Psych: Mental Health and Addictions

For a client who is demonstrating manic behavior, which behavior is the most important to monitor?

1 Withdrawal can lead to social isolation. 2 Speech patterns may inhibit verbalizing needs. 3 Overeating can result in weight gain. Correct 4 Excessive activity may cause exhaustion. 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.

The client is mute, immobile, unresponsive to questions, and appears unaware of the surroundings. Which term describes these symptoms?

1 Alogia Correct 2 Catatonia 3 Echopraxia 4 Flat affect Catatonia is the term to describe stupor, rigidity, or extreme flexibility of the limbs; excitability; confusion; and lack of verbal expression. Alogia is a term used to describe an inability to speak or near-absence of speech. Echopraxia is the term for the mimicking or repetition of the actions of another person. Flat affect is the term for blunted or constricted facial expression.

Which disorder would the nurse classify as neurodevelopmental?

1 Anxiety 2 Bipolar disorder 3 Schizophreniform disorder Correct 4 Attention-deficit/hyperactivity disorder Neurodevelopmental disorders are a group of conditions with onset in the developmental period. Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder. Anxiety, bipolar disorder, and schizophreniform disorder are not classified as neurodevelopmental.

Which mental mechanism would the nurse suspect when a client with alcohol use disorder who has not worked for the past 10 years states, "I currently work in the office of a local construction company"?

1 Regression 2 Sublimation 3 Compensation Correct 4 Confabulation The client is using confabulation. Confabulation is often used by people with long-standing alcohol use disorder to cover lapses of memory that occur with Wernicke-Korsakoff syndrome; it is an unconscious means of self-protection. Regression is a return to a prior stage of development as a way to cope with stress. Sublimation is the channeling of unacceptable thoughts and feelings into socially acceptable behaviors. Compensation is replacement of a real or imagined deficit with a more positive attribute or trait.

Which action would be required of the client with alcohol use disorder who attends Alcohol Anonymous (AA) meetings?

1 Speaking aloud at weekly meetings 2 Maintaining controlled drinking after 6 months 3 Promising to attend at least 12 meetings yearly Correct 4 Acknowledging an inability to control the alcoholism The client would have to acknowledge an inability to control the alcoholism. A major premise of AA is that, to be successful in achieving sobriety, clients with an alcohol use disorder must acknowledge their inability to control the use of alcohol. There are no rules of speaking at meetings or attendance, although both actions are strongly encouraged. Maintaining controlled drinking after 6 months is not part of the AA program; this group strongly supports total abstinence for life.

Which strategy would be effective for a client with alcohol use disorder who says, "Drinking is a way out of my depression"? 1 A self-help group 2 Psychoanalytical therapy 3 A visit with a religious advisor 4 Talking with an alcoholic friend

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 clinical finding is observed in catatonic schizophrenia? 1 Crying 2 Self-mutilation 3 Immobile posturing 4 Repetitive rituals

Clients with catatonia exhibit rigidity and posturing behaviors. Most clients with catatonic schizophrenia are unable to express feelings. Self-mutilation is associated with borderline personality disorder. Repetitive rituals are associated with obsessive-compulsive disorders.

A new employee is able to connect with her feelings, thoughts, and actions but frequently states, "I feel so nervous about starting this new job." Which interpretation would the nurse make about the employee?

Correct 1 She displays a moderate level of job-related anxiety. 2 She has a severe level of anxiety related to new situations. 3 She shows an exaggerated response to handling new situations. 4 She has ineffective coping skills for handling job-related stress. The ability to connect feelings, thoughts, and actions, plus inattention to all but the anxiety-causing subject, is associated with a moderate level of anxiety. Severe anxiety is related to dissociation, selective inattention, and an inability to connect feelings, thoughts, and actions. The development of mild or moderate anxiety is common in new situations because of apprehension related to the unknown. The client may have ineffective coping skills, but additional assessment would be needed.

For a client with an obsessive-compulsive disorder, which rationale explains the function of obsessions and compulsions?

Correct 1 Unconscious control of unacceptable feelings 2 Intentional act to punish self for shortcomings 3 Obedience to voices that direct behaviors 4 Symbolic reenactment of punishing others In carrying out the compulsive ritual, the client unconsciously tries to control anxiety by avoiding acting on unacceptable feelings and impulses. The compulsions do not fill the need to punish self or others. Hallucinations are not part of this disorder.

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? 1 Erotomanic 2 Somatic 3 Grandiose 4 Persecutory

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.

Which behavior is expected of members of Alcoholics Anonymous (AA)? 1 Speaking at and participating in weekly meetings 2 Promising to attend at least 12 meetings yearly 3 Maintaining controlled drinking after 6 months 4 Acknowledging an inability to control the drinking

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.

A client with a bipolar disorder, depressed episode, displays an increase in depression over the past month. Which behavior is expected? 1 Elated affect 2 Loose associations 3 Physical exhaustion 4 Slowed thought processes

As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion can occur during the manic episode of bipolar disorder.

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.

Correct 1 Fatigue 2 Panic attacks 3 Acute pain Correct 4 Early morning awakenings Correct 5 Reduced concentration Correct 6 Irritability 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).

A client who is disheveled and agitated demands, "Do something to make these feelings stop!" Which clinical manifestation is the client most likely experiencing?

Correct 1 Feelings of panic 2 Suicidal tendencies 3 Manic hyperactivity 4 Generalized dissociation 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.

Which primary feeling would the nurse anticipate that clients with bulimia nervosa experience after an episode of bingeing?

Correct 1 Guilt 2 Paranoia 3 Euphoria 4 Satisfaction Guilt is a primary feeling clients experience after a bingeing episode. A sense of being out of control accompanies the consumption of large amounts of food, resulting in guilt, depression, and disgust with one's self. Paranoia is associated with schizophrenia and paranoid personality disorder, not with bulimia nervosa. After bingeing, a person with bulimia nervosa usually feels guilt rather than euphoria or satisfaction because these clients are aware that the eating pattern is abnormal.

Which common clinical manifestation is expected during the initial stage of alcohol detoxification? 1 Nausea 2 Euphoria 3 Bradycardia 4 Hypotension

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

A client with major depressive disorder is most likely to experience which feeling? 1 Hedonia 2 Isolation 3 Paranoia 4 Ambivalence

In an attempt to control anxiety, the client continues to retreat from people and the activities within the environment; this will eventually precipitate feelings of loneliness and isolation. Depressed clients exhibit a decreased interest in pleasurable activities (anhedonia) rather than an excessive interest in pleasurable activities (hedonia). Paranoia and ambivalence could accompany depression, but these feelings are less likely because they require more psychic energy.

Which clinical manifestations accompany methamphetamine use? Select all that apply. One, some, or all responses may be correct. 1 Bradypnea 2 Tachycardia 3 Hyperthermia 4 Constricted pupils 5 Decreased blood pressure

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 childhood problem has legal and emotional aspects? 1 School phobia 2 Fear of animals 3 Fear of monsters 4 Sleep disturbances

School phobia is a disorder that cannot legally be ignored because children must attend school. It requires intervention to alleviate the separation anxiety and promote the child's increasing independence. Fear of animals and monsters and sleep disturbances all require parents to comfort the child, to reorient the child to reality, and to help the child regain self-control. Legally there are no requirements mandating treatment for these common childhood problems.

The client says, "Those foreign agents implanted a microcomputer in my ear." Which psychotic symptom is the client experiencing? 1 Illusions 2 Delusion 3 Hallucination 4 Disorganized thoughts

The client is expressing a delusion, which is a fixed set of false beliefs that cannot be corrected by reason. An illusion is a misperception of an actual environmental stimulus. Disorganized thought would include the inability to organize thought processes. Hallucinations are false sensory stimuli (e.g., hearing voices, seeing dead people).

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?

1 Denial 2 Projection 3 Identification Correct 4 Rationalization 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 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?

1 Projection 2 Sublimation Correct 3 Reaction formation 4 Compensation 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?

Which of these questions is included on the CAGE screening test for alcoholism?

1 "Do you feel that you are a normal drinker?" Correct 2 "Have you ever felt bad or guilty about your drinking?" 3 "Are you always able to stop drinking when you want to?" 4 "How often did you have a drink containing alcohol in the past year?" The CAGE screening test for alcoholism contains four questions corresponding to the letters CAGE: Have you ever felt you ought to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning (as an " Eye-opener") to steady your nerves or get rid of a hangover? "Do you feel that you are a normal drinker?" and "Are you always able to stop drinking when you want to?" are two of the 26 questions on the Michigan Alcohol Screening Test (MAST). "How often did you have a drink containing alcohol in the past year?" is one of the 10 questions on the Alcohol Use Disorders Identification Test (AUDIT).

Which drug would the nurse ask the client about using when presenting to the emergency department with increased energy, irritability, hypertension, and hyperthermia?

1 Alcohol 2 Heroin 3 Oxycodone Correct 4 Methamphetamine Methamphetamine is a stimulant that increases the temperature and blood pressure. It can cause increased energy, irritability, convulsions, and death. Alcohol is a central nervous system (CNS) depressant. Overdose of alcohol leads to a decreased level of consciousness, hypotension, hypothermia, and respiratory depression. Heroin, an opioid, leads to euphoria, sedation, confusion, and slowed breathing. Oxycodone is an opioid and CNS depressant, leading to psychomotor retardation, drowsiness, slurred speech, and pupillary constriction.

For a client with a bipolar mood disorder, manic episode, which factor would the nurse consider when planning care?

1 Client is likely to feel embarrassed by the manic behavior Correct 2 Client is acutely aware of the environment and reality 3 Client should be able to control the acting-out behavior 4 Client is likely to engage in bingeing and purging behavior Manic individuals are acutely aware of what is happening and react strongly to environmental stimuli. These clients are not out of contact with reality; in fact, they are continually reacting to it. These clients' symptoms are an attempt to avoid anxiety and do not cause embarrassment. They are unable to control acting-out behavior. Bingeing and purging behavior is a symptom of bulimia.

For a client with bipolar I disorder, manic episode, which factor would be considered to meet rest and sleep needs?

1 Experiences few sleep pattern disturbances 2 Requires less sleep than the average person Correct 3 Is easily stimulated, and this interferes with sleep 4 Needs to expend energy to be tired enough to sleep Manic individuals readily respond to environmental cues. Increased stimulation increases activity; decreased stimulation decreases activity. Sleep pattern disturbances characteristically occur because of psychomotor activity. All individuals require adequate rest and sleep; hyperactive clients may become exhausted because of their high activity level. Expending energy only increases the tendency to remain awake.

For clients with chronic alcoholism, which communication pattern suggests marked memory loss?

1 Grandiosity 2 Flight of ideas Correct 3 Confabulation 4 Pressured speech Alcoholic clients have loss of memory and adapt to this by unconsciously filling in with false information. Ideas of grandeur do not occur in this disease. Flight of ideas and pressured speech occur in hyperactive states, such as mania.

Which substance would pose the greatest risk of addiction for clients attending an alcohol rehabilitation program?

1 Heroin 2 Cocaine Correct 3 Nicotine 4 Phencyclidine Although polysubstance abuse is common, clients undergoing rehabilitation from alcohol dependence are more likely to use or develop a dependence on nicotine, another legal substance, than on an illegal substance such as heroin, cocaine, or phencyclidine.

A client says, "The doctors lied about me. They said I murdered my mother. You killed her. She died before I was born." Which psychotic feature is the client experiencing?

1 Ideas of grandeur 2 Confusing illusions Correct 3 Persecutory delusions 4 Auditory hallucinations The client believes that others are blaming her or him for negative actions. The client is not verbalizing feelings of greatness or power, and there is no misinterpretation of stimuli. The client is delusional, but she or he is not hallucinating.

Which term would the nurse use to describe the thought processes of a male client who insists that he is the commander of an alien spaceship despite repeated reality orientation?

1 Illusion Correct 2 Delusion 3 Confabulation 4 Hallucination The term the nurse would use is delusion. A delusion is a fixed false belief. An illusion is a false sense interpretation of an external stimulus. Confabulation is the client's attempt to fill gaps in memory with imaginary events. A hallucination is a false sensory perception with no external stimulus.

A client reports overwhelming and irresistible attacks of sleep. Which sleep disorder is she or he describing?

1 Insomnia Correct 2 Narcolepsy 3 Sleep terror 4 Sleep apnea Narcolepsy is overwhelming sleepiness that results in irresistible attacks of sleep, loss of muscle tone (cataplexy), and hallucinations or sleep paralysis at the beginning or end of sleep episodes; the person usually awakens from the sleep feeling refreshed. Insomnia is difficulty initiating or maintaining sleep. Sleep terrors are recurrent episodes of abrupt awakening from sleep accompanied by intense fear, screaming, tachycardia, tachypnea, and diaphoresis with no detailed dream recall. Sleep apnea is a breathing-related sleep disorder caused by disrupted respirations or airway obstruction; sleep is disrupted numerous times throughout the night.

Which characteristic is associated with anorexia nervosa?

1 Manic 2 Rebellious 3 Hypoactive Correct 4 Perfectionistic Perfectionistic standards and extremes of self-discipline are an attempt to maintain control and meet the client's own and others' expectations. People with anorexia nervosa are often anxious and depressed, not manic. Compliance is frequently an attempt to meet the expectations of others. Excessive exercise is used as a means of losing weight.

Which intervention would the nurse use to prevent self-induced vomiting in a client admitted for anorexia nervosa?

1 Monitor telephone calls. Correct 2 Stay in the bathroom with the client. 3 Provide structured meal times. 4 Establish normal eating patterns To prevent self-induced vomiting, a staff member should always accompany a client with anorexia to the bathroom. Monitoring telephone calls will not prevent self-induced vomiting. Structured meal times and normal eating patterns would be inpatient therapy interventions but do not prevent self-induced vomiting.

An individual is found unconscious and is admitted to the hospital with heroin overdose. Which nursing action is the priority?

1 Monitoring level of consciousness Correct 2 Establishing a patent airway 3 Monitoring for heroin withdrawal 4 Establishing a therapeutic relationship The client is unconscious and unable to meet physical needs; a patent airway, breathing, and circulation are essential needs. Monitoring level of consciousness would be the next priority. Symptoms of heroin withdrawal will occur 6 to 8 hours after the last dose if the client has a physical addiction. Establishment of a therapeutic relationship will increase in importance once the client's physical condition has stabilized.

A client has been instructed to stop smoking. Which action would the nurse take upon discovering a pack of cigarettes in the client's bathrobe?

1 Notify the health care provider. 2 Report this to the nurse manager. Correct 3 Tell the client about finding the cigarettes. 4 Discard the cigarettes without telling client. Honest nurse-client interaction should be maintained so that trust can develop. Although other health care team members may eventually need to be informed, the initial action should involve only the nurse and client. Discarding the cigarettes without commenting to the client does not promote trust or communication between the client and nurse.

Which assessment finding would the nurse observe in a client who has been found to have an antisocial personality disorder?

1 Pays great attention to detail and demonstrates a high level of anxiety 2 Has scars from self-mutilation and a history of many negative relationships Correct 3 Displays charm, has an above-average intelligence, and tends to manipulate others 4 Demonstrates suspiciousness, avoids eye contact, and engages in limited conversation 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 personality disorder would the nurse suspect in a client telling a rambling, lengthy, unclear, and overly detailed story about their dog, who they say is the president? Select all that apply. One, some, or all responses may be correct.

1 Schizoid 2 Paranoid 3 Histrionic 4 Borderline 5 Narcissistic Correct 6 Schizotypal People with schizotypal personality disorder demonstrate symptoms that are strikingly strange and unusual, such as magical thinking, odd beliefs, strange speech patterns, and inappropriate affect. A client telling an odd and rambling story about their dog being the president would be demonstrating behavior consistent with schizotypal personality disorder. People with schizoid personality disorder display a lack of interest in social relationships. Paranoid personality disorder is characterized by a longstanding distrust and suspicion of others based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive the person. People with histrionic personality disorder are excitable and dramatic yet often high functioning. Borderline personality disorder is characterized by severe impairments in functioning caused by patterns of marked instability in emotional control or regulation, impulsivity, identity or self-image distortions, unstable mood, and unstable interpersonal relationships. Narcissistic personality disorder is characterized by feelings of entitlement, an exaggerated belief in one's own importance, and a lack of empathy.

A client is having a manic episode and has not eaten in the 2 weeks preceding hospitalization. Which rationale explains the eating pattern?

1 The client has feelings of unworthiness. Correct 2 The client's activity level interferes with eating. 3 The client unconsciously desires punishment. 4 The client is preoccupied with ritualistic behavior. During a manic episode the affected individual tries to keep active to prevent depression; avoidance of feelings, not food, is the priority, and manic people do not take the time to eat. Feelings of grandeur have replaced unconscious feelings of unworthiness at this phase of the illness. The manic phase is not characterized by a desire for punishment. Manic clients are usually not aware of unconscious feelings. Clients in the manic phase do not control anxiety by the use of ritualistic behavior; ritualistic behavior is common in clients with an obsessive-compulsive disorder.

For a client with schizophrenia, which symptoms are classified as negative symptoms? Select all that apply. One, some, or all responses may be correct.

Correct 1 Lack of energy Correct 2 Anhedonia 3 Illogical speech 4 Ideas of reference 5 Agitated behavior A lack of energy (anergy) and anhedonia (inability to experience pleasure) are negative symptoms associated with schizophrenia. Illogical speech and ideas of reference, (i.e., a person believes she or he is the object of environmental attention) are positive symptoms of schizophrenia. Agitated, hostile, angry, and violent behaviors are positive symptoms of schizophrenia.

In the rehabilitation of a client addicted to alcohol, which factor is most important? 1 Motivational readiness 2 Availability of community resources 3 Accepting attitude of the family 4 Level of the client's physical state

Intrinsic motivation (stimulated from within) is essential if rehabilitation is to be successful. Often clients are most emotionally ready for help when they have "hit bottom." Only then are they ready to face reality and put forth the necessary energy and effort to change behavior. Community resources, physical state, and family have less effect on the success of rehabilitation.

A client with schizophrenia repeatedly says, "No moley, jandu!" Which language disturbance is the client exhibiting? 1 Echolalia 2 Neologism 3 Concretism 4 Perseveration

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.

For a 3-year-old child with a pervasive developmental disorder, not otherwise specified, which behavior would be considered most unusual for the child to demonstrate? 1 Interest in soft music 2 Ritualistic behavior 3 Attachment to odd objects 4 Responsiveness to the parents

One of the symptoms that an autistic child displays is lack of responsiveness to others; there is little or no extension to the external environment. Soft music is nonthreatening, comforting, and soothing. Repetitive behavior provides comfort. Repetitive visual stimuli, such as a spinning top, are nonthreatening and soothing.

When managing the care of an acutely depressed client, which approach would demonstrate that the nurse recognizes the client's fundamental mental health need?

Correct 1 Role modeling a hopeful attitude regarding life and the future 2 Sharing that life has presented depressing situations for all of us at times 3 Devoting time with the client while focusing on happy, positive memories 4 Identifying the client's personal weaknesses to design interventions to strengthen them The nurse would role model a hopeful attitude regarding life and the future. Role modeling has been shown to be an excellent tool in molding adaptive behavior. Depression affects the individual's ability to see hope in the future, and role modeling will help provide adaptation to similar feelings. Affirming that everyone has depressive situations in their lives does not foster a positive response in the depressed client and belittles the client's feelings. Reminiscing about happier times and events is likely to highlight the client's current loss of happiness rather than foster positive feelings. When a client is depressed, the nurse would identify the client's personal strengths, not weaknesses, and focus on interventions to reinforce those strengths. Focusing on a client's weaknesses when the client is already depressed may initiate a deeper depression.

Which feeling will result from withdrawn behavior? 1 Anger 2 Paranoia 3 Loneliness 4 Boredom

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 rationale would explain the reason a client abuses alcohol? 1 To blunt reality 2 To precipitate euphoria 3 To promote social interaction 4 To stimulate the central nervous system

Clients abuse alcohol to blunt reality. Alcohol, by depressing the central nervous system and distorting or altering reality, reduces anxiety. Alcohol depresses the central nervous system; it may cause lability of mood, impaired judgment, and aggressive actions rather than euphoria. Although alcohol is used as a social lubricant, clients with alcohol use disorder frequently drink in isolation. Also, alcohol can lead to inappropriate and aggressive behavior that may impair social interaction. Alcohol depresses the central nervous system; amphetamines and cocaine are stimulants.

To foster toilet training in a cognitively impaired child, which reward is best to reinforce appropriate use of the toilet? 1 Candy bar 2 Piece of fruit 3 Hug with praise 4 Choice of rewards

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.

For a client with obsessive-compulsive disorder, which event will increase the client's anxiety level? 1 The day progresses and the sun is close to setting. 2 Family members come to the unit to visit. 3 The nurse performs the morning physical assessment. 4 Limits are set on the performance of a ritual.

Setting limits on the performance of a ritual will increase the client's anxiety. The ritual is a defense that controls anxiety. The client needs time to develop other defenses before the ritual can be limited. The precipitation of anxiety in a client with obsessive-compulsive disorder is usually unrelated to the time of day. Sundowning is an increase in confusion (in the early evening) seen in clients with dementia. Visits from the family or physical assessment by the nurse could precipitate anxiety for any client, but nonjudgmental and supportive attitudes should decrease anxiety.

In comparing anorexia nervosa with bulimia nervosa, which statement is true? 1 Clients with anorexia nervosa tend to be more extroverted than clients with bulimia nervosa. 2 Clients with anorexia seek intimate relationships, whereas clients with bulimia avoid them. 3 Clients with anorexia nervosa are at greater risk for fluid imbalances. 4 Clients with bulimia nervosa generally recognize that their eating pattern is abnormal.

The client with anorexia nervosa denies the illness; the client with bulimia nervosa hides the behavior because the eating patterns are recognized as problematic. Clients with anorexia nervosa are more introverted and tend to avoid relationships. Clients with bulimia are at a greater risk for fluid imbalance because of the purging.

For a client with the diagnosis of bulimia nervosa, purging type, which clinical manifestation would be monitored? 1 Weight gain 2 Dehydration 3 Hyperactivity 4 Hyperglycemia

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.

Which information would the nurse include in client education regarding alcoholic blackouts? 1 It is a fugue state resembling absence seizures. 2 It is fainting spells followed by loss of memory. 3 It is a loss of consciousness lasting less than 10 minutes. 4 It is an absence of memory in relation to drinking episodes

The nurse would include that it is an absence of memory in relation to drinking episodes. Although the exact cause is unclear, alcoholic blackouts appear to result from alcohol's ability to block the consolidation of new memories. The individual does not have any type of seizure during the blackout. Fainting is not associated with the blackout. The individual loses memory but not consciousness. The person is still able to perform tasks, even complicated ones.

Which term or description would the nurse use for a client who repeatedly performs ritualistic behaviors throughout the day to limit anxious feelings? 1 Obsessions 2 Compulsions 3 Under personal control 4 Related to rebelliousness

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.

For Alcoholics Anonymous, which goal is the priority? 1 Acknowledging and changing destructive behavior 2 Developing functional social and family relationships 3 Identifying how people present themselves to others 4 Understanding interactional patterns within the group

The purpose of a self-help group is for individuals to develop their strengths and new, constructive patterns of coping. Developing functional relationships, identifying how people present themselves to others, and understanding patterns of interaction within the group are also desirable outcomes of group therapy.