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? Select all that apply. A. To modify automatic thoughts to promote minimization of negative cognitions B. To apply a variety of methods to create change in an individual's thinking C. To apply cognitive principles in order to change an individual's basic schema D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change

ANS: B, D, E In cognitive therapy, the therapist's objective is to use a variety of methods to create change in a client's thinking and belief system, in an effort to bring about lasting emotional and behavioral change. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

12. Which of the following are accurate descriptors of a therapeutic community? (Select all that apply.) A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists.

ANS: B, E In a therapeutic community, the unit responsibilities are assigned according to client capability and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills. PTS: 1 REF: 228-229 KEY: Cognitive Level: Application | Integrated Process: Implementation

20. Because of cultural characteristics, in which of the following cultural groups would a nurse's assessment of mood and affect be most challenging? (Select all that apply.) A. Arab Americans B. Native Americans C. Latino Americans D. Western European Americans E. Asian Americans

ANS: B, E The nurse should expect that both Native Americans and Asian Americans might be difficult to assess for mood and affect. In both cultures, expressing emotions is difficult. Native Americans are encouraged to not communicate private thoughts. Asian Americans may have a reserved public demeanor and may be perceived as shy or uninterested. PTS: 1 REF: 108-109 KEY: Cognitive Level: Application | Integrated Process: Assessment

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply? A. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." C. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." D. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

ANS: B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder.

A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity

ANS: B. Altered nutrition: less than body requirements R/T inadequate food intake Based on Maslow's hierarchy, the priority nursing diagnosis for this client must address physical needs prior to emotional considerations. This client must be immediately physically stabilized due to the life-threatening nature of his or her nutritional status.

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa? A. Provide privacy during meals. B. Remain with the client for at least 1 hour after the meal. C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

ANS: B. Remain with the client for at least 1 hour after the meal. A nurse should remain with clients diagnosed with either anorexia nervosa or bulimia nervosa for at least 1 hour after meals. This allows the nurse to monitor for food discarding (anorexia nervosa) and/or self-induced vomiting (bulimia nervosa).

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan

ANS: B. To emphasize that the client is capable of consuming food without purging By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future.

30. The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. The triage nurse should expect which client to be admitted? A. The client who is experiencing tremors and has a need for medication adjustment B. The client who is experiencing anxiety and a sad mood after separation from spouse C. The client who is a single parent and hears voices stating, "Kill your infant son" D. The client who argued with her boyfriend and inflicted a superficial cut on her arm

ANS: C In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. These data are prioritized to meet client needs with an emphasis on safety. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

16. An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure? A. "Your son should be consistently disciplined by only one parent." B. "You should not have any more children because your son will need your full attention." C. "You need to keep the lines of communication open between all of you." D. "Allow your son to make his own choices because this new situation will be stressful."

ANS: C Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure. PTS: 1 REF: 204 KEY: Cognitive Level: Application | Integrated Process: Implementation

12. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? A. Health teacher B. Case manager C. Milieu manager D. Psychotherapist

ANS: C The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. Health teaching involves promoting health and a safe environment. Case management is utilized to organize client care so that outcomes are achieved. Psychotherapy involves conducting individual, couples, group, and family counseling. PTS: 1 REF: 173 KEY: Cognitive Level: Comprehension | Integrated Process: Implementation

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of his or her illness is a way to help the client accept that the hallucinations are not real.

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? A. "Tell him to stop discussing the voices." B. "Ignore what he is saying, while attempting to discover the underlying cause." C. "Focus on the feelings generated by the hallucinations and present reality." D. "Present objective evidence that the voices are not real."

ANS: C The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing response? A. "Tell him to stop discussing the voices." B. "Ignore what he is saying, while attempting to discover the underlying cause." C. "Focus on the feelings generated by the hallucinations and present reality." D. "Present objective evidence that the voices are not real."

ANS: C The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce them by encouraging the client to accept that they are not real. PTS: 1 REF: Page: 331 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary, but the devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate response by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of the illness is a way to help the client accept that the hallucinations are not real. PTS: 1 REF: Page: 331 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Implementation

13. A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order to increase independence." B. "Why would you want to leave a secure home?" C. "Let's discuss and explore all of your options." D. "I'm afraid you would feel very guilty leaving your parents."

ANS: C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

3. Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

ANS: C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

ANS: C The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

1. Which data gathering technique is employed during the assessment phase of the nursing process? A. Asking the client to rate mood after administering an antidepressant B. Asking the client to verbalize understanding of previously explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful

ANS: C The nurse should ask the client to describe any thoughts of self-harm during the assessment phase of the nursing process. Assessment involves collecting and analyzing data about the client that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities. The other three options are employed during the evaluation phase of the nursing process. PTS: 1 REF: 165 KEY: Cognitive Level: Application | Integrated Process: Assessment

1. A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? A. Abnormal; the grandmother should be concerned with issues other than childrearing. B. Abnormal; a two-parent household is the most advantageous arrangement for parenting. C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures.

ANS: C The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal. PTS: 1 REF: 204 KEY: Cognitive Level: Application | Integrated Process: Assessment

9. A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results? A. The psychiatrist B. The psychiatric social worker C. The clinical psychologist D. The clinical nurse specialist

ANS: C The nurse should consult with the clinical psychologist to review psychological testing results for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process. PTS: 1 REF: 230 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology? A. Dissociative disorders B. Alzheimer's dementia C. Stress-related disorders D. Schizophrenia-spectrum disorders

ANS: C The nurse should correlate Northern European American values, such as punctuality, hard work, and acquisition of material possessions, with stress-related disorders. Psychopathology may occur when individuals fail to meet the expectations of the culture. PTS: 1 REF: 106 KEY: Cognitive Level: Application | Integrated Process: Assessment

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication. B. Persecutory delusions; orient the client to reality. C. Command hallucinations; warn the psychiatrist. D. Altered thought processes; call an emergency treatment team meeting.

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. Clients demonstrating a risk for violence could potentially be physically, emotionally, and/or sexually harmful to others or to self. PTS: 1 REF: Page: 328 | Page: 331 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis

15. A client has flashbacks of sexual abuse by her uncle. She had not been aware of these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan's concept of the self-system? A. The "good me" B. The "bad me" C. The "not me" D. The "bad you"

ANS: C The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the "not me" part of the personality. According to Sullivan, the "not me" part of the personality develops in response to situations that produced intense anxiety in childhood. PTS: 1 REF: 37 KEY: Cognitive Level: Application | Integrated Process: Assessment

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

ANS: C The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness. PTS: 1 REF: Page: 324 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

9. A client diagnosed with psychosis NOS tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is a risk of other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions. PTS: 1 REF: Page: 330 KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Diagnosis

A client diagnosed with psychosis NOS (not otherwise specified) tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

13. A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to come from which cultural group? A. African Americans B. Asian Americans C. Native Americans D. Jewish Americans

ANS: C The nurse should recognize that Native American clients might have a history of missed or late medical appointments. Many Native Americans are not ruled by the clock. The concept of time is casual and focused on the present. PTS: 1 REF: 108 KEY: Cognitive Level: Application | Integrated Process: Assessment

13. A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: C The nurse should recognize that a 26-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Erikson's developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this tasks results in the capacity for mutual love and respect. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

2. A jilted college student is admitted to a hospital following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize a deficit in which developmental stage? A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair

ANS: C The nurse should recognize that the client who states, "No one will ever love a loser like me." has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Assessment

5. Which statement regarding nursing interventions should a nurse identify as accurate? A. Nursing interventions are independent from the treatment team's goals. B. Nursing interventions are solely directed by written physician orders. C. Nursing interventions occur independently but in concert with overall treatment team goals. D. Nursing interventions are standardized by policies and procedures.

ANS: C The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the client's care. PTS: 1 REF: 173 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should determine that according to Mahler's developmental theory, this child's development is at which phase? A. The autistic phase B. The symbiotic phase C. The differentiation subphase of the separation-individuation phase D. The rapprochement subphase of the separation-individuation phase

ANS: C The nurse should understand that this client is in the differentiation subphase of the separation-individuation phase. This subphase begins with the child's initial physical movements away from the mothering figure. A primary recognition of separateness commences. PTS: 1 REF: 42 KEY: Cognitive Level: Application | Integrated Process: Assessment

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the correctly written priority nursing diagnosis for this client? A. Ineffective coping R/T situational crisis AEB powerlessness B. Anxiety R/T fear of failure C. Risk for self-directed violence R/T hopelessness D. Risk for low self-esteem R/T loss events AEB suicidal ideations

ANS: C The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes based on potential safety risk to the client and/or others. Nursing diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is determined to be potential. PTS: 1 REF: 244 KEY: Cognitive Level: Analysis | Integrated Process: Diagnosis

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity. PTS: 1 REF: Page: 346 KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation

19. A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

22. The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

20. Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. "You did not attend group today. Can we talk about that?" B. "I'll sit with you until it is time for your family session." C. "I notice you are wearing a new dress and you have washed your hair." D. "I'm happy that you are now taking your medications. They will really help."

ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment. PTS: 1 REF: 153 KEY: Cognitive Level: Application | Integrated Process: Implementation

28. A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

A client diagnosed with borderline personality disorder states, "Get out of here. No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention? A. "You have an anti-anxiety medication ordered. It may make you feel better." B. "It sounds like you are feeling really frustrated." C. "Can you explain further your thinking about your situation?" D. "No one cares about you?"

ANS: C When a nurse asks for an explanation about a client's thinking, the nurse is using a cognitive approach to assessment. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

When using a cognitive approach, a nurse would include which point in teaching a client about panic disorder? A. "You might want to stay in the house when you notice the symptoms beginning." B. "Medications such as lorazepam (Ativan) should be taken when symptoms start." C. "Remind yourself that symptoms of a panic attack are time limited and will end." D. "Keep a journal in order to note feelings surrounding the panic attacks."

ANS: C When a nurse reminds a client that symptoms of a panic attack are time limited and will end, the nurse is using the cognitive approach of presenting rational thinking. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

ANS: C When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

18. A client is angry because her husband has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her husband because she is afraid she will lose control. How should the nurse interpret this client's means of coping with anger? A. Coping by attacking B. Coping by surrendering C. Coping by avoiding D. Coping by belittling

ANS: C When coping by avoidance, differences are never acknowledged openly. The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement. Avoidance also occurs when an individual fears loss of control of his or her temper. PTS: 1 REF: 208 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100 mL bottle. The label reads 20 mg/5 mL. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense? A. 25 mL B. 20 mL C. 15 mL D. 10 mL

ANS: C. 15 mL Twenty mg of Prozac multiplied by three results in the calculated 60 mg daily dose ordered by the physician. Each 5 mL contains 20 mg. Five mL multiplied by three equals the liquid dosage of 15 mL.

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

ANS: C. Metabolic acidosis Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this client's fainting to the loss of alkaline stool due to laxative abuse which would lead to a relative metabolic acidotic condition.

A morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication? A. Diazepam (Valium) B. Dexfenfluramine (Redux) C. Sibutramine (Meridia) D. Pemoline (Cylert)

ANS: C. Sibutramine (Meridia) The nurse should teach the client that sibutramine (Meridia) is an anorexiant medication prescribed for morbidly obese clients. The mechanism of action in the control of appetite appears to occur by inhibiting the neutotransmitters serotonin and norepinephrine. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.

ANS: C. The client demonstrates healthy coping mechanisms that decrease anxiety. The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing which is followed by inappropriate compensatory behaviors.

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.

ANS: C. The client will gain 2 pounds prior to the next weekly appointment. The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

ANS: C. The client will perceive an ideal body weight and shape as normal. The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

ANS: C. The home environment is overprotective and demands perfection. The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

ANS: C. The nurse who refuses to engage in power struggles related to food consumption The nurse who refuses to engage in power struggles related to food consumption will probably be most effective when dealing with clients diagnosed with eating disorders. Because of this attitude the nurse recognizes that the real issues have little to do with food or eating patterns. The nurse will be able to focus on the control issues that precipitated these behaviors.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

ANS: C. To promote the processing of anxiety associated with eating. When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client? A. "Thought patterns are triggered by specific stressful stimuli." B. "Thought patterns contain the client's fundamental beliefs and assumptions." C. "Thought patterns are flexible and based on personal experience." D. "Thought patterns include a predominance of automatic thoughts."

ANS: D According to Beck, automatic thoughts consist of rapid responses to a situation without rational analysis. These thoughts are often negative and based on erroneous logic. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, "What's cognitive therapy and how can it help me?" Which is the nurse's most appropriate reply? A. "It is a system of techniques in which you use positive thinking to improve your mood." B. "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences." C. "It is an interpersonal treatment approach that specifically targets magical thinking." D. "It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors."

ANS: D Cognitive therapy is meant to be a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

27. The nurse practitioner plans to use a psychoanalytical framework when treating a client diagnosed with an anxiety disorder. Which would be the focus of this nursing intervention? A. Correcting inappropriate learning patterns B. Changing a dysfunctional social environment C. Exploring the "here-and-now" with the client and family D. Dealing with issues of physical abuse at an early age

ANS: D Freud, a psychoanalytic theorist, considered the first 5 years of a child's life to be the most important, because he believed that an individual's basic character had been formed by the age of five. PTS: 1 REF: 35 KEY: Cognitive Level: Application | Integrated Process: Implementation

20. According to psychoanalytic theory, treatment of symptoms should involve which nursing action? A. Modifying client behaviors by manipulating the environment B. Expressing empathy and presenting reality C. Encouraging the client to note cause and effects of actions D. Recognizing and discussing the client's use of ego defense mechanisms

ANS: D From a psychoanalytic perspective, understanding the use of ego defense mechanisms is important in making determinations about maladaptive behaviors, in planning care for clients to assist in creating change, or in helping clients accept themselves as unique individuals. PTS: 1 REF: 36 KEY: Cognitive Level: Application | Integrated Process: Intervention

8. A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts? A. All family members should use past incidents to make their point. B. One family member should act as a gatekeeper in order to avoid family confrontation. C. One family member should act as a compromiser to preserve harmony in the family system. D. All family members should respect differing opinions and use compromise and negotiation.

ANS: D Functional families allow and respect differences among members. They learn to handle differences and conflict through negotiation and compromise. PTS: 1 REF: 208 KEY: Cognitive Level: Application | Integrated Process: Implementation

22. A client who has slept 6 hours the previous night reports this to the assigned psychiatric nurse. What should be the initial nursing action to address this situation? A. Provide warm milk and a backrub. B. Give a sleep medication. C. Hold a relaxation group before bedtime. D. Review the client's normal sleep pattern.

ANS: D In the assessment phase of the nursing process, the nurse collects comprehensive health data that are pertinent to the client's health or situation. In this situation, the nurse must initially determine the client's normal sleep patterns in order to evaluate if a true problem exists. PTS: 1 REF: 165 KEY: Cognitive Level: Analysis | Integrated Process: Assessment

24. Which nursing response would be appropriately used in the evaluation phase of the nursing process? A. "If I were in your situation, I would not repeat a behavior that has caused problems." B. "What do you think needs changing, and what do you want to do differently?" C. "What exactly will it take to carry out your plan, and what else do you need to do?" D. "This new approach seems to work for you."

ANS: D In the evaluation phase of the nursing process, the nurse evaluates progress toward attainment of the expected outcomes. PTS: 1 REF: 174 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of these? A. "Try singing Happy Birthday until the voices are gone." B. "Document what the voices are saying, to note cause and effect." C. "Try listening to music using headphones for distraction." D. "Remind yourself that the voices are symptoms of your disease."

ANS: D The focus of cognitive therapy is on the modification of distorted cognitions and maladaptive behaviors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence. PTS: 1 REF: Page: 331 KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation

6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior.

ANS: D The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client and does not reinforce appropriate behavior. PTS: 1 REF: 244 KEY: Cognitive Level: Analysis | Integrated Process: Planning

2. A client on an inpatient unit angrily states to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? A. "I'll talk to Peter and present your concerns." B. "Why are you overreacting to this issue?" C. "You should bring this to the attention of your treatment team." D. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

ANS: D The most appropriate nursing response involves restating the client's feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills. PTS: 1 REF: 227 KEY: Cognitive Level: Application | Integrated Process: Implementation

16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

ANS: D The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

12. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. "Why do you continue to alienate your peers by your angry outbursts?" B. "You accomplish nothing when you lose your temper like that." C. "Showing your anger in that manner is very childish and insensitive." D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."

ANS: D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice. PTS: 1 REF: 160 KEY: Cognitive Level: Application | Integrated Process: Implementation

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

3. A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term outcome is realistic in addressing this client's crisis? A. The client will change his or her type A personality traits to more adaptive ones by week 1. B. The client will list five positive self-attributes. C. The client will examine how childhood events led to an overachieving orientation. D. The client will return to previous adaptive levels of functioning by week 6.

ANS: D The nurse should identify that a realistic long-term outcome for this client would be to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific, measurable, realistic, and contain a time frame. PTS: 1 REF: 242 KEY: Cognitive Level: Application | Integrated Process: Planning

1. According to Erikson's developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client? A. To develop a basic trust in others B. To achieve a sense of self-confidence and recognition from others C. To reflect back on life events to derive pleasure and meaning D. To achieve established life goals and consider the welfare of future generations

ANS: D The nurse should identify that an appropriate developmental task for a 47-year-old client would be to achieve established life goals and consider the welfare of future generations. According to Erikson, the client would be in the generativity versus stagnation stage of development. PTS: 1 REF: 40 KEY: Cognitive Level: Application | Integrated Process: Planning

6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic? A. Dream analysis B. Creative cooking C. Paint by number D. Stress management

ANS: D The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a client's learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance. PTS: 1 REF: 232 KEY: Cognitive Level: Application | Integrated Process: Planning

5. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau's interpersonal theory, in which stage of development should the nurse identify a need for improvement? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: D The nurse should identify that this client needs to improve in the "Developing skills in participation" stage of Peplau's interpersonal theory. Older children in this phase learn the skills of compromise, competition, and cooperation with others. PTS: 1 REF: 48 KEY: Cognitive Level: Application | Integrated Process: Assessment

During an admission assessment, a nurse assesses that a client, diagnosed with schizophrenia, has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in older patients. B. Clozapine (Clozaril), because it is incompatible with desipramine. C. Risperidone (Risperdal), because it exacerbates symptoms of depression. D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines.

ANS: D The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine (Mellaril) are both classified as phenothiazines. PTS: 1 REF: Page: 343 KEY: Cognitive Level: Knowledge | Integrated Process: Nursing Process: Assessment

During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

ANS: D The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.

10. When planning client care for a Latino American, the nurse should be aware of which cultural influence that may impact access to health care? A. The root doctor may be the first contact made when illness is encountered. B. The "yin" and "yang" practitioner may be the first contact made when illness is encountered. C. The shaman may be the first contact made when illness is encountered. D. The curandero may be the first contact made when illness is encountered.

ANS: D The nurse should understand that some Latin Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs. PTS: 1 REF: 110 KEY: Cognitive Level: Application | Integrated Process: Assessment

1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis? A. This type of crisis is precipitated by unexpected external stressors. B. This type of crisis is precipitated by preexisting psychopathology. C. This type of crisis is precipitated by an acute response to an external situational stressor. D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

ANS: D The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance. PTS: 1 REF: 240 KEY: Cognitive Level: Application | Integrated Process: Planning

5. A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"

ANS: D The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings. PTS: 1 REF: 156 KEY: Cognitive Level: Application | Integrated Process: Implementation

4. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture? A. Extremes of emotional expression prevent accurate assessment of this culture. B. Suspicion of Western civilization has resulted in minimal cultural research. C. The small size of this subpopulation makes research virtually impossible. D. The Asian American culture includes individuals from many different countries.

ANS: D The nursing instructor's best explanation is that the Asian American culture is difficult to classify globally due to the number of countries that identify with this culture. The Asian American culture includes peoples and descendents from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes. PTS: 1 REF: 109 KEY: Cognitive Level: Application | Integrated Process: Evaluation

30. A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

25. Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

18. A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"

ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

B

A decrease in which of the following neurotransmitters has been implicated in depression? a. GABA, acetylcholine, and aspartate b. Norepinephrine, serotonin, and dopamine c. Somatostatin, substance P, and glycine d. Glutamate, histamine, and opioid peptides

B

Anna, age 72, has been grieving the death of her dog, Lucky, for 3 years. She is not able to take care of her activities of daily living and wants only to make daily visits to Lucky's grave. Her daughter has likely put off seeking help for Anna because a. Women are less likely than men to seek help for emotional problems. b. Relatives often try to "normalize" the behavior rather than label it mental illness. c. She knows that all older people are expected to be a little depressed. d. She is afraid that the neighbors "will think her mother is crazy."

B

Anne, age 24, and her husband are seeking treatment at the sex therapy clinic. They have been married for 3 weeks and have never had sexual intercourse together. Pain and vaginal tightness prevent penile entry. Sexual history reveals Anne was raped when she was 15 years old. The physician would most likely assign which of the following diagnoses to Anne? a. Female orgasmic disorder b. Genito-pelvic pain/penetration disorder c. Female sexual interest/arousal disorder d. Sexual aversion disorder

B

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is: a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work, Dan." c. "Get real, Dan! You're a boozer and you know it!" d. "Why do you think your boss sent you here, Dan?"

B

From a physiological point of view, the most common cause of obesity is probably a. lack of nutritional education. b. more calories consumed than expended. c. impaired endocrine functioning. d. low basal metabolic rate.

B

Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. She is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. The priority nursing diagnosis for Margaret is a. imbalanced nutrition: less than body requirements related to not eating. b. risk for injury related to hyperactivity. c. disturbed sleep pattern related to agitation. d. ineffective coping related to denial of depression.

B

Mr. J. is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J.? a. Intimacy vs. isolation b. Generativity vs. self-absorption c. Trust vs. mistrust d. Autonomy vs. shame and doubt

B

Nancy, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Nancy? a. Complicated grieving b. Imbalanced nutrition: Less than body requirements c. Interrupted family processes d. Anxiety (severe)

B

Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of Adjustment Disorder with Depressed Mood. The priority nursing diagnosis for Nina would be a. risk-prone health behavior related to loss of dependency. b. complicated grieving related to breakup of marriage. c. ineffective coping related to problems with dependency. d. social isolation related to depressed mood.

B

Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? a. "Cheer up, Nina. You have a lot to be happy about." b. "You are grieving for the marriage you did not have. It's natural for you to feel badly." c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better." d. "You did the right thing, Nina. Knowing that should make you feel better."

B

Tony, age 21, has been diagnosed with Schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Tony is to a. give him an injection of Thorazine. b. ensure a safe environment for him and others. c. place him in restraints. d. order him a nutritious diet.

B

Which of the following activities would be most appropriate for the child with ADHD? a. Monopoly b. Volleyball c. Pool d. Checkers

B

Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? a. Belittling themselves and their abilities b. A lifelong pattern of social withdrawal c. Suspicious and mistrustful of others d. Overreacting inappropriately to minor stimuli

B

Which of the following groups is most commonly used for drug management of the child with ADHD? a. CNS depressants (e.g., diazepam [Valium]) b. CNS stimulants (e.g., methylphenidate [Ritalin]) c. Anticonvulsants (e.g., phenytoin [Dilantin]) d. Major tranquilizers (e.g., haloperidol [Haldol])

B

Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Phenytoin (Dilantin)

B

Which of the following medications is used to treat Tourette's disorder? a. Methylphenidate (Ritalin) b. Haloperidol (Haldol) c. Imipramine (Tofranil) d. Phenytoin (Dilantin)

B

Which of the following statements by Anna might suggest that she is achieving resolution of her grief over Lucky's death? a. "I don't cry anymore when I think about Lucky." b. "It's true. Lucky didn't always mind me. Sometimes he ignored my commands." c. "I remember how it happened now. I should have held tighter to his leash!" d. "I won't ever have another dog. It's just too painful to lose them."

B

The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following nursing interventions are appropriate for this child? Select all that apply. a. Socially isolate the child when interactions with others are inappropriate. b. Set limits with consequences on inappropriate behaviors. c. Provide rewards for appropriate behaviors. d. Provide group situations for the child.

B, C, D

Which of the following statements is (are) correct regarding the use of restraints? Select all that apply. a. Restraints may never be initiated without a physician's order. b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents. c. Clients in restraints must be observed and assessed every hour for issues regarding circulation, nutrition, respiration, hydration, and elimination. d. An in-person evaluation must be conducted within one hour of initiating restraints.

B, D

Which of the following is a true statement about mental health recovery? (Select all that apply.) a. Mental health recovery applies only to severe and persistent mental illnesses. b. Mental health recovery serves to provide empowerment to the client. c. Mental health recovery is based on the medical model. d. Mental health recovery is a collaborative process.

B,C

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not effective for generalized anxiety disorder." B. "Buspirone must be taken daily to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."

B. "Buspirone must be taken daily to be effective."

The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder: A. " The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort." B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." C. "Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath." D. "The average onset of panic disorder is in the late 20s."

B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." Panic disorder is characterized by recurrent panic attacks, the onset of which is UNPREDICTABLE. The symptoms come on unexpectedly, not before or on exposure to a situation that usually causes anxiety. pg. 532

Suicide is the 3rd leading cause of death for which age group? A. Youth under the age of 18 B. 15-24 years C. 25-44 years D. 45-64 years

B. 15-24 years(pg 275). For 25-44 years, suicide is the 4th leading cause of death; for 45-64 years it is the 8th leading cause of death. Suicide is the 10th leading cause of death overall.

Velma told Betty a secret that Mary told her. This is an example of which of the following? A. Too flexible boundary. B. A boundary violation. C. Rigid boundary. D. Enmeshed boundary

B. A boundary violation is the correct answer because Velma told Betty something that Mary shared with her in confidence. Other examples of boundary violations are invading someone's personal space, opening their mail, reading their diary, unwanted touching, even smoking in non-smoking public areas. Telling someone they "should" believe, feel, decide, choose or think in a certain way is another example of a boundary violation.

Which is the greatest protective factor against the risk of suicide? A. One or more previous suicide attempts B. A sense of responsibility to family, including spouse and children C. Fear of dying D. A cultural belief that suicide is a shameful resolution for a dilemma

B. A sense of responsibility to family, including spouse and children Correct Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor.

Which of the following individuals is at highest risk for suicide? A. Nancy, age 33, Asian American, Catholic, middle socioeconomic group, alcoholic B. Josh, age 72, white, Methodist, low socioeconomic group, dx of metastatic cancer of the pancreas. C. Carole, age 15, African american, Baptist, high socioeconomic group, no health problems D. Mike, age 55, Jewish, middle socioeconomic group, suffered MI A year ago.

B. Josh, age 72, white, Methodist, low socioeconomic group, dx of metastatic cancer of the pancreas. This answer has the most risk factors: advanced age, white, male, low socioeconomic status and serious health dx.

An assessment tool that is useful to nurses in rating suicide risk is the A. AIMS scale. B. Sad Persons scale. C. CAGE questionnaire. D. Mini-Mental Status Examination.

B. Sad Persons scale. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The Sad Persons scale is short and easy to use. It thoroughly covers major risk factors and gives guidelines for action to meet the client's needs.

Karen, age 23 graduated from nursing school with a 3.2/4.0 gpa. She recently took the NCLEX exam and did not pass. Because of this, she had to give up her graduate nursing job until she can pass the exam. She has become very depressed and has sought counseling at the mental health clinic. Karen says to the psychiatric nurse, "I am a complete failure. I'm so dumb, I can't do anything right." What is the most appropriate nursing dx. for Karen? A. Chronic low self-esteem. B. Situational low self-esteem C. Defensive coping D. Risk for situational low self esteem.

B. Situational low self-esteem is correct because it relates to Karen's feeling of failure in a situation of importance. The dx is evidenced by Karen's statement that she is a complete failure, she is dumb and can't do anything right based on this one experience. Karen is not a risk because she has had the failure and her dx is not chronic because it is not the result of repeated failures. Defensive coping is not applicable because Karen is asking for help.

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the ct's bathroom locked so she can't wash her hands all the time. B. Structure the ct's schedule so that she has plenty of time for washing her hands. C. Place the ct in isolation until she promises to stop washing her hands so much. D. Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.

B. Structure the ct's schedule so that she has plenty of time for washing her hands.

Success of long-term psychotherapy with Theresa (Who attempted suicide following a break up with her boyfriend) could be measured by which of the following behaviors? A. Theresa has a new boyfriend B. Theresa has an increased sense of self-worth C. Theresa does not take antidepressants anymore D. Theresa told her old boyfriend how angry she was with him for breaking up with her

B. Theresa has an increased sense of self-worth

A mother berates her child for breaking a cup and says, "Your are BAD and SO DESTRUCTIVE." This statement discourages the development of positive self-esteem by not meeting which parenting focus as described by Warren? A. A sense of competence B. Unconditional love C. A sense of survival D. Realistic goals

B. Unconditional love. According to warren, Parents promote self-esteem when they provide unconditional love for their children. CHILDREN NEED TO KNOW THAT THEY ARE LOVED AND ACCEPTED REGARDLESS OF SUCCESSES OR FAILURES. Criticism of behavior should not be linked with criticism of the child. In the situation presented the mother discourages the development of positive self-esteem by not meeting the child's need for unconditional love.

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of A. anger. B. denial. C. confusion. D. sympathy.

B. denial. Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life."

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit she must remain in her room.

C

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? *A.* Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. *B.* Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. *C.* Set limits on the amount of time Sandy may engage in the ritualistic behavior. *D.* Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? a. Give attention to the ritualistic behaviors each time they occur and point out their inappropriateness. b. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. c. Set limits on the amount of time Sandy may engage in the ritualistic behavior. d. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C

A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality

C

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietitian will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. "You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital, because we know that is important to you."

C

A nurse is assisting an individual with mental illness recovery using the Tidal Model. Which of the following is a component of this model? a. The wellness toolbox b. The daily maintenance list c. The individual's personal story d. Triggers

C

A nurse who is helping a client with mental illness recovery using the WRAP Model says to the client, "First you must create a wellness toolbox." She explains to the client that a wellness toolbox is which of the following? a. A list of words that describe how the individual feels when he or she is feeling well b. A list of things the client needs to do every day to maintain wellness c. A list of strategies the client has used in the past that help relieve disturbing symptoms d. A list of the client's favorite health-care providers and phone numbers

C

Anne, age 24, and her husband are seeking treatment at the sex therapy clinic. They have been married for 3 weeks and have never had sexual intercourse together. Pain and vaginal tightness prevent penile entry. Sexual history reveals Anne was raped when she was 15 years old. The most appropriate nursing diagnosis for Anne would be a. pain related to vaginal constriction. b. ineffective sexuality patterns related to inability to have vaginal intercourse. c. sexual dysfunction related to history of sexual trauma. d. complicated grieving related to loss of self-esteem because of rape.

C

Attempting to calm an angry client by using "talk therapy" is an example of which of the following clients' rights? a. The right to privacy b. The right to refuse medication c. The right to the least-restrictive treatment alternative d. The right to confidentiality

C

Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? a. Search his room for evidence. b. Ask, "Have you been drinking alcohol, Dan?" c. Send a urine specimen from Dan to the lab for drug screening. d. Tell Dan, "These guys cannot come to the unit to visit you again."

C

ECT is thought to effect a therapeutic response by a. stimulation of the CNS. b. decreasing the levels of acetylcholine and monoamine oxidase. c. increasing the levels of serotonin, norepinephrine, and dopamine. d. altering sodium metabolism within nerve and muscle cells.

C

For what reason would Anna's illness be considered a neurosis rather than a psychosis? a. She is unaware that her behavior is maladaptive. b. She exhibits inappropriate affect (emotional tone). c. She experiences no loss of contact with reality. d. She tells the nurse, "There is nothing wrong with me!"

C

Fred rides a crowded subway every day. He stands beside a woman he views as very attractive. Just as the subway is about to stop, he places his hand on her breast and rubs his genitals against her buttock. As the door opens, he dashes out and away. Later he fantasizes she is in love with him. This is an example of which paraphilia? a. Voyeuristic disorder b. Sexual sadism disorder c. Frotteuristic disorder d. Exhibitionistic disorder

C

In evaluating the progress of Jack, a client diagnosed with Antisocial Personality Disorder, which of the following behaviors would be considered the most significant indication of positive change? a. Jack got angry only once in group this week. b. Jack was able to wait a whole hour for a cigarette without verbally abusing the staff. c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight. d. Jack stated that he would no longer start any more fights.

C

Joanie is a new patient at the mental health clinic. She has been diagnosed with Body Dysmorphic Disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie? a. Alprazolam (Xanax) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Olanzapine (Zyprexa)

C

Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? *A.* Alprazolam (Xanax) *B.* Diazepam (Valium) *C.* Fluoxetine (Prozac) *D.* Olanzapine (Zyprexa)

C

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be a. imbalanced nutrition: less than body requirements. b. complicated grieving. c. risk for suicide. d. social isolation.

C

Margaret, age 68, is diagnosed with Bipolar I Disorder, Current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to a. sit with her during meals to ensure that she eats everything on her tray. b. have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes. c. provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." d. tell Margaret that she will be on room restriction until she starts gaining weight.

C

Nina has been hospitalized with Adjustment Disorder with Depressed Mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of an adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina's symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced an adjustment disorder if she had a higher level of intelligence.

C

Nurse Jones decides to tell the client of his terminal status because she believes it is her duty to do so. Which of the following ethical theories is considered in this decision? a. Natural law theories b. Ethical egoism c. Kantianism d. Utilitarianism

C

Psychotropic medications that are strong blockers of the D2 receptor may result in which of the following side effects? a. Sedation b. Urinary retention c. Extrapyramidal symptoms d. Hypertensive crisis

C

Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. Bradycardia b. Amenorrhea c. Tolerance d. Convulsions

C

Symptoms of alcohol withdrawal include: a. euphoria, hyperactivity, and insomnia. b. depression, suicidal ideation, and hypersomnia. c. diaphoresis, nausea and vomiting, and tremors. d. unsteady gait, nystagmus, and profound disorientation.

C

The child with autism spectrum disorder has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? a. Encourage all staff to hold the child as often as possible, conveying trust through touch. b. Assign a different staff member each day so child will learn that everyone can be trusted. c. Assign same staff person as often as possible to promote feelings of security and trust. d. Avoid eye contact, because this is extremely uncomfortable for the child and may even discourage trust.

C

The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with Major Depressive Disorder. The nurse says to Nancy, "Please tell me what it was like when you were growing up." Which nursing role described by Peplau is the nurse fulfilling in this instance? a. Surrogate b. Resource person c. Counselor d. Technical expert

C

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing a. somatic delusions. b. catatonic stupor. c. auditory hallucinations. d. pseudoparkinsonism.

C

The nursing history and assessment of an adolescent with a conduct disorder might reveal all of the following behaviors except a. manipulation of others for fulfillment of own desires. b. chronic violation of rules. c. feelings of guilt associated with the exploitation of others. d. inability to form close peer relationships.

C

Three years ago, Anna's dog Lucky, whom she had had for 16 years, was run over by a car and killed. Anna's daughter reports that since that time, Anna has lost weight, rarely leaves her home, and just sits and talks about Lucky. Anna's behavior would be considered maladaptive because a. it has been more than 3 years since Lucky died. b. her grief is too intense over just the loss of a dog. c. her grief is interfering with her functioning. d. people in this culture would not comprehend such behavior over the loss of a pet.

C

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the client's pent-up tension. b. Administer a dose of prn chlorpromazine to keep the client calm. c. Call for sufficient help to control the situation safely. d. Convey to the client that his behavior is unacceptable and will not be permitted.

C

Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol)

C

Which of the following is the most appropriate therapy for a client with agoraphobia? *A.* 10 mg Valium qid *B.* Group therapy with other agoraphobics *C.* Facing her fear in gradual step progression *D.* Hypnosis

C

Which of the following is the most appropriate therapy for a client with agoraphobia? a. 10 mg Valium qid b. Group therapy with other agoraphobics c. Facing her fear in gradual step progression d. Hypnosis

C

You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn't want to ask her patient about suicidal ideation because "It might put ideas in her head about suicide. You're best response would be: A. "I'm glad you are thinking that way. She may not have thought of suicide before, and we don't want to introduce that." B. "You are right; however, because of professional liability, we have to ask that question." C. "Actually, it's a myth that asking about suicide puts ideas into someone's head." D. "If I were you, I'd ask Dr. Carmichael to talk to the patient about that subject."

C. "Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe. Cognitive Level: Analyze (Analysis) Nursing Process: Assessment NCLEX: Safe and Effective Care Environment

Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone. She says to the nurse, "My boyfriend brokeup with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? A. "You'll get over it in time, Theresa." B. "Forget him. There are other fish in the sea." C. "You must be feeling very sad about your loss." D. "Why do you think he broke up with you, Theresa?"

C. "You must be feeling very sad about your loss."

An individual who kills himself after losing his job is committing what social category of suicide, according to sociological theory? A. Egoistic B. Altruistic C. Anomic

C. Anomic suicide: occurs in response to changes that occur in an individual's life such as divorce, loss of job. There is a feeling of "separateness" from the formerly cohesive group. Egoistic suicide is the response to feeling separate and apart from mainstream society-this person doesn't belong to any cohesive group. Altruistic suicide is the opposite of egoistic suicide and occurs when an individual is overly integrated into the group and sacrifices his/her life for the group (page 278)

Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C. Fluoxetine (Prozac)

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? A. γ-Aminobutyric acid B. Dopamine C. Serotonin D. Acetylcholine

C. Serotonin Correct Low serotonin levels have been noted among individuals who have committed suicide.

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. C. Set limits on the amount of time Sandy may engage in the ritualistic behavior. D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.

The psychiatric nurse encourages Nancy (the client in question 3) to express her anger. Why is this an appropriate nursing intervention? A. Anger is the basis for self-esteem problems. B. The nurse suspects that Nancy was abused as a child. C. The nurse is attempting to guide Nancy through the grief process. D. The nurse recognizes that Nancy has long-standing repressed anger.

C. The nurse is attempting to guide Nancy through the grief process is part of the evaluation process when reassessing to determine if the client has been successful.

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. The most appropriate short-term goal would be that while hospitalized, the client will A. reclaim any prized possessions that were given away. B. name three personal strengths. C. seek help when feeling self-destructive. D. participate in a self-help group.

C. seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here.

Some of the most important characteristics of staff members who work with suicidal clients are A. the ability to be consistently organized. B. the ability to teach problem-solving skills. C. warmth and consistency when interacting. D. interview and counseling skills.

C. warmth and consistency when interacting. Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency.

Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) 1. Client outcomes are specifically formulated by nurses. 2. Client outcomes are not restricted by time frames. 3. Client outcomes are specific and measurable. 4. Client outcomes are realistically based on client capability. 5. Client outcomes are formally approved by the psychiatrist.

Client outcomes are specific and measurable. Client outcomes are realistically based on client capability.

The most common comorbid condition in children with bipolar disorder is a. schizophrenia. b. substance disorder. c. oppositional defiant disorder. d. attention-deficit/hyperactivity disorder.

D

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? a. The client's level of agitation increases. b. The client complains of a sore throat. c. The client's skin has a yellowish cast. d. The client develops tremors and a shuffling gait.

D

A depressed client is receiving an ECT treatment. In the treatment room, the anesthesiologist administers methohexital sodium (Brevital) followed by IV succinylcholine (Anectine). The purposes of these medications are to a. decrease secretions and increase heart rate. b. prevent nausea and induce a calming effect. c. minimize memory loss and stabilize mood. d. induce anesthesia and relax muscles.

D

A nurse is assisting an individual with mental illness recovery using the Psychological Recovery Model. The client says to the nurse, "I have schizophrenia. Nothing can be done. I might as well die." In which stage of the Psychological Recovery Model would the nurse assess this individual to be? a. The awareness stage b. The preparation stage c. The rebuilding stage d. The moratorium stage

D

Based on the information in Question 1, Anna's grieving behavior would most likely be considered to be a. delayed. b. inhibited. c. prolonged. d. distorted.

D

Carol, age 16, has recently been diagnosed with Diabetes Mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed, and her mother reports that Carol refuses to change her diet and often skips her medication. Carol has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Carol at this time? a. Anxiety related to hospitalization, evidenced by noncompliance b. Low self-esteem related to feeling different from her peers, evidenced by social isolation c. Risk for suicide related to new diagnosis of Diabetes Mellitus d. Risk-prone health behavior related to denial of seriousness of her illness, evidenced by refusal to follow diet and take medication

D

Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be a contributing factor? a. Parents who are overprotective b. Parents who have high expectations for their children c. Parents who consistently set limits on their children's behavior d. Parents who are alcohol dependent

D

Clint, a client on the psychiatric unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That's ridiculous, Clint. No one is going to hurt you." b. "The CIA isn't interested in people like you, Clint." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, Clint, but it's really hard for me to believe."

D

Education for the client who is taking monoamine oxidase inhibitors (MAOIs) should include which of the following? a. Fluid and sodium replacement when appropriate, frequent blood drug levels, signs and symptoms of toxicity. b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment. d. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.

D

Frank drives his car up to a strange woman, stops, and asks her for directions. As she is explaining, he reveals his erect penis to her. This is an example of which paraphilic disorder? a. Sexual sadism disorder b. Sexual masochism disorder c. Frotteuristic disorder d. Exhibitionistic disorder

D

Janet, a psychiatric client diagnosed with Borderline Personality Disorder, has just been hospitalized for threatening suicide. According to Mahler's theory, Janet did not receive the critical "emotional refueling" required during the rapprochement phase of development. What are the consequences of this deficiency? a. She has not yet learned to delay gratification. b. She does not feel guilt about wrongdoings to others. c. She is unable to trust others. d. She has internalized rage and fears of abandonment.

D

Joe is very restless and is pacing a lot. The nurse says to Joe, "If you don't sit down in the chair and be still, I'm going to put you in restraints!" With which of the following legal actions might the nurse be charged because of this nursing action? a. Defamation of character b. Battery c. Breach of confidentiality d. Assault

D

John is 32 years old. He buys women's clothing at the thrift shop. Sometimes he dresses as a woman and goes to a singles' bar. He becomes sexually excited as he fantasizes about men being attracted to him as a woman. This is an example of which paraphilic disorder? a. Sexual masochism disorder b. Voyeuristic disorder c. Exhibitionistic disorder d. Transvestic disorder

D

Ms. T. has been diagnosed with Agoraphobia. Which behavior would be most characteristic of this disorder? a. Ms. T. experiences panic anxiety when she encounters snakes. b. Ms. T. refuses to fly in an airplane. c. Ms. T. will not eat in a public place. d. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

D

Psychotropic medications that block the reuptake of serotonin may result in which of the following side effects? a. Dry mouth b. Constipation c. Blurred vision d. Sexual dysfunction

D

The primary focus of family therapy for clients with schizophrenia and their families is a. to discuss concrete problem-solving and adaptive behaviors for coping with stress. b. to introduce the family to others with the same problem. c. to keep the client and family in touch with the health-care system. d. to promote family interaction and increase understanding of the illness.

D

With implosion therapy, a client with phobic anxiety would be: *A.* Taught relaxation exercises. *B.* Subjected to graded intensities of the fear *C.* Instructed to stop the therapeutic session as soon as anxiety is experienced. *D.* Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D

A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? A. Altered nutrition less than body requirements B. Altered social interaction C. Impaired verbal communication D. Altered family processes

D. Altered family processes The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.

Nancy tried out for the cheer leading squad in junior high, but was rejected. At age 15, she had looked forward to trying out for the cheer leading squad in high school. She took cheer leading classes and practiced for many hours every day. However, when tryouts were held, she was not selected. She has become despondent, and her mother takes her to the mental health clinic for counseling. She tells the nurse, "What's the use of trying? I'm not good at anything!" Which of the following nursing interventions is best for Nancy's specific problem? A. Encourage Nancy to talk about her feeling of shame over the second failure. B. Assist Nancy to problem-solve her reasons for not making the team. C. Help Nancy understand the importance of good self-care and personal hygiene in the maintenance of self-esteem. D. Explore with Nancy her past successes and accomplishments.

D. Explore with Nancy her past successes and accomplishments.

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? A. Ms. T. experiences panic anxiety when she encounters snakes. B. Ms. T refuses to fly in an airplane. C. Ms. T. Will not eat in public places. D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder

D. Narcissistic personality disorder is associated body dysmorphic disorder. Associated symptoms of hoarding disorder include: perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing.

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises. B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced. D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain her attempt in which of the following ways? A. She feels hopeless about her future w/o her boyfriend B. W/o her boyfriend she feels like an outsider with her peers. C. She is feeling intense guilt b/c her boyfriend broke up with her. D. She is angry at her boyfriend for breaking up with her and has turned her anger inward on herself.

D. She is angry at her boyfriend for breaking up with her and has turned her anger inward on herself.

Karen's counselor asked her if she would like a hug. This is an example of which of the following? A. Rigid boundary B. A boundary violation C. Enmeshed boundary D. Showing respect for the boundary of another

D. Showing respect for the boundary of another is the correct answer because the counselor respected Karen's personal and psychological space by asking if she would like a hug, not just hugging her.

Who has the highest risk of suicide? A. A 16 year old Asian American male B. A 35 year old Native American woman C. A 20 year old Hispanic American woman D. a 84 year old white male

D. a 84 year old white male White males over the age of 80 are at the greatest risk of all age/gender/race groups. Suicide and age are positively correlated, especially for males. Whites are at highest risk, followed by Native Americans, Hispanics, and Asians. Page 276

When working with a client who may have made a covert reference to suicide, the nurse should A. be careful not to mention the idea of suicide. B. listen carefully to see whether the client mentions it a second time. C. ask about the possibility of suicidal thoughts in a covert way. D. ask the client directly if he or she is thinking of attempting suicide.

D. ask the client directly if he or she is thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis.

What areas need to be considered when conducting a suicidal assessment?

Demographics, presenting symptoms, medical-psychiatric diagnosis, suicidal ideas or acts, interpersonal support system, analysis of the suicidal crisis, psychiatric/medical/family history, and coping strategies. page 278

Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.) 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

Depression Fatigue

What is the difference between fear and anxiety?

Fear involves cognition-the intellectual appraisal of a threatening stimulus while anxiety is the emotional response to that stimulus.

What is the purpose of a nurse gathering client information? 1. It enables the nurse to modify behaviors related to personality disorders. 2. It enables the nurse to make sound clinical judgments and plan appropriate care. 3. It enables the nurse to prescribe the appropriate medications. 4. It enables the nurse to assign the appropriate Axis I diagnosis.

It enables the nurse to make sound clinical judgments and plan appropriate care.

An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which ethical principle should a nurse determine has been violated based on these actions? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

Justice

A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed? 1. Learning to count on others 2. Learning to delay satisfaction 3. Identifying oneself 4. Developing skills in participation

Learning to delay satisfaction

A nurse attends an interdisciplinary team meeting regarding a newly admitted client. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.) 1. Respiratory therapist and psychiatrist 2. Occupational therapist and psychologist 3. Recreational therapist and art therapist 4. Social worker and hospital volunteer 5. Mental health technician and chaplain

Occupational therapist and psychologist Recreational therapist and art therapist Mental health technician and chaplain

An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? 1. Conflict should be avoided at all costs on inpatient psychiatric units. 2. Conflict should be resolved by the nursing staff. 3. On inpatient units, every interaction is an opportunity for therapeutic intervention. 4. Conflict resolution should only be addressed during group therapy.

On inpatient units, every interaction is an opportunity for therapeutic intervention.

A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? 1. Maturational/developmental crisis 2. Psychiatric emergency crisis 3. Anticipated life transition crisis 4. Traumatic stress crisis

Psychiatric emergency crisis

How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in ..." which of the following? 1. Psychosocial, biological, or developmental process underlying mental functioning 2. Psychological, cognitive, or developmental process underlying mental functioning 3. Psychological, biological, or developmental process underlying mental functioning 4. Psychological, biological, or psychosocial process underlying mental functioning

Psychological, biological, or developmental process underlying mental functioning

Which of the following statements is true regarding culture and protective factors against suicide? A. Asian Americans have the highest rates of suicide. B. Religion and the importance of family are protective factors for Hispanic Americans. C. Older women have the highest risk for suicide among African Americans. D. American Indians and Pacific Islanders have the lowest rates of suicide.

Religion and the importance of family are protective factors for Hispanic Americans. Correct Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true. Cognitive Level: Analyze (Analysis) Nursing Process: Assessment NCLEX: Safe and Effective Care Environment

An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

Serotonin syndrome; possibly caused by ingestion of two different SSRIs

A brother calls to speak to his sister, who has been admitted to a psychiatric unit. The nurse connects him to the community phone, and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken? 1. The National Alliance for the Mentally Ill Act 2. The Tarasoff Ruling 3. The Health Insurance Portability and Accountability Act 4. The Good Samaritan Law

The Health Insurance Portability and Accountability Act (HIPAA)

A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client's crisis? 1. The client will change his type-A personality traits to more adaptive ones by one week. 2. The client will list five positive self-attributes. 3. The client will examine how childhood events led to his overachieving orientation. 4. The client will return to previous adaptive levels of functioning by week six.

The client will return to previous adaptive levels of functioning by week six.

A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB MNA, DFA, and daytime napping. Which is a correctly written and appropriate outcome for this client? 1. The client will avoid daytime napping and attend all groups. 2. The client will exercise, as needed, before bedtime. 3. The client will sleep seven uninterrupted hours by day four of hospitalization. 4. The client's sleep habits will improve during hospitalization.

The client will sleep seven uninterrupted hours by day four of hospitalization.

A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

The client's behaviors demonstrate no functional impairment, indicating no mental illness.

When planning client care, which folk belief that may affect health-care practices should a nurse identify as characteristic of the Latino American culture? 1. The root doctor is often the first contact made when illness is encountered. 2. The yin and yang practitioner is often the first contact made when illness is encountered. 3. The shaman is often the first contact made when illness is encountered. 4. The curandero is often the first contact made when illness is encountered.

The curandero is often the first contact made when illness is encountered.

Which underlying concept should a nurse associate with interpersonal theory when assessing a client? 1. The effects of social processes on personality development 2. The effects of unconscious processes and personality structures 3. The effects on thoughts and perceptual processes 4. The effects of chemical and genetic influences

The effects of social processes on personality development

An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? 1. The employee assertively confronts the boss. 2. The employee leaves the staff meeting to work out in the gym. 3. The employee criticizes a coworker. 4. The employee takes the boss out to lunch.

The employee criticizes a coworker.

Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development?1. The group leader establishes the rules that will govern the group after discharge. 2. The group leader encourages members to rely on each other for problem solving. 3. The group leader presents and discusses the concept of group termination. 4. The group leader helps the members to process feelings of loss.

The group leader helps the members to process feelings of loss.

During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? 1. The leader should referee the debate. 2. The leader should adamantly oppose physical disciplining measures. 3. The leader should redirect the group to a less controversial topic. 4. The leader should positively reinforce the behavior of collective problem solving.

The leader should positively reinforce the behavior of collective problem solving.

Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

The limbic system

A nurse says to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? 1. The therapeutic technique of giving advice 2. The therapeutic technique of defending 3. The nontherapeutic technique of presenting reality 4. The nontherapeutic technique of giving reassurance

The nontherapeutic technique of giving reassurance

A client has flashbacks of sexual abuse by her uncle. She did not have these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan's concept of the self-system? 1. The good me 2. The bad me 3. The not me 4. The bad you

The not me

A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis? 1. This type of crisis is precipitated by unexpected external stressors. 2. This type of crisis is precipitated by preexisting psychopathology. 3. This type of crisis is precipitated by an acute response to an external situational stressor. 4. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

Matching

a. Atropine - pretreatment medication, used to decrease secretions and counteract the effects of vagal stimulation b. Propofol - short-acting anesthetic c. Diazepam - muscle relaxant to prevent muscle contractions during seizure

Which of the following behaviors are associated with the phenomenon of transference? (Select all that apply.) a. The client attributes toward the nurse feelings associated with a person from the client's past. b. The nurse attributes toward the client feelings associated with a person for the nurse's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent of the nurse and forms unrealistic expectations of him or her.

a. The client attributes toward the nurse feelings associated with a person from the client's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent of the nurse and forms unrealistic expectations of him or her.

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? Select all that apply a. dont eat chocolate b. it sometimes take a while for the medication to be effective c. dont take this medication with your migraine drugs "triptans" d. go to the lab each each to check therapeutic level e. this drug causes a high degree of sedation, take at bedtime

b c

A patient has been ordered ECT and asks the nurse, "Exactly how does ECT work?" Which of the following is the most accurate response by the nurse? a. "I'm not allowed to tell you that because that would be informed consent." b. "The exact mechanism is unknown, but there are several ways that ECT may have antidepressant effects." c. "The administration of a shock to the brain induces memory loss, which will make you forget you are depressed." d. "The neuroplasticity affected by seizure activity prevents further brain damage."

b. "The exact mechanism is unknown, but there are several ways that ECT may have antidepressant effects."

Nurse Rosetta, who is the adult child of an alcoholic, is working with John, a client who abuses alcohol. John has experience a successful detoxification process and is beginning a rehabilitation program. He says to Rosetta, "I'm not going to go to those stupid AA meetings. They don't help anything." Rosetta, who's father died of complications from alcoholism, responds with anger: "Don't you even care what happens to your children?" Rosetta's response is an example of which of the following? a. Transference b. Countertransference c. Self-disclosure d. A breach of professional boundaries

b. Countertransference

Which of the following best describes the average number of ECT treatments given and the timing of administration? a. One treatment per month for 6 to 12 months b. One treatment every other day, three times a week for a total of 6 to 12 treatments c. One treatment three times per week for 6 to 12 months d. One treatment every day for a total of 10 to 20 treatments

b. One treatment every other day, three times a week for a total of 6 to 12 treatments

Education for the client who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment. d. Tyramine-restricted diet, prohibitive concurrent use of over the counter medications without physician notification.

d