Psych Quiz #5 SFSU Windle 2019 Chapter 11, 17, 23, 24 Varcarolis Book

A 24-year-old patient diagnosed with borderline personality disorder (BPD) is admitted to the inpatient psychiatric unit following a suicide attempt. Which client statements illustrate a primary coping style of persons with BPD? "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." "I will never again speak to any of my messed up family members. I know that this will help me to be more functional." "I promise I am not feeling suicidal. I won't hurt myself."

"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The other options do not describe splitting, which is a primary coping style of patients with BPD.DIF: Cognitive Level: Analyze (Analysis)REF: page 32TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? Select all that apply. Academic performance Activities of daily living Physical growth Social relationships Personal perception

Academic performance Activities of daily living Social relationships Personal perception For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.REF: 183-184

The nurse caring for a client diagnosed with Alzheimer's disease can anticipate that the family will need information about which medication therapy? Antihypertensives Benzodiazepines Immunosuppressants Acetylcholinesterase inhibitors

Acetylcholinesterase inhibitors Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.REF: 441-442

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess for which nightly behavior? Agitation Lethargy Depression Mania

Agitation Sundowning involves increased disorientation and agitation occurring at night. None of the other options are associated with sundowning.REF: 440

A 78-year-old patient diagnosed with Alzheimer's disease picks up a glass from the bedside table but does not recognize the purpose of the object. This inability is associated with which characteristic of the disorder? Apraxia Agnosia Aphasia Agraphia

Agnosia Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.DIF: Cognitive Level: Remember (Knowledge)REF: page 5TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Which statement is true of pharmacological therapies associated with the treatment of personality disorders? Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.

Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off-label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.DIF: Cognitive Level: Apply (Application)REF: page 30TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

Which type of dementia has a clear genetic link? Alcohol-induced dementia Multi-infarct dementia Creutzfeldt-Jakob disease Alzheimer's disease

Alzheimer's disease Family members of people with Alzheimer's disease have a higher risk of developing the disease than does the general population. Research does not support such a claim for any of the other options.REF: 435-436

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? Select all that apply. Mood stabilizers Antianxiety agents Anticholinesterase inhibitors First-generation antipsychotics Second-generation antipsychotics

Antianxiety agents First-generation antipsychotics Second-generation antipsychotics Drugs with Food and Drug Administration (FDA) approval for treating tics are the first-generation antipsychotics haloperidol and pimozide, and the second-generation antipsychotic aripiprazole.Clonidine hydrochloride, an alpha 2-adrenergic agonist, used to treat hypertension, is also prescribed for tics. While less effective and far slower acting than the antipsychotics, it has fewer side effects. The antianxiety drug clonazepam (Klonopin) is used as a supplement to other medications. It may work by reducing anxiety and resultant tics. The other options are not used or approved for the treatment of Tourette's disorder.DIF: Cognitive Level: Applying (Application)REF: page 24TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity

What is the priority nursing intervention for a client diagnosed with borderline personality disorder? Protect other clients from manipulation. Respect the client's need for attention. Assess for suicidal and self-mutilating behaviors. Provide clear, consistent limits and boundaries.

Assess for suicidal and self-mutilating behaviors. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress. While the other options may be appropriate, none have the priority of safety.REF: 463-464

Which statement concerning syndromes seen in other cultures but not seen in our own, such as piblokto, Navajo frenzy witchcraft, and amok should be considered true? Dissociative disorders such as dissociative identify disorders Physical disorders, not mental disorders Culture-bound syndromes that are not dissociative disorders Myths, or rumors, because they have not been sufficiently studied to be classified as real.

Culture-bound syndromes that are not dissociative disorders Certain culture-bound disorders exist in which there is a high level of activity, a trancelike state, and running or fleeing, followed by exhaustion, sleep, and amnesia regarding the episode. These syndromes, if observed in individuals native to the corresponding geographical areas, should be differentiated from dissociative disorders. The other responses are incorrect.DIF: Cognitive Level: Apply (Application)REF: page 47TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character for the client who truly has early stage Alzheimer's disease? Select all that apply. Easily frustrated by cognitive losses Charming behavior designed to hide memory deficit Confabulation to compensate for forgotten information Avoidance of questions by subject changing

Easily frustrated by cognitive losses Frustration and anger are characteristics of the middle stage of Alzheimer's. During early-stage Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation. The remaining options are associated with the early stage of Alzheimer's disease.REF: 438; Table 23-3

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? Somatic disorder Factitious disorder Illness anxiety disorder Conversion disorder

Illness anxiety disorder Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic. This is not an accurate description of any of the other options.REF: 317

A 4 years old is referred to the outpatient mental health clinic after being in a severe car accident during which the child mother died. The father states that the child is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again when playing. The child states, "It's my fault because I'm bad." What trauma induced disorder does this data support? Adjustment disorder Dissociative identity disorder Posttraumatic stress disorder (PTSD) Acute stress disorder (ASD)

Posttraumatic stress disorder (PTSD) PTSD in preschool children may manifest as repetitive play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion. Children may blame themselves for the traumatic event and manifest persistent negative thoughts about themselves. Unlike PTSD, adjustment disorder may be diagnosed immediately or within 3 months of exposure. Responses to the stressful event may include combinations of depression, anxiety, and conduct disturbances. Dissociative identity disorder includes the presence of "alters" or other personalities that take over in times of stress. As compared with PTSD that occurs a month after the trauma, ASD occurs from 3 days and up to 1 month after exposure to a highly traumatic event. Individuals with ASD experience three or more dissociative symptoms either during or after the traumatic event, including the following: a sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization (a sense of unreality related to the environment); depersonalization (experience of a sense of unreality or self-estrangement); or dissociative amnesia (loss of memory).DIF: Cognitive Level: Apply (Application)REF: page 29TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

The term "perceptual disturbance" refers to difficulty in which area of function? Processing information about one's internal and external environment Can be one's way of thinking to accommodate new information Performing purposeful motor movements Formulating words appropriately

Processing information about one's internal and external environment Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way. None of the other options are associated with this inability.REF: 432-433

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff should implement which personal intervention? Regularly discuss their feelings about the client during the unit's interprofessional care meetings. Attend in-services that focus on the various aspects of somatic disorders. Rotate care of the client among the entire nursing department staff to minimize the frustration. Provide a unified approach to the client's behavior so as to manage and lessen the barrier itself.

Regularly discuss their feelings about the client during the unit's interprofessional care meetings. It is helpful for health care workers, no matter the setting, to discuss responses to these patients in conferences with other health care members to allow for expression of feelings and, ultimately, to provide for consistent care. While the other options are appropriate, none are as staff oriented as the correct option.REF: 320-321

A 37-year-old patient, referred to the mental health clinic with a suspected personality disorder, is withdrawn and suspicious and states, "I've always preferred to be alone" and then adds, "I can read your thoughts whenever I want to." This presentation supports which psychiatric diagnosis? Obsessive-compulsive personality disorder Narcissistic personality disorder Avoidant personality disorder Schizotypal personality disorder (STPD)

Schizotypal personality disorder (STPD) The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence of goals long after they are necessary, even if they are self-defeating or negatively affect relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.DIF: Cognitive Level: Apply (Application)REF: page 9TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

A 5-year-old who consistently omits the sound for 'r' and 's' when speaking is demonstrating which type of disorder? Speech Language Social communication Specific learning

Speech Speech disorders are marked by problems in making sounds. Children may have trouble making certain sounds, or they may distort, add, or omit sounds. Such patterns are not associated with any of the other options.REF: 179

Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? "A combination of antianxiety and antidepressant therapy is the most effective therapy." "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

"Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders." CBT is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder.DIF: Cognitive Level: Analyze (Analysis)REF: Table 17-5TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement? "I do like you, but I don't like it when you grab my pen." "Liking you has nothing to do with whether I will loan you my pen." "It sounds as though you are feeling helpless and insecure." "You must ask for permission before taking someone else's things."

"I do like you, but I don't like it when you grab my pen." This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others. None of the other options provide the necessary degree of positive regard.REF: 186, Box 11-3

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? "I feel less anxiety than before." "My memory is better than it was a month ago." "I take my medications just as the physician prescribed." "I don't think about my symptoms all the time as I used to."

"I don't think about my symptoms all the time as I used to." This statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome. Neither medication adherence nor memory loss is associated with this disorder. The client would not acknowledge generalized anxiety as a symptom of their disorder.REF: 326-327

Which statement made by a client would support the diagnosis of Illness anxiety disorder? "I feel confused and disoriented." "I feel as though I'm outside my body watching what is happening." "I know I have cancer, but the doctors just cannot find it." "I woke up one morning, and my left leg was paralyzed from the knee down."

"I know I have cancer, but the doctors just cannot find it." Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. People experience extreme worry and fear about the possibility of having a disease. None of the other statements accurately support this illogical fear of illness.REF: 317

A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." What response should the nurse provide to address the client's comment? "I will be continuing to follow the care plan for the patient." "I see you are trying to control that patient's therapy as well as your own." "Your eye for perfection extends even to my nursing interventions." "That patient's care is really of no concern to you or to other clients."

"I will be continuing to follow the care plan for the patient." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.REF: 458

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be: "That will be fine. I'll have you sign our hospital release form." "Because we do not have a copy of durable power of attorney, we cannot release them to you." "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." "I would like to have your mother wear them. It will help her to be less confused or retain more of her orientation."

"I would like to have your mother wear them. It will help her to be less confused or retain more of her orientation." Clients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids. None of the other options support this client need.REF: 440-441

Which statement, made by a client diagnosed with dissociative identity disorder, demonstrates effective understanding in response to the question, "What exactly are the 'alters'? your provider told you about?" illustrates that the education you provided has been effective? "So, alters are based in mysticism and religiosity, such as demons." "So, alters are separate personalities with their own characteristics that take over during stress." "So, alters are never aware of each other." "So, alters are just like me, but they have no memory of the trauma I went through."

"So, alters are separate personalities with their own characteristics that take over during stress." Dissociative identity disorder appears to be associated with at least two dissociative identity states: one is a state or personality that functions on a daily basis and blocks access and responses to traumatic memories, and another state (also referred to as an alter state) is fixated on traumatic memories. Each alter has its own memories, behavior patterns, and characteristics. Transition from one personality to another (switching) occurs during times of stress. The other responses are incorrect, because alters may be aware of the existence of each other to some degree, and alters are not just like the host—they have different behaviors and memories.DIF: Cognitive Level: Analyze (Analysis)REF: pages 50, 51TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" "Your legs don't work because your brain is screwed up." "Your emotional distress is being expressed as a physical symptom." "You are making up your symptoms as a cry for help." "You are overly anxious about having a severe illness."

"Your emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder.DIF: Cognitive Level: Apply (Application)REF: pages 7, 8TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder? 13-year-old male 23-year-old female 33-year-old male 43-year-old female

23-year-old female The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals.REF: 316

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A court date this week for drunk driving Was adopted at the age of 5 years A history of physical abuse by his stepfather A history of oppositional-defiant disorder Raised primarily in a single parent household

A court date this week for drunk driving Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home is not known to be a causative factor in malingering.DIF: Cognitive Level: Analyze (Analysis)REF: page 36TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

Based on the current research, which patient is most likely to develop dementia? An office manager in a high-stress environment A former boxer and is now a trainer A worker in a factory where asbestos is found A bartender in a dark underground club/bar

A former boxer and is now a trainer Brain injury and trauma are associated with a greater risk of developing Alzheimer's disease and other dementias. People who suffer repeated head trauma, such as boxers and football players, may be at greater risk. The other options do not specifically represent known risk.DIF: Cognitive Level: Apply (Application)REF: page 14TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity

A client diagnosed with Alzheimer's disease looks confused and cannot recall many common household objects by name, such as a pencil or glass. The nurse should document this loss of function using which term? Apraxia Agnosia Aphasia Anhedonia

Agnosia Agnosia is a loss of the ability to recognize familiar objects. The loss is not associated with any of the other options.REF: 437

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? Attention deficit disorder Attention deficit hyperactivity disorder Autism Conduct disorder

Attention deficit hyperactivity disorder The data are most consistent with attention deficit hyperactivity disorder (ADHD) as described in the DSM-5. The other options present with characteristics and behaviors that differ from those in the scenario.REF: 183

Which social behavior is often a result of a child having been exposed to some form of abuse? Speech disorders Bullying others Eating disorders Delayed motor skills

Bullying others Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood. None of the remaining options are as directly associated with abuse as bullying.REF: 173

Studies have shown a correlation between mental disorders and which medical condition? Psoriasis Asthma Chronic renal failure Cardiovascular disease

Cardiovascular disease Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions such as cardiovascular disease and cancer. No such correlation has been proven between medical and any suggest psychiatric conditions.REF: 317-318

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? Client will walk unassisted within 1 week. Client will return to a pre-illness level of functioning within 2 weeks. Client will be able to state two new effective coping skills within 2 weeks. Client will assume full self-care within 3 weeks.

Client will be able to state two new effective coping skills within 2 weeks. An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic.DIF: Cognitive Level: Apply (Application)REF: Table 17-3TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial Integrity

Which statement about somatoform disorders is true? An organic basis exists for each group of disorders. Nurses perceive clients with these disorders as easy to care for. No relation exists between these disorders and early childhood loss or trauma. Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Clients lack awareness of the relations among symptoms, anxiety, and conflicts. Somatization disorders are believed to be responses to psychosocial stress, although the patient often shows no insight into the potential stressors. None of the other options accurately describe somatoform disorders.REF: 328-329

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? Utilizing many different therapeutic strategies or modalities for enhanced coping Involving every member of the family as well as the patient in treatment Incorporating spirituality and religion into treatment Considering all dimensions of the patient, including biological, psychological, and sociocultural

Considering all dimensions of the patient, including biological, psychological, and sociocultural It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.DIF: Cognitive Level: Understand (Comprehension)REF: page 2TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

Which mental health disorder is an example of a somatoform disorder? Depersonalization Dissociative fugue Conversion disorder Dissociative identity disorder

Conversion disorder Somatic disorders include conversion disorders that are functional neurological disorders. None of the other options are associated with this classification of mental health disorders.REF: 316-317

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? Steering conversation away from the client's feelings Conveying an interest in the client rather than in the symptoms Encouraging the client to use benzodiazepines liberally Encouraging the client to rely on the nurse to meet the client's needs

Conveying an interest in the client rather than in the symptoms When the nurse focuses on the client rather than on the symptoms, the client's self-worth and coping skills are enhanced. The discussion related to client feelings is a major focus of therapy. Neither of the remaining options serves to help the client identify the causes of the illness and so would not serve as effective interventions.REF: 326; Table 17-4

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention? Suggest that the child's father become her primary caregiver. Encourage the mother to consider attending parenting classes. Counsel the mother regarding ways to better bond with her child. Educate the father regarding signs that the child is being physically abused.

Counsel the mother regarding ways to better bond with her child. All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.REF: 173

The family members of a client with early-stage Alzheimer's disease cannot provide adequate supervision for the client. What would be a reasonable alternative for the nurse to explore with them to meet their current needs? Day care Acute care hospitalization Long-term institutionalization Group home residency

Day care Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions. The other options may be considered as the client moves into the advances stages of the disease disorder.REF: 443; Table 23-8

When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse should include information related to which local resourses? Select all that apply. Day care centers Legal professionals Home health services Family support groups Professional counseling

Day care centers Home health services Family support groups Professional counseling Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.REF: 439 and 443; Tables 23-8

A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with which cognitive disorder? Delirium Dementia Amnesic disorder Selective inattention

Delirium Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time. None of the other options share these characteristics.REF: 447-448

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? Potential for violence Level of confusion Dependence on medication Personal identity disturbance

Dependence on medication Many clients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the client has taken, but also for amounts and length of time over which the drugs have been prescribed. None of the other options are routinely associated with somatoform disorders.REF: 320-321

A 62-year-old patient who is recovering from a urinary tract infection that has required hospitalized for delirium. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess regularly after discharge? Sleeping habits Sexual functioning Symptoms of posttraumatic stress Depression and level of cognition

Depression and level of cognition Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.DIF: Cognitive Level: Analyze (Analysis)REF: page 25TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Which of the following statements about dissociative disorders is true? Dissociative symptoms are under the person's conscious control. Dissociative symptoms are not under the person's conscious control. Dissociative symptoms are usually a cry for attention. Dissociative symptoms are always negative.

Dissociative symptoms are not under the person's conscious control. Dissociation is involuntary and results in failure of the normal control over a person's mental processes and normal integration of conscious awareness. The other responses are untrue.DIF: Cognitive Level: Apply (Application)REF: page 43TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

The primary difference between a factitious disorder and other somatic disorders is described in which statement? Factitious disorders respond well to confrontation as a primary therapeutic technique. Factitious disorders have a symptomatology that is actually controlled by the client. Factitious disorders have their origins in depression and anxiety. Factitious disorders are always self-directed.

Factitious disorders have a symptomatology that is actually controlled by the client. Factitious disorders, in contrast to other somatic disorders, are under conscious control. None of the other statements accurately describe these disorders.REF: 327

A physician describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? Falsely claiming to have symptoms. Experiencing symptoms that cannot be explained medically. Experiencing symptoms that have a physiological basis. Seeking medication to ease pain of psychological origin.

Falsely claiming to have symptoms. Malingering is a consciously motivated act to deceive based on the desire for material gain. The symptoms described are nonexisting and so none of the other options are correct statements of behavior.REF: 338-329

A client diagnosed with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to which characteristic symptom of delirium? Anger Fear Unmet physical need Unmet social interaction

Fear Clients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious clients who are fearful may strike out at others, seemingly without provocation. Anger may develop but it is triggered by fear. Neither of the remaining options are generally associated with the behavior described.REF: 433

Which of the following symptoms would lead a provider to suspect that a client is experiencing PTSD? Select all that apply. Visiting the scene of the accident over and over Talking with strangers about the events of the accident Flashbacks of the accident Hypervigilance Irritability Difficulty concentrating Mania

Flashbacks of the accident Hypervigilance Irritability Mania

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? Difficulty in social relationships Humming while performing activities that require concentration Frequent eye blinking Difficulty in completing tasks on time

Frequent eye blinking Persistent motor or vocal ticking is characteristic of Tourette's syndrome. Dysfunctional social relationship is an inconclusive symptom, especially for a 4-year-old. Humming can be a normal response of a child at play. Ineffective time management is usually associated with a child who demonstrates ADHD, not Tourette's syndrome.REF: 179-180

When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is experiencing what characteristic symptom? Hallucinations Illusion Hypervigilant Agnosia

Illusion Illusions are errors in the perception of a sensory stimulus. None of the other options are associated with this form of misperception.REF: 433

Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. Which nursing diagnosis best addresses this sort of interpersonal dysfunction? Spiritual distress Defensive coping Impaired social interaction Disturbed sensory perception

Impaired social interaction For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used. None of the other options appropriately deals with this type of dysfunctional behavior.REF: 467

Which nursing diagnosis should be investigated for clients with somatoform disorders? Deficient fluid volume Self-care deficit Ineffective coping Delayed growth and development

Ineffective coping Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms. This information supports that clients generally demonstrate ineffecting coping of anxiety, loneliness, and risk of suicide. None of the other options are associated with somatoform disorders.REF: 322-323

A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of what process? Regression Depersonalization La belle indifference Dissociative amnesia

La belle indifference La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety. Such indifference is not observed in any of the other options.REF: 317

What initial intervention should the nurse suggest to the family members of a client diagnosed with Alzheimer's disease who has become incontinence of urine? Label the bathroom door with a picture. Provide toileting on an as-needed basis. Apply disposable diapers. Encourage hourly toileting.

Label the bathroom door with a picture. Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are. The remaining options may need to be implemented eventually when such prompting is no longer effective.REF: 437

Patients diagnosed with BPD exhibit negative effect, which includes rapidly moving from one emotional extreme to another. What term is used to describe this characteristic? Lability Impulsivity Splitting Denial

Lability One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Patients exhibiting this trait are often documented as being labile. None of the other options is used to describe this characteristic.DIF: Cognitive Level: Remember (Knowledge)REF: page 32TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply). of, inattention, and impulsivity have to be apparent: Select all that apply. Low frustration tolerance Poor school performance Impulsive behaviors Easily intimidated Mood swings

Low frustration tolerance Poor school performance Impulsive behaviors Mood swings Individuals with ADHD show an inappropriate degree of inattention, impulsiveness, and hyperactivity. Attention problems and hyperactivity contribute to low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self-esteem. ADHD is not generally characterized by meekness or by being easily intimidated.DIF: Cognitive Level: Apply (Application)REF: pages 35, 36TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which of the client's classic characteristics? Mood shifts, impulsivity, and splitting Grief, anger, and social isolation Altered sensory perceptions and suspicion Perfectionism and preoccupation with detail

Mood shifts, impulsivity, and splitting Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings. The remaining options suggest characteristics not associated with this disorder.REF: 463

Which statement is true regarding antisocial personality disorder (APD)? Select all that apply. It is the least studied of the personality disorders. It is characterized by rigidity and inflexible standards of self and others. Persons with APD display magical thinking. Persons with APD are concerned with personal pleasure and power. It is characterized by deceitfulness, disregard for others, and manipulation. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. Frontal lobe dysfunction is a brain change identified in APD.

Persons with APD are concerned with personal pleasure and power. It is characterized by deceitfulness, disregard for others, and manipulation. Frontal lobe dysfunction is a brain change identified in APD. APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes STPD. People with APD usually present with depression because of the consequences of their behaviors, not because they care about the effects of their actions on others.DIF: Cognitive Level: Comprehension (Understanding)REF: pages 23, 24TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Personality

When discussing somatic disorders from a cultural perspective, which statement is true? Somatic disorders are rarely observed in males. Somatic symptoms vary widely from culture to culture. Underdeveloped countries rarely tolerate somatic disorders. Secondary gain is seldom a factor in somatic disorders.

Somatic symptoms vary widely from culture to culture. The type and frequency of somatic symptoms vary across cultures. Currently, none of the other options have been supported by research.REF: 320

A student nurse is working with an 82-year-old patient diagnosed with dementia. The student is frustrated at times by not knowing how best to care for or communicate with the client. Which of the statement by the student best illustrates best care practice? Lighthearted banter: "Carl, you look great today in your new sweater, you handsome devil!" Limit setting: "Carl, you cannot yell out in your room. You are upsetting other patients." Firm direction: "You will take a shower this morning; there is no debating about it so don't try to argue." Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."

Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day." Positive regard implies respect. It is the ability to view another person as being worthy of caring about and as someone who has strengths. The attitude of unconditional positive regard is the nurse's single most effective tool in caring for people with dementia. It induces people to cooperate with care and increases family members' satisfaction with care. Although the patient may not be able to verbalize plans for his day, this response conveys belief that the patient has something to offer and treats him with respect. It also shows that the nurse wants to care for the patient and conveys commitment to the relationship. Limit-setting may be necessary at times; however, it is not the most effective care tool. The other responses are nontherapeutic.DIF: Cognitive Level: Apply (Application)REF: page 23TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? Select all that apply. Parents may initiate a lawsuit if injury occurs. Staff have conflicted feelings leading to ineffectiveness. Research suggests both are psychologically and physically harmful. Staff tends to be undertrained in use of restraints in children. The principle of least restrictive intervention is a primary concern.

Research suggests both are psychologically and physically harmful The principle of least restrictive intervention is a primary concern. Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention. This principle requires that you use more-restrictive interventions only after attempting less restrictive interventions to manage the behavior that have been unsuccessful. The other options are not correct reasons why restraint and seclusion are controversial in children.DIF: Cognitive Level: Analyzing (Analysis)REF: page 17TOP: Nursing Process: PlanningMSC: NCLEX: Safe and Effective Care Environment

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? Resilience Malnutrition Child abuse Having a depressed parent

Resilience Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills.REF: 173-174

A newly admitted client has a diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be directed toward which classic client need? Set firm limits on behavior. Respect need for social isolation. Encourage expression of feelings. Involve in milieu and group activities.

Respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.REF: 455

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing characteristic? Temperament Resilience Vulnerability Cultural assimilation

Temperament Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship. None of the other options would reflect this characteristic.REF: 173-174

A 10-year-old who is frequently disruptive in the classroom begins to fidget and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior? Therapeutic holding Seclusion Quiet room Touch control

Touch control The appropriate adult can move closer to the child and place a hand on his/her arm or an arm around his/her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried initially; before any of the other options.REF: 186; Box 11-3

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? Select all that apply. Unable to explain the phrase, "Raining cats and dogs" Reads below age level Is capable of providing effective oral self care Enjoy interacting with developmentally similar peers Physically lashes out when frustrated

Unable to explain the phrase, "Raining cats and dogs" Reads below age level Physically lashes out when frustrated IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. These children demonstrate difficulty with self care and with almost any social interactions.DIF: Cognitive Level: Analyzing (Analysis)REF: pages 25, 26TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Which event would an older client diagnosed with early stage Alzheimer's disease have greatest difficulty remembering? His or her high school graduation The births of his or her children The story of a teenage escapade What he or she ate for breakfast

What he or she ate for breakfast Initially, recent memory is impaired, and remote memory remains intact.REF: 438; Table 23-3

The nurse educator is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (4) restrictive: a. Allowing the patient to sit in the sensory room b. Placing the patient in physical restraints c. Placing the patient in a locked seclusion room d. Offering a PRN medication by mouth

a = 1, b = 4, c = 3, d = 2

The nurse is preparing to assess a child who primarily speaks Span- ish but is fluent in English. Which is the appropriate method for gathering information? a. Begin the assessment in English. b. Utilize a Spanish dictionary to ask questions of the child. c. Ask the child if he understands English. d. Obtain an interpreter who is fluent in Spanish

a. Begin the assessment in English.

A class of medications commonly prescribed for somatic disorders is mood stabilizers. antidepressants. anxiolytics. antipsychotics.

anxiolytics. Primary care providers prescribe anxiolytic agents for patients who seem highly anxious and concerned about their symptoms. Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety or to induce sleep.REF: 322-323

5. The nurse is caring for a patient with attention deficit hyperactivity disorder. The child has been prescribed methylphenidate (Ritalin). Which of the following symptoms are side effects the nurse will monitor for? (Select all that apply.) a. Hypotension b. Decreased appetite c. Sedation d, Insomnia e. Headache f. Seizure

b. Decreased appetite d, Insomnia e. Headache

The nurse is developing a care plan for a teenage patient with attention deficit hyperactivity disorder who is at high risk for self-harm due to poor judgment, high risk-taking behaviors, and impulsivity. Which of the following is the priority nursing intervention? a. Schedule a regular nurse-patient session daily, and encourage her to explore stressors that may worsen her depressed mood b. Develop a "no self-harm" contract with the patient, and encour- age her to engage in all unit activities c. Assign a staff member one-to-one close observation until the treatment team determines she is no longer a risk for self-harm. d. The patient is to wear hospital-issue clothing (pajamas) and sit/ sleep within view of staff until the physician determines she is no longer a risk for self-harm.

c. Assign a staff member one-to-one close observation until the treatment team determines she is no longer a risk for self-harm.

4. A 7-year-old male without any other diagnosed problem engages in jaw clenching and rocking back and forth. Which condition should the nurse anticipate? a. Attention deficit hyperactivity disorder b. Tourette's disorder c. Stereotypic movement disorder d. Autism spectrum disorder

d. Autism spectrum disorder

A 72-year-old patient is hospitalized diagnosed with pneumonia and experiencing delirium. When the client points to the IV pole and screams, "Get him out of here! He's going to hurt me!", the nurse recognizes the response as a(n) hallucination. delusion. illusion. confabulation.

illusion. Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.DIF: Cognitive Level: Understand (Comprehension)REF: page 6TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

A child diagnosed with autism will demonstrate impaired development in which area? Adhering to routines playing with other children swallowing and chewing eye-hand coordination

playing with other children Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction. Other behaviors include stereotypical repetitive speech, obsessive focus on specific objects, over adherence to routines or rituals, hyper- or hypo-reactivity to sensory input, and extreme resistance to change. None of the other options are characteristically associated with autism.REF: 182

Which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD? Anxiety risk for injury defensive coping impaired verbal communication

risk for injury The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth.REF: 181; Table 11-1

A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be risk for injury. acute confusion. imbalanced nutrition. impaired environmental interpretation syndrome.

risk for injury. Memory loss, agnosia, poor judgment, and the other symptoms of Alzheimer's disease contribute to placing the client at risk for injuries such as burns and falling down stairs. Risk for injury is always present for the client diagnosed with dementia. The remaining options suggest diagnoses that are associated with certain stages and degrees of cognitive impairment.REF: 440-441