Test bank for mental health exam 4

In group exercise, Mr.B, a 79 year old man with major depression, reports feelings tired and states "Nothing is going to help." Which nursing action should take priority? A. Asess Mr. B attends for suicide risk B. Encourage Mr.B to get more sleep. C. Give Mr.B to PRN anti-anxiety medication. D. Encourage Mr.B to talk about his wife's death

A

Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority

A

Mr.B, age 79, is admitted to the psychiatric unit for depression. He has lost weight and has become socially isolated. His wife dies 5 years ago and his son tells the nurse," He did very well when mom died. He didn't even cry." Which would be priority nursing diagnosis for Mr.B? A. Complicated grieving B. Imbalanced nutrition: less than body requirements C. Social isolation D. Risk for injury

A

Shane, a veteran of the war in Iraq, has been diagnosed with post-traumatic stress disorder (PTSD). He is a pt of a VA outpatient clinic. He tells the nurse that he experiences panic attacks. Which of the following medications may be prescribed for Shane to treat his panic attacks? A. Alprazolam B. Lithium C. Carbamazepine D. Haldol

A

John, a homeless person, has just come to live in the shelter. The shelter nurse is assigned to his care. Which of the following is a priority intervention on the part of the nurse? a. referring John to a social worker b. Developing a plan of care for John c. conducting a behavioral and needs assessment on John d. helping John apply for social security benefits

C

Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be a contributing factor? a. Parents who are overprotective b. Parents who have high expectations for their children c. Parents who consistently set limits on their children's behavior d. Parents who are alcohol dependent

D

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? 1. Being firm, consistent, and empathic, while addressing specific client behaviors 2. Promoting client self-expression by implementing laissez-faire leadership 3. Using authoritative leadership to help clients learn to conform to society norms 4. Overlooking inappropriate behaviors to avoid providing secondary gains

1 ~ The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting.

Which assessment data should a school nurse recognize as a sign of physical neglect? 1. The child is often absent from school and seems apathetic and tired. 2. The child is very insecure and has poor self-esteem. 3. The child has multiple bruises on various body parts. 4. The child has sophisticated knowledge of sexual behaviors.

1 ~ The nurse should recognize that a child who is often absent from school and seems apathetic and tired may be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

1 ~ The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T paranoid thinking. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that result in a constant threat readiness. They are often tense and irritable, which increases the likelihood of violent behavior.

A school nurse provides education on drug abuse to a high school class. This nursing action is an example of which level of preventive care? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Primary intervention

1. Primary prevention ANS: 1 Rationale: Providing nursing education on drug abuse to a high school class is an example of primary prevention. Primary prevention services are aimed at reducing the incidence of mental health disorders within the population.

From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Contract with the client to reinforce positive behaviors with unit privileges. 3. Teach the purpose of anti-anxiety medications to improve medication compliance. 4. Encourage the client to journal feelings to improve awareness of abandonment issues.

2 ~ The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change.

A highly emotional client presents at an outpatient clinic appointment and states, My dead husband returned to me during a sance. Which personality disorder should a nurse associate with this behavior? 1. Obsessive-compulsive personality disorder 2. Schizotypal personality disorder 3. Narcissistic personality disorder 4. Borderline personality disorder

2 ~ The nurse should associate schizotypal personality disorder with this behavior. The behaviors of people diagnosed with schizotypal personality disorder are odd and eccentric but do not decompensate to the level of schizophrenia.

When planning care for a client diagnosed with borderline personality disorder, which self- harm behavior should a nurse expect the client to exhibit? 1. The use of highly lethal methods to commit suicide 2. The use of suicidal gestures to elicit a rescue response from others 3. The use of isolation and starvation as suicidal methods 4. The use of self-mutilation to decrease endorphins in the body

2 ~ The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.

Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? 1. A client diagnosed with antisocial personality disorder 2. A client diagnosed with borderline personality disorder 3. A client diagnosed with schizoid personality disorder 4. A client diagnosed with paranoid personality disorder

2 ~ The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilating behaviors. Most gestures are designed to elicit a rescue response.

A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, My father has recently moved back to town. What should the nurse suspect? 1. Possible major depressive disorder 2. Possible history of childhood incest 3. Possible histrionic personality disorder 4. Possible history of childhood physical abuse

2 ~ The nurse should suspect that this client may have a history of childhood incest. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? 1. Allow the clients to apply the democratic process when developing unit rules. 2. Maintain consistency of care by open communication to avoid staff manipulation. 3. Allow the client spokesman to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of autocratic leadership.

2 ~ The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

Order the description of the progressive phases of Walkers model of the cycle of battering? ________ This phase is the most violent and the shortest, usually lasting up to 24 hours. ________ In this phase, the mans tolerance for frustration is declining. ________ In this phase, the batterer becomes extremely loving, kind, and contrite.

2, 1, 3 ~ In her classic studies of battered women and their relationships, Walker identified a cycle of predictable behaviors that are repeated over time. The behaviors can be divided into three distinct phases that vary in time and intensity both within the same relationship and among different couples. 1. Tension building phase. In this phase, the man's tolerance for frustration is declining. 2. Acute battering incident phase. This phase is the most violent and the shortest, usually lasting up to 24 hours. 3. Honeymoon phase. In this phase, the batterer becomes extremely loving, kind, and contrite.

A nursing instructor is teaching about case management. What student statement indicates that learning has occurred? 1. Case management is a method used to achieve independent client care. 2. Case management provides coordination of services required to meet client needs. 3. Case management exists mainly to facilitate client admission to needed inpatient services. 4. Case management is a method to facilitate physician reimbursement.

2. "Case management provides coordination of services required to meet client needs." ANS: 2 Rationale: The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames.

A homeless client comes to an emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease, which has recently become more prevalent among the homeless community, should a nurse suspect? 1. Meningitis 2. Tuberculosis 3. Encephalopathy 4. Mononucleosis

2. Tuberculosis ANS: 2 Rationale: The nurse should suspect that the homeless client has contracted tuberculosis. Tuberculosis is a growing problem among individuals who are homeless, owing to being in crowded shelters, which are ideal conditions for the spread of respiratory tuberculosis. Prevalence of alcoholism, drug addiction, HIV infection, and poor nutrition also impact the increase of contracted cases of tuberculosis.

When questioned about bruises, a woman states, It was an accident. My husband just had a bad day at work. Hes being so gentle now and even brought me flowers. Hes going to get a new job, so it wont happen again. This client is in which phase of the cycle of battering? 1. Phase I: The tension-building phase 2. Phase II: The acute battering incident phase 3. Phase III: The honeymoon phase 4. Phase IV: The resolution and reorganization phase

3 ~ The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

When planning care for clients diagnosed with personality disorders, what should be the goal of treatment? 1. To stabilize the clients pathology by using the correct combination of psychotropic medications 2. To change the characteristics of the dysfunctional personality 3. To reduce personality trait inflexibility that interferes with functioning and relationships 4. To decrease the prevalence of neurotransmitters at receptor sites

3 ~ The goal of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships. Personality disorders are often difficult and, in some cases, seem impossible to treat. There are no psychotropic medications approved specifically for the treatment of personality disorders.

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? 1. Provide objective evidence that reasons for violence are unwarranted. 2. Initially restrain the client to maintain safety. 3. Use clear, calm statements and a confident physical stance. 4. Empathize with the clients paranoid perceptions.

3 ~ The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude provides the client with a feeling of safety and security. It may also be beneficial to have sufficient staff on hand to present a show of strength.

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, The beatings have been getting worse, and Im afraid, next time, he will kill me. Which is the appropriate nursing response? 1. Leopards dont change their spots, and neither will he. 2. There are things you can do to prevent him from losing control. 3. Lets talk about your options so that you dont have to go home. 4. Why dont we call the police so that they can confront your husband with his behavior?

3 ~ The most appropriate response by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions on their own without the nurse being the rescuer. Imposing judgments and giving advice is non-therapeutic.

At 11:00 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing response is most appropriate? 1. Go ahead and use the phone. I know this pending divorce is stressful. 2. You know better than to break the rules. I'm surprised at you. 3. It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow. 4. A divorce shouldn't be considered until you have had a good nights sleep.

3 ~ The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration.

A client asks, Why does a rapist use a weapon during the act of rape? Which is the most appropriate nursing response? 1. To decrease the victimizers insecurity. 2. To inflict physical harm with the weapon. 3. To terrorize and subdue the victim. 4. To mirror learned family behavior patterns related to weapons.

3 ~ The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience, from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? 1. Interpreting the compliment as a secret code used to increase personal power 2. Feeling the compliment was well deserved 3. Being grateful for the compliment but fearing later rejection and humiliation 4. Wondering what deep meaning and purpose is attached to the compliment

3 ~ The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.

Looking at a slightly bleeding paper cut, the client screams, Somebody help me quick! Im bleeding. Call 911! A nurse should identify this behavior as characteristic of which personality disorder? 1. Schizoid personality disorder 2. Obsessive-compulsive personality disorder 3. Histrionic personality disorder 4. Paranoid personality disorder

3 ~ The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over gregarious, and seductive.

A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense? 1. Controlled response pattern 2. Compounded rape reaction 3. Expressed response pattern 4. Silent rape reaction

3 ~ The nurse should recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen.

Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? 1. The client experiences unwanted, intrusive, and persistent thoughts. 2. The client experiences unwanted, repetitive behavior patterns. 3. The client experiences inflexibility and lack of spontaneity when dealing with others . 4. The client experiences obsessive thoughts that are externally imposed.

3 ~ The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care? 1. Teaching an adolescent about pregnancy prevention 2. Teaching a client the reportable side effects of a newly prescribed neuroleptic medication 3. Teaching a client to cook meals, make a grocery list, and establish a budget 4. Teaching a client about his or her new diagnosis of bipolar disorder

3. Teaching a client to cook meals, make a grocery list, and establish a budget ANS: 3 Rationale: The nurse who teaches a client to cook meals, make a grocery list, and establish a budget is implementing care within the parameters of tertiary prevention. Tertiary prevention consists of services aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.

When a home health nurse administers an outpatients injection of haloperidol decanoate (Haldol decanoate), which level of care is the nurse providing? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

3. Tertiary prevention level of care ANS: 3 Rationale: When administering medication in an outpatient setting, the nurse is providing a tertiary prevention level of care. Tertiary prevention services are aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.

During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder? 1. I dont have a problem. My family is inflexible, and relatives are out to get me. 2. I am so excited about working with you. Have you noticed my new nail polish, Ruby Red Roses? 3. I spend all my time tending my bees. I know a whole lot of information about bees. 4. I am getting a message from the beyond that we have been involved with each other in a previous life.

4 ~ The nurse should assess that a client who states that she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof & isolated & behave in a bland & apathetic manner. The person experiences magical thinking, ideas of reference, illusions & depersonalization as part of daily life.

A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? 1. You really dont have to go by that schedule. Id just stay home sick. 2. There has got to be a hidden agenda behind this schedule change. 3. Who do you think you are? I expect to interact with the same nurse every Saturday. 4. You cant make these kinds of changes! Isnt there a rule that governs this decision?

4 ~ The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

4 ~ The priority nursing diagnosis for a client diagnosed with avoidant personality disorder should be social isolation R/T inability to relate to others. These clients avoid close or romantic relationships, interpersonal attachments & intimate sexual relationships.

When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention? 1. Teaching assertiveness skills in order to meet assessed needs 2. Supplying the couple with guidelines related to marital seminar leadership 3. Teaching the couple about various methods of birth control 4. Counseling the couple related to open and honest communication skills

4. Counseling the couple related to open and honest communication skills ANS: 4 Rationale: Counseling the couple related to open and honest communication skills is a reflection of a nursing intervention at the secondary level of prevention. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

A battered women presents to the ER with multiple abrasions and cuts. Her right eye is swollen shut. She says her husband did this to her. Which of the following is the priority nursing intervention? A. Tending to the immediate care of her wounds B. Providing her with information about a safe place to stay C. Administering the PRN tranquilizer ordered by the physician D. Explaining how she may go about bringing charges against her husband

A

A school nurse notices bruises and scars on Jana's body. The nurse suspects that the child is being physically abused. How should the nurse proceed with this information? A. As a healthcare worker, report the suspicion to child protective services. B. Check Jana again in a week and see if there are any new bruises. C. Meet with Jana's agents and ask them how Jana got the bruises. D. Initiate paperwork to have Jana placed in foster care.

A

According to the literature , which if the following is most important for individuals to maintain a healthy adaptive old age? A. To remain socially interactive B. To disengage slowly in preparation of the last stage of his life C. To move in with family D. To maintain total independence and accept no help from anyone

A

Clara, an 80 year old woman, says tot he nurse, "I'm all alone now. My husband is gone. My daughter is busy with her work and family. I might as well just go, too." Which is the best response by the nurse? a. "Are you thinking that you want to die, Clara?" b. "You have lots to live for, Clara." c. "Cheer up, Clara. You have so much to be thankful for." d. "Tell me about your family, Clara."

A

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. She tells the nurse that her husband inflicted these wounds on her. She says," I didn't want to come. I'm really okay. He only does this when he's has too much to drink. I just shouldn't have yelled at him." Which of the following is the best response by the nurse? A. "How often does he drink too much?" B. "It is not your fault. You did the right thing by coming here." C. "How many times has he done this to you?" D. "He is not a good husband. You can have to leave before he kills you."

A

The physician orders trazodone for Mrs. W, a 78-year old with depression, 150 mg to take at bedtime. Which of the following statements about this medication would be appropriate for the home health nurse to make in the teaching Mrs. W about trazadone? A. "You may feel dizzy when you stand up, so go slowly when you get up from sitting or lying down." B. "You must be sure and not eat any chocolate while you are taking this medication." C. "We will need to draw a sample of blood to send the lab every month while you are on this medication." D. "If you don't feel better right away with this medicine, the doctor can order a different kind for you."

A

When Frank's wife of 34 dies, he is very stoic, handles all the funeral arrangements, doesn't cry or appear sad, and comforts al of the other family members in their grief. Two years later, when Frank's best fiend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing his job. This is an example of which of the responses to loss? A. Delayed grieving B. Distorted grieving C. Prolonged grieving D. Exaggerated grieving

A

Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? A. Overly self-centered and exploitive of others B. Suspicious and mistrustful of others C. Rule of conscious and disapproving of change D. Anxious and socially isolated

A

Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? A. In clinical depression, anhedonia is prevalent. B. In normal grieving, the person has generalized feelings of guilt. C. The person who is clinically depressed relates feelings of expression to a specific loss. D. In normal grieving, there is a persistent state of dysphoria.

A

Which of the following is least likely to predispose a child to Tourette's disorder? A. Absence of parenteral bonding B. Family history of the disorder C. Abnormalities of brain neurotransmitters D. Structural abnormalities of the brain

A

Which of the following is thought to facilitate the grief process? A. The ability to grieve in anticipation of the loss B. The ability to grieve alone without interference C. Having recently grieved for another loss D. Taking personal responsibility for the loss

A

Which of the following represents a nursing intervention at a primary level of prevention? A. Teaching a class in parenteral effectiveness training B. Leading a group of adolescents in drug rehab C. Referring a married couple for sex therapy D. Leading a support group for battered women

A

Which of the following represents a nursing intervention at the tertiary level of prevention? A. Serving a case manager for a mentally ill homeless pt B. Leading a support group for newly retired men C. Teaching prepared childbirth classes D. Caring for a depressed widow in the hospital

A

Amy's husband of 1 year left 2 weeks ago for a year-long deployment in Afghanistan. Amy makes an appointment with psychiatric nurse practitioner at the community mental health clinic. She tells the nurse that she can't sleep, has no appetite, is chronically fatigued, thinks about he husband constantly, and fears for his life. Which of the following might the nurse suggest/prescribe for Amy? (SATA) A. A prescription for Zoloft 50mg/day B. Participation in a support group C. Resume involvement in usual activities D. Perform regular relaxation exercises

A,b,c,d

Which of the following is most likely to initiate a grief response? (SATA) A. Death of a pet dog B. Being told by her doctor that she has begun menopause C. Failing an exam D. Losing a spouse through divorce

A,b,c,d

Which of the following issues have been identified as contributing to the rise in the population of those who are homeless? (SATA) A. Poverty B. Lack of affordable healthcare C. Substance abuse D. Severe and persistent healthcare E. Growth in the number of family members living together

A,b,c,d

Dana's husband, who has deployed to Afghanistan a year ago, is returning home this week. Which of the following postdeployment situations may be likely to occur during the first few months of his return? (SATA) A. A honeymoon period of physical reconnection B. Resistance from the spouse regarding possible loss of autonomy C. Rejection by the children for perceived abandonment D. A period of adjustment to reconnect emotionally

A,b,d

Mike, a veteran of combat in Afghanistan, has a diagnosis of mild TBI. The psychiatric home health nurse form the VA medical center is assigned to make home visits to Mike and his wife, Nancy, who is his caregiver. Which of the following be an appropriate nursing intervention by the home health nurse? Select all that apply. a. Assess for use of substances by Mike or Nancy b. Encourage Nancy to do everything for Mike to prevent further deterioration in his condition c. Assess Nancy's level of stress and potential for burnout d. Encourage Nancy to allow Mike to be as independent as possible e. Suggest that Nancy ask the physician for a nursing home replacement for Mike

A,c,d

A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis? 1. The client will name own body parts as separate from others by day five. 2. The client will establish a means of communicating personal needs by discharge. 3. The client will initiate social interactions with caregivers by day four. 4. The client will not harm self or others by discharge.

ANS: 1 Rationale: An appropriate outcome for this client is to name own body parts as separate from others. The nurse should assist the client in the recognition of separateness during self-care activities, such as dressing and feeding. The long-term goal for disturbed personal identity is for the client to develop an ego identity.

Which individual is most likely to be below the poverty level in the United States? 1. A 70-year-old Hispanic woman living alone 2. A 72-year-old African American man living alone 3. A 68-year-old Asian American woman living with family 4. A 75-year-old Latino American man living with family

ANS: 1 Rationale: Approximately 3.5 million persons age 65 or older were below the poverty level in 2010. Older women had a higher poverty rate than older men, and older Hispanic women living alone had the highest poverty rate.

According to Reichard, Livson, and Peterson, a client is classified as an armored man. Which personality description led to this classification? 1. Rigid and stable, presenting a strong silent front 2. Passive-dependent individuals who lean on others for support 3. Aggressiveness is common, as is suspicion of others 4. Animosity is turned inward on themselves

ANS: 1 Rationale: In a classic study by Reichard, Livson, and Peterson, the personalities of older men were classified into five major categories according to their patterns of adjustment to aging. Armored men have well-integrated defense mechanisms, which serve as adequate protection. Rigid and stable, they present a strong silent front and often rely on activity as an expression of their continuing independence.

Approximately two million American children have experienced the deployment of a parent to Iraq or Afghanistan. How many of these children either lost a parent or have a parent who was wounded in these conflicts? 1. 48,000 2. 26,000 3. 11,000 4. 8,000

ANS: 1 Rationale: More than 48,000 children have either lost a parent or have a parent who was wounded in Iraq or Afghanistan.

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? 1. I know that it was not my fault. 2. My boyfriend has trouble controlling his sexual urges. 3. If I dont put myself in a dating situation, I wont be at risk. 4. Next time I will think twice about wearing a sexy dress.

ANS: 1 Rationale: The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

An elderly pt says to the nurse, "I don't want to go that crafts class. I'm too old to learn anything." Based knowledge of the aging process, which of the following is true statement? A. "Are you thinking that you want to die, Clara?" B. "You have lots to live for,Clara." C. "Cheer up, Clara. You have so much to be thankful for." D. "Tell me about your family, Clara."

C

A client at the mental health clinic tells the case manager, I cant think about living another day, but dont tell anyone about the way I feel. I know you are obligated to protect my confidentiality. Which case manager response is most appropriate? 1. The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care. 2. Lets discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk. 3. You seem to be preoccupied with self. You should concentrate on hope for the future. 4. This information is secure with me because of client confidentiality.

ANS: 1 Rationale: The most appropriate response by the case manager is to explain that sharing the information with the treatment team is critical to the clients care. This case managers priority is to ensure client safety and to inform others on the treatment team of the clients suicidal ideation.

A son, who recently brought his extremely confused parent to a nursing home for admission, reports feelings of guilt. Which is the appropriate nursing response? 1. Support groups are held here on Mondays for children of residents in similar situations. 2. You did what you had to do. I wouldnt feel guilty if I were you. 3. Support groups are available to low-income families. 4. Your parent is doing just fine. Well take very good care of him.

ANS: 1 Rationale: The most appropriate response by the nurse is to offer support to the son by presenting available support groups. Caregivers can often experience negative emotions and guilt. Release of these emotions can serve to prevent caregivers from developing psychopathology such a depression.

An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client? 1. Electroconvulsive therapy (ECT) 2. Neuroleptic therapy 3. An antiparkinsonian agent 4. An anxiolytic agent

ANS: 1 Rationale: The nurse should anticipate that ECT will be ordered to treat this client's symptoms of depression. ECT remains one of the safest and most effective treatments for major depression in older adults. The response to ECT may be slower in older clients, and the effects may be of limited duration.

A nurse discharges a female client to home after delivering a stillborn infant. The client finds that neighbors have dismantled the nursery that she and her husband planned. According to Worden, how could this intervention affect the womans grieving task completion? 1. This intervention may hamper the woman from continuing a relationship with her infant. 2. This intervention would help the woman forget the sorrow and move on with life. 3. This intervention communicates full support from her neighbors. 4. This intervention would motivate the woman to look to the future and not the past.

ANS: 1 Rationale: The nurse should anticipate that this intervention could hinder the woman from continuing a relationship with her infant. The first task in Worden's grief process is to accept the reality of the loss. It is common for individuals to refuse to believe that the loss has occurred. Behaviors may include misidentifying an individual in the environment as their loved one, retaining possessions of the lost loved one, and removing all reminders of the loved one in order to avoid reality.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the childs face and arms. What other symptom should indicate to the nurse that the child may have been physically abused? 1. The child shrinks at the approach of adults. 2. The child begs or steals food or money. 3. The child is frequently absent from school. 4. The child is delayed in physical and emotional development.

ANS: 1 Rationale: The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child.

A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data? 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. 2. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. 3. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and, therefore, improvement is likely. 4. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

ANS: 1 Rationale: The nurse should determine that childhood-onset conduct disorder is more severe than adolescent-onset type. These individuals are likely to develop antisocial personality disorder in adulthood. Individuals with this subtype are usually boys and frequently display physical aggression and have disturbed peer relationships.

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourettes syndrome? 1. Neuroleptic medications 2. Anti-manic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications

ANS: 1 Rationale: The nurse should recognize that neuroleptic (antipsychotic) medications are effective in the treatment of Tourette's syndrome. These medications are used to reduce the severity of tics and are most effective when combined with psychosocial therapy.

A nursing instructor is teaching about the typical grieving behaviors of Chinese Americans. Which student statement would indicate that more instruction is necessary? 1. In this culture, the color red is associated with death and is considered bad luck. 2. In this culture, there is an innate fear of death. 3. In this culture, emotions are not expressed openly. 4. In this culture, death and bereavement are centered on ancestor worship.

ANS: 1 Rationale: The nursing instructor should evaluate that more instruction is needed if a student states that the color red is associated with death and bad luck in the Chinese culture. Chinese Americans consider the color white as associated with death and is considered bad luck. Red is the ultimate color of luck in this culture. Chinese Americans also avoid purchasing insurance because of the fear that they may be inviting death.

A client diagnosed with schizophrenia is hospitalized owing to an exacerbation of psychosis related to non-adherence with antipsychotic medications. Which level of care does the clients hospitalization reflect? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

ANS: 2 Rationale: The client's hospitalization reflects the secondary prevention level of care. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included? 1. Power and control are central to the dynamic of domestic violence. 2. Poor communication and social isolation are central to the dynamic of domestic violence. 3. Erratic relationships and vulnerability are central to the dynamic of domestic violence. 4. Emotional injury and learned helplessness are central to the dynamic of domestic violence.

ANS: 1 Rationale: The nursing instructor should include the concept that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.

ANS: 1 Rationale: The pharmacological action of Ritalin causes a decrease in appetite, which often leads to weight loss. Methylphenidate is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability.

A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this childs behavior. Which student response indicates an appropriate evaluation of the situation? 1. This childs behavior must be evaluated according to developmental norms. 2. This child has symptoms of attention deficit-hyperactivity disorder. 3. This child has symptoms of the early stages of autistic disorder. 4. This childs behavior indicates possible symptoms of oppositional defiant disorder.

ANS: 1 Rationale: The students evaluation of the situation is appropriate when indicating a need for the client to be evaluated according to developmental norms. The DSM-5 indicates that emotional problems exist if the behavioral manifestations are not age-appropriate, deviate from cultural norms, or create deficits or impairments in adaptive functioning.

What term should a nurse use when assessing a response to grieving that includes a sudden physical collapse and paralysis, and which cultural group would be associated with this behavior? 1. Falling out in the African American culture 2. Body rocking in the Vietnamese American culture 3. Conversion disorder in the Jewish American culture 4. Spirit possession in the Native American culture

ANS: 1 The nurse should use the term falling out to describe a sudden physical collapse and paralysis in the African American culture. The individuals may also experience an inability to see or speak yet maintain hearing and understanding.

Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.) 1. Low self-esteem 2. Powerlessness 3. Disturbed personal identity 4. Knowledge deficit 5. Non-adherence

ANS: 1, 2 Rationale: An adult survivor of incest would most likely have low self-esteem and a sense of powerlessness. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) 1. The client will relate one empathetic statement to another client in group by day two. 2. The client will identify one personal limitation by day one. 3. The client will acknowledge one strength that another client possesses by day two. 4. The client will list four personal strengths by day three. 5. The client will list two lifetime achievements by discharge.

ANS: 1, 2, 3 Rationale: The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include relating empathetic statements to other clients, identifying one personal limitation, and acknowledging one strength in another client. Narcissistic personality disorder is characterized by an exaggerated sense of self-worth, a lack of empathy, and exploitation of others.

Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? (Select all that apply.) 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

ANS: 1, 2, 3 Rationale: The nurse should recognize a family history of Tay-Sachs disease, childhood meningococcal infections, and deprivation of nurturance and social contact as risk factors that would predispose a child to IDD. There are five major predisposing factors of IDD: hereditary factors, early alterations in embryonic development, pregnancy and perinatal factors, medical conditions acquired in infancy or childhood, and environmental influences and other mental disorders.

Owing to the unique challenges experienced by children of active duty military, which of the following fears would a nurse most likely identify? (Select all that apply.) 1. Fear of not being accepted in new schools 2. Fear of being behind academically 3. Fear of not making friends in new schools 4. Fear of losing athletic standing 5. Fear of discrimination from new school faculty

ANS: 1, 2, 3, 4 Rationale: Military children face unique challenges. They fear not being accepted, being behind academically, not making friends, and losing athletic standing as they move from one school to another. Fear of discrimination from new school faculty has not been shown as a realistic fear in this population.

Which of the following should a nurse identify as stressors in the lives of military spouses and children? (Select all that apply.) 1. Frequent moves 2. School credit transfer issues 3. Complications of spousal employment 4. Spousal loneliness 5. Loss of military privileges during spousal deployment

ANS: 1, 2, 3, 4 Rationale: The lives of military spouses and children are clearly affected when the service- members active duty assignments require frequent family moves. These include, among others, school credit transfer issues, complications of spousal employment, and spousal loneliness. Military privileges are not lost during spousal deployment.

A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.) 1. Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. 2. Intimate partner violence is used to gain power and control over the other intimate partner. 3. Fifty-one percent of victims of intimate violence are women. 4. Women ages 25 to 34 experience the highest per capita rates of intimate violence. 5. Victims are typically young married women who are dependent housewives.

ANS: 1, 2, 4 Rationale: Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. It is used to gain power and control over the other intimate partner. Women ages 25 to 34 experience the highest per capita rates of intimate violence. Eighty-five percent of victims of intimate violence are women. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives. Cognitive Level: A

A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Ego-centrism and goal setting based on personal gratification. 2. Incapacity for mutually intimate relationships. 3. Frequent feelings of being down miserable and/or hopeless. 4. Disregard for and failure to honor financial and other obligations. 5, Intense feelings of nervousness, tenseness, or panic.

ANS: 1, 2, 4 Rationale: The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. Pathological personality traits of antagonism and disinhibition must occur in order to meet the criteria for the diagnosis of antisocial personality disorder. Frequent feelings of being down, miserable, and/or hopeless and intense feelings of nervousness, tenseness, or panic are characteristics of the pathological personality trait domain of negative affectivity. This domain is listed by the DSM-5 for the diagnosis of borderline personality disorder, not antisocial personality disorder.

A nursing instructor is preparing a lesson plan related to the history of the diagnosis of post- traumatic stress disorder (PTSD). Which of the following facts would be appropriate to include? (Select all that apply.) 1. Between 1950 and 1970, little was written about PTSD. 2. During the 1970s and 1980s, there was a major increase in research on PTSD. 3. During the 1970s and 1980s, much research was related to World War II veterans. 4. PTSD did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 5. PTSD did not appear until the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

ANS: 1, 2, 4 Rationale: Very little was written about PTSD during the years between 1950 and 1970. This absence was followed in the 1970s and 1980s with an explosion in the amount of research and writing on the subject. During this time, much research was related to Vietnam not World War II veterans. PTSD did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (Select all that apply.) 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by abuse between their parents. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay.

ANS: 1, 2, 4 Rationale: When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

A nurse is leading a bereavement group. Which of following members of the group should the nurse identify as being at high risk for complicated grieving? (Select all that apply.) 1. A widower who has recently experienced the death of two good friends 2. A man whose wife died suddenly after a cerebrovascular accident 3. A widow who removed life support after her husband was in a vegetative state for a year 4. A woman who had a competitive relationship with her recently deceased brother 5. A young couple whose child recently died of a genetic disorder

ANS: 1, 2, 4, 5 Rationale: The nurse should identify that individuals are at a high risk for complicated grieving when the bereaved person was strongly dependent on the lost entity, the relationship with the lost entity was highly ambivalent, the individual experienced a number of recent losses, the loss is that of a young person, the individuals physical or psychological health is unstable, and the bereaved person perceived responsibility for the loss. Having a year to process grief while her husband was in a vegetative state would reduce the widows risk for the problem of complicated grieving.

Which of the following have been assessed as the most common types of mental illness identified among homeless individuals? (Select all that apply.) 1. Schizophrenia 2. Body dysmorphic disorder 3. Antisocial personality disorder 4. Neurocognitive disorder 5. Conversion disorder

ANS: 1, 3, 4 Rationale: A number of studies have been conducted, primarily in large, urban areas, which have addressed the most common types of mental illness identified among homeless individuals. Schizophrenia is frequently described as the most common diagnosis. Other prevalent disorders include bipolar disorder, substance abuse and dependence, depression, personality disorders, and neurocognitive disorders.

An instructor is teaching nursing students about Wordens grief process. According to Worden, which of the following client behaviors would delay or prolong the grieving process? (Select all that apply.) 1. Refusing to allow oneself to think painful thoughts 2. Indulging in the pain of loss 3. Using alcohol and drugs 4. Idealizing the object of loss 5. Recognizing that time will heal

ANS: 1, 3, 4 Rationale: The nurse should identify that refusing to allow oneself to think painful thoughts, using alcohol and drugs, and idealizing the object of loss will delay or prolong the grieving process. Task II of Wordens grief process is working through the pain or grief. Pain must be acknowledged and processed in order to move on.

Ann is a psychitric home health nurse. She has jut received an order to begin regular visits to Mrs. W, a 78 year old widow who lives alone. Mrs. W's primary-care physician has diagnosed her as depressed. Based on a needs assessment, which of the following problems would Ann address during her first visit? A. Complicated grieving B. Social isolation C. Risk for injury D. Sleep pattern disturbance

C

A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this clients care? (Select all that apply.) 1. This client has personality traits that are deeply ingrained and difficult to modify. 2. This client needs medication to treat the underlying physiological pathology. 3. This client uses manipulation, making the implementation of treatment problematic. 4. This client has poor impulse control that hinders compliance with a plan of care. 5. This client is likely to have secondary diagnoses of substance abuse and depression.

ANS: 1, 3, 4, 5 Rationale: The nurse should consider that individuals diagnosed with antisocial personality disorders have deeply ingrained personality traits, use manipulation, have poor impulse control, and often have secondary diagnoses of substance abuse or depression.

A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.) 1. The client has been diagnosed with sickle cell anemia. 2. The client has an inflated self-appraisal and feels a sense of entitlement. 3. The client has a history of a substance use disorder. 4. The client is odd and eccentric but not delusional. 5. The client has an intellectual developmental disorder.

ANS: 1, 3, 5 Rationale: The DSM-5 states that impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). The nurse would question the diagnosis of a personality disorder in a client with sickle cell anemia, substance use disorder, or an intellectual developmental disorder.

Which of the following types of care should the interdisciplinary team of hospice provide? (Select all that apply.) 1. Physical care available on a 24/7 basis 2. Counseling on the addictive properties of pain-management medications 3. Discussions related to death and dying 4. Explorations of new aggressive treatments 5. Assistance with obtaining spiritual support and guidance

ANS: 1, 3, 5 Rationale: The nurse should identify that the interdisciplinary team of hospice provides physical care available on a 24/7 basis, discussions related to death and dying, and assistance with obtaining spiritual support and guidance. Hospice is a program that provides palliative and supportive care to meet the needs of people who are dying and their families.

A student nurse asks the instructor, Which psychiatric disorder is most likely initially diagnosed in the elderly? Which instructor response gives the student accurate information? 1. Schizophrenia is most likely diagnosed later in life. 2. Major depressive disorder is most likely diagnosed later in life. 3. Phobic disorder is most likely diagnosed later in life. 4. Dependent personality disorder is most likely diagnosed later in life.

ANS: 2 Rationale: Major depressive disorder is most likely to be identified later in life. Depression among older adults can be increased by physical illness, functional disability, cognitive impairment, and loss of a spouse.

Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate IDD? 1. Meeting all of the clients self-care needs to avoid injury to the client 2. Providing simple directions and praising clients independent self-care efforts 3. Avoid interfering with the clients self-care efforts in order to promote autonomy 4. Encouraging family to meet the clients self-care needs to promote bonding

ANS: 2 Rationale: Providing simple directions and praise is an appropriate intervention for a teenager diagnosed with moderate IDD. Individuals with moderate mental retardation can perform some activities independently and may be capable of academic skill to a second-grade level.

A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred? 1. Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives. 2. Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. 3. Reminiscence therapy is a social group where members chat about past events and future plans. 4. Reminiscence therapy encourages members to share positive memories of significant life transitions.

ANS: 2 Rationale: Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. Stimulation of life memories serve to help older clients work through their losses and maintain self-esteem. Reminiscence therapy can take place in one-on-one or group settings.

A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client? 1. The nurse should document using the term older. 2. The nurse should document using the term elderly. 3. The nurse should document using the term aged. 4. The nurse should document using the term very old.

ANS: 2 Rationale: The U.S. Census Bureau classifies a 70-year-old individual as elderly. The U.S. Census Bureau has developed a system for classification of older Americans: older: 5564; elderly: 6574; aged: 7584; very old: 85 years and older.

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD? 1. Risk for injury R/T self-mutilation 2. Altered social interaction R/T non-adherence to social convention 3. Altered verbal communication R/T delusional thinking 4. Social isolation R/T severely decreased gross motor skills

ANS: 2 Rationale: The appropriate nursing diagnosis associated with this degree of IDD is altered social interaction R/T non-adherence to social convention. A client with an IQ of 47 would be diagnosed with moderate intellectual developmental disorder and may also experience some limitations in speech communications.

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior? 1. You are very disrespectful. You need to learn to control yourself. 2. I understand that you are angry, but this behavior will not be tolerated. 3. What behaviors could you modify to improve this situation? 4. What anti-personality disorder medications

ANS: 2 Rationale: The appropriate nursing response is to reflect the clients feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.

An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention? 1. Implement complete bedrest. 2. Advocate for a complete physical exam. 3. Address self-esteem needs. 4. Advocate for individual psychotherapy.

ANS: 2 Rationale: The initial nursing intervention should be to advocate for a complete physical exam. Sudden onset of dizziness, weakness, and confusion could indicate a problem with the client's cardiovascular or respiratory symptoms. Physical symptoms should be thoroughly assessed prior to attributing symptoms to psychological causes.

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? 1. Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling. 2. Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs. 3. They tend to develop few relationships because they are strongly independent but generally maintain deep affection. 4. They pay particular attention to details, which can interfere with the development of relationships.

ANS: 2 Rationale: The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? 1. Discourage the client from discussing the rape, because this may lead to further emotional trauma. 2. Remain nonjudgmental while actively listening to the clients description of the violent rape event. 3. Meet the clients self-care needs by assisting with showering and perineal care. 4. Probe for further, detailed description of the rape event.

ANS: 2 Rationale: The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process.

A family asks why their father is attending activity groups at the long-term care facility. The son states, My father worked hard all of his life. He just needs some rest at this point. Which is the appropriate nursing response? 1. Im glad we discussed this. Well excuse him from the activity groups. 2. The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation. 3. The groups are optional. Only clients at high functioning levels would benefit. 4. If your father doesnt go to these activity groups, he will be at high risk for developing cognitive problems.

ANS: 2 Rationale: The most appropriate nursing response is to educate the family that the purpose of activity groups is to provide social interaction, sensory stimulation, and reality orientation. Groups can also serve to increase self-esteem and reduce depression.

A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, Im such a terrible mother. What did I do to cause this? Which nursing response is most appropriate? 1. Researchers really dont know what causes autistic spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored. 2. Poor parenting doesnt cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control. 3. Research has shown that the mother appears to play a greater role in the development of autistic spectrum disorder than the father. 4. Lack of early infant bonding with the mother has shown to be a cause of autistic spectrum disorder. Did you breastfeed or bottle-feed?

ANS: 2 Rationale: The most appropriate response by the nurse is to explain to the parent that autistic spectrum disorder is believed to be caused by abnormalities in brain structure or function, not poor parenting. Autism occurs in approximately 11.3 per 1,000 children and is about 4.5 times more likely to occur in boys than girls.

An older, emaciated client is brought to an emergency department by the clients caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate? 1. The client will honestly reveal the nature of the injuries. 2. The client may deny or minimize the injuries. 3. The client may have forgotten what caused the injuries. 4. The client will ask to be placed in a nursing home.

ANS: 2 Rationale: The nurse should anticipate that the client may deny or minimize the injuries. The older client may be unwilling to disclose information, because of fear of retaliation, embarrassment about the existence of abuse in the family, protectiveness toward a family member, or unwillingness to bring about legal action.

A nurse is caring for an Irish client who has recently lost his wife. The client tells the nurse that he is planning an elaborate wake and funeral. According to George Engel, what purpose would these rituals serve? 1. To delay the recovery process initiated by the loss of the clients wife 2. To facilitate the acceptance of the loss of the clients wife 3. To avoid dealing with grief associated with the loss of the clients wife 4. To eliminate emotional pain related to the loss of the clients wife

ANS: 2 Rationale: The nurse should anticipate that the purpose of these rituals is to facilitate the acceptance of the loss of the client's wife. Resolution of the loss is the fourth stage in Engel's grief process, in which the bereaved experiences a preoccupation with the loss, which gradually decreases over time.

A nurse is caring for an Irish client who has recently lost his wife. The client tells the nurse that he is planning an elaborate wake and funeral. According to George Engel, what purpose would these rituals serve? 1. To delay the recovery process initiated by the loss of the clients wife 2. To facilitate the acceptance of the loss of the clients wife 3. To avoid dealing with grief associated with the loss of the clients wife 4. To eliminate emotional pain related to the loss of the clients wife

ANS: 2 Rationale: The nurse should anticipate that the purpose of these rituals is to facilitate the acceptance of the loss of the client's wife. Resolution of the loss is the fourth stage in Engel's grief process, in which the bereaved experiences a preoccupation with the loss, which gradually decreases over time.

Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did that. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? a. Task I. Accepting the reality of the loss b. Task II. Processing the pain of grief c. Task III. Adjusting to a world without the lost entity d. Task IV. Finding an enduring connection with the lost entity in the midst of embarking on a new life

C

A client is diagnosed with terminal cancer. Which situation represents Kbler-Rosss grief stage of anger? 1. The client registers for an iron-man marathon to be held in 9 months. 2. The client is a devout Catholic but refuses to attend church and states that his faith has failed him. 3. The client promises God to give up smoking if allowed to live long enough to witness a grandchilds birth. 4. The client gathers family in order to plan a funeral and make last wishes known.

ANS: 2 Rationale: The nurse should assess that the client is in the anger stage of grieving when the client refuses to attend church and states that his faith has failed him. Anger is the second stage of Kbler-Rosss grief process, in which the reality of the situation is realized, and the individual has feelings of sadness, guilt, shame, helplessness, and hopelessness.

Which is the most accurate description of the nursing diagnosis of dysfunctional grieving? 1. Inability to form a valid appraisal of a loss and to use available resources 2. The experience of distress, with accompanying sadness, which fails to follow norms 3. A perceived lack of control over a current loss situation 4. Aloneness perceived as imposed by others and as a negative or threatening state

ANS: 2 Rationale: The nurse should define dysfunctional grieving as the experience of distress, with accompanying sadness, which fails to follow norms. Three types of pathological grief reactions are delayed or inhibited grief, distorted (exaggerated) grief response, and chronic or prolonged grieving. One crucial difference between normal and dysfunctional grieving is the loss of self-esteem marked my feelings of guilt or worthlessness that may precipitate depression.

A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the childs mother? 1. Children with mild IDD need constant supervision. 2. Children with mild IDD develop academic skills up to a sixth-grade level. 3. Children with mild IDD appear different from their peers. 4. Children with mild IDD have significant sensory-motor impairment.

ANS: 2 Rationale: The nurse should inform the child's mother that children with mild IDD develop academic skills up to a sixth-grade level. Individuals with mild IDD are capable of independent living, capable of developing social skills, and have normal psychomotor skills.

A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

ANS: 2 Rationale: The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development.

A preschool child is admitted to a psychiatric unit with the diagnosis autistic spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this clients plan of care? 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.

ANS: 2 Rationale: The nurse should provide consistent caregivers as part of the plan of care for a child diagnosed with autistic spectrum disorder. Children diagnosed with autistic spectrum disorder have an inability to trust. Providing consistent caregivers allows the client to develop trust and a sense of security.

Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders? 1. Involving parents in designing and implementing the treatment process 2. Reinforcing positive actions to encourage repetition of desirable behaviors 3. Providing opportunities to learn appropriate peer interactions 4. Administering psychotropic medications to improve quality of life

ANS: 2 Rationale: The nurse should reinforce positive actions to encourage repetition of desirable behaviors when caring for children diagnosed with disruptive behavior disorder. Behavior therapy is based on the concepts of classical conditioning and operant conditioning.

Which grieving behaviors should a nurse anticipate when caring for a Navajo client who recently lost a child? 1. Celebrating the life of a deceased person with festivities and revelry 2. Not expressing grief openly and reluctance to touch the dead body 3. Holding a prayerful vigil for a week following the persons death 4. Expressing grief openly and publicly and erecting an altar in the home to honor the dead

ANS: 2 The nurse should identify that a Navajo client who recently lost a child would not express grief openly and would be reluctant to touch the dead body. Navajo Indians do not bury the body of a deceased person for four days after death, and they conduct a cleaning ceremony prior to burial. The dead are buried with their shoes on the wrong feet and rings on their index fingers.

According to genetic theory, aging is an involuntarily inherited process that operates over time to alter cellular or tissue structures. Which of the following findings support this theory? (Select all that apply.) 1. Decreased amounts of adrenocorticotropic hormone, resulting in less-efficient stress response 2. The development of collagen 3. The development of lipofuscin 4. The increased frequency in the occurrence of cancer 5. The increased frequency in the occurrence of autoimmune disorders

ANS: 2, 3, 4, 5 Rationale: According to genetic theory, aging is an involuntarily inherited process that operates over time to alter cellular or tissue structures. This theory suggests that life span and longevity changes are predetermined. The development of free radicals, collagen, and lipofuscin in the aging body, and an increased frequency in the occurrence of cancer and autoimmune disorders, provide some evidence for this theory and the proposition that error or mutation occurs at the molecular and cellular level. Decreased amounts of adrenocorticotropic hormone, resulting in less-efficient stress response is part of the normal aging process of the endocrine system.

A nurse assigns a client the nursing diagnosis of complicated grieving. According to Bowlby, which long-term outcome would be most appropriate for this nursing diagnosis? 1. The client will accomplish the recovery stage of grief by year one. 2. The client will accomplish the acceptance stage of grief by year one. 3. The client will accomplish the reorganization stage of grief by year one. 4. The client will accomplish the emotional relocation stage of grief by year one.

ANS: 3 Rationale: The nurse should identify that, according to Bowlby, an appropriate long-term outcome for this client is to accomplish the reorganization stage of grief by year one. Until the client can recognize and accept personal feelings regarding the loss, grief work cannot progress. The reorganization stage of grieving is the final stage in which the individual accepts the loss and new goals and patterns are established.

Which of the following are characteristics of a Program of Assertive Community Treatment (PACT), as described by the National Alliance on Mental Illness (NAMI)? (Select all that apply.) 1. PACT offers nationally based treatment to people with serious and persistent mental illnesses. 2. PACT is a type of case-management program. 3. The PACT team provides services 24 hours a day, 7 days a week, 365 days a year. 4. The PACT team provides highly individualized services directly to consumers. 5. PACT is a multidisciplinary team approach.

ANS: 2, 3, 4, 5 Rationale: NAMI defines PACT as a service-delivery model that provides comprehensive, locally, not nationally, based treatment to people with serious and persistent mental illnesses. PACT is a type of case-management program that provides highly individualized services directly to consumers. It is a team approach and includes members from psychiatry, social work, nursing, substance abuse, and vocational rehabilitation. The PACT team provides these services 24 hours a day, 7 days a week, 365 days a year.

After reporting a sexual assault, a female soldier is diagnosed with a personality disorder. Which of the following consequences may result? (Select all that apply.) 1. Court-martial proceedings 2. Loss of health-care benefits 3. Loss of service-related disability compensation 4. Stigma of a psychiatric diagnosis 5. Service discharge

ANS: 2, 3, 4, 5 Rationale: Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are loss of health-care benefits, loss of service-related disability compensation, and the stigma of a psychiatric diagnosis. The report of a sexual assault would not lead to courtmartial proceedings for the victim.

Which of the following findings should a nurse identify that would contribute to a clients development of ADHD? (Select all that apply.) 1. The clients father was a smoker. 2. The client was born 7 weeks premature. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

ANS: 2, 4 Rationale: The nurse should identify that premature birth and having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. Research indicates evidence of genetic influences in the etiology of ADHD. Studies also indicate that environmental influences, such as lead exposure and diet, can be linked with the development of ADHD.

Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.) 1. An acutely suicidal teenager 2. A chronically mentally ill woman who has a history of medication non-adherence 3. A socially isolated older individual 4. A depressed individual who is able to contract for safety 5. A client who is hearing voices that tell the client to harm others

ANS: 2, 4 Rationale: The nurse should recommend a structured day program for a chronically mental ill woman who has a history of medication non-adherence and for a depressed individual who is able to contract for safety. Day programs (also called partial hospitalizations) are designed to prevent institutionalization or to ease the transition from inpatient hospitalization to community living.

What is the expected feeling and/or behavior experienced by military families during the sustainment cycle of deployment, as described by Pincus and associates? 1. Feelings alternate between denial and anticipation of loss. 2. Feelings alternate between excitement and apprehension associated with homecoming. 3. Feelings focus on the establishment of new support systems and new family routines. 4. Feelings focus on the struggle to take charge of the details of the new family structure.

ANS: 3 Feedback 1 In the predeployment cycle, feelings alternate between denial and anticipation of loss. 2 In the redeployment cycle, feelings alternate between excitement and apprehension associated with homecoming. 3 In the sustainment cycle, families establish new support systems and new family routines. 4 In the deployment cycle, the spouse struggles to take charge of the details of living without his or her partner.

Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety. 3. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis. 4. Clients diagnosed with schizoid personality disorder avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate self on a continual basis.

ANS: 3 Rationale: A client diagnosed with schizoid personality disorder exhibits a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder prefer being alone to being with others and avoid social situations, social contacts, and activities

A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act? 1. Many perspective clients did not meet criteria for mental illness diagnostic-related groups. 2. Zoning laws discouraged the development of community mental health centers. 3. States could not match federal funds to establish community mental health centers. 4. There was not a sufficient employment pool to staff community mental health centers.

ANS: 3 Rationale: A deterring factor to the proper implementation of the Community Mental Health Centers Act of 1963 was that states could not match federal funds to establish community mental health centers. This act called for the construction of comprehensive community mental health centers to offset the effect of deinstitutionalization, the closing of state mental health hospitals.

Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? 1. A physically healthy client who is dependent on meeting social needs by contact with 15 cat 2. A physically healthy client who has a history of depending on intense relationships to meet basic needs 3. A physically healthy client who lives with parents and depends on public transportation 4. A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide security

ANS: 3 Rationale: A physically healthy adult client who lives with parents and depends on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors.

Research has shown that an adolescent (13 to18 years) would typically exhibit which behavior as a reaction to parental military deployment? 1. May exhibit regressive behaviors and assume blame for parents departure. 2. May become sullen, tearful, throw temper tantrums, or develop sleep problems. 3. May participate in high-risk behaviors, sexual acting out, and drug or alcohol abuse. 4. May respond to schedule disruptions with irritability and/or apathy and weight loss.

ANS: 3 Rationale: Infants (birth to 12 months) may respond to schedule disruptions with irritability and/or apathy and weight loss. Toddlers (1 to 3 years) may become sullen, tearful, throw temper tantrums, or develop sleep problems. Preschoolers (3 to 6 years) may regress in areas such as toilet training, sleep, separation fears, physical complaints, or thumb sucking and may assume blame for parents departure. School age children (6 to 12 years) are more aware of potential dangers to parent. May exhibit irritable behavior, aggression, or whininess. May become more regressed and fearful about parents safety. Adolescents (13 to 18 years) may be rebellious, irritable, or more challenging of authority. Parents need to be alert to high-risk behaviors, such as problems with the law, sexual acting out, and drug or alcohol abuse

A newly admitted homeless client diagnosed with schizophrenia states, I have been living in a cardboard box for two weeks. Why did the government let me down? Which is an appropriate nursing response? 1. Your discharge from the state hospital was done prematurely. Had you remained in the state hospital longer, you would not be homeless. 2. Your premature discharge from the state hospital was not intended for patients diagnosed with chronic schizophrenia. 3. Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success. 4. Your discharge from the state hospital was based on presumed family support, and this was not forthcoming.

ANS: 3 Rationale: The most accurate nursing response is to explain to the client that the resources were not available to make transitioning out of a state hospital a success. There are several factors that are thought to contribute to homelessness among the mentally ill: deinstitutionalization, poverty, lack of affordable housing, lack of affordable health care, domestic violence, and addiction disorders.

A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? 1. Place client in restraints until the aggression subsides. 2. Sedate the client with neuroleptic medications. 3. Hold clients head steady and apply a helmet. 4. Distract the client with a variety of games and puzzles.

ANS: 3 Rationale: The most appropriate intervention for head banging is to hold the client's head steady and apply a helmet. The helmet is the least restrictive intervention and will serve to protect the client's head from injury.

A client in the middle stage of Alzheimers disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication? 1. Discourage attempts at verbal communication owing to increased client frustration. 2. Increase the volume of the nurses communication responses. 3. Verbalize the nurses perception of the implied communication. 4. Encourage the client to communicate by writing.

ANS: 3 Rationale: The most appropriate nursing intervention is to verbalize the nurse's perception of the implied communication. The nurse should also keep explanations simple, use face-to-face interaction, and speak slowly without shouting.

A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living (ADLs). Which nursing intervention is most appropriate to maintain the clients self-esteem? 1. Leave the client alone in the bathroom to test ability to perform self-care. 2. Assign a variety of caregivers to increase potential for socialization. 3. Allow client to choose between two different outfits when dressing for the day. 4. Modify the daily schedule often to maintain variety and decrease boredom.

ANS: 3 Rationale: The most appropriate nursing intervention to maintain this client's self-esteem is to allow the client to choose between two different outfits when dressing for the day. The nurse should also provide appropriate supervision to keep the client safe, maintain consistency of caregivers, and maintain a structured daily routine to minimize confusion.

In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome? 1. The client will communicate all needs verbally by discharge. 2. The client will participate with peers in a team sport by day four. 3. The client will establish trust with at least one caregiver by day five. 4. The client will perform most self-care tasks independently.

ANS: 3 Rationale: The most realistic client outcome for a child diagnosed with autistic spectrum disorder is for the client to establish trust with at least one caregiver. Trust should be evidenced by facial responsiveness and eye contact. This outcome relates to the nursing diagnosis impaired social interaction.

An older client who lives with a caregiver is admitted to an emergency department with a fractured arm. The client is soaked in urine and has dried fecal matter on lower extremities. The client is 6 feet tall and weighs 120 pounds. Which condition should the nurse suspect? 1. Inability for the client to meet self-care needs 2. Alzheimers disease 3. Abuse and/or neglect 4. Caregiver role strain

ANS: 3 Rationale: The nurse should expect that this client is a victim of elder abuse or neglect. Indicators of elder physical abuse include bruises, fractures, burns, and other physical injury. Neglect may be manifested as hunger, poor hygiene, unattended physical problems, or abandonment.

A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her childs ADHD. Which nursing response best addresses the mothers concern? 1. The physician will probably switch from Ritalin to a central nervous system stimulant. 2. The physician may prescribe an antihistamine with the Ritalin to improve effectiveness. 3. Your child has probably developed a tolerance to Ritalin and may need a higher dosage. 4. Your child has developed sensitivity to Ritalin and may be exhibiting an allergy.

ANS: 3 Rationale: The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur.

The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following nursing interventions are appropriate for this child? (SATA) A. Socially isolate the child when interaction with others inappropriate. B. Set limits with consequences on inappropriate behaviors. C. Provide rewards for appropriate behaviors. D. Provide group situations for the child.

B,C, and D.

An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime? 1. Altered cortical and intellectual functioning 2. Altered respiratory and gastrointestinal functioning 3. Altered liver and kidney functioning 4. Altered endocrine and immune system functioning

ANS: 3 Rationale: The nurse should question the use of antidepressant medication in a client with altered liver and kidney function. Antidepressant medication should be administered with consideration for age-related physiological changes in absorption, distribution, elimination, and brain receptor sensitivity. Because of these changes, medications can reach high levels despite moderate oral dosage.

Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder? 1. Modify environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behavior and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors.

ANS: 3 Rationale: The priority nursing intervention when caring for a child diagnosed with conduct disorder should be to recognize escalating aggressive behavior and to intervene before violence occurs. This intervention serves to keep the client as well as others safe, which is the priority nursing concern.

A raped client answers a nurses questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this clients responses? 1. The client may be lying about the incident. 2. The client may be experiencing a silent rape reaction. 3. The client may be demonstrating a controlled response pattern. 4. The client may be having a compounded rape reaction.

ANS: 3 Rationale: This client is most likely demonstrating a controlled response pattern. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying sobbing, smiling, restlessness, and tension.

When attempting to provide health-care services to the homeless, what should be a realistic concern for a nurse? 1. Most individuals that are homeless reject help. 2. Most individuals that are homeless are suspicious of anyone who offers help. 3. Most individuals that are homeless are proud and will often refuse charity . 4. Most individuals that are homeless relocate frequently.

ANS: 4 Rationale: A realistic concern in the provision of health-care services to the homeless is that individuals who are homeless relocate frequently. Frequent relocation confounds service delivery and interferes with providers efforts to ensure appropriate care.

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? 1. Altered thought processes R/T increased stress 2. Risk for suicide R/T loneliness 3. Risk for violence: directed toward others R/T paranoid thinking 4. Social isolation R/T inability to relate to others

ANS: 4 Rationale: An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are not sociable.

According to Reichard, Livson, and Peterson, which classification of the personalities of older men describe passive-dependent individuals who are content to lean on others for support, to disengage, and to let most of lifes activities pass them by? 1. Mature men personalities 2. Armored men personalities 3. Self-haters personalities 4. Rocking chair personalities

ANS: 4 Rationale: In a classic study by Reichard, Livson, and Peterson, the personalities of older men were classified into five major categories according to their patterns of adjustment to aging. "Rocking chair" personalities are found in passive-dependent individuals who are content to lean on others for support, to disengage, and to let most of life's activities pass them by.

After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize? 1. Arguing and annoying older sibling over the past year 2. Angry and resentful behavior over a three-month period 3. Initiating physical fights for more than 18 months 4. Arguing with authority figures for more than six months

ANS: 4 Rationale: The DSM-5 rules out the diagnosis of ODD when only siblings are involved in argumentative interactions. Angry and resentful behavior over more than six months, not three months, would be considered a symptom of ODD. Initiating physical fights is a symptom of conduct disorder, not ODD. Arguing with authority figures for more than six months is listed by the DSM-5 as a symptom for the diagnosis of ODD.

An instructor is teaching nursing students about the difference between partial and inpatient hospitalization. In what way does partial hospitalization differ from traditional inpatient hospitalization? 1. Partial hospitalization does not provide medication administration and monitoring. 2. Partial hospitalization does not use an interdisciplinary team. 3. Partial hospitalization does not offer a comprehensive treatment plan. 4. Partial hospitalization does not provide supervision 24 hours a day.

ANS: 4 Rationale: The instructor should explain that partial hospitalization does not provide supervision 24 hours a day. Partial hospitalization programs generally offer a comprehensive treatment plan formulated by an interdisciplinary team. They have proved to be an effective method of preventing hospitalization.

A couple both reside in a long-term care facility. The husband is admitted to the psychiatric unit after physically abusing his wife. He states, My wife is having an affair with a young man, and I want it investigated. Which is the appropriate nursing response? 1. Your wife is not having an affair. What makes you think that? 2. Why do you think that your wife is having an affair? 3. Your wife has told us that these thoughts have no basis in fact. 4. I understand that you are upset. We will talk about it.

ANS: 4 Rationale: The most appropriate response by the nurse is to empathize with the client and encourage the client to talk about the situation. The nurse should remain nonjudgmental and help maintain client's orientation, memory, and recognition.

In evaluating the progress of Jack, a patient diagnosed with antisocial disorder, which of the following behaviors would be considered the most significant indication of positive change? A. Jack got angry only once in a week. B. Jack tells the nurse how much he respects her work and that she has helped him immediately. C.On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight. D. Jack stated that he would not start any more fights.

C

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder (IDD)? 1. The client can perform some self-care activities independently. 2. The client has more advanced speech development. 3. Other than possible coordination problems, the clients psychomotor skills are not affected. 4. The client communicates wants and needs by acting out behaviors.

ANS: 4 Rationale: The nurse should identify that a client diagnosed with severe IDD may communicate wants and needs by "acting out" behaviors. Severe IDD indicates an IQ between 20 and 34. Individuals diagnosed with severe IDD require complete supervision and have minimal verbal skills and poor psychomotor development.

A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect? 1. The woman may be exhibiting a controlled response pattern. 2. The woman may have a history of childhood neglect. 3. The woman may be exhibiting codependent characteristics. 4. The woman may be a victim of incest.

ANS: 4 Rationale: The nurse should suspect that this client may be a victim of incest. Many women who are battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive relationships often grew up in an abusive home.

A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate intellectual developmental disorder (IDD). Which student statement indicates that further instruction is needed? 1. These clients can work in a sheltered workshop setting. 2. These clients can perform some personal care activities. 3. These clients may have difficulties relating to peers. 4. These clients can successfully complete elementary school.

ANS: 4 Rationale: The nursing student needs further instruction about moderate IDD, because individuals diagnosed with moderate IDD are capable of academic skill up to a second-grade level. Moderate IDD reflects an IQ range of 35 to 49.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, Why doesnt she just leave him? Which is the nursing supervisors most appropriate response? 1. These clients dont know life any other way, and change is not an option until they have improved insight. 2. These clients have limited cognitive skills and few vocational abilities to be able to make it on their own. 3. These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation. 4. These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.

ANS: 4 Rationale: The nursing supervisor is accurate when stating that clients who are in abuse relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.

A teenager has recently lost a parent. Which grieving behavior should a school nurse expect when assessing this client? 1. Denial of personal mortality 2. Preoccupation with the loss 3. Clinging behaviors and personal insecurity 4. Acting-out behaviors, exhibited in aggression and defiance

ANS: 4 Rationale: The school nurse should anticipate that the teenager will exhibit aggression and acting out. Adolescents have the ability to understand death on an adult level yet have difficulty tolerating the intense feelings associated with the death of a loved one. It is often easier for adolescents to talk with peers about feelings than with other adults.

________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

ANS: Dependent Rationale: Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation. These characteristics are evident in the tendency to allow others to make decisions, to feel helpless when alone, to act submissively, to subordinate needs to others, to tolerate mistreatment by others, to demean oneself to gain acceptance, and to fail to function adequately in situations that require assertive or dominant behavior.

_____________________ personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people.

ANS: Histrionic Rationale: Histrionic personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance from others.

_____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.

ANS: Paranoid Rationale: Paranoid personality disorder is a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This disorder begins in early adulthood and presents in a variety of contexts.

Members of various components of the National Guard and U.S. Military Reserves are classified as the _________________________/_______________________.

ANS: Ready Reserve Rationale: More than 1 million men and women make up the U.S. Military Ready Reserve, who are members of various components of the National Guard and U.S. Military Reserves.

Order the goals of the levels of prevention as they progress through the public health model set forth by Gerald Caplan. ________ Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness ________ Services aimed at reducing the residual defects that are associated with severe and persistent mental illness ________ Services aimed at reducing the incidence of mental disorders within the population

ANS: The correct order is 2, 3, 1 Rationale: The premise of the model of public health is based largely on the concepts set forth by Gerald Caplan (1964) during the initial community mental health movement. They include primary prevention, secondary prevention, and tertiary prevention.

Order the stages of normal grief, according to J. William Worden. ________ Finding an enduring connection with the lost entity in the mist of embarking on a new life ________ Accepting the reality of the loss ________ Adjusting to a world without the lost entity ________ Processing the pain of grief

ANS: The correct order is 4, 1, 3, 2 Rationale: Worden views the bereaved person as active and self-determining rather than a passive participant in the grief process. He proposes that bereavement includes a set of tasks that must be reconciled in order to complete the grief process. 1. Accepting the reality of the loss 2. Processing the pain of grief 3. Adjusting to a world without the lost entity 4. Finding an enduring connection with the lost entity in the mist of embarking on a new life

Order the stages of normal grief, according to John Bowlby. ________ Reorganization ________ Disequilibrium ________ Disorganization and despair ________ Numbness/protest

ANS: The correct order is 4, 2, 3, 1 Rationale: John Bowlby hypothesized four stages in the grief process. He implies that these behaviors can be observed in all individuals who have experienced the loss of something or someone of value, even in babies as young as 6 months of age. 1. Numbness/Protest 2. Disequilibrium 3. Disorganization and despair 4. Reorganization

An association between Parkinsons disease and combat-related traumatic brain injury (TBI) has been established. This disorder may develop years after TBI as a result of damage to the _________________________/_______________________.

ANS: basal ganglia

A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed _____________________

ANS: battering Rationale: Battering is a pattern of behavior used to establish power and control over another person with whom an intimate relationship is or has been shared through fear and intimidation, often including the threat or use of violence. Battering happens when one person believes they are entitled to control another.

Physical ________________ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision.

ANS: neglect Rationale: Physical neglect of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision. Children are vulnerable and relatively powerless, and the effects of maltreatment are infinitely deep and long lasting.

The DSM-5 criteria for ODD specifies that: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least ______________ months.

ANS: six Rationale: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least six months according to the DSM-5 criteria for the diagnosis of ODD.

Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response? 1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. 2. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant personality disorder do not. 3. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. 4. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

Ans: 1 Rationale: The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder may exhibit odd and eccentric behaviors but not to the extent of psychosis.

A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of suffering in silence. Which statement best explains the etiology of this clients personality disorder? 1. Childhood nurturance was provided from many sources, and independent behaviors were encouraged. 2. Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged. 3. Childhood nurturance was provided exclusively from one source, and independent behaviors were encouraged. 4. Childhood nurturance was provided from many sources, and independent behaviors were discouraged.

Ans: 2 Rationale: The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder? 1. As the day-shift nurse leaves the unit, the client suddenly hugs the nurses arm and whispers, The night nurse is evil. You have to stay. 2. As the day-shift nurse leaves the unit, the client suddenly hugs the nurses arm and states, I will be up all night if you dont stay with me. 3. As the day-shift nurse leaves the unit, the client suddenly hugs the nurses arm, yelling, Please dont go! I cant sleep without you being here. 4. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, I cut myself because you are leaving me.

Ans: 4 Rationale: The client who states, I cut myself because you are leaving me reflects impulsive behavior that is commonly associated with borderline personality disorder. Repetitive, self- mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others.

A young women who was a recent victim of a sexual assault is brought into the ER by a friend. Which of the following is the primary nursing intervention? A. Help her to bathe and clean herself up. B. Provide physical and emotional support during evidence collection. C. Provide her with a written list of community resources for survivors of rape. D. Discuss the importance of a follow-up visit to evaluate for sexually transmitted disease.

B

Ann is a psychiatric home health nurse. She has just received an order to begin regular visits to Mrs. W, a 78-year-old widow who lives alone. Mrs. W's primary care physician has diagnosed her as depressed. Which of the following criteria would qualify Mrs. W for home health visits? a. Mrs. W never learned to drive and has to depend on others for her transportation. b. Mrs. W is physically too weak to travel without risk of injury. c. Mrs. W refuses to seek assistance as suggested by her physician because "I don't have a psychiatric problem." d. Mrs. W says she would prefer to have home visits than go to the physician's office.

B

In an effort to help the child with mild to moderate intellectual developmental disorder develop satisfying relationships with others, which of the following nursing interventions is most appropriate? A. Interpret the child's behavior for others. B. Set limits on behavior that is socially inappropriate. C. Allow the child to behave spontaneously, for he or she has no concept of right or wrong. D. This child is not capable of forming social relationships

B

Jana, age 5, is sent to the school nurse's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jana has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jana's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that a. Jana is experiencing physical and sexual abuse. b. Jana is experiencing physical abuse and neglect. c. Jana is experiencing emotional neglect. d. Jana is experiencing sexual and emotional abuse.

B

Shane, a veteran of the war in Iraq, has been diagnosed with post-traumatic stress disorder (PTSD). He has been hospitalized after swallowing a handful of his antipanic medication. His physical condition has been stabilized in the emergency department, and he has been admitted to the psychiatric unit. In developing his initial plan of care, which is the priority nursing diagnosis for Shane? a. Post-trauma syndrome b. Risk for suicide c. Complicated grieving d. Disturbed thought processes

B

Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? A. Belittling themselves and their abilities B. A lifelong pattern of social withdrawal C. Suspiciousness and mistrust of others D. Overreacting inappropriately to monitor stimuli

B

Which of the following drug classes is most commonly used for management of the child with ADHD? A. CNS depressants (diazepam) B. CNS stimulants (methylphenidate) C. Anticonvulsants (phenytoin) D. Major tranquilizers (haloperidol)

B

Which of the following is the leading cause of TBI in activity military duty personnel in combat? A. Military vehicle accidents B. Blasts from exposure devices C. Falls D. Blows to the head from falling debris

B

Which of the following medications is used as to treat Tourette's disorder? A. Methylphenidate B. Haloperidol C. Imipramine D. Phenytoin

B

Which of the following nursing diagnoses would be most appropriate for a child with ADHD ? A. Monopoly B. Volleyball C. Pool D. Checkers

B

Which of the rolling represents a nursing intervention at the secondary level of prevention? A. Teaching a class about menopause to middle aged women B. Providing support in the ER to a rape victim C. Leading a support group for women in transition D. Making monthly visits to the home of a pt with schizophrenia to ensure medication compliance

B

Shelia, a nurse, served as a captain in the military and returned from active duty 3 months ago. She repoerts experiencing nightmares and headaches since her return but denies being in active combat during her tour of duty. Which of the following should the nurse include in the psychosocial assessment? (SATA) A. Folstein's mini-mental status exam B. History of sexual trauma C. History of military promotions D. Risks for a substance use disorders

B and D

Juan, a veteran of the war in Iraq, has been diagnosed with post-traumatic stress disorder (PTSD). He has been hospitalized on the psychiatric unit following an attempted suicide. In the middle of the night, he wakes up yelling and tells the nurse he was having a flashback to when his unit transport drove over an improvised explosive device (IED) and most of his fellow soldiers were killed. He is breathing heavily, perspiring, and his heart is pounding. The nurse's most appropriate initial intervention is which of the following? a. Contact the doctor on call to report the incident. b. Administer the prn order for chlorpromazine. c. Stay with Juan and reassure him of his safety. d. Have Juan sit outside the nurses' station until he is calm.

C

Mike was injured during combat in Afghanistan. He has a diagnosis of TBI. Which of the following medications might the physician prescribe to improve Mike's memory and thinking capability? a. carbamazepine b. duloxetine c. donepezil d. bupropion

C

Mr.B, age 79, is admitted to the psychiatric unit for depression. He has lost weight and has become socially isolated. His wife died 5 years ago, and he lives alone. A suicide assessment is conducted. Why is Mr.B at high risk for suicide? A. All depressed people are at high risk for suicide. B. Mr.B is in the age group in which the highest percentage of suicides occur. C. Mr.B is a whit man, recently bereaved, living alone. D. His son reports that Mr.B owns a gun.

C

Nancy, who is dying of cancer, says to the nurse, "I just want to see my new grandbaby. If only God will let me live until she is born. Then I'll be ready to go." This is an example of which of Kübler-Ross's stages of grief? a. Denial b. Anger c. Bargaining d. Acceptance

C

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. In the interview, Sharon tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared. So I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge about the cycle of battering, what does this situation represent? a. Phase I. Sharon was desperately trying to stay out of his way and keep everything calm. b. Phase I. A minor battering incident for which Sharon assumes all the blame. c. Phase II. The acute battering incident that Sharon provoked with her threat to leave. d. Phase III. The honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again."

C

Stanley, age 72, is admitted to the hospital for depression. His son reports that he has periods of confusion and forgetfulness. In her admission assessment, the nurse notices an open sore on Stanley's arm. When she questions him about it he says, "I scraped it on the fence 2 weeks ago. It's smaller than it was." How might the nurse analyze these data? a. Consider that Stanley may have been attempting self-harm b. The delay in healing may indicate that Stanley has developed skin cancer c. A diminished inflammatory response in the elderly increases healing time d. Age-related skin changes and distribution of adipose tissue delay healing in the elderly

C

The nursing history and assessment of an adolescent with a conduct disorder Ishtar reveal all of the following behaviors except: A. Manipulation of others for fulfillment of own desires. B. Chronic violation of rules. C. Feeling of guilt associated with the exploitation of others. D. Inability to form close peer relationships.

C

Which of the following is not true regarding grieving by an adolescent? A. Adolescents may not show their true feelings about death B. Adolescents tend to hav an immortal attitude C. Adolescents do not perceive death as inevitable D. Adolescents may exhibit acting-out behaviors as part or their grief.

C

Why is it important for the nurse to check the temperature of the water before an elderly individual gets into the shower? A. The pt may catch a cold if the water temperature is too low. B. The pt Ishtar burn himself cause of a higher pain threshold. C. Elderly pts have difficulty discriminating between hot and cold. D. The water must be exactly 98.6

C

"Splitting" by the client with BPD denotes which of the following? A. Evidence of precocious development B. A primitive defense mechanisms in which the pt sees objects as all good or all bad. C. Differentiation phase, during which the child fils to bond with the mother. D. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence.

D

A school nurse notices bruises and scars on a child's body, but the child reuses to say how she received them. What is another way in which the nurse can get information from the child? A. Have her evaluated by the school psychologist B. Tell her she may select a "treat" from the treat box if she answers the nurse's questions. C. Explain to her that if she answers the questions, she may stay in the nurse's office and not have to go back to class. D. Use a "family" of dolls to role-play the child's family with her.

D

A woman who has a long history of being battered by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is, a. "I just can't believe you have decided to go back to that horrible man." b. "I'm just afraid he will kill you or the children when you go back." c. "What makes you think things have changed with him?" d. "I hope you have made the right decision. Call this number if you need help."

D

A woman who was sexually assaulted 6 months ago by a man with whom she was acquainted has since been attending a support group for survivors of rape. From this group, she has learned that the most likely reason the man raped her was: A) because he had been drinking, he was not in control of his actions B) he had not had sexual relations with a girl in many months C) he was predisposed to become a rapist by virtue of the poverty conditions under which he was reared D) he was expressing power and dominance by means of sexual aggression and violence

D

Engel identifies which of the following as successful resolution of the grief process? a. When the bereaved person can talk about the loss without crying b. When the bereaved person no longer talks about the lost entity c. When the bereaved person puts all remembrances of the loss out of sight d. When the bereaved person can discuss both positive and negative aspects about the lost entity

D

John, a homeless person, has a history of schizophrenia and noncompliance with medications. Which of the following medications might be the best choice for John? a. Haldol b. Navane c. Lithium carbonate d. Prolixin decanoate

D

Kim has diagnosed of BPD. She often exhibits alternating clinging and distancing behaviors. Which of the following is the most appropriate nursing intervention with this type of behavior? A. Encourage Kim to establish trust in one staff person with whom all therapeutic interaction should take place. B. Secure a verbal contract from Kim that she will discontinue these behaviors. C. Withdraw attention if these are continue. D. Rotate staff members who work with Kim so that she will learn to relate to more than one person.

D

Mr.B, age 79, is admitted to the psychiatric unit for depression. He has lost weight and has become socially isolated. His wife dies 5 years ago and his son tells the nurse," He did very well when mom died. He didn't even cry." Which would be the priority nursing intervention for Mr.B? A. Take BP once each shift B. Ensure that Mr.B attends group activities C. Encourage Mr.B to eat all of the food on his food tray D. Encourage Mr.B to talk about wife's death

D

Mrs. W, a 78-year-old depressed widow, says to her home health nurse, "What's the use? I don't have anything to live for anymore." Which is the best response on the part of the nurse? a. "Of course you do, Mrs. W. Why would you say such a thing?" b. "You seem so sad. I'm going to do my best to cheer you up." c. "Let's talk about why you are feeling this way." d. "Have you been thinking about harming yourself in any way?"

D

What is the most appropriate way to communicate with an elderly person who is deaf in is right ear? A. Speak loudly into his left ear B.speak to him from a position on his left side C. Speak face to face in a high pitched voice D. Speak face to face in a low pitched voice.

D

Which of the following psychosocial therapies has been shown to be helpful for pts with TBI? A. Eye movement desensitization B. Psychoanalysis C. Reality therapy D. CBT

D

Kim, a patient diagnosed with BPD, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: a. Refusal to stay in room alone, stating, "It's so lonely." b. Asking the nurse for cigarettes after 30 minutes, knowing that the assigned nurse has explained she must wait 1 hour. c. Stating to the nurse, "I really like having you for my nurse. You're the best one around here." d. Cutting arms with razor blade after discussing discharge plans with physician.

a. Refusal to stay in room alone, stating, "It's so lonely."

Which of the following nursing diagnoses would be considered the priority in planning care for the child with a severe autism spectrum disorder? A. Risk for self-mutilation evidenced by banging head against wall. B. Impaired social interaction evidenced by unresponsiveness to people. C. Impaired verbal communication evidenced by absence of verbal expression. D. Disturbed personal identity evidenced by inability to differentiate self from others.

a. Risk for self-mutilation evidenced by banging head against wall

The ________________________ movement closed state mental hospitals and caused the discharge of individuals with mental illness.

deinstitutionalization

______________________ grieving is the experiencing of the feelings and emotions associated with the normal grief response before the loss actually occurs.

anticipatory

A major difference between normal and maladaptive grieving has been identified by which of the following? A. There are no feelings of depression in normal grieving B. There is no loss of self-esteem in normal grieving C. Normal grieving lasts no longer than 1 year. D. In normal grief, the person does not show anger toward the loss.

b. There is no loss of self-esteem in normal grieving.

Milieu therapy is a good choice for clients with antisocial personality disorder because it: a. provides a system of punishment and rewards for behavior modification b. emulates a social community in which the client may learn to live harmoniously with others c. provides mostly one-to-one interaction between the client and therapist d. provides a very structured setting in which the clients have very little input into the planning of their care

b. emulates a social community in which the client may learn to live harmoniously with others

Which grief reaction can the nurse anticipate in a 10 year old child? a. statements that the deceased person will soon return b. regressive behaviors, such as loss of bladder control c. a preoccupation with the loss d. Thinking that they may have done something to cause the death

c. A preoccupation with the loss

The child with Autism spectrum disorder has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? A. Encourage all staff to hold the child as often as possible, conveying trust through touch. B. Assign a different staff member each day so child will learn that everyone can be trusted. C. Assign same staff person as often as possible to promote feelings of security and trust. D. Avoid eye contact, because this is extremely uncomfortable for the child, and may even discourage trust.

c. Assign same staff person as often as possible to promote feelings of security and trust.

Jessica is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient who is diagnosed with BPD, and the patient states, "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD? a. Impulsivity b. Self-harming behaviors c. Dissociation d. Splitting

d. Splitting

The discipline of _______________________ is the branch of clinical medicine specializing in psychopathology of the elderly population.

geropsychiatry

_______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.

schizoid