MH Exam 2 - Personality Disorders & Eating Disorders

Which predisposing factor would be implicated in the etiology of paranoid personality disorder? 1. The individual may have been subjected to parental demands, criticism, and perfectionistic expectations. 2. The individual may have been subjected to parental indifference, impassivity, or formality. 3. The individual may have been subjected to parental bleak and unfeeling coldness. 4. The individual may have been subjected to parental antagonism and harassment.

1. 1. Individuals diagnosed with narcissistic, not paranoid, personality disorder most likely would be subjected to parental demands, criticism, and perfectionistic expectations. 2. Individuals diagnosed with schizotypal, not paranoid, personality disorder most likely would be subjected to parental indifference, impassivity, or formality. 3. Individuals diagnosed with schizoid, not paranoid, personality disorder most likely would be subjected to parental bleak and unfeeling coldness. 4. Individuals diagnosed with paranoid personality disorder most likely would be subjected to parental antagonism and harassment. These individuals likely served as scapegoats for displaced parental aggression and gradually relinquished all hope of affection and approval. They learned to perceive the world as harsh and unkind, a place calling for protective vigilance and mistrust. TEST- TAKING HINT: To answer this question correctly, the test taker must study and understand the predisposing factors involved in personality disorders. The test taker also needs to understand that although personality disorders are diagnosed in adulthood, they usually begin in childhood and adolescence and often are rooted in parental behaviors and attitudes.

When using a behavioral modification approach for the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? 1. Take a matter-of-fact, directive approach with the input of the entire treatment team. 2. Clients should perceive that they are in control of clearly communicated treatment choices. 3. Appropriate treatment choices are presented to the client's family for consideration. 4. The treatment team develops a system of rewards and privileges that can be earned by the client.

1. A behavior modification program should be instituted with client input and involvement. A directive approach would not give the client the needed and sought-after control over behaviors. Typically, control issues are the underlying problem precipitating eating disorders. 2. A behavior modification program for clients diagnosed with eating disorders should ensure that the client does not feel "controlled" by the program. Issues of control are central to the etiology of these disorders, and for a program to succeed, the client must perceive that he or she is in control of behavioral choices. This is accomplished by contracting with the client for privileges based on weight gain. 3. A behavior modification program should be instituted with client input and involvement. Focusing on the family and excluding the client from treatment choices has been shown to be ineffective. 4. It is important for staff members and clients to work jointly to develop a contract for rewards and privileges that can be earned by the client. It would be inappropriate for the treatment team to solely develop this contract. The client should have ultimate control over behavioral choices, including whether to abide by the contract. TEST-TAKING HINT: To select the correct answer, the test taker must understand that issues of control are central to the etiology of eating disorders. Effective nursing interventions are client focused. Only answer 2 involves the client in developing the plan of care.

Although there are differences among the three personality disorder clusters, there also are some traits common to all individuals diagnosed with personality disorders. Which of the following are common traits? Select all that apply. 1. Failure to accept the consequences of their own behavior. 2. Self-injurious behaviors. 3. Reluctance in taking personal risks. 4. Cope by altering environment instead of self. 5. Lack of insight.

1. A common trait among individuals diagnosed with a personality disorder is the failure to accept the consequences of their own behavior. Although these individuals can identify correct and appropriate behavior, they repeatedly avoid change and cling to patterns that meet their unhealthy needs. 2. Self-injurious behaviors, such as self-mutilation or cutting, are characteristics specific to borderline personality disorder. This trait is not commonly associated with other disorders. 3. Reluctance in taking personal risks or engaging in any new activities for fear of embarrassment is a particular trait seen in avoidant personality disorders. This trait is not commonly associated with other disorders. 4. A common trait among individuals diagnosed with a personality disorder is their response to stress. When feeling threatened, these individuals cope by attempting to change the environment instead of changing themselves. 5. A common trait among individuals diagnosed with a per son ality disorder is the lack of insight. These individuals lack understanding of the impact of their behaviors on others. TEST-TAKING HINT: To answer this question correctly, the test taker must note that the essential characteristics of personality disorders are pervasive, maladaptive, and chronic.

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which long-term, correctly written outcome addresses client problem improvement? 1. The client's BMI will be 20 by the 6-month follow-up appointment. 2. The client will be free of signs and symptoms of malnutrition and dehydration. 3. The client will use one healthy coping mechanism during a time of stress by discharge. 4. The client will understand a previous dependency role by the 3-month follow-up visit.

1. A normal BMI range is 20 to 25. Achieving the outcome of a BMI of 20 would indicate improvement for the stated nursing diagnosis of imbalanced nutrition: less than body requirements. 2. Experiencing no signs and symptoms of malnutrition and dehydration is an outcome related to the nursing diagnosis of imbalanced nutrition. However, this outcome is incorrectly written because it does not contain a time frame. 3. Improving the ability to demonstrate healthy coping mechanisms by discharge is a short-term outcome related to the nursing diagnosis of ineffective coping, not imbalanced nutrition. 4. Stating understanding of a previous dependency role by the 3-month follow-up appointment is a long-term outcome related to the nursing diagnosis of low self-esteem, not imbalanced nutrition. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the measurable outcome that is a realistic expectation of client improvement. Answers 3 and 4 may be appropriate outcomes for clients diagnosed with eating disorders, but only answer 1 indicates client improvement related to imbalanced nutrition: less than body requirements.

A client is leaving the inpatient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? 1. Client will accept refeeding as part of a daily routine. 2. Client will perform nasogastric tube feeding independently. 3. Client will verbalize recognition of "fat" body misperception. 4. Client will discuss importance of monitoring weight daily.

1. Accepting refeeding as part of a daily routine is an outcome that would be appropriate early in treatment and should have been accomplished before discharge planning consideration. 2. Performing nasogastric tube feeding independently is an outcome that would be appropriate early in treatment and should have been accomplished before discharge planning consideration. 3. The outcome of verbalizing recognition of misperception involving "fat" body image is a long-term outcome, appropriate for discharge planning for a client diagnosed with anorexia nervosa. 4. Monitoring weight on a daily basis is an inappropriate outcome for a client diagnosed with anorexia nervosa. Obsession about food and weight gain is a characteristic symptom of the disease, and this outcome would reinforce this problem. TEST-TAKING HINT: An outcome that is appropriate for discharge planning must be a long-term outcome. Answers 1 and 2 are short term in nature and should occur early in treatment. Answer 4 would be excessive and inappropriate. Answers 1, 2, and 4 can be eliminated immediately.

A suicidal client is diagnosed with borderline personality disorder. Which correctly written short-term outcome is most beneficial for the client? 1. The client will be free from self-injurious behavior. 2. The client will express feelings without inflicting self-injury by discharge. 3. The client will socialize with peers in the milieu by day three. 4. The client will acknowledge his or her role in altered interpersonal relationships.

1. Although it is important for the client to be safe and free from self-injurious behaviors, this outcome does not have a time frame and is incorrectly written. 2. The client's being able to express feelings without inflicting self-injury by discharge is an outcome that reinforces the priority for client safety, is measurable, and has a time frame. 3. Although it is important for the client to be able to socialize with peers in the milieu, it is not the priority outcome. 4. The ultimate outcome for a client diagnosed with borderline personality disorder is to understand better how specific personal behaviors affect interpersonal skills. Because this outcome does not have a time frame and does not reinforce the priority of safety, it is incorrect. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the criteria for outcomes, making sure that all answers are measurable, specific, client-centered, and positive and have a time frame. Answers 1 and 4 can be eliminated immediately because they do not have a time frame.

Which client situation requires the nurse to prioritize the implementation of limit setting? 1. A client making sexual advances toward a staff member. 2. A client telling staff that another staff member allows food in the bedrooms. 3. A client verbally provoking another client who is paranoid. 4. A client refusing medications to receive secondary gains.

1. Although limit setting is needed, this situation does not pose a threat, and immediate limiting setting would not be indicated. 2. The client in this situation is attempting to "split" the staff. Although the nurse needs to set limits on the client's manipulative behavior, there is no potential physical threat, so limit setting in this situation does not take priority. 3. A paranoid client has the potential to strike out defensively if provoked. Because safety is the nurse's first concern, and this situation poses a physical threat, this situation takes priority and needs immediate intervention by the nurse. 4. Attention-seeking by refusing medications is a secondary gain that the nurse may want to address with the client. This situation presents no physical threat, however, and is not the nurse's immediate concern. TEST-TAKING HINT: When the word prioritize is used in a question, the test taker must pay attention to which situation the nurse would need to address first. Safety is always the priority.

A client newly admitted to an inpatient psychiatric unit is diagnosed with schizotypal personality disorder. The client states, "I envision my future death by fire." Which is the most appropriate nursing response? 1. "I don't know what you mean by envisioning your future death." 2. "Your future death? Can you please tell me more about that?" 3. "I was wondering if you want to come to group to talk about that." 4. "I can see your thoughts are bothersome. How can I help?"

1. Although the nurse may want to further assess the client's perception of future death, the nurse would not ask a question that supports this altered thought process. It is important for the nurse to make it clear that the visions of future death are not real before assessing further. 2. Asking the client to elaborate about the visions allows the client to continue with altered thoughts. The nurse would want to ask specific questions and then move on to assisting the client in dealing with the uncomfortable feelings. 3. Asking the client to come to group to talk further about the visions does not support the client's feelings and encourages the client to continue to focus on the altered thoughts. 4. Acknowledging the client's feelings about the altered thoughts is an important response. The nurse supports the client's feelings but not the altered thoughts. At the same time, the nurse explores ways to help the client feel comfortable. TEST-TAKING HINT: To answer this question correctly, the test taker must remember that when a client is experiencing altered thoughts, it is important for the nurse to be empathetic about the feelings that occur. The nurse never wants to make statements that reinforce altered thoughts, however real they may be to the client.

Which anorexia nervosa etiology is from a neuroendocrine perspective? 1. Anorexia nervosa is more common among sisters and mothers of clients with the disorder than among the general population. 2. Altered structure and function of the thalamus is implicated in the diagnosis of anorexia nervosa. 3. There is a higher-than-expected frequency of mood disorders among first-degree relatives of clients diagnosed with anorexia nervosa. 4. Clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine.

1. Anorexia nervosa is more common among sisters and mothers of clients with the disorder than among the general population. However, this is an etiological implication from a genetic, not neuroendocrine, perspective. 2. An altered structure and function of the hypothalamus, not thalamus, is implicated in the diagnosis of anorexia nervosa. This would support a physiological, not neuroendocrine, etiological perspective. 3. There is a higher-than-expected frequency of mood disorders among first-degree relatives of clients diagnosed with anorexia nervosa. However, this is an etiological implication from a genetic, not neuroendocrine, perspective. 4. Research has shown that clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine. This is an etiological implication from a neuroendocrine perspective. TEST-TAKING HINT: To answer this question correctly, the test taker should note the perspective required in the question. All answers except 2 are correct etiological implications for the diagnosis of anorexia nervosa; however, only answer 4 is from a neuroendocrine perspective.

A client diagnosed with schizoid personality disorder chooses solitary activities, lacks close friends, and appears indifferent to criticism. Which nursing diagnosis would be appropriate for this client's problem? 1. Anxiety R/T poor self-esteem AEB lack of close friends. 2. Ineffective coping R/T inability to communicate AEB indifference to criticism. 3. Altered sensory perception R/T threat to self-concept AEB magical thinking. 4. Social isolation R/T discomfort with human interaction AEB avoiding others.

1. Anxiety is defined as a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. The client in the question is experiencing feelings of indifference, not anxiety. 2. This client is expressing ineffective coping by choosing solitary activities, avoiding socialization, and exhibiting indifference to criticism, but there is nothing in the question that indicates the client is unable to communicate. The "related to" statement of this diagnosis is incorrect. 3. The nursing diagnosis of altered sensory perception generally is reserved for clients experiencing hallucinations or delusions or both. Nothing in the question indicates that this client is experiencing hallucinations, delusions, or magical thinking. 4. Clients diagnosed with schizoid personality disorder are unsociable and prefer to work in isolation. These individuals are characterized primarily by a profound defect in the ability to form personal relationships or to respond to others in any meaningful or emotional way. They display a lifelong pattern of social withdrawal, and their discomfort with human interaction is very apparent. This client is choosing solitary activities and lacks friends. The nursing diagnosis of social isolation is appropriate in addressing this client's problem. TEST-TAKING HINT: To answer this question correctly, the test taker needs to link the behaviors described in the question with the nursing diagnosis that reflects the client's problem.

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "I'll weigh you after your meal." 3. "Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

1. Because clients diagnosed with anorexia nervosa are obsessed with food, the nurse should not discuss food or eating behaviors. Discussion of food or eating behaviors can provide unintended positive reinforcement for negative behaviors. This statement by the nurse also focuses on the nurse and not the client. 2. The nurse should weigh the client daily, immediately on arising, following first voiding, and not after a meal. 3. It is important to offer support and positive reinforcement for improvements in eating behaviors. Because clients diagnosed with anorexia nervosa are obsessed with food, discussion of food can provide unintended positive reinforcement for negative behaviors. In this answer choice, the nurse is appropriately redirecting the client. 4. When the nurse requests an explanation that the client cannot give, the client may feel defensive. "Why" questions are blocks to therapeutic communication. TEST-TAKING HINT: The test taker must understand the underlying obsession and preoccupation with food that clients diagnosed with eating disorders experience. When this is understood, it is easy to choose an answer that does not support this maladaptive behavior.

Using interpersonal theory, which statement is true regarding development of paranoid personality disorder? 1. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia. 2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment. 3. There is an alteration in the ego development so that the ego is unable to balance the id and superego. 4. During the anal stage of development, the client diagnosed with paranoid personality disorder has problems with control within his or her environment.

1. Biological, not interpersonal, theory attributes a higher incidence of paranoid personality disorder to relatives of clients with schizophrenia. 2. An example of an interpersonal theory of development might involve a client whose background reflects parental emotional abuse to the extent that paranoid personality disorder eventually will be diagnosed. 3. Intrapersonal, not interpersonal, theory would discuss the alteration in the ego development and the inability to balance the id and superego. 4. Intrapersonal, not interpersonal, theory would discuss alterations in the anal stage of development. TEST-TAKING HINT: "Intrapersonal" theory and "interpersonal" theory are sometimes confused. To answer this question correctly, the test taker can best differentiate these terms by thinking of the comparison between "interpersonal" and "interstate" (an "interstate" is a road between states, and "interpersonal" is between two persons). "Intrapersonal" means existing or occurring within one person's mind or self.

A client with diabetes is admitted to a medical floor for medication stabilization and has a history of antisocial personality disorder. Which documented behaviors would support this diagnosis? Select all that apply. 1. "Labile mood and affect and old scars noted on wrists bilaterally." 2. "Appears younger than stated age with flamboyant hair and makeup." 3. "Began cursing when confronted with drug-seeking behaviors." 4. "Demands foods prepared by personal chef to be delivered to room." 5. "Attempted to use insincere flattery to obtain extra snacks."

1. Borderline personality disorder, not antisocial personality disorder, is characterized by a marked instability in interpersonal relationships, mood, and self-image. These clients also exhibit self-destructive behaviors, such as cutting. 2. Histrionic personality disorder, not antisocial personality disorder, is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior. In their attempt to be the center of attention, these clients also exhibit inappropriate sexual, seductive, or provocative behavior. 3. Antisocial personality disorder is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior. These clients disregard the rights of others and frequently fail to conform to social norms with respect to lawful behaviors. They are also deceitful, impulsive, irritable, and aggressive. 4. Narcissistic personality disorder, not antisocial personality disorder, is characterized by a constant need for attention; a grandiose sense of self-importance; and preoccupations with fantasies of success, power, brilliance, and beauty. These clients have a sense of entitlement and unreasonable expectations of special treatment. 5. Antisocial personality disorder is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior. These clients disregard rules, authority, and social norms. They will frequently use insincere flattery and manipulation for their own gain. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize characteristic behaviors that reflect various personality disorders.

When confronted, a client diagnosed with narcissistic personality disorder states, "Contrary to what everyone believes, I do not think that the whole world owes me a living." This client is using what defense mechanism? 1. Minimization. 2. Denial. 3. Rationalization. 4. Projection.

1. Clients diagnosed with a narcissistic personality disorder may attempt to minimize problems brought about by their effect on others, but the situation described is not reflective of the defense mechanism of minimization. 2. Denial is used when a client refuses to acknowledge the existence of a real situation or associated feelings. When the client states, "I don't think the whole world owes me a living," denial is being used to avoid facing others' perceptions. 3. Rationalization is an attempt to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors. Clients diagnosed with narcissistic personality disorder often use this defense, but the situation described is not reflective of the defense mechanism of rationalization. 4. When a client attributes unacceptable feelings or impulses to another person, the client is using the defense mechanism of projection. Clients diagnosed with narcissistic personality disorder often use this defense, but the situation described is not reflective of the defense mechanism of projection. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that although narcissistic individuals may use any defense mechanism, the client in this question is refusing to recognize others' perceptions. The test taker needs to study and recognize examples of the defense mechanism of denial.

A 5-foot 4-inch client, weighing 75 pounds, diagnosed with anorexia nervosa, has been assigned a nursing diagnoses of Imbalanced nutrition: less than body requirements R/T altered body perception. Which nursing intervention would address this client's problem? 1. Encourage the client to keep a diary of food intake. 2. Plan exercise tailored to individual choice. 3. Help the client to identify triggers to self-induced purging. 4. Monitor physician-ordered nasogastric tube feedings.

1. Clients diagnosed with anorexia nervosa have a preoccupation with food. Focusing on food by encouraging the client to keep a food diary only reinforces maladaptive behaviors. Encouraging a food diary is an appropriate nursing intervention for clients designated as obese. 2. Clients diagnosed with anorexia nervosa are critically ill. They are not meeting their nutritional needs because of poor caloric intake. Exercise would increase the client's metabolic requirements further and exacerbate the client's problem. 3. Self-induced purging is typical of bulimia nervosa, not anorexia nervosa. Also, identifying triggers does not directly address the nursing diagnosis of imbalanced nutrition: less than body requirements. 4. If clients are unable or unwilling to maintain adequate oral intake, the physician may order a liquid diet to be administered via nasogastric tube. This treatment is initiated because without adequate nutrition a life-threatening situation exists for these clients. Nursing care of a client receiving tube feedings should be based on established hospital procedures. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the nursing intervention that addresses this problem. Only answer 4 correlates with the client problem of imbalanced nutrition: less than body requirements.

Which of the following diagnostic criteria describe the characteristics of avoidant personality disorder? Select all that apply. 1. Fearing shame and/or ridicule, does not form intimate relationships. 2. Has difficulty making everyday decisions without reassurance from others. 3. Is unwilling to be involved with people unless certain of being liked. 4. Shows perfectionism that interferes with task completion. 5. Views self as socially inept, unappealing, and inferior.

1. Clients diagnosed with avoidant personality disorder show a pervasive pattern of social inhibitions, feelings of inadequacies, and hypersensitivity to negative evaluation and find it difficult to form intimate relationships. 2. Clients diagnosed with dependent, not avoidant, personality disorder are unable to assume the responsibility for making decisions. They have problems with doing things on their own and have difficulties initiating projects. 3. Clients diagnosed with avoidant personality disorder are extremely sensitive to rejection and need strong guarantees of uncritical acceptance. 4. Clients diagnosed with obsessive-compulsive, not avoidant, personality disorder display a pervasive pattern of preoccupation with orderliness and perfectionism. The tendency to be rigid and unbending about rules and procedures often makes task completion a problem. 5. Although there may be a strong desire for companionship, a client with avoidant personality disorder has such a pervasive pattern of inadequacy, social inhibition, and withdrawal from life that the desire for companionship is negated. TEST-TAKING HINT: To answer this question correctly, the test taker should note that an individual diagnosed with an avoidant personality disorder is generally unwilling to get involved with another person unless certain of being liked.

When assessing a client exhibiting passive-aggressive personality traits, which characteristic behavior might the nurse identify? 1. The client exhibits behaviors that attempt to "split" the staff. 2. The client shows reckless disregard for the safety of self or others. 3. The client has unjustified doubts about the trustworthiness of friends. 4. The client seeks subtle retribution when feeling others have wronged him or her.

1. Clients diagnosed with borderline personality disorder, not passive-aggressive traits, have a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This client behavior manifests itself in a major defense mechanism referred to as "splitting." 2. Clients diagnosed with antisocial personality disorder, not passive-aggressive traits, have a sense of entitlement and a lack of remorse, believing they have the right to hurt others. These individuals have little regard for the safety of self or others and are repeatedly involved in altercations. 3. Clients diagnosed with paranoid personality disorder, not passive-aggressive traits, suspect that others will exploit, harm, or deceive them. These individuals have recurrent suspicions, without justification, regarding friends and relatives. 4. Clients exhibiting passive-aggressive traits believe another individual has wronged them, and they may go to great lengths to seek retribution or "get even." This is done in a subtle and passive manner, rather than by discussing their feelings with the offending individual. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize the characteristics associated with passive-aggressive personality traits.

When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior? 1. Odd beliefs and magical thinking. 2. Grandiose sense of self-importance. 3. Preoccupation with orderliness and perfection. 4. Attention-seeking flamboyance.

1. Clients diagnosed with schizotypal, not histrionic, personality disorder exhibit odd beliefs and magical thinking that influence behavior and are inconsistent with subcultural norms (e.g., belief in clairvoyance, telepathy, or "sixth sense"). These clients present with a pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships. 2. Clients diagnosed with narcissistic, not histrionic, personality disorder are preoccupied with fantasies of unlimited success, brilliance, beauty, or ideal love. Through a grandiose sense of self, this individual expects to be recognized as superior without commensurate achievements. 3. Clients diagnosed with obsessive-compulsive, not histrionic, personality disorder have a pervasive pattern of preoccupation with orderliness, perfection, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. 4. Clients diagnosed with histrionic personality disorder have a pervasive pattern of excessive emotionality and attention-seeking behaviors. These individuals are uncomfortable in situations in which they are not the center of attention and have a style of speech that is excessively impressionistic and lacking in detail. TEST-TAKING HINT: To answer this question correctly, the test taker must pair characteristic behaviors with various personality disorders. For clients diagnosed with histrionic personality disorder, it may help the test taker to remember, "Life is a stage, and they are the director."

After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa is suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. 1. Extreme weight loss. 2. Amenorrhea. 3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

1. Clients with bulimia nervosa can maintain a normal weight. Extreme weight loss would be a symptom of anorexia nervosa, not bulimia nervosa. 2. Amenorrhea, due to estrogen deficiencies, is a symptom of anorexia nervosa, not bulimia nervosa. A dentist would not be in a position to evaluate this symptom during a routine dental examination. 3. A client diagnosed with bulimia nervosa may show evidence of dental discoloration due to the presence of acidic gastric juices in the oral cavity during frequent vomiting. 4. Bruises of the palate and posterior pharynx occur because of continual vomiting owing to purging behaviors by clients diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. 5. Dental enamel dysplasia occurs because of the presence of g astric juices in the mouth from continual vomiting owing to purging behaviors by the client diagnosed with bulimia nervosa. This would be an indication to the dentist that bulimia nervosa should be suspected. TEST-TAKING HINT: The test taker should consider the situation presented in the question to gain clues to the correct answer. What assessment data would a dentist gather? A dentist would not gather assessment information related to menstruation, so answer 2 can be eliminated quickly.

A client diagnosed with obsessive-compulsive personality disorder is admitted to a psychiatric unit in a highly agitated state. The physician prescribes a benzodiazepine. Which of the following medications should the nurse expect to administer? Select all that apply. 1. Clonazepam. 2. Lithium carbonate. 3. Clozapine. 4. Olanzapine. 5. Chlordiazepoxide.

1. Clonazepam is a benzodiazepine medication. 2. Lithium carbonate is a mood stabilizer, or antimanic, not a benzodiazepine. 3. Clozapine is an atypical antipsychotic, not a benzodiazepine. 4. Olanzapine is an antipsychotic, not a benzodiazepine. 5. Chlordiazepoxide is a benzodiazepine medication. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to recognize various classifications of psychotropic medications.

A client diagnosed with a personality disorder states, "You are the very best nurse on the unit and not at all like that mean nurse who never lets us stay up later than 9 p.m." This statement would be associated with which personality disorder? 1. Borderline personality disorder. 2. Schizoid personality disorder. 3. Dependent personality disorder. 4. Paranoid personality disorder.

1. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with borderline personality disorder are characterized by a marked instability in interpersonal relationships, mood, and self-image. Clients with this disorder attempt to pit one individual against another. This is known as "splitting" and is related to an inability to integrate and accept positive and negative feelings. Splitting is a primitive ego defense mechanism that is common in individuals with borderline personality disorder. In the question, the client's statement typifies splitting behavior. 2. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizoid personality disorder are characterized by an inability to form close, personal relationships. The behaviors exhibited by the client are not associated with this personality disorder. 3. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. Clients diagnosed with obsessive-compulsive disorder are characterized by difficulty in expressing emotions, along with a pervasive pattern of perfectionism and inflexibility. This client is not displaying any features of a cluster C disorder. 4. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with paranoid personality disorder are characterized by a pervasive and unwarranted suspiciousness and mistrust of people. The behaviors exhibited by the client described are not associated with this personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize the behaviors in the question as splitting behaviors. Next, the test taker must understand that splitting behaviors are commonly seen in clients diagnosed with borderline personality disorder.

Personality disorders are grouped in clusters according to their behavioral characteristics. In which cluster are the disorders correctly matched with their behavioral characteristics? 1. Cluster C: antisocial, borderline, histrionic, narcissistic disorders; anxious or fearful characteristic behaviors. 2. Cluster A: avoidant, dependent, obsessive-compulsive disorders; odd or eccentric characteristic behaviors. 3. Cluster A: antisocial, borderline, histrionic, narcissistic disorders; dramatic, emotional, or erratic characteristic behaviors. 4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.

1. Cluster B, not cluster C, consists of antisocial, borderline, histrionic, and narcissistic personality disorders. Being anxious or fearful is the correct description for clients diagnosed with a cluster C personality disorder. 2. Cluster C, not cluster A, includes avoidant, dependent, and obsessive-compulsive personality disorders. Cluster A consists of paranoid, schizoid, and schizotypal personality disorders, with characteristic behaviors described as odd or eccentric. 3. Cluster B, not cluster A, consists of antisocial, borderline, histrionic, and narcissistic personality disorders. These disorders are correctly described as dramatic, emotional, or erratic. 4. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Anxious or fearful is the correct description for clients diagnosed with a cluster C personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must review which personality disorders make up clusters A, B, and C and then the characteristic behaviors of clients diagnosed with these disorders. The test taker also must understand that when one part of the answer choice is incorrect, the whole answer choice is incorrect.

A client diagnosed with a personality disorder insists that a grandmother, through reincarnation, has come back to life as a pet kitten. The thought process described is reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Schizotypal personality disorder. 3. Borderline personality disorder. 4. Schizoid personality disorder.

1. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. Clients diagnosed with obsessive-compulsive personality disorder are characterized by difficulty in expressing emotions, along with a pervasive pattern of perfectionism and inflexibility. The characteristics of this disorder are not reflected in the question. 2. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizotypal personality disorder are characterized by peculiarities of ideation, appearance, and behavior; magical thinking; and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. In the question, this client's statement reflects ideations of magical thinking. 3. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with borderline personality disorder are characterized by a marked instability in interpersonal relationships, mood, and self-image. These behaviors are not described in the question. 4. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizoid personality disorder are characterized by an inability to form close, personal relationships. In contrast to schizotypal behavior, a client with this disorder would be incapable of establishing any type of personal alliance the way the client presented in the question has established with his or her grandmother. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the differences between schizoid and schizotypal personality disorders.

Which anorexia nervosa symptom is physical in nature? 1. Dry, yellow skin. 2. Perfectionism. 3. Frequent weighing. 4. Preoccupation with food.

1. Dry, yellow skin is a physical symptom of anorexia nervosa. This is due to the release of carotenes as fat stores are burned for energy. 2. Perfectionism is often experienced by clients with a diagnosis of anorexia nervosa, but it is a behavioral, not physical, symptom. 3. Frequent weighing is a behavioral, not physical, symptom of anorexia nervosa. 4. Preoccupation with food is a cognitive, not physical, symptom of anorexia. TEST-TAKING HINT: To select the correct answer, the test taker first must determine if the symptom presented is a symptom of anorexia nervosa, then be able to categorize this symptom accurately as physical.

The instructor is teaching nursing students about the psychodynamic influences of eating disorders. Which statement indicates that more teaching is necessary? 1. "Eating disorders result from very early and profound disturbances in father-infant interactions." 2. "Disturbances in mother-infant interactions may result in retarded ego development." 3. "When a mother meets the physical and emotional needs of a child by providing food, this behavior contributes to the child's ego development." 4. "Poor self-image leads to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating."

1. Eating disorders result from very early and profound disturbances in mother-infant, not father-infant, interactions. This statement would indicate that more teaching is necessary. 2. Disturbances in mother-infant interactions result in retarded ego development, which contributes to the development of an eating disorder. This is a correct statement and further teaching is not necessary. 3. Ego development can be attributed to a mother meeting the physical and emotional needs of a child by providing food. This is a correct statement and further teaching is not necessary. 4. Poor self-image leads to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating. This is a correct statement and further teaching is not necessary. TEST-TAKING HINT: The question is asking for an incorrect statement about eating disorders, which would indicate that "more teaching is necessary."

Which etiological implication for obesity is from a physiological perspective? 1. Eighty percent of offspring of two obese parents become obese. 2. Individuals who are obese have unresolved dependency needs and are fixed in the oral stage of development. 3. Hyperthyroidism interferes with metabolism and may lead to obesity. 4. Lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity.

1. Eighty percent of offspring of two obese parents become obese. However, this etiological implication is from a genetic, not physiological, perspective. 2. The psychoanalytic, not physiological, view of obesity proposes that obese individuals have unresolved dependency needs and are fixed in the oral stage of development. 3. Hypothyroidism, not hyperthyroidism, decreases metabolism and is more likely to lead to obesity. Hyperthyroidism, because of increased metabolic rates, may lead to weight loss. 4. A theory of obesity from a physiological perspective is that lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity. TEST-TAKING HINT: To answer this question correctly, the test taker must look for a potential obesity cause from a physiological, or "physical," perspective. Answer 3 is physiologically based but contains inaccurate information and so can be eliminated.

A client diagnosed with an obsessive-compulsive personality disorder has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do that." Which correctly written short-term outcome is appropriate for this client? 1. During a 3-hour period after admission to the unit, the client will refrain from hand washing. 2. The client will wash hands only at appropriate bathroom and meal intervals. 3. The client will refrain from hand washing throughout the night. 4. Within 72 hours of admission, the client will notify staff when signs and symptoms of anxiety escalate.

1. Expecting the client to abstain from ritualistic hand washing on admission is an unrealistic outcome. To do this would heighten, rather than lower, the client's anxiety level. There is no mention of a time frame, so this outcome cannot be measured. 2. This outcome has no specific measurable time frame. Although this might be a reasonable client outcome if started after treatment has begun, it might be an unreasonable expectation if implemented too soon after admission. Only after the client has learned new coping skills can ritualistic behaviors be decreased without increasing anxiety levels. 3. Although this may eventually be a reasonable client expectation, there is no mention of a time frame, so this outcome cannot be measured. 4. This short-term outcome is stated in observable and measurable terms. This outcome sets a specific time for achievement (within 72 hours). It is specific (signs and symptoms), and it is written in positive terms. When the client can identify signs and symptoms of increased anxiety, the next step of problem-solving can begin. TEST-TAKING HINT: To answer this question correctly, the test taker must note that outcomes need to be realistic for clients diagnosed with personality disorders to achieve success. An outcome that may be inappropriate on admission may be attainable and appropriate by discharge.

Which medication is used most often in the treatment of clients diagnosed with anorexia nervosa? 1. Fluphenazine. 2. Clozapine. 3. Fluoxetine. 4. Methylphenidate.

1. Fluphenazine is an antipsychotic medication prescribed for thought disorders and is rarely used in the treatment of anorexia nervosa. 2. Clozapine is an antipsychotic medication prescribed for thought disorders and is rarely used in the treatment of anorexia nervosa. 3. Fluoxetine is an antidepressant medication. Feelings of depression and anxiety often accompany anorexia nervosa, making antianxiety and antidepressant medications the treatments of choice for the disorder. 4. Methylphenidate is a stimulant medication prescribed for attention deficit-hyperactivity disorder, not anorexia nervosa. TEST-TAKING HINT: The test taker must note keywords in the question, such as most often, to answer this question correctly. Although antipsychotic medications can, on rare occasions, be used to treat selected clients diagnosed with anorexia nervosa, the most frequently used medications are antidepressants and antianxiety agents.

After being treated in the emergency department (ED) for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority? 1. Administer tranquilizing drugs. 2. Observe client frequently. 3. Encourage client to verbalize hostile feelings. 4. Explore alternative ways of handling frustration.

1. Giving the client tranquilizing medications, such as anxiolytics or antipsychotics, may have a calming effect and reduce aggressive behavior, but it does not address the client's priority safety issue. Tranquilizing medications are considered a chemical restraint and would be used only when all other, less-restrictive measures have been attempted. 2. The priority nursing intervention is to observe the client's behavior frequently. The nurse should do this through routine activities and interactions to avoid appearing watchful and suspicious. Close observation is required so that immediate interventions can be implemented as needed. 3. Encouraging the client to verbalize hostile feelings may help the client to come to terms with unresolved issues, but it does not address the client's priority safety need. 4. It is important to explore alternative ways of handling frustration, such as physical activities. Although this may relieve pent-up frustration, it does not address the client's priority safety need. TEST-TAKING HINT: To answer this question correctly, the test taker must note important words in the question, such as priority. Physical safety is a major concern, and client safety must be considered a priority whenever the nurse formulates a nursing plan of care.

Which diagnostic criterion describes a characteristic of schizotypal personality disorder? 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Is preoccupied with unjustified doubts about the loyalty of friends and associates. 3. Considers relationships to be more intimate than they actually are. 4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.

1. Having no close relationship with either friends or family is described as a characteristic of schizoid, not schizotypal, personality disorder. 2. Preoccupation with unjustified doubts and suspicions is often a principal aberration associated with paranoid, not schizotypal, personality disorder. Individuals with paranoid personality disorder are extremely oversensitive and tend to misinterpret even minute cues within the environment, magnifying and distorting them into thoughts of trickery and deception. Paranoid behaviors are not commonly associated with individuals diagnosed with schizotypal personality disorders. 3. Individuals diagnosed with histrionic, not schizotypal, personality disorder have a tendency to be self-dramatizing, attention seeking, overly gregarious, and seductive. Because they have difficulty maintaining long-lasting relationships, they tend to exaggerate the intimacy of a relationship. In contrast, individuals diagnosed with schizotypal personality disorders are aloof and isolated and behave in a bland and apathetic manner. 4. Magical thinking and odd beliefs that influence behavior and are inconsistent with subcultural norms are defined as criteria for schizotypal personality disorder, which is often described as "latent schizophrenia." Clients with this diagnosis are odd and eccentric but do not decompensate to the level of schizophrenia. TEST-TAKING HINT: To differentiate between schizotypal and schizoid personality disorders, the test taker should remember that clients diagnosed with schizotypal personality disorder typically are odd and eccentric, and clients diagnosed with schizoid personality disorder are void of close relationships.

A client diagnosed with antisocial personality disorder demands, at midnight, to speak to the ethics committee about the involuntary commitment process. Which nursing statement is appropriate? 1. "I realize you're upset; however, this is not the appropriate time to explore your concerns." 2. "Let me give you a sleeping pill to help put your mind at ease." 3. "It's midnight, and you are disturbing the other clients." 4. "I will document your concerns in your chart for the morning shift to discuss with the ethics committee."

1. In this situation, the nurse empathizes with the client's concerns and then sets limits on inappropriate behaviors in a matter-of-fact manner. 2. Offering a sleeping pill in this situation avoids the client's frustrations and the need to set limits on inappropriate behaviors. 3. "It's midnight and you are disturbing the other clients" is a judgmental response and does not deal with the client's concerns or the inappropriate behavior. 4. Documenting the client's concerns in the chart placates the client and avoids addressing the client's concerns directly. Here, the nurse is transferring responsibility to other staff members versus dealing with the immediate situation. This interaction allows the client to split staff. TEST-TAKING HINT: To answer this question correctly, the test taker must remember that when setting limits on manipulative behaviors, the nurse always should give reasons for the limits and deal with the situation in a timely manner.

A client diagnosed with a dependent personality disorder has a nursing diagnosis of social isolation R/T parental abandonment AEB fear of involvement with individuals not in the immediate family. Which nursing intervention would be appropriate? 1. Address inappropriate interactions during group therapy. 2. Recognize when client is playing one staff member against another. 3. Role-model positive relationships. 4. Encourage client to discuss conflicts evident within the family system.

1. Inappropriate interactions are associated with the nursing diagnosis of impaired social interaction, not social isolation. Also, nothing in the question indicates the client is exhibiting inappropriate interactions. 2. A client playing one staff member against another is known as "splitting." Nothing in the question indicates that the client is attempting to split staff. 3. Role-modeling positive relationships would provide a motivation to initiate interactions with others outside the client's family. This is an appropriate intervention for the nursing diagnosis of social isolation. 4. There is no mention of conflict within the family. The conflict that is being addressed is the client's inability to reach beyond the family system because of unresolved abandonment issues. TEST-TAKING HINT: To answer this question correctly, the test taker must find the nursing interaction that addresses the problem of social isolation. Role-modeling positive interactions is an appropriate nursing intervention for this problem. Understanding the difference between social isolation and impaired social interaction assists the test taker in eliminating answer 1 immediately.

An 18-year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? 1. The client meets the criteria for a diagnosis of bulimia nervosa. 2. The client meets the criteria for a diagnosis of anorexia nervosa. 3. The client needs further assessment to be diagnosed. 4. The client is exhibiting normal developmental tasks according to Erikson.

1. Included in the diagnostic criteria for bulimia nervosa are binge eating, self-induced vomiting, abuse of laxatives, and/or poor self-evaluation unduly influenced by body shape and weight. This client is not experiencing any binge eating, purging, or inappropriate use of laxatives. Although weight may fluctuate, clients diagnosed with bulimia nervosa can maintain weight within a normal range. This client does not meet the criteria for a diagnosis of bulimia nervosa. 2. Significantly low body weight in the context of age, sex, developmental trajectory, and physical health; disturbance in the way in which one's body weight is experienced; undue influence of body weight on self-evaluation; and lack of recognition of the seriousness of the current low body weight are all diagnostic criteria for anorexia nervosa. This client meets the criteria for this diagnosis. 3. Because the client meets the diagnostic criteria for anorexia nervosa, additional assessments are unnecessary. 4. Extreme weight loss, disturbed body image, and amenorrhea are not normal developmental tasks for an 18-year-old client, according to Erikson. Erikson identified the development of a secure sense of self as the task of the adolescent stage (12 to 20 years) of psychosocial development. TEST-TAKING HINT: To answer this question correctly, the test taker must remember diagnostic criteria for anorexia nervosa and differentiate these from the criteria for bulimia nervosa.

Which behavior would the nurse expect to observe if a client is diagnosed with paranoid personality disorder? 1. The client sits alone at lunch and states, "Everyone wants to hurt me." 2. The client is irresponsible and exploits other peers in the milieu for cigarettes. 3. The client is shy and refuses to talk to others because of poor self-esteem. 4. The client sits with peers and allows others to make decisions for the entire group.

1. Individuals with paranoid personality disorder would be isolative and believe that others were out to get them. The behavior presented reflects a client diagnosed with this disorder. 2. Individuals with antisocial personality disorder, not paranoid personality disorder, would be irresponsible and try to exploit others in the milieu. 3. Individuals with avoidant, not paranoid, personality disorder would be shy and refuse to talk with others because of poor self-esteem. 4. Individuals with dependent, not paranoid, personality disorder would sit with peers and allow others to make decisions for the entire group. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the signs and symptoms of the different personality disorders and be able to recognize them in various presented behaviors.

A client diagnosed with antisocial personality disorder is caught smuggling cigarettes into the nonsmoking clinical area. Which initial nursing intervention is appropriate? 1. Confront the client about the behavior. 2. Tell the client's primary nurse about the situation. 3. Remind all clients of the no smoking policy in the community meeting. 4. Teach alternative coping mechanisms to assist with anxiety.

1. It is important to address an individual's behavior in a timely manner to set appropriate limits. Limit setting is to be done in a calm, but firm, manner. A client diagnosed with antisocial personality disorder may have no regard for rules or regulations, which necessitates limit setting by the nurse. 2. Limit setting needs to be applied immediately, by all staff members, to avoid client manipulation and encourage responsible and appropriate behaviors. 3. Although the nurse may want to remind all clients about unit rules, the word "initial" makes this answer incorrect. Initially, the nurse needs to confront the behavior. 4. The word "initial" makes this answer incorrect. Addressing inappropriate or testing behaviors must be a priority to bring into the client's awareness the consequences of inappropriate actions. The nurse should follow up limit setting at a later time with constructive discussions regarding the cause and effects of inappropriate behaviors. TEST-TAKING HINT: The test taker must note important keywords in the question, such as initial, priority, or most important. These words assist the test taker in determining the correct answer.

A client diagnosed with anorexia nervosa is newly admitted to an inpatient psychiatric unit. Which intervention takes priority? 1. Assessment of family issues and health concerns. 2. Assessment of early disturbances in mother-infant interactions. 3. Assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment. 4. Assessment and monitoring of vital signs and laboratory values to recognize and anticipate medical problems.

1. It is important to assess family issues and health concerns, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 2. It is important to assess early disturbances in mother-infant interactions, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 3. It is important to assess the client's previous knowledge of selective serotonin reuptake inhibitors before any teaching, but because of the critical nature of physical problems experienced by clients diagnosed with anorexia nervosa, this intervention is not prioritized. 4. The immediate priority of nursing interventions in eating disorders is to restore the client's nutritional status. Complications of emaciation, dehydration, and electrolyte imbalance can lead to death. The assessment and monitoring of vital signs and laboratory values to recognize and anticipate these medical problems must take priority. When the physical condition is no longer life threatening, other treatment modalities may be initiated. TEST-TAKING HINT: To answer this question correctly, the test taker must note that the question requires a "priority" intervention. Physical needs that threaten life always take priority over psychological needs.

Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa in avoiding the urge to purge after discharge? 1. Locking the door to the client's bathroom. 2. Holding a mandatory group after mealtime to assist in exploration of feelings. 3. Discussing preplanned meals to decrease anxiety around eating. 4. Educating the family to recognize purging side effects.

1. Locking the client's door would be an appropriate behavioral approach to prevent purging in an inpatient setting but would not assist the client in avoiding the urge to purge when discharged. 2. Holding a mandatory group after mealtime to assist in exploration of feelings is an appropriate intervention to help the hospitalized client diagnosed with bulimia nervosa to avoid the urge to purge after discharge. If the client can become aware of feelings that may trigger purging, future purging may be avoided. 3. Discussing preplanned meals to decrease anxiety around eating is an intervention focused on binging, not purging. 4. Educating the family to recognize purging side effects would not directly assist the client in avoiding purging after discharge. This intervention is focused on providing the family tools to use if purging behaviors continue, not on helping the client to avoid these behaviors. TEST-TAKING HINT: To answer this question correctly, the test taker must note the time frame presented in the question. The client must be present on the unit for answer 1 to be a possible intervention. Although answer 2 occurs on the unit, the information presented in group therapy would help the client to avoid purging behaviors after discharge. Answer 4 can be eliminated because it focuses on the family instead of the client.

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort.

1. Mood disorders often accompany the diagnosis of bulimia nervosa, but the client symptoms described in the question do not reflect a mood disorder. 2. Nutritional deficits are characteristic of bulimia nervosa, but the client symptoms described in the question do not reflect a nutritional deficit. 3. Purging behaviors, such as vomiting, may lead to dehydration and electrolyte imbalance. Hallucinations and restlessness can be signs of electrolyte imbalance. Dry mucous membranes indicate dehydration. 4. Binging large quantities of food can cause abdominal discomfort, but the client symptoms described in the question do not reflect abdominal discomfort. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize common signs and symptoms of electrolyte imbalance and dehydration.

A nursing instructor is teaching about personality disorder characteristics. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with personality disorders need frequent hospitalizations." 2. "Clients perceive their behaviors as uncomfortable and disorganized." 3. "Personality disorders cannot be cured or controlled successfully with medication." 4. "Practitioners have a good understanding about the etiology of personality disorders."

1. Most personality-disordered individuals, although functioning inconsistently in subcultural norms, maintain themselves in the community. Because of this, individuals with a diagnosis of a personality disorder may never be hospitalized. 2. In contrast to a client diagnosed with anxiety disorders, depressive disorders, schizophrenia spectrum disorders, or other mental disorders, clients with personality disorders experience no feelings of discomfort or disorganization with their inappropriate behaviors. 3. It is important for nurses to understand that for individuals diagnosed with personality disorders, no prescribed medications are available to cure or control these disorders. Clients' inappropriate behaviors and skewed perceptions often lead to anxiety or depression or both; therefore, anxiolytics, antidepressants, and antipsychotics sometimes are prescribed. 4. Although there are many different theories related to the development of personality disorders, it is unclear why some individuals develop personality disorders and others do not. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review theories regarding the etiology of personality development and treatment modalities for individuals diagnosed with a personality disorder.

Which individual would be at highest risk for obesity? 1. A poor black woman. 2. A rich white woman. 3. A rich white man. 4. A well-educated black man.

1. Obesity is more common in black women than in white women, and the prevalence among lower socioeconomic classes is six times greater than among upper socioeconomic classes. Therefore, this individual is at highest risk for obesity compared with the others described. 2. Obesity is less common in white women than in black women, and the prevalence among lower socioeconomic classes is six times greater than among upper socioeconomic classes. Therefore, this client has a comparatively lower risk for obesity than the other clients presented. 3. Obesity is more common in white men than in black men, but because the prevalence among lower socioeconomic classes is six times higher than among upper socioeconomic classes, this individual's risk is comparatively lower than the other clients presented. 4. Obesity is more common in white men than in black men, and there is an inverse relationship between obesity and education level. Therefore, this client has a comparatively lower risk for obesity than the other clients presented. TEST-TAKING HINT: The test taker must be aware of the epidemiological factors that influence the prevalence rate of obesity to determine which of the individuals described is at highest risk for becoming obese.

Which of the following statements are true as they relate to obesity? Select all that apply. 1. Obesity is a psychiatric disorder, and diagnostic criteria are similar to other eating disorders. 2. Binge-eating disorder is described as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and this disorder can lead to obesity. 3. Obesity is currently evaluated for all clients as a psychological factor affecting medical conditions. 4. Obesity is not classified as an eating disorder but can be considered as a psychological factor affecting other medical conditions. 5. The World Health Organization (WHO) defines obesity as a BMI of 30.0 or greater.

1. Obesity is not classified as a psychiatric disorder but because of the strong emotional factors associated with the condition, it may be considered under "psychological factors affecting medical conditions." 2. Binge-eating disorder is described as an eating disorder in the Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Obesity is a factor in binge-eating disorder because the individual binges on large amounts of food (as in bulimia nervosa) but does not engage in behaviors to rid the body of the excess calories. 3. Because of the strong emotional factors associated with obesity, it may be considered under "psychological factors affecting medical conditions"; however, this evaluation does not apply to "all clients." 4. Obesity is not classified as an eating disorder. It is considered under "psychological factors affecting medical conditions" in the DSM-5. 5. Obesity is defined by the World Health Organization as a BMI of 30.0 or greater. TEST-TAKING HINT: Note the words all clients in answer 3. Superlatives that are all inclusive or exclusive, such as all, always, and never, usually indicate that the answer choice is incorrect.

A client diagnosed with binge-eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client's problem? 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with decreased stimulation. 4. Allow the client to remain in a dependent role throughout treatment.

1. Offering independent decision-making opportunities promotes feelings of control. Making decisions and dealing with the consequences of these decisions should increase independence and improve the client's self-esteem. 2. Reviewing previously successful coping strategies is an effective nursing intervention for clients experiencing altered coping, not low self-esteem. Altered coping is a common problem for clients diagnosed with binge-eating disorder, but this nursing diagnosis is not stated in the question. 3. Providing a quiet environment with decreased stimulation is an effective nursing intervention for clients experiencing anxiety, not low self-esteem. Anxiety is a common problem for clients diagnosed with binge-eating disorder, but this nursing diagnosis is not stated in the question. 4. Allowing the client to remain in a dependent role throughout treatment would decrease, rather than increase, self-esteem. There is little opportunity for successful experiences and increased self-esteem when decisions and choices are made for the client. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the client problem presented in the question with the nursing intervention that addresses this prob lem. Answers 2 and 3 may be appropriate interventions for clients diagnosed with binge-eating disorder, but only answer 1 correlates with the client problem of low self-esteem.

A client diagnosed with borderline personality disorder superficially cut both wrists, is disruptive in group, and is "splitting" staff. Which nursing diagnosis would take priority? 1. Risk for self-mutilation R/T need for attention. 2. Ineffective coping R/T inability to deal directly with feelings. 3. Anxiety R/T fear of abandonment AEB "splitting" staff. 4. Risk for suicide R/T past suicide attempt.

1. Repetitive, self-mutilating behaviors are classic manifestations of borderline personality disorder. These individuals seek attention by self-mutilating until pain is felt in an effort to counteract feelings of emptiness. Some clients reported that "to feel pain is better than to feel nothing." Because these clients often inflict injury on themselves, this diagnosis must be prioritized to ensure client safety. 2. This client is expressing ineffective coping by self-mutilating, exhibiting disruptive behaviors, and splitting staff. However, because the client is self-mutilating, client safety must be prioritized. 3. Although clients diagnosed with borderline personality disorder may exhibit anxiety, because the client is self-mutilating, client safety must be prioritized. 4. Although self-mutilation acts can be fatal, most commonly they are manipulative gestures designed to elicit a rescue response from significant others. Nothing in the question indicates the client has a history of a suicide attempt, so the "related to" statement of this diagnosis is incorrect. TEST-TAKING HINT: To answer this question correctly, the test taker needs to link the behaviors presented in the question with the nursing diagnosis that describes this client's problem. Client safety should always be prioritized.

A client diagnosed with antisocial personality disorder states, "My kids are so busy at home and school, they don't miss me or even know I'm gone." Which nursing diagnosis applies to this client? 1. Risk for injury. 2. Risk for violence: self-directed. 3. Ineffective denial. 4. Powerlessness.

1. Risk for injury is defined as when a client is at risk for injury as a result of internal or external environmental conditions interacting with the individual's adaptive and defensive resources. Nothing presented in the question would indicate that this client is at risk for injury. 2. Risk for violence: self-directed is defined as when a client is at risk for behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful to self. Nothing presented in the question would indicate that this client is at risk for violence: self-directed. 3. Ineffective denial is defined as the conscious or unconscious attempt to disavow knowledge or meaning of an event to reduce anxiety or fear. The client presented in the question is denying his or her children's need for parental support by turning the situation around and making himself or herself sound like the victim who is not needed. 4. Powerlessness is defined as the perception that one's own action would not significantly affect an outcome, a perceived lack of control over a current situation or immediate happening. Although the client in the question would like to be perceived as powerless over the situation, nothing presented in the question would indicate that this client is experiencing powerlessness. TEST-TAKING HINT: To answer this question correctly, the test taker needs to use the information presented in the question to determine the nursing diagnosis for this client.

A nursing student is learning about narcissistic personality disorder. Which of the following student statements indicate that learning has occurred? Select all that apply. 1. "These clients have peculiarities of ideation." 2. "These clients require constant approval and affirmation." 3. "These clients are impulsive and self-destructive." 4. "These clients express a grandiose sense of self-importance." 5. "These clients have a deep need for admiration."

1. Schizotypal, not narcissistic, personality disorder is characterized by peculiarities of ideation, appearance, and behavior; magical thinking; and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. 2. Histrionic, not narcissistic, personality disorder is characterized by a pervasive pattern of excessive emotionality, attention-seeking behavior, and the seeking of constant affirmation of approval and acceptance from others. 3. Borderline, not narcissistic, personality disorder is characterized by a marked instability in interpersonal relationships, mood, and self-image. These clients are impulsive and self-destructive. They lack a clear sense of identity and have fluctuating attitudes toward others. 4. Narcissistic personality disorder is characterized by a grandiose sense of self-importance and preoccupations with fantasies of success, power, brilliance, and beauty. These clients sometimes may exploit others for self-gratification. 5. Clients diagnosed with narcissistic personality disorder have adeep need for admiration and exhibit a lack of empathy for others. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to distinguish among behaviors exhibited by clients diagnosed with various personality disorders.

A client exhibiting passive-aggressive personality traits continuously complains to the marriage counselor about a nagging husband who criticizes her indecisiveness. Which nursing diagnosis reflects this client's problem? 1. Social isolation R/T decreased self-esteem. 2. Impaired social interaction R/T inability to express feelings openly. 3. Powerlessness R/T spousal abuse. 4. Self-esteem disturbance R/T unrealistic expectations of husband.

1. Social isolation is defined as aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state. There is nothing in the question indicating that this client is experiencing social isolation. 2. Impaired social interaction is defined as the insufficient or excessive quantity or ineffective quality of social exchange. When the client in the question complains about a nagging husband who criticizes her indecisiveness, she is passively expressing covert aggression. This negative expression impedes her ability to interact appropriately and to express feelings openly, which leads to the correct nursing diagnosis, impaired social interaction. 3. Powerlessness is defined as a perceived lack of control over a current situation or immediate happening. As a tactic of interpersonal behavior, passive-aggressive individuals commonly switch among the roles of the martyr, the affronted, the aggrieved, the misunderstood, the contrite, the guilt ridden, the sickly, and the overworked. These roles empower, not render powerless, the passive-aggressive individual. Also, nothing in the question suggests that the client's spouse is abusive. 4. Self-esteem disturbance is defined as a negative self-evaluation and feelings about self or self-capabilities. Nothing in the question indicates the client is experiencing low self-esteem. The husband's wanting the client to make decisions is not an unrealistic expectation. By stating that her husband's expectations are unrealistic, the client is attempting to make this situation his, not her, fault. TEST-TAKING HINT: To answer this question correctly, the test taker needs to link the behaviors described in the question with the nursing diagnosis that reflects the client's problem.

A nurse is discharging a client diagnosed with narcissistic personality disorder. Which employment opportunity is most likely to be recommended by the treatment team? 1. Home builder. 2. Air traffic controller. 3. Night security guard at the zoo. 4. Prison warden.

1. The flexibility and mobility of construction work, which uses physical versus interpersonal skills, may be best suited for a client diagnosed with antisocial personality disorder. These clients tend to exploit and manipulate others, and construction work would provide less opportunity for the client to exhibit these behaviors. A client diagnosed with narcissistic personality disorder would not be suited for this job. 2. Individuals with obsessive-compulsive personality disorder are inflexible and lack spontaneity. They are meticulous and work diligently and patiently at tasks that require accuracy and discipline. They are especially concerned with matters of organization and efficiency and tend to be rigid and unbending about rules and procedures, making them, and not the client described in the question, good candidates for the job of air traffic controller. 3. Clients diagnosed with schizoid personality disorder are unable to form close, personal relationships. These clients are comfortable with animal companionship, making a night security job at the zoo an ideal occupation. A client diagnosed with narcissistic personality disorder would not be suited for this job. 4. Individuals diagnosed with narcissistic personality disorder have an exaggerated sense of self-worth and believe they have an inalienable right to receive special consideration. They tend to exploit others to fulfill their own desires. Because they view themselves as "superior" beings, they believe they are entitled to special rights and privileges. Because of the need to control others inherent in the job of prison warden, this would be an appropriate job choice for a client diagnosed with narcissistic personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the characteristics of the various personality disorders and how these traits would affect employment situations.

A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Ineffective coping R/T lack of control. 2. Altered nutrition: less than body requirements R/T decreased intake. 3. Self-care deficit: feeding R/T fatigue. 4. Anxiety R/T feelings of helplessness.

1. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of ineffective coping. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources. An appropriate outcome for ineffective coping for clients diagnosed with eating disorders would be to use healthy coping strategies effectively to deal with anxiety or lack of control without resorting to self-starvation. 2. The outcome of gaining 2 pounds in 1 week is directly related to the nursing diagnosis of altered nutrition: less than body requirements. Altered nutrition: less than body requirements is defined as the state in which individuals experience an intake of nutrients insufficient to meet metabolic needs. Weight loss is characteristic of the diagnosis of anorexia nervosa, with weight gain being a critical outcome. 3. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of self-care deficit: feeding R/T fatigue. Self-care deficit is related to the inability of the client to perform the acts of self-care, in this case feeding. Clients diagnosed with anorexia nervosa have the ability to feed themselves but choose not to because of impaired body image. 4. The outcome of gaining 2 pounds in 1 week is not directly related to the nursing diagnosis of anxiety R/T feelings of helplessness. Feelings of depression and anxiety often accompany the diagnosis of anorexia nervosa, but in the short term, weight gain would increase, not decrease, the anxiety experienced by the client. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the nursing outcome presented in the question with the correct nursing diagnosis. There always must be a correlation between the stated outcome and the problem statement.

A client on an inpatient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? 1. "Thanks for checking in." 2. "I will accompany you to the bathroom." 3. "Let me know when you get back to the dayroom." 4. "I'll stand outside your door to give you privacy."

1. The response "Thanks for checking in" does not address the nurse's responsibility to deter the client's self-induced vomiting behavior. The nurse should accompany the client to the bathroom. 2. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. 3. The response "Let me know when you get back to the dayroom" does not address the nurse's responsibility to deter the client's self-induced vomiting behavior. The nurse should accompany the client to the bathroom. 4. The response "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the client's self-induced vomiting behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits. TEST-TAKING HINT: The test taker must understand that sometimes all client needs cannot be met. Although privacy is a client need, in this case the nurse must put aside the client's need for privacy to intervene to prevent further nutritional deficits resulting from self-induced vomiting.

Which structure in the brain contains the appetite regulation center? 1. Thalamus. 2. Amygdala. 3. Hypothalamus. 4. Medulla.

1. The thalamus integrates all sensory input (except smell) on its way to the cortex and is involved with emotions and mood. It does not regulate appetite. 2. The amygdala is located in the temporal lobe of the brain and may play a major role in memory processing and "learned fear." It does not regulate appetite. 3. The hypothalamus exerts control over the actions of the autonomic nervous system and regulates appetite and temperature. 4. The medulla of the brain contains vital centers that regulate heart rate; blood pressure; respiration; and reflex centers for swallowing, sneezing, coughing, and vomiting. It does not regulate appetite. TEST-TAKING HINT: The test taker must be familiar with the structure and function of the various areas of the brain to recognize the hypothalamus as the appetite regulation center.

Which of the following diagnostic criteria describe the characteristics of borderline personality disorder? Select all that apply. 1. Arrogant, haughty behaviors or attitudes. 2. Frantic efforts to avoid real or imagined abandonment. 3. Recurrent suicidal and self-mutilating behaviors. 4. Unrealistic preoccupation with fears of being left to take care of self. 5. Chronic feelings of emptiness.

1. This criterion describes narcissistic, not borderline, personality disorder, which is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), a need for admiration, and a lack of empathy for others. 2. This criterion describes borderline personality disorder, which is characterized by a pervasive pattern of instability of interpersonal relationships. Having real or imagined feelings of abandonment is the first criterion of this disorder. 3. Recurrent suicidal and self-mutilating behavior is a diagnostic criterion that describes borderline personality disorder. 4. This criterion describes dependent, not borderline, personality disorder, which is characterized by a pervasive and excessive need to be cared for, leading to submissive and clinging behavior. 5. Having chronic feelings of emptiness is a diagnostic criterion that describes borderline personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that all four disorders in cluster B may have many characteristics that overlap; however, each cluster has at least one defining characteristic. In the case of borderline personality, feelings of abandonment, self-mutilating behavior, and feelings of emptiness are the key components of this disorder.

A client diagnosed with paranoid personality disorder needs information regarding medications. Which nursing intervention would best assist this client in understanding prescribed medications? 1. Ask the client to join the medication education group. 2. Provide one-on-one teaching in the client's room. 3. During rounds, have the physician ask if the client has any questions. 4. Let the client read the medication information handout.

1. When a client is diagnosed with paranoid personality disorder, the client may have difficulty participating in a group activity and may miss important information regarding medications. 2. When a client is diagnosed with paranoid personality disorder, one-on-one teaching in a client's room would decrease the client's paranoia, support a trusting relationship, and allow the client to ask questions. The nurse also would be able to evaluate the effectiveness of medication teaching. 3. When a client is diagnosed with paranoid personality disorder, the client may feel uncomfortable asking questions during rounds, and the client may miss important information about the prescribed medications. 4. Although it may be a good idea to give a client diagnosed with paranoid personality disorder written material to refer to, if the nurse does not encourage a trusting relationship by one-on-one teaching, the client may not feel comfortable asking questions. The client may miss important information, and the nurse would not have any way of noting if the teaching was effective. TEST-TAKING HINT: The test taker must review important information regarding dealing with clients exhibiting paranoia and understand the interventions that the nurse may use to assist in building a successful and therapeutic nurse-client relationship.

Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. 1. The client participates in individual therapy. 2. The client has a BMI of 16. 3. The client consumes adequate calories as determined by the dietitian. 4. The client is dependent on his or her mother for most basic needs. 5. The client states, "I realize that I can't be perfect."

1. Willingness to participate in individual therapy is an indication that this client meets discharge criteria. Individual therapy encourages the client to explore unresolved conflicts and to recognize maladaptive eating behaviors as defense mechanisms used to ease emotional pain. 2. The BMI for normal weight is 20 to 25. Because this client's BMI is lower than the normal range, consideration for discharge may be inappropriate at this time. 3. It is significant when a client diagnosed with anorexia nervosa consumes adequate calories to maintain metabolic needs. This assessment information would indicate that the client should be considered for discharge. 4. Families of clients diagnosed with anorexia nervosa often consist of a passive father, a domineering mother, and an overly dependent child. This client's continued dependence on the mother may indicate that consideration for discharge is inappropriate at this time. 5. A high value is placed on perfectionism in families of clients diagnosed with anorexia nervosa. These clients feel that they must satisfy these unrealistic standards, and when this is found to be impossible, helplessness results. Because this client shows insight into this problem by the recognition that perfection is impossible, consideration for discharge is appropriate. TEST-TAKING HINT: To answer this question correctly, the test taker must have an understanding of the basic problems underlying the diagnosis of anorexia nervosa. Remembering the BMI value for normal weight eliminates answer 2.

A nursing student is studying the historical aspects of personality disorder. Which entry on the examination indicates that learning has occurred? 1. Zeus, in the 3rd century B.C.E., identified, described, and applied the theory of object relations. 2. Hippocrates, in the 4th century B.C.E., identified four fundamental personality styles. 3. Narcissus, in 923 C.E, introduced the word personality from the Greek term "persona." 4. Achilles, in 866 C.E., described the pathology of personality as a complex behavioral phenomenon.

1. Zeus did not play a part in the historical aspects of personality disorders. He was a figure of Greek mythology, the chief deity, and son of Cronus and Rhea. In 1975, Mahler, Pine, and Berman developed the theory of object relations, which deals with infants passing through six phases from birth to 36 months, when a sense of separateness from the parenting figure is finally established. 2. In the 4th century B.C., Hippocrates, also known as the father of medicine, identified four fundamental personality styles that he concluded stemmed from excesses in the four humors: the irritable and hostile choleric (yellow bile), the pessimistic melancholic (black bile), the overly optimistic and extroverted sanguine (blood), and the apathetic phlegmatic (phlegm). 3. Although the word personality is from the Greek term "persona," Narcissus cannot be credited with this introduction. Narcissus, according to Greek mythology, was a beautiful youth who, after Echo's death, was made to pine away for the love of his own reflection while gazing into spring water. The roots for narcissistic personality disorder can be traced back to this well-known Greek myth. 4. Achilles did not play a part in the historical aspects of personality disorders. He was a mythical Greek warrior and leader in the Trojan War. TEST-TAKING HINT: To answer this question correctly, the test taker must study the historical aspects of personality disorders and understand how Hippocrates described the concept of personality.

A client tells the nurse, "When I was a waiter I used to spit in the dinners of annoying customers." This statement would be associated with which personality trait? 1. Paranoid personality trait. 2. Schizoid personality trait. 3. Passive-aggressive personality trait. 4. Antisocial personality trait.

A personality trait is an enduring pattern of perceiving, relating to, and thinking about the environment and oneself that is exhibited in a wide range of social and personal contexts. Personality disorders occur when these traits become inflexible and maladaptive and cause either significant functional impairment or subjective distress. 1. Clients exhibiting paranoid personality traits are characterized by a pervasive and unwarranted suspiciousness and mistrust of people. These characteristics are not reflected in the question. 2. Clients exhibiting schizoid personality traits are characterized by an inability to form close, personal relationships. These characteristics are not reflected in the question. 3. Clients exhibiting passive-aggressive personality traits are characterized by a passive resistance to demands for adequate performance in occupational and social functioning. The client in the question is demonstrating passive-aggressive traits toward customers that he or she finds annoying. 4. Clients exhibiting antisocial personality traits are characterized by a pattern of socially irresponsible, exploitive, and guiltless behaviors. These characteristics are not reflected in the question. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the behaviors noted in the question with the correct personality trait.

The nurse is assessing a client diagnosed with borderline personality disorder. According to Mahler's theory of object relations, which describes the client's unmet developmental need? 1. The need for survival and comfort. 2. The need for awareness of an external source for fulfillment. 3. The need for awareness of separateness of self. 4. The need for internalization of a sustained image of a love object/person.

According to Mahler's theory of object relations, the infant passes through six phases from birth to 36 months. If the infant is successful, a sense of separateness from the parenting figure is established. 1. Phase 1 (birth to 1 month) is the normal autism phase of Mahler's development theory. The main task of this phase is survival and comfort. According to Mahler's theory, fixation in this phase may predispose the child to autistic spectrum disorders. 2. Phase 2 (1 to 5 months) is the symbiosis phase. The main task of this phase is the development of the awareness of an external source of need fulfillment. According to Mahler's theory, fixation in this phase may predispose the child to adolescent or adult-onset psychotic disorders. 3. Phase 3 (5 to 36 months) is the separation-individuation phase. The main task of this phase is the primary recognition of separateness from the mother figure. According to Mahler's theory, fixation in this phase may predispose the child to borderline personality. 4. Consolidation is the third subcategory of the separation-individuation phase. With the achievement of consolidation, the child is able to internalize a sustained image of the mothering figure as enduring and loving. The child also is able to maintain the perception of the mother as a separate person in the outside world, leading to successful personality development. TEST-TAKING HINT: The test taker first must understand Mahler's theory of object relations and then recognize that clients diagnosed with borderline personality disorder have deficits during the separation-individuation phase.

A client with cachexia states, "I don't care what you say; I am horribly fat and will continue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? 1. Ineffective denial. 2. Imbalanced nutrition: less than body requirements. 3. Disturbed body image. 4. Ineffective coping.

Cachexia is a state of ill health, malnutrition, and wasting. 1. When clients diagnosed with eating disorders are unable to admit the effect of maladaptive eating behaviors on life patterns, they are experiencing ineffective denial. This is a valid nursing diagnosis for this client because there is an inability to admit emaciation. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. 2. The immediate and priority problem that this client faces is imbalanced nutrition: less than body requirements. Impaired nutrition causes complications of emaciation, dehydration, and electrolyte imbalance that can lead to death. When the physical condition is no longer life threatening, other problems may be addressed. 3. When emaciated clients diagnosed with eating disorders are negative about their appearance and see themselves as overweight, they are experiencing disturbed body image. This is a valid nursing diagnosis for this client because the client views the body as "horribly fat" when in reality the client is critically thin. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. 4. Clients diagnosed with eating disorders cope ineffectively with stress and anxiety by maladaptive eating patterns. This is a valid nursing diagnosis because this client is choosing not to eat to deal with unconscious stressors. This diagnosis should be considered, however, only after resolution of life-threatening nutritional status. TEST-TAKING HINT: To answer this question correctly, the test taker first must understand the terms used in the question, such as cachexia. Physiological needs must take priority over psychological needs. If physiological needs are not addressed, the client is at risk for life-threatening complications.

A client diagnosed with bulimia nervosa has responded well to citalopram. Which is the possible cause for this response? 1. There is an association between bulimia nervosa and dilated blood vessels and inactive alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitter dopamine. 3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. 4. There is an association between bulimia nervosa and a malfunction of the thalamus.

Citalopram is a selective serotonin reuptake inhibitor (SSRI) and affects the neurotransmitter serotonin. 1. Vascular headaches, not bulimia nervosa, are caused by dilated blood vessels in the brain. Drugs such as ergotamine are used to treat vascular headaches by stimulating alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine, not dopamine. 3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. Because citalopram is an SSRI, it would be useful in the treatment of bulimia nervosa and responsible for a positive client response. 4. There is an association between bulimia nervosa and a malfunction of the hypothalamus, not thalamus. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize citalopram as an SSRI.

A nurse encourages an angry client to attend group therapy. Knowing that the client has been diagnosed with a cluster B personality disorder, which client response might the nurse expect? 1. Sarcastically states, "That group is only for crazy people with problems." 2. Scornfully states, "No, can't you see that I'm having a séance with my mom?" 3. Suspiciously states, "No, that room has been bugged." 4. Hesitantly states, "OK, but only if I can sit next to you."

Clients diagnosed with a cluster B personality disorder do not believe that they have any problems and frequently blame others for their behaviors. 1. In the question, the client's statement would represent a typical response from someone who was diagnosed with an antisocial personality disorder. These clients also display patterns of socially irresponsible, exploitive, and guiltless behaviors that reflect a disregard for the rights of others. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with cluster B personality disorders exhibit behaviors that are dramatic, emotional, or erratic. 2. This client statement would represent a typical response from a client diagnosed with schizotypal personality disorder. These clients also are characterized by peculiarities of ideation with odd and eccentric behaviors. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. 3. This client statement would represent a typical response from a client diagnosed with paranoid personality disorder. These clients are characterized by a pervasive and unwarranted suspiciousness and mistrust of people, as portrayed in the question. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. 4. This client statement would represent a typical response from a client diagnosed with dependent personality disorder. These clients are characterized by the inability to function independently and by allowing others to assume responsibility for major areas of life. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the behaviors noted in the question with the appropriate personality disorder. If the test taker understands that clients diagnosed with a cluster A disorder may have suspicious behaviors, answer 3 can be eliminated immediately.

The nurse is assessing a client with a body mass index (BMI) of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. 1. Hypoglycemia. 2. Rheumatoid arthritis. 3. Angina. 4. Respiratory insufficiency. 5. Hyperlipidemia.

Clients with a body mass index (BMI) of 30 or greater are classified as obese. It is important to learn the complications of obesity because, based on World Health Organization (WHO) guidelines, half of all Americans are obese. 1. Obese clients commonly have hyperglycemia, not hypoglycemia, and are at risk for developing diabetes mellitus. 2. Osteoarthritis, not rheumatoid arthritis, results from trauma to weight-bearing joints and is commonly seen in obese clients. 3. Workload on the heart is increased in obese clients, often leading to symptoms of angina. 4. Workload on the lungs is increased in obese clients, often leading to symptoms of respiratory insufficiency. 5. Due to intake of increased amounts of fatty foods, obese clients often present with hyperlipidemia, particularly elevated triglyceride and cholesterol levels. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize that this client is obese as reflected by the BMI mentioned in the question.

A client, diagnosed with an eating disorder, asks the nurse about medications to help with food cravings. The nurse should provide information on which of the following medications? Select all that apply. 1. Bupropion-naltrexone. 2. Lorcaserin. 3. Orlistat. 4. Phentermine-topiramate. 5. Liraglutide.

Clients, diagnosed with eating disorders, may be prescribed various medications to control symptoms. Nurses need to be aware of newly developed medications in order to provide clients with accurate information. 1. Brupropion-naltrexone is believed to work in two areas of the brain, the hunger center and reward system. This medication could be prescribed for this client, and the nurse should provide appropriate medication information. 2. Lorcaserin works by controlling appetite, specifically by activating brain receptors for serotonin, a neurotransmitter that triggers feelings of fullness and satisfaction. This medication could be prescribed for this client, and the nurse should provide appropriate medication information. 3. Orlistat is a gastrointestinal lipase inhibitor for obesity management that acts by inhibiting the absorption of dietary fats. This medication would not be prescribed for this client. 4. Phentermine-topiramate affects the neurotransmitter gamma-aminobutyric acid (GABA), suppressing appetite and enhancing fullness. This medication could be prescribed for this client, and the nurse should provide appropriate medication information. 5. Liraglutide is an injectable medication that mirrors a hormone the body produces naturally that regulates appetite, known as glucagon-like peptide-1 (GLP-1). By activating areas of the brain that regulate appetite, liraglutide reduces hunger. It is prescribed for clients with excess weight (BMI >27) who also have weight-related medical problems. This medication could be prescribed for this client, if they meet the other requirements listed above. If liraglutide is prescribed, the nurse should provide appropriate medication information. TEST-TAKING HINT: In order to answer this question correctly, the test taker must first understand the mechanism of action for each medication listed. The nurse would only provide information regarding medications appropriate to address food cravings. Answer 3, orlistat, addresses weight loss by inhibiting the absorption of dietary fats, not decreasing cravings for food.

The family of a client diagnosed with anorexia nervosa has cancelled the past two family counseling sessions. Which of the following could be reasons for this nonadherence? Select all that apply. 1. The family is fearful of the social stigma of having a family member with emotional problems. 2. The family is dealing with feelings of guilt because of the perception that they have contributed to the disorder. 3. There may be a pattern of conflict avoidance, and the family fears conflict would surface in the sessions. 4. The family may be attempting to maintain family equilibrium by keeping the client in the sick role. 5. The client is now maintaining adequate nutrition, and the sessions are no longer necessary.

Eating disorders are considered "family" disorders, and resolution of the disease cannot be achieved until dynamics within the family have improved. 1. Support is given through family counseling as families deal with the existing social stigma of having a family member with emotional problems. This stigma also may discourage adherence with therapies, as the family copes with the stress by denying the illness. 2. Families who are experiencing feelings of guilt associated with the perception that they have contributed to the onset of the disorder may avoid dealing with this guilt by being nonadherent with family therapy. 3. Dysfunctional family dynamics may lead the family to avoid conflict by avoiding highly charged family sessions. 4. Dysfunctional family systems often focus conflicts and stress on a scapegoat family member. These families balance their family system by maintaining this member in a dependent, sick role. Because of disruption in the dysfunctional family system, there is little interest shown in changing the role of this "sick" member. 5. Anorexia nervosa is a disease that requires long-term treatment for successful change to occur. It would be improbable that the client would begin eating spontaneously, maintain adequate nutrition, and no longer require treatment. TEST-TAKING HINT: To select the correct answer, the test taker must recognize the deterrents to active participation in family therapy. It is vital to understand these deterrents to be able to encourage effective adherence with family therapy.

A client diagnosed with borderline personality disorder coyly requests diazepam. When the physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using? 1. Undoing. 2. Splitting. 3. Altruism. 4. Reaction formation.

Ego defenses are either adaptive or pathological. They can be grouped into the following four categories: mature defenses, neurotic defenses, immature defenses, and psychotic defenses. 1. The defense mechanism of undoing is the symbolic negation or cancellation of thoughts or experiences that one finds intolerable. The only thing that the manipulative client in the question finds intolerable is the physician who refuses to give the requested drug. 2. The client in the question is using the defense mechanism of splitting. An individual diagnosed with borderline personality disorder sees things as either "all good" or "all bad." In the question, when the client's manipulative charm does not work in obtaining the drug from the "good" physician, the client determines that the physician is now "bad" and seeks another physician to meet his or her needs. 3. The defense mechanism of altruism is considered a mature defense and is used when emotional conflicts and stressors are dealt with by meeting the needs of others. The client in the question is meeting no one else's needs but his or her own. 4. The defense mechanism of reaction formation prevents unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating the opposite thoughts or types of behaviors. The client in the question does not perceive his or her thoughts or behaviors as either unacceptable or problematic and is not exaggerating the opposite behavior. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize the behavior in the question as pathological. In understanding this, the test taker can eliminate answer 3 immediately

Irresponsible, guiltless behavior is to a client diagnosed with cluster B personality disorder as avoidant, dependent behavior is to a client diagnosed with a: 1. Cluster A personality disorder. 2. Cluster B personality disorder. 3. Cluster C personality disorder. 4. Cluster D personality disorder.

Irresponsible and guiltless behavior is a characteristic of an individual diagnosed with an antisocial personality disorder, which is grouped in the cluster B classification. 1. Cluster A categorizes behaviors that are odd or eccentric, and it comprises the following disorders: (1) paranoid personality disorder, which is characterized by a pervasive and unwarranted suspiciousness and mistrust of people; (2) schizoid personality disorder, which is characterized by an inability to form close, personal relationships; and (3) schizotypal personality disorder, which is characterized by peculiarities of ideation, appearance, behavior, and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. 2. Cluster B categorizes behaviors that are dramatic, emotional, or erratic, and it comprises the following disorders: (1) antisocial personality disorder, which is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior; (2) borderline personality disorder, which is characterized by a marked instability in interpersonal relationships, mood, and self-image; (3) histrionic personality disorder, which is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior; and (4) narcissistic personality disorder, which is characterized by a constant need for attention; a grandiose sense of self-importance; and preoccupations with fantasies of success, power, brilliance, and beauty. 3. Cluster C categorizes behaviors that are anxious or fearful, and it comprises the following disorders: (1) avoidant personality disorder, which is characterized by social withdrawal brought about by extreme sensitivity to rejection; (2) dependent personality disorder, which is characterized by allowing others to assume responsibility for major areas of life because of one's inability to function independently; and (3) obsessive-compulsive personality disorder, which is characterized by a pervasive pattern of perfectionism and inflexibility. 4. There is n o Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) cluster D classification. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that there are three clusters of personality disorders, A, B, and C. This eliminates answer 4 immediately.

A client diagnosed with dependent personality disorder has a nursing diagnosis of altered sleep pattern R/T impending divorce. The client is prescribed oxazepam prn. Which is an appropriate correctly written outcome for this nursing diagnosis? 1. The client verbalizes a decrease in tension and racing thoughts. 2. The client expresses understanding about the medication side effects by day two. 3. The client sleeps 4 to 6 hours a night by day three. 4. The client notifies the nurse when the medication is needed.

Oxazepam is a benzodiazepine used in the treatment of anxiety disorders. 1. There is no time frame on this outcome; therefore, it is incorrectly written. 2. This outcome would be appropriate for the nursing diagnosis of knowledge deficit, not altered sleep pattern. 3. This outcome relates directly to the stated nursing diagnosis (altered sleep pattern), is measurable (sleeps 4 to 6 hours a night) and has a time frame (by day three). 4. There is no time frame included in this outcome; therefore, it is not measurable. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize the appropriate outcome as it relates to the stated nursing diagnosis and must also note that outcomes must be client specific, attainable, positive, and measurable and include a time frame

The nurse is teaching about factors that influence eating patterns. Which of the following statements indicate that learning has occurred? Select all that apply. 1. "Factors such as taste and texture can affect appetite." 2. "The function of my digestive organs affects my eating behaviors." 3. "High socioeconomic status determines nutritious eating patterns." 4. "Social interaction contributes little to eating patterns." 5. "Society and culture influence eating patterns."

Providing a social setting can improve eating patterns, whereas societal pressures may be detrimental. 1. Environmental factors, such as taste, texture, temperature, and stress, can affect eating behaviors. 2. The function of the gastrointestinal tract affects eating behaviors and appetite. Physiological variables include the balance of neuropeptides and neurotransmitters, metabolic rate, the structure and function of the gastrointestinal tract, and the ability to taste and smell. 3. A high socioeconomic status does not determine healthy eating patterns. Many people in affluent cultures in the United States and all over the world have poor nutritional status because of poor eating choices. 4. Social interactions do contribute to eating patterns. Eating is a social activity. Most special events revolve around the presence of food. Providing a social setting can improve appetite and eating behaviors. 5. Society and culture have a great deal of influence on eating behaviors and perceptions of ideal weight. Eating patterns are developed based on attempts to meet these societal norms. TEST-TAKING HINT: The test taker must recognize the impact of the social activity of eating and the effect society has on eating patterns to answer this question correctly.

Eating Disorders

Questions 46-75

A client diagnosed with paranoid personality disorder is prescribed risperidone. The client is noted to have restlessness and weakness in the lower extremities and is drooling. Which nursing intervention would be most important? 1. Hold the next dose of risperidone and document the findings. 2. Monitor vital signs and encourage the client to rest in his or her room. 3. Give the ordered prn dose of trihexyphenidyl. 4. Get a fasting blood sugar measurement because of potential hyperglycemia.

Risperidone is an atypical antipsychotic medication used in the treatment of paranoia. Restlessness, weakness in lower extremities, and drooling are extrapyramidal symptoms (EPS) caused by antipsychotic medications. 1. It is unnecessary to hold the next dose of risperidone because the symptoms noted are not life threatening and can be corrected using an anticholinergic medication, such as trihexyphenidyl. 2. The client in the question is experiencing EPS. Having EPS would not alter the client's vital signs. 3. The symptoms noted are EPS caused by antipsychotic medications. These can be corrected by using anticholinergic medications, such as trihexyphenidyl, benztropine, or diphenhydramine. 4. Although antipsychotic medications can cause hyperglycemia, the symptoms noted in the question are not related to hyperglycemia. TEST-TAKING HINT: To answer this question correctly, the test taker must review the various side effects of antipsychotic medications and the interventions that address these side effects.

A male client diagnosed with a personality disorder boasts to the nurse that he has to fight off female attention and is the highest paid in his company. These statements are reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Avoidant personality disorder. 3. Schizotypal personality disorder. 4. Narcissistic personality disorder.

The concept of narcissism has its roots in Greek mythology, where Narcissus drowns himself after falling in love with his watery reflection. It is estimated that this disorder occurs in 2% to 16% of the clinical population and less than 1% of the general population. It is diagnosed more often in men than in women. 1. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. Clients diagnosed with obsessive-compulsive personality disorder are characterized by difficulty in expressing emotions, along with a pervasive pattern of perfectionism and inflexibility. Nowhere in the stem does it mention that the client is perfectionistic or inflexible. 2. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. Clients diagnosed with avoidant personality disorder are characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. 3. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizotypal personality disorder are characterized by peculiarities of ideation, appearance, and behavior and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. Nowhere in the question does this client demonstrate schizotypal behaviors. 4. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with narcissistic personality disorder are characterized by a constant need for attention, a grandiose sense of self-importance, and preoccupations with fantasies of success, power, brilliance, and beauty, all of which this client is displaying. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the behaviors noted in the question to the appropriate personality disorder.

A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity R/T unmet dependency needs AEB the inability to be alone. Which nursing intervention would be appropriate? 1. Ask the client directly, "Have you thought about killing yourself?" 2. Maintain a low level of stimuli in the client's environment. 3. Frequently orient the client to reality and surroundings. 4. Help the client identify values and beliefs.

The definition of the nursing diagnosis of disturbed personal identity is the inability to distinguish between self and others. 1. This intervention addresses suicidal behavior, but nothing in the question suggests that this client is suicidal. 2. This intervention decreases agitation and aggressive behavior, but nothing in the question suggests that this client needs this type of intervention. 3. Presenting reality is a necessary intervention when a client is experiencing a thought process problem, but nothing in the question suggests that this client needs this type of intervention. 4. This client has been diagnosed with borderline personality disorder resulting from fixation in an earlier developmental level. This disruption during the establishment of the client's value system has led to disturbed personal identity. When the nurse helps the client to identify internalized values, beliefs, and attitudes, the client begins to distinguish personal identity. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the appropriate nursing intervention with the stated nursing diagnosis.

A client diagnosed with an avoidant personality disorder has the nursing diagnosis of social isolation R/T severe malformation of the spine AEB "I can't be around people, looking like this." Which correctly written, short-term outcome is appropriate for this client's problem? 1. The client will see self as straight and tall by the time of discharge. 2. The client will see self as valuable after attending assertiveness training courses. 3. The client will be able to participate in one therapy group by end of shift. 4. The client will join in a charade game to decrease social isolation.

The hallmark of a client diagnosed with avoidant personality disorder is social isolation. The cause of social isolation in these clients is the fear of criticism and rejection. 1. This is an idealistic, but unrealistic, outcome. The client has a deformity that needs to be dealt with realistically. There is nothing deformed about the client's mind, character, principles, or value system. It is up to the nurse to explore the client's strengths and develop, through a plan of care, the client's positive, rather than negative, attributes. 2. Seeing self as valuable is a positive step in increasing self-esteem and self-worth; however, it does not relate to the nursing diagnosis of social isolation. Also, the completion of the course most likely would extend beyond discharge, and positive results would be considered a long-term, not short-term, outcome. 3. This short-term outcome is stated in observable and measurable terms. This outcome sets a specific time for achievement (by end of shift). It is short and specific (one therapy group), and it is written in positive terms, all of which should contribute to the final goal of the client having increased social interaction. 4. This is not a measurable outcome because it does not include a time frame and therefore can be eliminated. TEST-TAKING HINT: To answer this question correctly, the test taker must look for an outcome that has a time frame and is positive, realistic, measurable, and client centered.

Structures of the brain impact eating disorders. Identify the following structures of the brain on the provided diagram. 1. _____ Thalamus. 2. _____ Amygdala. 3. _____ Hypothalamus. 4. _____ Hippocampus.

The labeling sequence is 1, 3, 2, 4. 1. The thalamus is labeled as "1" on the diagram of the brain. This structure of the brain integrates all sensory input except smell. The thalamus also is involved in emotions and mood. 2. The amygdala is labeled as "3" on the diagram of the brain. This structure of the brain, located in the anterior portion of the temporal lobe, plays an important role in arousal. 3. The hypothalamus is labeled as "2" on the diagram of the brain. This structure of the brain regulates the anterior and posterior lobes of the pituitary gland, controls the auditory nervous system, and regulates appetite and temperature. 4. The hippocampus is labeled as "4" on the diagram of the brain. This structure of the brain is part of the limbic system, which is associated with fear and anxiety, anger and aggression, love, joy, hope, sexuality, and social behavior. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the location of various structures of the brain.

A client diagnosed with anorexia nervosa is admitted with dehydration. An IV of D5W is ordered to run at 150 mL/hr. Using tubing that delivers 15 gtt/mL, the nurse should adjust the rate of flow to _____ gtt/min.

The nurse should adjust the rate of flow to 38 gtts/min. TEST-TAKING HINT: When calculating drip rates, the test taker must remember that there is no such thing as a half-drop, and drip rates must be rounded to the nearest whole number. Newer electronic pumps may accept less than whole-number calculations.

A 15-year-old client living in a residential facility has a nursing diagnosis of ineffective coping R/T abuse AEB defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply. 1. Set limits on manipulative behavior. 2. Refuse to engage in controversial and argumentative encounters. 3. Obtain an order for tranquilizing medications. 4. Encourage the discussion of angry feelings. 5. Remove all dangerous objects from the client's environment.

The nursing diagnosis of ineffective coping is defined as the inability to form a valid appraisal of stressors, inadequate choices of practiced responses, or inability to use available resources. 1. Setting limits on manipulative behaviors is an appropriate intervention to discourage dysfunctional coping, such as oppositional and defiant behaviors. It is important to convey to the client that inappropriate behaviors are not tolerated. 2. By refusing to engage in debate, argument, rationalization, or bargaining with a client, the nurse has intervened effectively to decrease manipulative behaviors and has decreased the opportunity for oppositional and defiant behaviors. 3. Tranquilizing medications may have a calming effect; however, nothing in the question indicates the client is agitated or anxious. Tranquilizing medications are considered a chemical restraint and would be used only when all other, less-restrictive measures have been attempted. 4. Dealing with feelings honestly and directly discourages ineffective coping. The client may cope with anger inappropriately by displacing this anger onto others. 5. When a client is a danger to self or others, ensuring safety in the environment is a priority. However, nothing in the question indicates any need for this intervention. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize interventions that directly affect defiant behaviors.

A client is being admitted to the inpatient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? 1. 5 to 10 years old. 2. 10 to 14 years old. 3. 18 to 22 years old. 4. 40 to 45 years old.

The onset of bulimia nervosa commonly occurs in late adolescence or early adulthood. Bulimia nervosa is more prevalent than anorexia nervosa. Research suggests that bulimia occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and in which an abundance of food is available. 1. These ages are not within the range of late adolescence to early adulthood. 2. These ages are not within the range of late adolescence to early adulthood. Age 14 would be considered early, not late, adolescence. 3. These ages are within the range of late adolescence to early adulthood, in which the onset of bulimia nervosa commonly occurs. 4. These ages are not within the range of late adolescence to early adulthood. Age 40 falls in the category of late, not early, adulthood. TEST-TAKING HINT: The test taker must recognize the age ranges for onset of bulimia nervosa to answer this question correctly.

A client has been diagnosed with a cluster A personality disorder. Which of the following client statements would reflect cluster A characteristics? Select all that apply. 1. "I'm the best chef on the East Coast." 2. "My dinner has been poisoned." 3. "I have to wash my hands 10 times before eating." 4. "I just can't eat when I'm alone." 5. "When my mom died, her spirit entered my cat."

This statement might be voiced by a client diagnosed with narcissistic personality disorder. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. This cluster's characteristic behaviors are dramatic, emotional, or erratic. 2. This statement might be voiced by a client diagnosed with paranoid personality disorder. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. This cluster's characteristic behaviors are odd or eccentric and include patterns of suspiciousness and mistrust. 3. This statement might be voiced by a client diagnosed with obsessive-compulsive personality disorder. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. This cluster's characteristic behaviors are anxious and fearful. 4. This statement might be voiced by a client diagnosed with dependent personality disorder. Cluster C includes dependent, avoidant, and obsessive-compulsive personality disorders. This cluster's characteristic behaviors are anxious and fearful. 5. This statement might be voiced by a client diagnosed with schizotypal personality disorder. This cluster's characteristic behaviors are odd or eccentric and include patterns of suspiciousness and mistrust. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the cluster noted in the question with the appropriate client statement.