PSYCH ch 11,21,24

Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a question is complete, and frequently interrupting others' conversations. How should the nurse document these behaviors? a. Disobedience b. Hyperactivity c. Impulsivity d. Anxiety

impulsivity

A health care provider recently convicted of Medicare fraud says to a nurse, "Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I deserve the money." These statements support what client characteristic? shame. suspiciousness. superficial remorse. lack of guilt feelings.

lack of guilt feelings

A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to achieve what? integration of self-concept. inpatient treatment for the child. loneliness and increase self-esteem.

loneliness and increase self-esteem.

Consider this comment to three different nurses by a client diagnosed with an antisocial personality disorder, "Another nurse said you don't do your job right." Collectively, these interactions can be documented using which term? a. seductive.b. detached.c. manipulative. d. guilt-producing.

manipulative

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Information will focus on which medication likely to be prescribed? a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine

methylphenidate

What personality traits are most likely to be documented by a client demonstrating characteristics of an obsessive-compulsive personality disorder (OCPD)? affable, generous. perfectionist, inflexible. suspicious, holds grudges. d. dramatic speech, impulsive.

perfectionist, inflexible.

When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year-old in a group that uses what strategy? guided imagery. talk focused on a specific issue. play and talk about a play activity. group discussion about selected topics.

play and talk about a play activity.

A 4-year-old cries for 5 minutes when the parents leave the child at preschool. The parents 13. 14. Stuvia.com - The Marketplace to Buy and Sell your Study Material ask the nurse, "What should we do?" What is the nurse's best response? "Ask the teacher to let the child call you at play time." "Withdraw the child from preschool until maturity increases." "Remain with your child for the first hour of preschool time." "Give your child a kiss before you leave the preschool program."

"Give your child a kiss before you leave the preschool program."

Which statement made by a client diagnosed with borderline personality disorder indicates the treatment plan is effective? "I think you are the best nurse on the unit." "I'm never going to get high on drugs again." "I felt empty and wanted to hurt myself, so I called you." "I hate my mother. I called her today, and she wasn't home."

"I felt empty and wanted to hurt myself, so I called you."

A client's spouse filed charges after repeatedly being battered. Which statement by this person supports an antisocial personality disorder? "I have a quick temper, but I can usually keep it under control." "I've done some stupid things in my life, but I've learned a lesson." "I'm feeling terrible about the way my behavior has hurt my family." "I hit because I am tired of being nagged. My spouse deserves the beating."

"I hit because I am tired of being nagged. My spouse deserves the beating."

A client says, "The other nurses won't give me my medication early, but you know what it's like to be in pain and don't let your clients suffer. Could you get me my pill now? I won't tell anyone." Which response by the nurse would be most therapeutic? "I'm not comfortable doing that," and then ignore subsequent requests for early medication. "I understand that you have pain but giving medicine too soon would not be safe." "I'll have to check with your doctor about that; I will get back to you after I do." "It would be unsafe to give the medicine early; none of us will do that."

"I understand that you have pain but giving medicine too soon would not be safe."

A client says, "I get in trouble sometimes because I make quick decisions and act on them." What is the nurse's most therapeutic response? "Let's consider the advantages of being able to stop and think before acting." "It sounds as though you've developed some insight into your situation." "I bet you have some interesting stories to share about overreacting." "It's good that you're showing readiness for behavioral change."

"Let's consider the advantages of being able to stop and think before acting."

The parent of a child diagnosed with Tourette's disorder says to the nurse, "I think my child is faking the tics because they come and go." Which response by the nurse is accurate? "Perhaps your child was misdiagnosed." "Your observation indicates the medication is effective." "Tics often change frequency or severity. That doesn't mean they aren't real." "This finding is unexpected. How have you been administering your child's medication?"

"Tics often change frequency or severity. That doesn't mean they aren't real."

Which child demonstrates behaviors indicative of a neurodevelopmental disorder? A 4-year-old who stuttered for 3 weeks after the birth of a sibling A 9-month-old who does not eat vegetables and likes to be rocked A 3-month-old who cries after feeding until burped and sucks a thumb A 3-year-old who is mute, passive toward adults, and twirls while walking

A 3-year-old who is mute, passive toward adults, and twirls while walking

A nurse works with a child who is sad and irritable because the child's parents are divorcing. Why is establishing a therapeutic alliance with this child a priority? Therapeutic relationships provide an outlet for tension. Focusing on the strengths increases a person's self-esteem. Acceptance and trust convey feelings of security to the child. The child should express feelings rather than internalize them.

Acceptance and trust convey feelings of security to the child.

The history shows that a newly admitted client is impulsive. The nurse would expect the client to demonstrate what characteristic behavior? Adherence to a strict moral code. Manipulative, controlling strategies. Acting without thought on urges or desires. Postponing gratification to an appropriate t

Acting without thought on urges or desires.

One month ago, a client diagnosed with borderline personality disorder and a history of selfmutilation began dialectical behavior therapy. Today the client telephones to say, "I feel empty and want to hurt myself." The nurse should immediately take what action? Arrange for emergency inpatient hospitalization. Send the client to the crisis intervention unit for 8 to 12 hours. Assist the client to choose coping strategies for triggering situations. Advise the client to take an antianxiety medication to decrease the anxiety level

Assist the client to choose coping strategies for triggering situations.

Shortly after the parents announced that they were divorcing, a 15-year-old became truant from school and assaulted a friend. The adolescent told the school nurse, ―I'd rather stay in my room and listen to music. It's easier than thinking about what is happening in my family.‖ Which nursing diagnosis is most applicable? Chronic low self-esteem related to role within the family Decisional conflict related to compliance with school requirements Defensive coping related to adjustment to changes in family relationships Disturbed personal identity related to self-perceptions of changing family dynamics

Defensive coping related to adjustment to changes in family relationships

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, ―I hate my parents. They focus all attention on my brother, who's perfect in their eyes.‖ Which nursing diagnosis is most applicable? Disturbed personal identity related to acting out as evidenced by prostitution Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents Defensive coping related to inappropriate methods of seeking parental attention as evidenced by acting out

Defensive coping related to inappropriate methods of seeking parental attention as evidenced by acting out

The family of a child diagnosed with an impulse control disorder needs help to function more adaptively. Which aspect of the child's plan of care will be provided by an advanced practice nurse rather than a staff nurse? a. Leading an activity group Providing positive feedback Formulating nursing diagnoses Dialectical behavioral therapy (DBT)

Dialectical behavioral therapy (DBT)

An adolescent acts out in disruptive ways. When this adolescent threatens to throw a heavy pool ball at another adolescent, which comment by the nurse would set appropriate limits? a. ―Attention everyone: we are all going to the craft room.‖ ―You will be taken to seclusion if you throw that ball.‖ ―Do not throw the ball. Put it back on the pool table.‖ ―Please do not lose control of your emotions.‖

Do not throw the ball. Put it back on the pool table

A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurse's best first action? Give notice to the chief administrator at the school regarding the events. Encourage the victimized child to share feelings about the experience. Encourage the victimized child to ignore the bullying behavior. Discuss the events with the aggressive classmate.

Encourage the victimized child to share feelings about the experience.

When a client diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action? It provides an outlet for feelings of anger and frustration. It respects the client's wishes, so assertiveness will develop. External controls are necessary due to failure of internal control. Anxiety is reduced when staff assumes responsibility for the client's behavior.

External controls are necessary due to failure of internal control.

A client diagnosed with borderline personality disorder (BPD) self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to which trigger? An inherited disorder that manifests itself as an incapacity to tolerate stress. Use of projective identification and splitting to bring anxiety to manageable levels. A constitutional inability to regulate affect, predisposing to psychic disorganization. Fear of abandonment associated with progress toward autonomy and independence.

Fear of abandonment associated with progress toward autonomy and independence.

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders? Impaired social interaction related to difficulty maintaining relationships Chronic low self-esteem related to excessive negative feedback Deficient fluid volume related to abnormal eating habits Anxiety related to nightmares and repetitive activities

Impaired social interaction related to difficulty maintaining relationships

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts. The nurse should monitor for which desired behavior? Increased expressiveness in communication with others Abilities to identify anxiety and implement self-control strategies Improved abilities to participate in cooperative play with other children Tolerates social interactions for short periods without disruption or frustration

Improved abilities to participate in cooperative play with other children

What is the most challenging nursing intervention with clients diagnosed with personality disorders who use manipulation? Supporting behavioral change Maintaining consistent limits Monitoring suicide attempts Using aversive therapy

Maintaining consistent limits

An adolescent was recently diagnosed with ODD. The parents say to the nurse, ―Isn't there some medication that will help with this problem?‖ Select the nurse's best response. a. ―There are no medications to treat this problem. This diagnosis is behavioral in nature.‖ ―It's a common misconception that there is a medication available to treat every health problem.‖ ―Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use.‖ ―There are many medications that will help your child manage aggression and destructiveness. The health care provider will discuss them with you.‖

Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use.

A client diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The client reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed? Benzodiazepine Mood stabilizing medication Monoamine oxidase inhibitor (MAOI) Cholinesterase inhibitor

Mood stabilizing medication

Which assessment findings support a diagnosis of ODD? Negative, hostile, and spiteful toward parents. Blames others for misbehavior. Exhibits involuntary facial twitching and blinking; makes barking sounds. Violates others' rights; cruelty toward people or animals; steals; truancy. Displays poor academic performance and reports frequent nightm

Negative, hostile, and spiteful toward parents. Blames others for misbehavior.

A child known as the neighborhood bully says, ―Nobody can tell me what to do.‖ After receiving a poor grade on a science project, this child secretly loaded a virus on the teacher's computer. These behaviors support a diagnosis of a. CD. ODD. intermittent explosive disorder. ADHD.

ODD

Parents of an adolescent diagnosed with a CD say, ―We don't know how to respond when our child breaks the rules in our house. Is there any treatment that might help us?‖ Which therapy is likely to be helpful for these parents? Parent-child interaction therapy (PCIT) Behavior modification therapy Multi-systemic therapy (MST) Pharmacotherapy

Parent-child interaction therapy (PCIT)

An adolescent diagnosed with a CD stole and wrecked a neighbor's motorcycle. Afterward, the adolescent was confronted about the behavior but expressed no remorse. Which variation in the central nervous system best explains the adolescent's reaction? Serotonin dysregulation and increased testosterone activity impair one's capacity for remorse. Increased neuron destruction in the hippocampus results in decreased abilities to conform to social rules. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy. Disturbances in the occipital lobe reduce sensations that help an individual clearly visualize the consequences of behavior.

Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy.

Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others? Refer requests and questions related to care to the case manager. Encourage the client to discuss feelings of fear and inferiority. Provide negative reinforcement for acting-out behavior. Ignore, rather than confront, inappropriate behavior.

Refer requests and questions related to care to the case manager.

What is the priority intervention for a nurse beginning to work with a client diagnosed with a schizotypal personality disorder? Respect the client's need for periods of social isolation. Prevent the client from violating the nurse's rights. Teach the client how to select clothing for outings. Engage the client in community activities.

Respect the client's need for periods of social isolation.

An 11-year-old diagnosed with ODD becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What is the nurse's initial action to defuse the situation? Say to the child, ―Tell me how you're feeling right now.‖ Take the child swimming at the facility's pool. Establish a behavioral contract with the child.

Say to the child, ―Tell me how you're feeling right now.‖

As a nurse prepares to administer medication to a client diagnosed with a borderline personality disorder, the client says, "Just leave it on the table. I'll take it when I finish combing my hair." What is the nurse's best response? Reinforce this assertive action by the client. Leave the medication on the table as requested. Respond to the client, "I'm worried that you might not take it. I'll come back later." Say to the client, "I must watch you take the medication. Please take it now." Ask the client, "Why don't you want to take your medication now?"

Say to the client, "I must watch you take the medication. Please take it now."

An adolescent diagnosed with CD has aggression, impulsivity, hyperactivity, and mood symptoms. The treatment team believes this adolescent may benefit from medication. The nurse anticipates the health care provider will prescribe which type of medication? a. Second- generation antipsychotic Antianxiety medication Calcium channel blocker β-blocker

Second- generation antipsychotic

What is the nurse's priority focused assessment for side effects in a child taking methylphenidate for attention deficit hyperactivity disorder (ADHD)? Dystonia, akinesia, and extrapyramidal symptoms Bradycardia and hypotensive episodes Sleep disturbances and weight loss Neuroleptic malignant syndrome

Sleep disturbances and weight loss

An 11-year-old diagnosed with ODD becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. Ignore the child's behavior. Send the child to time-out for 2 hours. Take the child to the gym and engage in an activity. Role-play a more appropriate behavior with the child.

Take the child to the gym and engage in an activity.

A 16-year-old diagnosed with a conduct disorder (CD) has been in a residential program for 3 months. Which outcome should occur before discharge? The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences. The adolescent identifies friends in the home community who are a positive influence. Temporary placement is arranged with a foster family until the parents complete a parenting skills class. The adolescent experiences no anger and frustration for 1 week.

The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences

Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? The child has been raised by a parent with recurring major depressive disorder. The child's best friend was absent from the child's birthday party. The child was not promoted to the next grade one year. The child moved to three new homes over a 2-year period.

The child has been raised by a parent with recurring major depressive disorder.

For which client behavior would limit setting be most essential? The client who clings to the nurse and asks for advice about inconsequential matters. The client who is flirtatious and provocative with staff members of the opposite sex. The client who is hypervigilant and refuses to attend unit activities. The client who urges a suspicious client to hit anyone who stares.

The client who urges a suspicious client to hit anyone who stares.

What is an appropriate initial outcome for a client diagnosed with a personality disorder who frequently manipulates others? The client will identify when feeling angry. The client will use manipulation only to get legitimate needs met. The client will acknowledge manipulative behavior when it is called to his or her attention.

The client will acknowledge manipulative behavior when it is called to his or her attention.

A new psychiatric technician says, "Schizophrenia ... schizotypal! What's the difference?" The nurse's response should include which information? A client diagnosed with schizophrenia is not usually overtly psychotic. In schizotypal personality disorder, the client remains psychotic much longer. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality. Schizotypal personality disorder causes more frequent and more prolonged

With schizotypal personality disorder, the person can be made aware of misinterpretations of reality.

Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the client's needs and maintain a therapeutic milieu? Ability to achieve true intimacy Flexibility and adaptability to stress Ability to provoke interpersonal conflict Inability to develop trusting relationships

ability to provoke interpersonal conflict

The parent of a 6-year-old says, "My child is in constant motion and talks all the time. My child isn't interested in toys but is out of bed every morning before me." The child's behavior is most consistent with diagnostic criteria for which disorder? communication disorder. stereotypic movement disorder. intellectual development disorder. attention deficit hyperactivity disorder (ADHD).

attention deficit hyperactivity disorder

The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with what disorder? attention deficit hyperactivity disorder (ADHD). posttraumatic stress disorder (PTSD). communication disorder. an anxiety disorder.

attention deficit hyperactivity disorder (ADHD).

Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior? a. Narcissistic b. Histrionic c. Avoidant d. Paranoid

avoidant

A nurse prepares to lead a discussion at a community health center regarding children's health problems. The nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse to use? (Select all that apply.) Autism Bullying Mental retardation Autism spectrum disorder Intellectual development disorder

bullying autism spectrum disorder intellectual developmental disorder

A 12-year-old has engaged in bullying for several years. The parents say, ―We can't believe anything our child says.‖ Recently this child shot a dog with a pellet gun and set fire to a neighbor's trash bin. The child's behaviors support the diagnosis of ADHD. intermittent explosive disorder. oppositional defiant disorder (ODD). CD.

cd

A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the Court, ―We can't manage our teenager.‖ The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescent's behavior? Attention deficit hyperactivity disorder (ADHD) Posttraumatic stress disorder (PTSD) Intermittent explosive disorder CD

cd

A child diagnosed with attention deficit hyperactivity disorder (ADHD) will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications? CNS stimulants Tricyclic antidepressants Antipsychotics Anxiolytics

cns stimulant

A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the child's disorder? has occasional toileting accidents. interrupts or intrudes on others. cries when separated from a parent. continuously rocks in place for 30 minutes.

continuously rocks in place for 30 minutes.

Which nursing diagnosis is appropriate to consider for a client diagnosed with any of the personality disorders? nonadherence. impaired social interaction. disturbed personal identity. diversional activity deficit.

impaired social interaction

A child diagnosed with attention deficit hyperactivity disorder (ADHD) had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? has an improved ability to identify anxiety and use self-control strategies has increased expressiveness in communication with others. shows increased responsiveness to authority figures. engages in cooperative play with other children.

engages in cooperative play with other children.

A 15-year-old was placed in a residential program after truancy, running away, and an arrest for theft. At the program, the adolescent refused to join in planned activities and pushed a staff member, causing a fall. Which approach by nursing staff will be most therapeutic? a. Planned ignoring Establish firm limits Neutrally permit refusals Coaxing to gain compliance

establish firm limits

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, ―I hate my parents. They focus all attention on my brother, who's perfect in their eyes.‖ Which type of therapy might promote the greatest change in the adolescent's behavior? a. Family therapy b. Bibliotherapy c. Play therapy d. Art therapy

family therapy

When preparing to interview a client diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include which characteristics? preoccupation with minute details; perfectionist. charm, drama, seductiveness; seeking admiration. difficulty being alone; indecisive, submissiveness. grandiosity, self-importance, and a sense of entitlement.

grandiosity, self-importance, and a sense of entitlement.

An adolescent diagnosed with an impulse control disorder says, ―I want to die. I spend my time getting even with people who hurt me.‖ When asked about a suicide plan, the adolescent replies, ―I'll jump from a bridge near my home. My father threw kittens off that bridge and they died.‖ Rate the suicide risk absent low moderate high

high

Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? plays with one toy for 30 minutes. repeats words spoken by a parent. holds the parent's hand while walking. spins around and claps hands while walking.

holds the parent's hand while walking.

A client diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should understand the need to deliver the care in what manner? a. maintaining a stern and authoritarian affect. providing care in a matter-of-fact manner. encouraging the client to express anger. being very rigid but not challenging.

providing care in a matter-of-fact manner.

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting relationship with a shelter volunteer. The child says, "My three friends and I got an A on our school science project." The nurse can assess that the child demonstrating what? resiliency. a passive temperament. at risk for post-traumatic stress disorder (PTSD). intellectualization to deal with problems.

resiliency.

What is the priority nursing diagnosis for a client diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects? Risk for other-directed violence Risk for self-directed violence Impaired social interaction Ineffective denial

risk for other-directed violence

A client diagnosed with borderline personality disorder was hospitalized several times after multiple episodes of head banging and carving on both wrists. The client remains impulsive. Which nursing diagnosis is the initial focus of this client's care? a. Self-mutilation b. Impaired skin integrity

self mutilation

When a 5-year-old is disruptive, the nurse says, "You must take a time-out." The expectation is that the child will do what? go to a quiet room until called for the next activity. slowly count to 20 before returning to the group activity. sit on the edge of the activity until able to regain self-control. sit quietly on the lap of a staff member until able to apologize for the behavior.

sit on the edge of the activity until able to regain self-control.

Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and avoided former friends. The child told the school nurse, "If my parents loved me, they would work out their problems." Which nursing diagnosis has the highest priority? Social isolation Decisional conflict Chronic low self-esteem Disturbed personal identity

social isolation

A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? Reality therapy Simple restitution Social skills group Insight-oriented group therapy

social skills group

The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include what characteristics? arrogant, grandiose, and a sense of self-importance. attention seeking, melodramatic, and flirtatious. impulsive, restless, socially aggressive behavior. socially anxious, rambling stories, peculiar ideas.

socially anxious, rambling stories, peculiar ideas.

nurse set limits while interacting with a client demonstrating behaviors associated with borderline personality disorder. The client tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was wrong. You're evil." This outburst can be documented using what term? denial. splitting. defensive. reaction formation.

splitting

When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurse's best action? Instruct the parents to take the aggressive child home. Direct the aggressive child to stop immediately. Call for emergency assistance from other staff. Take the aggressive child to another room.

take the aggressive child to another room

A nurse determines desired outcomes for a client diagnosed with schizotypal personality disorder. What is the best outcome? The client will adhere willingly to unit norms. The client will report decreased incidence of self-mutilative thoughts. The client will demonstrate fewer attempts at splitting or manipulating staff. The client will demonstrate ability to introduce self to a stranger in a social situation.

the client will demonstrate ability to introduce self to a stranger in a social situation.

Which behavior demonstrated by that a client diagnosed with an antisocial personality disorder most clearly warrants limit setting? Flattering the nurse Lying to other clients Verbal abuse of another client Detached superficiality during counseling

verbal abuse of another client