NG308 EAQ's

D (The elated client expends a great deal of energy; dehydration, oxygen deficit, cardiac problems, and death may occur. The elated person does not withdraw from reality but continues to run headfirst into reality. The elated client has little difficulty verbalizing needs. The elated client usually does not take time to eat while expending a great deal of energy, so weight loss is the problem.)

For a client who is demonstrating manic behavior, which behavior is the most important to monitor? A. Withdrawal can lead to social isolation. B. Speech patterns may inhibit verbalizing needs. C. Overeating can result in weight gain. D. Excessive activity may cause exhaustion.

A (Behaviors that reflect acceptance and consistency are the best approaches to overcoming these client expectations. What the nurse does is a better indicator of acceptance than an explanation. The nurse's actions over time are better indicators of acceptance than verbal reassurance. Confrontational measures increase anxiety.)

Addicted clients commonly expect discrimination and lack of empathy from others. Which intervention would the nurse use to overcome these expectations? A. Demonstrate a nonjudgmental attitude. B. Explain that an addiction is a disease. C. Offer reassurance that the client is accepted. D. Confront these attitudes when they are expressed.

A (The focus should be on the immediate situation and any issues that affect safety. If the client is unsafe, then the client is given specific directions, such as to call 911 or leave a dangerous scene. The client's perception of the event, ability to control the situation, and methods of coping are assessed once safety is ensured.)

At 4 AM a client calls the crisis hotline. Which assessment is the priority? A. Current issues affecting safety B. Perception of the crisis event C. Inability to control the situation D. Methods used for crisis resolution

C (Amenorrhea (cessation of menses) results from endocrine imbalances that occur when fat stores are depleted. Galactorrhea is a milky discharge from the nipples that is not related to normal breast milk production. Gynecomastia is a swelling of the breast tissue in males. Premenstrual dysphoric disorder occurs about 1 week before menses and includes mood swings, depression, fatigue, bloating, overeating, and difficulty focusing. These symptoms resolve when menstruation starts.)

Which dysfunction of the reproductive system is associated with anorexia nervosa in females? A. Galactorrhea B. Gynecomastia C. Amenorrhea D. Premenstrual dysphoric disorder

a (During the first stage of alcohol detoxification, nausea, anorexia, irritability, tachycardia, and hypertension are expected.)

Which common clinical manifestation is expected during the initial stage of alcohol detoxification? A. Nausea B. Euphoria C. Bradycardia D. Hypotension

A (An illusion is a misperception of an actual stimulus. A delusion is a fixed false belief that is unrelated to an external stimulus. Dissociation is a disturbance in the integrative functions of the client. A hallucination is a false perception with no actual external stimulus.)

A client says, "It sounds like there is a roaring fire in the bathroom!" In reality, the client's roommate has just turned on the shower. Which term describes this experience? A. Illusion B. Delusion C. Dissociation D. Hallucination

D (The client's exact adherence to the compulsive ritual relieves anxiety, at least temporarily. The compulsive act is useful, and the person cannot stop the activity. Compulsive rituals are manifestations of rigidity and inflexibility, which are features of the disorder. Depression is often a comorbidity, but rituals do not relieve depression.)

For a client with an obsessive-compulsive personality disorder, which purpose is served by ritualistic behavior? A. The rituals are useless but uncontrollable. B. Rituals lessens rigidity and inflexibility. C. Ritualistic behavior decreases depression. D. The rituals temporarily relieve anxiety.

C (Depressed clients demonstrate decreased social interaction because of a lack of psychic or physical energy. They tend to withdraw, speak in monosyllables, and avoid contact with others. Loss of faith and visual hallucinations can occur but are less commonly associated with major depression. Hallucinations are typically associated with schizophrenic disorders. Loss of family support can occur because of client withdrawal, but many family members will remain hopeful and supportive.)

For a client with the diagnosis of major depression, which problem is the most common? A. Loss of faith in God B. Visual hallucinations C. Decreased social interaction D. Loss of family support

D (Autistic behavior turns inward. Autistic children do not respond to the environment; instead, they attempt to maintain emotional equilibrium by rubbing and manipulating themselves, and they display a compulsive need for behavioral repetition. Autistic children do seem to respond to music, but not necessarily loud, cheerful music. Large-group (or small-group) activities have little effect on the autistic child's response. Part of the autistic pattern is the inability to interact with others in the environment, regardless of the size of the group.)

Which activities would be best for an autistic child? A. Activities with loud, cheerful music B. Large-group activities C. Cooperative craft activities D. His or her own self-stimulating activities

D (The client's statement is self-derogatory and reflects a low self-appraisal. The client is not experiencing paranoia, persecution, or loss of control; he feels like he deserves what happened.)

A client who is extremely depressed after losing his job because of downsizing says, "I'm a useless, worthless person. No wonder I lost my job." Which feeling state is the client expressing? A. Paranoia B. Persecution C. Loss of control D. Self-deprecation

d (Rationalization is an unconscious defense mechanism whereby a person finds logical reasons for behavior or feelings while ignoring the real reasons, which are illogical or unacceptable. During denial, intolerable situations or events are not acknowledged. In projection, personal inadequacies are blamed on others. In identification, an individual assumes the characteristics, traits, posture, and achievements of another person or group.)

A person with a history of alcoholism says, "I've been drinking since last Friday to celebrate my son's graduation from college." Which defense mechanism is the person displaying? A. Denial B. Projection C. Identification D. Rationalization

c (Secondary reinforcers involve social approval; a hug meets this requirement. Food is a primary reinforcer and should not be associated with behavior modification. The child with cognitive impairment may not be capable of choosing an appropriate secondary reinforcer.)

To foster toilet training in a cognitively impaired child, which reward is best to reinforce appropriate use of the toilet? A. Candy bar B. Piece of fruit C. Hug with praise D. Choice of rewards

c (Impulsive, potentially self-damaging behaviors are typical of clients with this personality disorder. Arrogance is associated with a narcissistic personality disorder. Eccentric behavior is more typical of the client with a schizotypal personality disorder. Dependent behavior is associated with dependent personality disorder.)

Which behavior is most typical for clients with borderline personality disorder? A. Arrogant B. Eccentric C. Impulsive D. Dependent

a (The client can no longer control or tolerate these overwhelming feelings of panic and is seeking help. With suicidal thoughts, clients tend to be quiet and contemplative. Additional assessment would be needed to determine if the client is expressing suicidal tendencies. Clients who are in the manic phase usually do not want the feelings to stop. In dissociative disorders, clients are unable to connect an emotional trauma to an event; thus they may be unable to identify or articulate specific feelings.)

A client who is disheveled and agitated demands, "Do something to make these feelings stop!" Which clinical manifestation is the client most likely experiencing? A. Feelings of panic B. Suicidal tendencies C. Manic hyperactivity D. Generalized dissociation

d (Ineffective coping is the impairment of a person's adaptive behaviors and problem-solving abilities in meeting life's demands; ritualistic behavior is an impaired type of coping. Additional assessment would be needed to determine if the client has problems with personal identity, impulse control, or spatial boundaries.)

A client who uses ritualistic behavior taps other clients on the shoulders three times as part of the ritual. Which rationale best explains the client's behavior? A. Client demonstrates blurred personal identity B. Client has poor control of sudden urges C. Client has a disturbance in spatial boundaries D. Client has limited ability to adapt to stressors

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

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

c (Displacement is the unconscious redirection of an emotion from a threatening source to a nonthreatening source. Projection is the attribution of one's unacceptable feelings and thoughts to someone else. Regression is the return to an earlier, more comfortable level of behavior; it is a retreat from the present. Rationalization is the attempt to make unacceptable behavior or feelings acceptable by justifying the reasons for them.)

Compulsive behavior usually incorporates the use of which defense mechanism? a. Projection b. Regression c. Displacement d. Rationalization

a (The client has low self-esteem and reacts by using hostile behavior. People with borderline personality disorder often have identity disturbances. Reality testing and hallucinations are psychotic features that do not accompany personality disorders. Impaired verbal communication can be related to organic causes, such as stroke or dementia, or to thought disturbances, such as schizophrenia.)

For a client with the diagnosis of borderline personality disorder, which problem is most likely to underlie angry or hostile behavior? A. Low self-esteem B. Inability to test reality C. Reaction to command hallucination D. Ineffective verbal communication

B (The nurse would be alert for dehydration caused by fluid loss through vomiting in the binge-purge cycle. Weight gain is not expected because purging frequently follows a binge. Hyperactivity is not expected because many individuals with bulimia withdraw and vomit after a binge. Hyperglycemia is not expected because of the vomiting that follows a binge.)

For a client with the diagnosis of bulimia nervosa, purging type, which clinical manifestation would be monitored? A. Weight gain B. Dehydration C. Hyperactivity D. Hyperglycemia

b (Clients with somatic symptoms would be instructed to direct all requests to the case manager to reduce manipulation. Frequent, brief, and regular office visits are recommended for clients with somatic symptoms. It would be counterproductive to remind the client who is in charge of their care, as power struggles are not helpful. A physical examination would always be conducted. The nurse would never imply that a client's symptoms are not real; rather, the nurse would acknowledge that the psychogenic symptoms are real to the client. After physical complaints have been investigated, the nurse would avoid taking vital signs for each complaint because this further reinforces the somatization.)

Which action would the nurse implement for a client with somatic symptoms? Select all that apply. One, some, or all responses may be correct. A. Scheduling office visits once a year B. Having the client direct all requests to the case manager C. Reminding the client who is in charge of their care D. Conducting a physical examination only when necessary E. Explaining to the client that the symptoms are not real F. Taking vital signs each time client complains of symptoms

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

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

C (Successful resolution means being able to remember the good as well as the bad qualities of the deceased and accepting them as part of the deceased. Resolution involves working through feelings, not just accepting what occurred. Resolution does not mean forgetting; rather, it means realistically remembering the past. Focusing mainly on the good qualities of the person who died is an unhealthy response that may become pathological as a result of the unresolved feelings about the person's other qualities.)

Which behavior indicates that an individual has successfully completed the grieving process after the death of a significant other? A. Verbalizes an acceptance that death is inevitable B. Goes on with life and forgets the pain and the past C. Remembers the significant other realistically D. Focuses on the good qualities of the person who died

A (Lack of eye contact is a typical behavior associated with autism. Children with autism usually have a pervasive impairment of reciprocal social interaction. Crying for attention, rigidity, and parallel play are not indicative of autism.)

Which behavior would be typical for a child with autism? A. Lack of eye contact B. Crying for attention C. Catatonia-like rigidity D. Engaging in parallel play

C (Poor interpersonal relationships, inappropriate behavior, and learning disabilities prevent autistic children from emotionally adapting or responding to the environment even when the intelligence level is high. It is the lack of response to stimuli that is the clue that the child may have autism. Children with autism have an aversion to physical contact. Low level of intelligence is not a defining characteristic for autistic children.)

Which characteristic is commonly seen in children who have autism? A. Excessive response to any stimulus B. Normal response to physical contact C. Lacks response to the environment D. Limited response due to low intelligence

A (Denial is a method of resolving conflict or escaping unpleasant realities by ignoring their existence. The person denies that the drinking is out of control and causing problems. In projection the person faults another person for having unacceptable impulses, thoughts, or behaviors that are too uncomfortable to accept as one's own. In displacement the person transfers an emotion from one object, person, or situation to another (usually safer) object, person, or situation. In compensation, the person makes up for personal inadequacies by emphasizing attributes to gain social approval.)

Which defense mechanism is most commonly used by clients who are alcoholics? A. Denial B. Projection C. Displacement D. Compensation

d (Sedatives can cause drowsiness; therefore, clients would be advised not to take them before activities such as working or driving. Melatonin is a naturally occurring hormone that can be used to promote sleep. Watching television before bed and daytime napping may interfere with the sleep cycle, but these actions do not lead to injuries.)

Which information would the nurse provide to a client with insomnia to prevent injury? A. Use melatonin for sleep B. Watch television before bed. C. Refrain from daytime napping. D. Avoid sedative use before activities.

C (Focusing on progress and strategies to prevent a relapse helps reinforce the client's small gains and provides encouragement for the future. The nurse avoids judgmental statements that focus on negative aspects (previous failures, possible death, noncompliance).)

Which initial statement would the nurse use when a client with a history of alcoholism returns to a previously attended residential alcohol treatment program? A. "It's too bad that you failed. What could you do to make things better?" B. "You could die if you keep drinking. Nobody wants to see that happen." C. "You've made progress; let's focus on strategies to prevent a relapse." D. "The program won't work unless you comply with recommendations."

a (The nurse would attempt to support the mother-child relationship; the mother is experiencing a developmental crisis while coping with drug addiction and possibly guilt. It is the client's right to decide who will share in the care of her child. The client needs contact with her new infant to facilitate bonding. Linking the infant's symptoms to the drug intake will make the mother feel guilty and will not facilitate positive interaction.)

Which intervention would the nurse use in the care of a drug-dependent mother and infant? A. Support the mother's positive responses toward her infant. B. Request that family members share responsibility for infant care. C. Separate the infant from the mother until the mother is drug free. D. Explain the relationship of infant's symptoms to the mother's drug use.

A (The primary purpose for action when a client is anxious is the reduction of emotional tension and prevention of escalation of the anxiety. When tension is reduced, anxiety is diminished, and the person feels more comfortable, safe, and secure. When acting to reduce anxiety, the person does not deny its existence, but causation is not always known. If physical symptoms are occurring because of anxiety, reduction of the emotional component reduces the physical manifestations. Mild anxiety can enhance decision-making and problem-solving, but higher levels of anxiety interfere with those cognitive functions.)

Which primary purpose is served when an individual takes action to reduce anxiety? A. Reduction of tension B. Denial of the situation C. Avoidance of physical discomfort D. Resolution in decision-making

a (Alcohol causes both physical and psychological dependence; the individual needs and depends on the alcohol to function. Dependency and addiction override motivation and will. The theory that alcoholics have no other coping mechanism is a myth that often is associated with alcoholism; the individual needs to learn how to use other coping mechanisms more consistently and effectively. People with alcoholism commonly drink alone or feel alone in a crowd.)

Which rationale best explains how an addiction to alcohol occurs? A. Person eventually requires alcohol for functioning B. Person lacks the motivation or will to stop drinking C. Person has developed very few coping mechanisms D. Person enjoys the social aspects of drinking alcohol

b, e (Older clients who have dementia often have short-term memory loss. Clients in whom dementia is developing often have difficulty expressing themselves (expressive aphasia) or understanding the spoken word (receptive aphasia). Clients with the diagnosis of schizophrenia or depression are often indecisive and ambivalent. A client who is experiencing a manic episode of bipolar disorder experiences flight of ideas. Loose associations between thoughts are related to schizophrenia.)

Which signs and symptoms are characteristic of Alzheimer dementia? Select all that apply. One, some, or all responses may be correct. A. Ambivalence B. Forgetfulness C. Flight of ideas D. Loose associations E. Expressive aphasia

A (A self-help group would be an effective strategy. Members of self-help groups, particularly Alcoholics Anonymous, are living with the problem themselves; therefore, problem identification and self-responsibility are emphasized, and manipulation is limited. Psychoanalytical therapy is long-term and tends to increase anxiety until resolution occurs; level of commitment and duration of therapy render it a less desirable choice for substance abusers. Depending on the client's feelings about religion, talking with a religious advisor may or may not be helpful. Whether talking with an alcoholic friend will be useful depends on the friend's drinking status; it may be helpful or harmful. These variables negate the effectiveness of this choice.)

Which strategy would be effective for a client with alcohol use disorder who says, "Drinking is a way out of my depression"? A. A self-help group B. Psychoanalytical therapy C. A visit with a religious advisor D. Talking with an alcoholic friend

a (Research indicates that sneezing, yawning, and tearing are the first physical signs of withdrawal from heroin. Depression and irritability accompany withdrawal from cocaine. Restlessness, shakiness, hallucinations, and sometimes coma accompany withdrawal from morphine. Insomnia, seizures, weakness, sweating, and anxiety accompany withdrawal from phenobarbital.)

Which substance produces sneezing, yawning, and tearing of the eyes as withdrawal occurs? A. Heroin B. Cocaine C. Morphine D. Phenobarbital

B (The nurse would use the term compulsion. A compulsion is an uncontrollable, persistent urge to perform an act repetitively to relieve anxiety. An obsession is a persistent idea, thought, or impulse that cannot be eliminated from the consciousness with logical reasoning. The urge to perform a compulsive act is not under the client's personal control because avoiding the act increases anxiety; it is a defense mechanism. Clients are compelled to perform these ritualistic behaviors to decrease anxiety; they are not trying to rebel.)

Which term or description would the nurse use for a client who repeatedly performs ritualistic behaviors throughout the day to limit anxious feelings? a. Obsessions b. Compulsions c. Under personal control d. Related to rebelliousness

a (The client is expressing an erotomanic delusion; he believes that his former girlfriend is still romantically interested in him. Somatic delusions concern preoccupation with the body, including complaints of disfigurement, nonfunctioning body parts, insect infestation, and presence of a serious illness. In a grandiose delusion, the client seeks a position of power by expressing an exaggerated belief in her or his importance or identity. Clients with persecutory delusions believe that they are being conspired against, spied on, drugged, or poisoned.)

A client who is diagnosed with delusional disorder says, "My ex-girlfriend is having affairs to re-create our relationship; that proves that she wants to come back to me." Which specific subtype is the client experiencing? A. Erotomanic B. Somatic C. Grandiose D. Persecutory

B (The nurse uses paraphrasing to restate feelings and content; this encourages further communication. Feelings are personal and cannot really be understood by others. Ineffective attempts to empathize end up refocusing the attention on the nurse. "We all have days" negates the client's feelings and cuts off communication. Offering platitudes or empty advice is never useful to the client.)

A young male client is undergoing dialysis treatment. With eyes lowered and his jaw clenched, he says, "My wife would at least get some insurance money if I died." Which response would the nurse use? A. "I can appreciate and understand how you feel." B. "You feel so bad you wish you were dead." C. "We all have days when we feel like that." D. "You need time to adjust to the treatments."

C (Universality is the sense that one is not alone in any situation; one purpose of group therapy is to share feelings and gain support from others with similar thoughts and feelings. Altruism in group therapy is giving support, insight, and reassurance to others, which eventually promotes self-knowledge and growth. Catharsis involves group members relating to one another through the verbal expression of negative and positive feelings. Transference occurs when a client unconsciously assigns to the therapist feelings and attitudes originally associated with another important person in the client's life.)

After attending group therapy, the client says, "It helps to know that I'm not the only one with this type of problem." Which concept does this statement reflect? A. Altruism B. Catharsis C. Universality D. Transference

a (Clients with anorexia nervosa have a disturbed self-image and always see themselves as fat and needing further weight loss. The mother-daughter relationship is usually not supportive; it is disturbed. Usually there is dissatisfaction with one's weight and a desire to lose more. Usually the client is a high achiever who is concerned about grades.)

For a young female client with anorexia nervosa, which comment is consistent with the disorder? A. "I would really like to improve my figure." B. "My mom and I have a close, loving relationship." C. "My weight is okay, but I wish my hair was longer." D. "School is not my thing; I don't care about grades."

d (A major premise of AA is that to be successful in achieving sobriety, clients with alcohol abuse problems must acknowledge their inability to control their drinking. There are no rules about speaking or attending, although members are encouraged strongly to do both. Maintaining controlled drinking after 6 months is not part of AA; this group strongly supports total abstinence for life.)

Which behavior is expected of members of Alcoholics Anonymous (AA)? A. Speaking at and participating in weekly meetings B. Promising to attend at least 12 meetings yearly C. Maintaining controlled drinking after 6 months D. Acknowledging an inability to control the drinking

D (With countertransference, the professional provider of care exhibits an emotional reaction to a client based on a previous relationship or on unconscious needs or conflicts. Affiliation is turning to others for support and help when stressed or conflicted. Displacement is the discharge of pent-up feelings onto something or someone else that is less threatening than the original source of the feelings. Compensation is attempting to balance deficiencies in one area by excelling in another area.)

Which behavior is the nurse displaying while caring for a depressed 75-year-old woman who reminds her of her grandmother when she spends extra time and attention and brings home-baked cookies? A. Affiliation B. Displacement C. Compensation D. Countertransference

a (A depressed client may formulate goals that are unrealistic and unattainable because of a lack of physical or emotional energy. This may trigger further negative feelings and decrease self-esteem. Criminal activity is typically associated with antisocial personality disorder. Depressed clients are experiencing cognitive distortions and negativity and usually do not have a desire to manipulate others. Depressed clients are usually unable to see their strengths and abilities as a result of their negative thinking.)

Which behavior is typical of a depressed client? A. Sets unrealistic goals B. Engages in criminal activity C. Attempts to manipulate others D. Overestimates current strengths

b (The sign of improvement is talking with at least one person on the unit daily. Initiation of interactions demonstrates that the depressed person is attempting to change behavior patterns. Avoiding people is a reinforcement of the depressed lifestyle. Solitary activities are nonthreatening but do not deal with the problem of impaired relationships in depressed clients. Clients who attempt to modify behavior to please others make only superficial changes that are not lasting.)

Which behavior would indicate improvement in a severely depressed male client who responds to therapy and, with the help of the staff, begins to set some daily objectives? A. Staying clear of people who make him anxious B. Talking with at least one person on the unit daily C. Sitting alone several hours a day to think about personal concerns D. Demonstrating to the staff that he can do what they want him to do

c (A pattern of withdrawn behavior prevents the individual from reaching out to others for sharing; the isolation produces feelings of loneliness. Anger or paranoia may cause or contribute to the decision to withdraw, but withdrawal does not typically produce these feelings. Boredom may occur if the withdrawal causes a loss of meaningful activity.)

Which feeling will result from withdrawn behavior? a. Anger b. Paranoia c. Loneliness d. Boredom

a, d (The nurse would ask about operating heavy machinery at work or whether sleepiness affects the client's ability to work. Sleep deprivation is unlikely to affect a client's hobbies and activities. Information on naps and knowing how many hours of sleep the client gets can help determine a client's sleep requirements, but this information would not determine potential for injury.)

Which question would the nurse ask to determine a client's potential for injury because of sleep deprivation? Select all that apply. One, some, or all responses may be correct. A. "Do you operate heavy machinery at work?" B. "What activities do you do in your spare time?" C. "Do you feel the need to take naps during the day?" D. "Does sleepiness affect your performance at work?" E. "How many hours of sleep do you get every night?"

a (The autistic child repeats sounds, or words spoken by others, which is echolalia. Stuttering is a speech disorder in which the same syllable is repeated, usually at the beginning of a word. Scanning speech is associated with neurological disorders, not autism. Pressured speech is rapid, tense, and difficult to interrupt. This occurs with anxiety or mania.)

Which speech pattern is observed in autistic children? A. Echolalia B. Stuttering C. Scanning speech D. Pressured speech

d (Clients with schizophrenia have increased levels of dopamine, which produces hallucinations. The most common are auditory hallucinations, causing the client to respond to internal stimulation. The loosening of associative links that occurs in schizophrenia makes logical deductions impossible. Clients with schizophrenia do commit suicide, but thought disorders limit the client's ability to organize and articulate a coherent suicide plan. Clients with schizophrenia have low self-esteem and usually have feelings of guilt, self-blame, and self-criticism.)

A client with schizophrenia is apathetic and exhibits an inappropriate affect. Which behavior is the client likely to exhibit? A. Logical deductions B. Suicidal preoccupation C. Absence of self-criticism D. Response to internal stimulation

b (Neologisms are words that are invented and understood only by the person using them. Echolalia is the verbal repeating of exactly what is heard. Concretism is a pattern of speech characterized by the absence of abstractions or generalizations. Perseveration is a disturbed system of thinking manifested by repetitive verbalizations or motions or by persistent repetition of the same idea in response to different questions.)

A client with schizophrenia repeatedly says, "No moley, jandu!" Which language disturbance is the client exhibiting? A. Echolalia B. Neologism C. Concretism D. Perseveration

b (Clear directions provide the disorganized client with the necessary structure to encourage participation and support a positive self-image. Schedules may increase anxiety, and the client may not have the cognitive ability or enough self-discipline to adhere to schedules. Bathing and dressing the client will increase dependency and add to the client's self-doubt.)

A female client appears disheveled and disorganized. Which intervention would the nurse use to gain the client's involvement in personal hygienic care? A. Develop a schedule with her and make her responsible for adhering to it. B. Assist her in bathing and dressing by giving her clear, simple directions. C. Set a schedule that dictates bathing times and lists appropriate clothing. D. Bathe and dress her each morning until she is willing to do it for herself.

c (The client's expressed feelings are opposite the client's behavior and are an acceptable substitute for repressed antisocial feelings when facing the roommate. The client's feelings are expressed to the nurse, not projected or attributed to others. The client has expressed real feelings to the nurse and has made no attempt to make an instinctual, socially unacceptable impulse into an acceptable behavior. The client is not emphasizing a strength to compensate for a weakness.)

A female client tells the nurse that she hates her roommate. Later, the client tells the roommate, "I missed you. Where have you been?" Which defense mechanism is the client using? A. Projection B. Sublimation C. Reaction formation D. Compensation

B (Clients acutely ill with schizophrenia frequently do not trust others; fear and feeling threatened can cause them to lash out. Hallucinations can cause fear and anxiety, and a client's act of self-protection could appear aggressive, but an experienced nurse will intervene before the hallucinations produce high levels of anxiety. Clients acutely ill with schizophrenia usually are more concerned with what is happening to them and are not able to be concerned about others. The nurse could be a phobic object, but if so, the client's fear reaction should be anticipated and nursing action should be adjusted accordingly (e.g., ask for permission to approach).)

As the nurse approaches a client who has schizophrenia, he unexpectedly shouts, "Get out of here before I hit you! Go away!" Which rationale best explains the client's behavior? A. Hallucinations cause aggression. B. He feels threatened by the nurse. C. He is afraid of harming the nurse. D. The nurse is a phobic object.

b (The client must learn to develop and use more healthful coping mechanisms to achieve sobriety; the responsibility lies with the client because the client must make the behavioral changes. Giving information about the detoxification program does not increase responsibility for change. Confrontation creates defensiveness; it usually does not foster the development of a trusting relationship. Medications may decrease withdrawal symptoms, but they do not provide the motivation for change.)

For clients who are about to enter a detoxification program for alcohol abuse, which nursing action will help them increase responsibility for self-control? A. Tell them about the detoxification program. B. Help them adopt more healthful coping patterns. C. Confront them about the substance abuse. D. Administer their medications as prescribed.

B (Akathisia is a side effect of some antipsychotic medications. With akathisia, the client exhibits a constant state of movement; this is characterized by restlessness and difficulty sitting still, including constant jiggling of the arms or legs. The distortion of voluntary movements, such as tics, spasms, or myoclonus, is known as dyskinesia. Maintaining a body position for hours is a form of catatonia known as waxy flexibility. Repeating the movements of another person is known as echopraxia.)

Which behavior would be observed in a client who has akathisia? A. Facial tics, spasms, and myoclonic twitches B. Motor restlessness and difficulty sitting still C. Maintaining a single body position for hours D. Repeating the movements of another person

a (The nurse would observe lability. Diffuse impairment of brain tissue function results in fluctuations in the extremes of emotions; lability of mood is common with major neurocognitive disorder. Clients with major neurocognitive disorder usually fluctuate between aggressive acting out and passive acceptance. Clients with major neurocognitive disorder are not independent; they usually need help with activities of daily living. These clients are not curious; intellectual deterioration associated with neurocognitive disorders decreases interest and curiosity in the environment. Clients with major neurocognitive disorders are not outgoing; they are withdrawn or moody.)

Which behavior would the nurse observe when caring for a client with major neurocognitive disorder? A. Lability B. Independence C. Curiosity D. Being outgoing

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

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

D (Realistic guidelines reduce anxiety, increase feelings of security, and increase adherence to the therapeutic regimen. A controlling environment and focusing on food set up power struggles between these clients and the nurses. These clients need realistic rules and regulations that they identify as helpful, not as empathetic.)

Which characteristic of the milieu is essential for clients with the diagnosis of bulimia nervosa? A. Control enforced by staff B. Focus on healthy food C. Empathy from the nurses D. Realistic guidelines

A, B, C (Complementary therapies involve the use of alternative therapies together with traditional treatment modalities. Alternative refers to the use of these therapies in place of conventional treatment. Yoga, meditation, massage, herbs, and supplements are considered nonmainstream treatments. Outpatient counseling, electroconvulsive therapy, psychotherapy, and pharmacological intervention are traditional treatment modalities.)

Which clients are using complementary and/or alternative medicine (CAM) to treat their symptoms of emotional distress and psychiatric illness? Select all that apply. One, some, or all responses may be correct. A. Client practices meditation to reduce anxiety in addition to outpatient counseling B. Client uses massage, lavender, and chamomile to decrease stress and anxiety C. Client undergoes electroconvulsive therapy and takes an antidepressant medication D. Client takes prescribed antianxiety medication and sees a psychiatrist for psychotherapy E. Client with depression takes an omega-3 fatty acid supplement and an antidepressant

B, C (Methamphetamine is a stimulant that causes a surge of dopamine and blocks its reuptake. The sympathetic nervous system is activated, resulting in an increase in the heart rate. Because methamphetamine affects the central nervous system, the body temperature will increase, sometimes to dangerous levels. The sympathetic nervous system is activated: respirations will increase, pupils will dilate, and blood pressure will increase.)

Which clinical manifestations accompany methamphetamine use? Select all that apply. One, some, or all responses may be correct. A. Bradypnea B. Tachycardia C. Hyperthermia D. Constricted pupils E. Decreased blood pressure

C (The client's inability to recall is an example of repression, which is the unconscious and involuntary forgetting of painful events, ideas, and conflicts. Denial is an unconscious refusal to admit an unacceptable situation. Regression is a return to an earlier, more comfortable developmental level. Dissociation is the separation and detachment of emotional affect and significance from an idea, situation, or incident.)

Which defense mechanism is a client displaying when the client can no longer remember why an event was stressful, even though it happened just 3 days ago? A. Denial B. Regression C. Repression D. Dissociation

c (Regression, an unconscious defense mechanism that reduces anxiety by returning to behavior that was successful in earlier years, is commonly used by clients with undifferentiated schizophrenia to reduce anxiety. Regression is considered a relatively primitive defense mechanism that leads to disorganized thought processes. Projection is the attributing of unacceptable feelings or thoughts to others. It is an organized defense used by clients with paranoid, not undifferentiated, schizophrenia. For clients with undifferentiated schizophrenia, disorganized thought processes prevent use of projection. Clients with schizophrenia are not able to use repression (putting disturbing thoughts, feelings, or desires out of the conscious mind). Conversion (an unconscious defense mechanism in which a person develops physical symptoms that have no organic cause) is usually not used by clients with undifferentiated schizophrenia.)

Which defense mechanism is most commonly used by clients who are diagnosed with schizophrenia, undifferentiated type? A. Projection B. Repression C. Regression D. Conversion

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

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

a, d, e, f (Symptoms of insomnia disorder include fatigue, early morning awakenings, reduced concentration, and irritability. Insomnia disorder is caused by emotional or physical stress not related to the direct physiological effects of a substance or illness or mental health disorder. Symptoms of insomnia disorder that the nurse might assess in this client would be fatigue, early morning awakenings, reduced concentration, and irritability. The DSM-5 criteria for insomnia disorder states that the insomnia is not attributable to another mental disorder (panic attacks) or medical conditions (acute pain).)

Which findings from the client's history would be symptoms of insomnia disorder? Select all that apply. One, some, or all responses may be correct. A. Fatigue B. Panic attacks C. Acute pain D. Early morning awakenings E. Reduced concentration F. Irritability

a (The deficiency of thiamine (vitamin B1) is thought to be a primary cause of alcohol-induced amnestic disorder. Reduced iron intake, increased serotonin, and riboflavin malabsorption are all unrelated to alcohol-induced amnestic disorder.)

Which imbalance is associated with alcohol-induced amnestic disorder? A. Thiamine deficiency B. A reduced iron intake C. An increase in serotonin D. Riboflavin malabsorption

a (The main reason for drinking alcohol in alcohol use disorder is that people are dependent on it. Alcohol causes both physical and psychological dependence; the individual needs the alcohol to function. Although people may lack the motivation to stop, it is because alcohol is so physiologically addictive. The client's body craves the alcohol; it is not the main reason. Although these people may use alcohol to cope, this is not the main reason. People with alcoholism usually drink alone or feel alone in a crowd; socialization is not the prime reason for their drinking.)

Which information would the nurse include as the main reason for drinking alcohol in people with alcohol use disorder? A. They are dependent on it. B. They lack the motivation to stop. C. They use it for coping. D. They enjoy the associated socialization.

B (The nurse would say, "Everyone is responsible for his own actions." This comment encourages the client to accept responsibility and does not support denial or rationalization as a defense mechanism. Although the comment, "I don't think that your wife is the problem," may be true, it may also close off communication; with a decrease in communication, the nurse cannot be effective in helping break through the denial. Although suggesting marriage counseling may be appropriate, it does not address the issue of denial. The question, "Why do you think that your wife is the cause of your problems?" enables the client to continue to avoid responsibility for his own behavior, and the use of "why" is nontherapeutic.)

Which is the best response the nurse would make to a male client who is denying addiction to alcohol but says that it is his nagging wife causing him to drink? A. "I don't think that your wife is the problem." B. "Everyone is responsible for his own actions." C. "Perhaps you should have marriage counseling." D. "Why do you think that your wife is the cause of your problems?"

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

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

d (The prognosis is guarded. There are many factors that affect a normal productive life. Accurate diagnosis has not been shown to promote a normal, productive life; however, early, intensive intervention may help individuals maximize their abilities. Although temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Stating that success is ensured as long as the child attends a school tailored to meet needs is false reassurance and is not helpful.)

Which prognosis for a normal, productive life would be appropriate for a child with autism spectrum disorder? A. Dependent on an accurate diagnosis B. Often related to the child's overall temperament C. Ensured as long as the child attends a school tailored to meet needs D. Guarded because of interference with so many parameters of function

B (Inquiring neutrally about the client's feelings about having a male nurse encourages the client to express and explore feelings in an open, nonjudgmental way. "Does it bother you?" is an assumption of bother that asks for a yes or no validation. The client could be trying to start a conversation about men in nursing. "There aren't many male nurses" is a nurse-focused response. Rather than immediately volunteering to get a female nurse, the nurse would conduct additional assessment about the client's comment.)

Which response would the male nurse give to the client who states, "You know, I've never had a male nurse before"? A. "Does it bother you to have a male nurse?" B. "How do you feel about having a male nurse?" C. "There aren't many male nurses; we're a minority." D. "You sound upset. I'll get a female nurse to care for you."

E (To meet the DSM-5 criteria for PTSD, the duration of intrusive symptoms (disturbing dreams, flashbacks, negative mood, and alterations in reactivity) must occur for more than 1 month. Clients with PTSD frequently demonstrate persistent negative beliefs about themselves. PTSD can occur in clients of any age, though the DSM-5 criteria are modified for children younger than 6 years of age. Clients frequently cannot remember important aspects of the traumatic event. Exposure to an actual or threatened event can cause PTSD. Derealization is a persistent experience of unreality; depersonalization means feeling detached from your body.)

Which statement by the nurse indicates understanding of DSM-5 criteria for post-traumatic stress disorder (PTSD)? Select all that apply. One, some, or all responses may be correct. A. "Feelings of self-worth remain high." B. "PTSD does not occur in children younger than 6 years of age." C. "Clients will remember all details of the event." D. "A person directly witnessed a traumatic event." E. "Flashbacks must last for longer than 1 month." F. "Derealization means feeling detached from your body."