Interactive Process/Coping and Stress Practice questions

In group therapy, an angry client becomes increasingly restless and irritable and shouts at the facilitator. Which nursing diagnosis takes priority? 1. Risk for injury toward others R / T inability to deal with frustration. 2. Ineffective coping R / T inability to express feelings AEB raised voice. 3. Anxiety R / T topic at hand AEB restlessness in group therapy. 4. Social isolation R / T intimidation of others AEB solitary activities

1 1. Because safety is always a priority, risk for injury toward others should be prioritized. The behaviors presented in the question indicate that the client may be in a prodromal state of crisis and may present an immediate threat. 2. Ineffective coping is an appropriate nursing diagnosis; however, it is not the priority diagnosis. 3. Anxiety is an appropriate nursing diagnosis; however, it is not the priority nursing diagnosis. 4. There is not enough evidence presented in the question to determine that this is an appropriate nursing diagnosis. TEST-TAKING HINT: When prioritizing client problems, the first consideration should be safety. Using Maslow's hierarchy of needs assists the test taker with this prioritization

A client diagnosed with obsessive-compulsive personality disorder is admitted to a psychiatric unit in a highly agitated state. The physician prescribes a benzodiazepine. Which medication is classified as a benzodiazepine? 1. Clonazepam (Klonopin). 2. Lithium carbonate (lithium). 3. Clozapine (Clozaril). 4. Olanzapine (Zyprexa).

1 1. Clonazepam (Klonopin) is a benzodiazepine medication. 2. Lithium carbonate (Lithium) is a mood stabilizer, or antimanic, not a benzodiazepine. 3. Clozapine (Clozaril) is an atypical antipsychotic, not a benzodiazepine. 4. Olanzapine (Zyprexa) is an antipsychotic, not a benzodiazepine. TEST-TAKING HINT: To answer this question correctly the test taker must be able to recognize the classifications of psychotropic medications.

A newly admitted client diagnosed with social phobia has a nursing diagnosis of social isolation R/T fear of ridicule. Which outcome is appropriate for this client? 1. The client will participate in two group activities by day 4. 2. The client will use relaxation techniques to decrease anxiety. 3. The client will verbalize one positive attribute about self by discharge. 4. The client will request buspirone (BuSpar) PRN to attend group by day 2

1 1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a timeframe. 2. Although the nurse may want the client to use relaxation techniques to decrease anxiety, this outcome does not have a timeframe and is not measurable. 3. Having the client verbalize one positive attribute about self by discharge relates to the nursing diagnosis of low self-esteem, not social isolation. 4. Buspirone (BuSpar) is not used on a PRN basis, and so this is an inappropriate outcome for this client. TEST-TAKING HINT: To express an appropriate outcome, the statement must be related to the stated problem, be measurable and attainable, and have a timeframe. The test taker can eliminate "2" immediately because there is no timeframe, and then "3" because it does not relate to the stated problem

During group therapy, a client diagnosed with somatization pain disorder monopolizes the group by discussing the client's back pain. Which nursing statement is an appropriate response in this situation? 1. "I can tell this is bothering you. Let's briefly discuss this further after group." 2. "Let's see if anyone in the group has ideas on how to deal with pain." 3. "We need to get back to the topic of dealing with anxiety." 4. "Let's check in and see how others in the group are feeling."

1 1. It is important to empathize with individuals diagnosed with somatization pain disorder; however, it is equally important to limit discussion of symptoms to avoid reinforcement and secondary gain. By telling the client that the nurse and client can discuss the client's complaints briefly at a future time, the nurse empathizes with the client and limits the client's monopolization of group. 2. When the nurse seeks from the group solutions for dealing with pain, the nurse has unwittingly provided the client with the secondary gain of group attention. This also validates the client's somatic symptom. 3. By ignoring the client's need for attention, the nurse fails to express empathy and does not acknowledge what the client is experiencing. This may impede the establishment of a nurse-client relationship. 4. When the nurse redirects attention to others in the group, the nurse has avoided acknowledging the client's feelings. The client may feel ignored, rejected, and belittled. This response by the nurse may impede any further client contributions to the group. TEST-TAKING HINT: To answer this question correctly, the test taker must be aware of appropriate nursing responses that would discourage secondary gains and symptom reinforcement for clients diagnosed with somatization pain disorder.

A client diagnosed with panic disorder has a nursing diagnosis of social isolation R/T fear. Using a cognitive approach, which nursing intervention is appropriate? 1. During a panic attack, remind the client to say, "I know this attack will last only a few minutes." 2. Discuss with the client the situation before the occurrence of a panic attack. 3. Encourage the client to acknowledge two trusted individuals who can assist the client during a panic attack. 4. Remind the client to use a journal to express feelings surrounding the panic attack.

1 1. Reminding a client to challenge his or her thought process in ways such as, "I know this attack will only last a few minutes," is an intervention that supports a cognitive approach. 2. Discussing the situation that occurred before a panic attack is an intervention that supports a behavioral, not cognitive, approach. 3. Encouraging the client to acknowledge two individuals the client trusts to assist him or her through a panic attack is an intervention that supports an interpersonal, not cognitive, approach. 4. Reminding the client to use a journal to express feelings surrounding the panic attack is an intervention that supports an intrapersonal, not cognitive, approach. TEST-TAKING HINT: When reviewing appropriate nursing interventions used during a panic attack, the test taker should pair the interventions being used with the theory that the intervention supports. This assists the test taker to become more familiar with the theory that supports the intervention.

Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder? 1. Social isolation R / T self-directed anger. 2. Low self-esteem R / T learned helplessness. 3. Risk for suicide R / T neurochemical imbalances. 4. Imbalanced nutrition less than body requirements R / T weakness.

1 1. Social isolation R/T self-directed anger supports the psychoanalytic theory in the development of major depressive disorder (MDD). Freud defines melancholia as a profoundly painful dejection and cessation of interest in the outside world, which culminates in a delusional expectation of punishment. He observed that melancholia occurs after the loss of a love object. Freud postulated that when the loss has been incorporated into the self (ego), the hostile part of the ambivalence that has been felt for the lost object is turned inward toward the ego. Another way to state this concept is that the client turns anger toward self. 2. Low self-esteem R/T learned helplessness supports a learning, not psychoanalytic, theory in the development of MDD. From a learning theory perspective, learned helplessness results from clients experiencing numerous failures, real or perceived. 3. Risk for suicide R/T neurochemical imbalances supports a biological, not psychoanalytic, theory in the development of MDD. From a neurochemical perspective, it has been hypothesized that depressive illness may be related to a deficiency of the neurotransmitters norepinephrine, serotonin, and dopamine at functionally important receptor sites in the brain. 4. Imbalanced nutrition less than body requirements R/T weakness supports a physiological, not psychoanalytic, theory in the development of MDD. From a physiological perspective, it has been hypothesized that deficiencies in vitamin B1 (thiamine), vitamin B6 (pyridoxine), vitamin B12, niacin, vitamin C, iron, folic acid, zinc, calcium, and potassium may produce symptoms of depression. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to recognize the connection between the underlying cause (R/T) of the client's problem

A client becomes agitated in group therapy and yells; "You are all making me worse!" Which would be an appropriate response from the group leader? 1. "You sound angry and frustrated. Can you tell us more about it?" 2. "Maybe you would like to go to another group from now on." 3. "We will talk more about this during our individual session." 4. "What do the other group members think?"

1 1. The leader first wants to appreciate the client's feelings by using the therapeutic technique of "attempting to translate into feelings." The group leader then asks a focusing question that assesses the situation further. 2. The group members may look at this as punishment. Group is there for clients to voice their feelings, and the leader is there to assist them in understanding where their feelings originate. 3. This dismisses the client's feelings, without gaining more information about the statement. If after assessing the topic the leader believes it is an inappropriate matter to discuss in group, the leader would appreciate the feeling and ask that it be discussed in the next individual session. 4. The leader needs to assess further before deciding to ask the group. If the leader asks the group before assessing, the client may feel he or she was still not being heard. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the need first to empathize with the client's fe

On an in-patient psychiatric unit, the nurse explores feelings about working with a woman who continually has allowed her husband to abuse her and her children physically and verbally. This interaction would occur in which phase of the nurse-client relationship? 1. Pre-interaction phase. 2. Orientation (introductory) phase. 3. Working phase. 4. Termination phase.

1 When the nurse reviews the client's previous medical record before meeting the client, the nurse-client relationship is in the pre-interaction stage. 1. The pre-interaction phase involves preparation for the first encounter with the client, such as reading previous medical records and exploring feelings regarding working with that particular client. In this example, the nurse obtains information about the client for initial assessment. This also allows the nurse to become aware of any personal biases about the client. Goal: Explore self-perception. 2. The orientation phase involves creating an environment that establishes trust and rapport. Another task of this phase includes establishing a contract for interventions that details the expectations and responsibilities of the nurse and the client. Goal: Establish trust and formulate contract for intervention. 3. The working phase includes promoting the client's insight and perception of reality, problem solving, overcoming resistant behaviors, and continuously evaluating progress toward goal attainment. Goal: Promote client change. 4. The termination phase occurs when progress has been made toward attainment of mutually set goals, a plan for continuing care is mutually established, and feelings about termination are recognized and explored. Goal: Evaluate goal attainment and ensure therapeutic closure. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that selfassessment is a major intervention that occurs in the pre-interaction phase of the nurse-client relationship. The nurse must be self-aware of any feelings or personal history that might affect the nurse's feelings toward the client.

A new client on the psychiatric unit has been diagnosed with depression and obsessive-compulsive personality disorder (OCPD). During visiting hours, her husband states to the nurse that he doesn't understand this OCPD and what can be done about it. What information should the nurse share with the client and her husband? Select all that apply. 1.Perfectionism and overemphasis on tasks usually interfere with friendships and leisure time. 2.It will help to interrupt her tasks and tell her you are going out for the evening. 3.There are medicines, such as clomipramine (Anafranil) or fluoxetine (Prozac) that may help. 4.Remind your wife that it is "OK" to be human and make mistakes. 5.Reinforce with her that she is not allowed to expect the whole family to be perfect too. 6.This disorder typically involves inflexibility and a need to be in control

1, 3, 4, 6. Inflexibility, need to be in control, perfectionism, overemphasis on work or tasks, and a fear of making mistakes are common symptoms of OCPD. Anafranil and Prozac may help with the obsessive symptoms, Interrupting the client's tasks is likely to increase her anxiety even more. Telling her that she cannot expect the family to be perfect is likely to create a power struggle.

Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

1,2,3 Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. 1. Insomnia is correct. 2. Tremor is correct. 3. Delirium is correct. 4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. 5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. TEST-TAKING HINT: The test taker must distinguish between benzodiazepine side effects and symptoms of withdrawal to answer this question correctly

A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

1,2,4 An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. 1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 3. Lithium carbonate (lithium) is a mood stabilizer, an antimanic, and would not be used to treat signs and symptoms of anxiety. 4. Clozapine (Clozaril) is an atypical antipsychotic and would not be used to treat signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. TEST-TAKING HINT: The test taker first must recognize the signs and symptoms presented in the question as an indication of increased levels of anxiety. Next, the test taker must recognize the medications that address these symptoms. Also, it is common to confuse lithium carbonate (lithium) and Librium and clozapine and clonazepam. To answer this question correctly, the test taker needs to distinguish between medications that are similar in spelling.

A client with obsessive-compulsive disorder reveals that he was late for his appointment "because of my dumb habit. I have to take off my socks and put them back on 41 times! I can't stop until I do it just right." The nurse interprets the client's behavior as most likely representing an effort to obtain which of the following? 1.Relief from anxiety. 2.Control of his thoughts. 3.Attention from others. 4.Safe expression of hostility"

1. A client who is exhibiting compulsive behavior is attempting to control his anxiety. The compulsive behavior is performed to relieve discomfort and to bind or neutralize anxiety. The client must perform the ritual to avoid an extreme increase in tension or anxiety even though the client is aware that the actions are absurd. The repetitive behavior is not an attempt to control thoughts; the obsession or thinking component cannot be controlled. It is not an attention-seeking mechanism or an attempt to express hostility.

A client diagnosed with obsessive-compulsive disorder arrives late for an appointment with the nurse at the outpatient clinic. During the interview, he fidgets restlessly, has trouble remembering what topic is being discussed, and says he thinks he is going crazy. Which of the following statements by the nurse best deals with the client's feelings of "going crazy?" 1."What do you mean when you say you think you're going crazy?" 2."Most people feel that way occasionally." 3."I don't know you well enough to judge your mental state." 4."You sound perfectly sane to me."

1. When the client says he thinks he is "going crazy," it is best for the nurse to ask him what "crazy" means to him. The nurse must have a clear idea of what the client means by his words and actions. Using an open-ended question facilitates client description to help the nurse assess his meaning. The other statements minimize and dismiss the client's concern and do not give him the opportunity to openly discuss his feelings, possibly leading to increased anxiety.

In which situation would the nurse suspect a medical diagnosis of social phobia? 1. A client abuses marijuana daily and avoids social situations because of fear of humiliation. 2. An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school. 3. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. 4. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

1. A client cannot be diagnosed with social phobia when under the influence of substances such as marijuana. It would be unclear if the client is experiencing the fear because of the moodaltering substance or a true social phobia. 2. Children can be diagnosed with social phobias. However, in children, there must be evidence of the capacity for age-appropriate social relationships with familiar people, and the anxiety must occur in peer and adult interactions. 3. If a general medical condition or another mental disorder is present, the social phobia must be unrelated. If the fear is related to the medical condition, the client cannot be diagnosed with a social phobia. 4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia. TEST-TAKING HINT: The test taker must understand the DSM-IV-TR diagnostic criteria for social phobia to answer this question correctly

A child diagnosed with oppositional defiant disorder begins yelling at staff members when asked to leave group therapy because of inappropriate language. Which nursing intervention would be appropriate? 1. Administer PRN medication to decrease acting-out behaviors. 2. Accompany the child to a quiet area to decrease external stimuli. 3. Institute seclusion following agency protocol. 4. Allow the child to stay in group therapy to monitor the situation further

2 1. Administering a PRN medication, such as an anxiolytic, does not address this child's impaired social interaction, negative temperament, or underlying hostilities. Sedating medication is rarely, if ever, administered to a child for disturbances in behavior. 2. Accompanying the child to a quiet area to decrease external stimuli is the most beneficial action for this child. This action would aid in decreasing anger and hostility expressed by the child's outburst and inappropriate language. Later, the nurse may sit with the child and develop a system of rewards for compliance with therapy and consequences for noncompliance. This can be accomplished by starting with minimal expectations and increasing these expectations as the child begins to manifest evidence of control and compliance. 3. Instituting seclusion would be punitive and counterproductive. This action would only serve to increase this child's anger and hostility, and may decrease compliance with further therapy. The nurse always should use interventions that are the least restrictive. 4. Allowing this child to remain in group therapy would not only disrupt the entire group, but also send the message that this behavior is acceptable. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that when managing a child diagnosed with ODD, support, understanding, and firm guidelines are critical. These criteria are missing in answers "1," "3," and "4."

A client on an in-patient psychiatric unit is sarcastic to staff and avoids discussions in group therapy. Which short-term outcome is appropriate for this client? 1. The client will not injure self or anyone else. 2. The client will express feelings of anger in group therapy by end of shift. 3. The client will take responsibility for own feelings. 4. The client will participate in out-patient group therapy sessions within 2 weeks of discharge

2 1. Although the staff does not want the client to injure self or anyone else, there is no timeframe presented in this short-term outcome, and it is not measurable. 2. It is important for the client to be able to discuss feelings of anger with staff in order to work through these feelings. This is a short-term outcome. 3. Although it is important for the client to take responsibility for his or her feelings, there is no timeframe presented in this outcome, and it is not measurable. 4. Expecting the client to participate actively in out-patient follow-up group therapy sessions is a long-term, not short-term outcome. TEST- TAKING HINT: A properly written outcome must be specific to the client's need, be realistic, be measurable, and contain a reasonable timeframe. If any of these characteristics is missing in an outcome, the outcome is incorrectly written. The test taker should note the word "short term" in the question. Short-term outcomes are expectations for clients during hospitalization, and long-term outcomes focus on what the client can accomplish after discharge.

In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.

2 1. Benzodiazepines, used to decrease anxiety symptoms, are not intended to be prescribed for long-term treatment. They can be prescribed for individuals diagnosed with posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Benzodiazepines are prescribed for shortterm treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation. 3. Although benzodiazepines are prescribed for short-term treatment, they are not prescribed for essential hypertension. Benzodiazepines are prescribed for short-term treatment of obsessive-compulsive disorder and skeletal muscle spasms. 4. Benzodiazepines are not intended to be prescribed for long-term treatment. They can be prescribed for short-term treatment for individuals diagnosed with panic disorder; for alcohol withdrawal, not dependence; and for agitation related to a manic episode. TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in the answers. Benzodiazepines are prescribed in the short-term because of their addictive properties. The test taker must understand that when taking a test, if one part of the answer is incorrect, the whole answer is incorrect, as in answer choice "3."

A client is experiencing hyperventilation, depersonalization, and palpitations. Which nursing diagnosis takes priority? 1. Social isolation. 2. Ineffective breathing pattern. 3. Risk for suicide. 4. Fatigue.

2 1. Clients with anxiety disorders can experience social isolation. This problem is defined as aloneness experienced by the individual and perceived as imposed by others and as a negative or threatening state. No information is presented in the question that indicates symptoms of social isolation. 2. Ineffective breathing pattern is defined as inspiration or expiration that does not provide adequate ventilation. This is a life-threatening problem that must be prioritized immediately. 3. Risk for suicide is defined as a risk for self inflicted, life-threatening injury. No information is presented in the question that indicates this client is exhibiting suicidal ideations. 4. Fatigue is defined as an overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level. No information is presented in the question that indicates this client is exhibiting fatigue. TEST-TAKING HINT: When prioritizing nursing diagnoses, the test taker needs to consider Maslow's hierarchy of needs. Physiological needs such as oxygen always take highest priority.

A client diagnosed with obsessive-compulsive disorder is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess? 1. Compulsive behaviors that occupy more than 4 hours per day. 2. Excessive worrying about germs and illness. 3. Comorbid abuse of alcohol to decrease anxiety. 4. Excessive sweating and an increase in blood pressure and pulse

2 1. Compulsive behaviors that occupy many hours per day would be a behavioral, not cognitive, symptom experienced by clients diagnosed with obsessive-compulsive disorder (OCD). 2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD. 3. Comorbid abuse of alcohol to decrease anxiety would be a behavioral, not cognitive, symptom experienced by clients diagnosed with OCD. 4. Excessive sweating and increased blood pressure and pulse are physiological, not cognitive, symptoms experienced by clients diagnosed with OCD. TEST-TAKING HINT: To answer this question correctly, the test taker must note the keyword "cognitive." Only "2" is a cognitive symptom

Which is the goal for the orientation phase of the nurse-client relationship? 1. Explore self-perceptions. 2. Establish trust. 3. Promote change. 4. Evaluate goal attainment.

2 1. Exploring self-perceptions is necessary for the therapeutic use of self and is the goal of the pre-interaction phase, not orientation phase, of the nurse-client relationship. 2. The establishment of trust is the goal of the orientation phase. During this phase, a contract is established with the client. 3. Promoting client change is the goal of the working phase, not orientation phase, of the nurse-client relationship. During this phase, effective interventions and problem solving occur. 4. Evaluating goal attainment and therapeutic closure is the goal of the termination phase, not orientation phase, of the nurse-client relationship. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that creating an environment for the establishment of trust and rapport is the first task and goal of the orientation phase of the nurse-client relationship. Reviewing the phases of the nurse-client relationship—pre-orientation, orientation, working, and termination—assists in answering this question.

A client experiencing a panic attack would display which physical symptom? 1. Fear of dying. 2. Sweating and palpitations. 3. Depersonalization. 4. Restlessness and pacing

2 1. Fear of dying is an affective, not physical, symptom of a panic attack. 2. Sweating and palpitations are physical symptoms of a panic attack. 3. Depersonalization is an alteration in the perception or experience of the self, so that the feeling of one's own reality is temporarily lost. Depersonalization is a cognitive, not physical, symptom of a panic attack. 4. Restlessness and pacing are behavioral, not physical, symptoms of a panic attack. TEST-TAKING HINT: The test taker must note important words in the question, such as "physical symptoms." Although all the answers are actual symptoms a client experiences during a

A nurse is discharging a client diagnosed with obsessive-compulsive personality disorder. Which employment opportunity is most likely to be recommended by the treatment team? 1. Home construction. 2. Air traffic controller. 3. Night watchman at the zoo. 4. Prison warden.

2 1. The flexibility and mobility of construction work, which uses physical versus interpersonal skills, may be best suited for a client diagnosed with antisocial personality disorder. These clients tend to exploit and manipulate others, and construction work would provide less opportunity for the client to exhibit these behaviors. A client diagnosed with obsessivecompulsive personality disorder would not be suited for this job. 2. Individuals diagnosed with obsessive-compulsive personality disorder are inflexible and lack spontaneity. They are meticulous and work diligently and patiently at tasks that require accuracy and discipline. They are especially concerned with matters of organization and efficiency, and tend to be rigid and unbending about rules and procedures, making them good candidates for the job of air traffic controller. 3. Clients diagnosed with schizoid personality disorder experience an inability to form close, personal relationships. These clients are comfortable with animal companionship making a night watchman job at the zoo an ideal occupation. This type of job would be unsuitable for a client diagnosed with obsessive-compulsive personality disorder. 4. Individuals diagnosed with narcissistic personality disorder have an exaggerated sense of self-worth and the right to receive special consideration. They tend to exploit others to fulfill their own desires. Because they view themselves as "superior" beings, they believe they are entitled to special rights and privileges. Because the need to control others is inherent in the job of prison warden, this would be an appropriate job choice for a client diagnosed with narcissistic personality and inappropriate for a client diagnosed with obsessive-compulsive personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the characteristics of the various personality disorders, and how these trai

A client diagnosed with obsessive-compulsive disorder has been hospitalized for the last 4 days. Which intervention would be a priority at this time? 1. Notify the client of the expected limitations on compulsive behaviors. 2. Reinforce the use of learned relaxation techniques. 3. Allow the client the time needed to complete the compulsive behaviors. 4. Say "stop" to the client as a thought-stopping technique.

2 1. The nurse would include, not notify, the client when making decisions to limit compulsive behaviors. To be successful, the client and the treatment team must be involved with the development of the plan of care. 2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4. 3. By day 4, the nurse, with the client's input, should begin setting limits on the compulsive behaviors. 4. The client, not the nurse, should say the word "stop" as a technique to limit obsessive thoughts and behaviors. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that nursing interventions should be based on timeframes appropriate to the expressed symptoms and severity of the client's disorder. The length of hospitalization also must be considered in planning these interventions. The average stay on an in-patient psychiatric unit is 5 to 7 days.

A client diagnosed with depersonalization disorder has a short-term outcome that states, "The client will verbalize an alternate way of dealing with stress by day 4." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Disturbed sensory perception R/T severe psychological stress. 2. Ineffective coping R/T overwhelming anxiety. 3. Self-esteem disturbance R/T dissociative events. 4. Anxiety R/T repressed traumatic events

2 1. The outcome of verbalizing alternate ways of dealing with stress would apply to the nursing diagnosis of ineffective coping, not disturbed sensory perception. An outcome that would support the nursing diagnosis of disturbed sensory perception would be, "The client will maintain a sense of reality during stressful situations." 2. The outcome of verbalizing alternate ways of dealing with stress would apply to the nursing diagnosis of ineffective coping R/T overwhelming anxiety. 3. The outcome of verbalizing alternate ways of dealing with stress would apply to the nursing diagnosis of ineffective coping, not selfesteem disturbance. An outcome that would support a nursing diagnosis of self-esteem disturbance would be, "The client will verbalize one positive aspect about self." 4. The outcome of verbalizing alternate ways of dealing with stress would apply to the nursing diagnosis of ineffective coping, not anxiety. An outcome that would support a nursing diagnosis of anxiety would be, "The client will verbalize an anxiety level at or below 4/10." TEST-TAKING HINT: The test taker first must understand what problem the expected client outcome addresses, then look for a nursing diagnosis that documents this problem.

On an in-patient psychiatric unit, a client states, "I want to learn better ways to handle my anger." This interaction is most likely to occur in which phase of the nurse-client relationship? 1. Pre-interaction phase. 2. Orientation (introductory) phase. 3. Working phase. 4. Termination phase.

2 1. The pre-interaction phase involves preparation for the first encounter with the client, such as reading previous medical records and exploring feelings regarding working with that particular client. Goal: Explore self-perception. 2. The orientation (introductory) phase involves creating an environment that establishes trust and rapport. Another task of this phase includes establishing a contract for interventions that details the expectations and responsibilities of the nurse and the client. In this example, the client has built the needed trust and rapport with the nurse. The client now feels comfortable and ready to acknowledge the problem and contract for intervention. Goal: Establish trust and formulate contract for intervention. 3. The working phase includes promoting the client's insight and perception of reality, problem solving, overcoming resistant behaviors, and continuously evaluating progress toward goal attainment. Goal: Promote client change. 4. The termination phase occurs when progress has been made toward attainment of mutually set goals, a plan for continuing care is mutually established, and feelings about termination are recognized and explored. Goal: Evaluate goal attainment and ensure therapeutic closure. TEST-TAKING HINT: Test takers must read this question completely. What makes this answer "orientation phase" is that the question presents a client who is willing to work with the nurse. If the question described the actual intervention of teaching adaptive ways to handle the client's aggression, the answer would be "working phase."

A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.

2 Clonazepam, a benzodiazepine, acts quickly to assist clients with anxiety symptoms. Buspirone, an antianxiety agent, and citalopram, a selective serotonin reuptake inhibitor, are used in the long-term treatment of anxiety symptoms. Buspirone and citalopram take about 4 to 6 weeks to take full effect, and the quick-acting benzodiazepine would be needed to assist the client with decreasing anxiety symptoms before these other medications take effect. All of these medications affect the neurotransmitter serotonin 1. Although it is important for all clients to be assessed for depression and suicidal ideation, it is not stated in the stem that this client is exhibiting signs of depression. The question is asking for the nurse to note important information related to using all the medications at the same time, and this statement is incorrect. 2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor. 3. These symptoms are signs of neuroleptic malignant syndrome, a rare but potentially deadly side effect of all antipsychotic medications, such as haloperidol (Haldol), but not of the medications listed in the stem. 4. These symptoms are signs of tardive dyskinesia and dystonia, which are potential side effects of all antipsychotic medications, but not of the medications listed in the question. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the signs and symptoms of serotonin syndrome and which psychotropic medications affec

A client with obsessive-compulsive disorder, who was admitted early yesterday morning, must make his bed 22 times before he can have breakfast. Because of his behavior, the client missed having breakfast yesterday with the other clients. Which of the following actions should the nurse institute to help the client be on time for breakfast? 1.Tell the client to make his bed one time only. 2.Wake the client an hour earlier to perform his ritual. 3.Insist that the client stop his activity when it's time for breakfast. 4.Advise the client to have breakfast first before making his bed.

2. The nurse should wake the client an hour earlier to perform his ritual so that he can be on time for breakfast with the other clients. The nurse provides the client with time needed to perform rituals because the client needs to keep his anxiety in check. The nurse should never take away a ritual, because panic will ensue. The nurse should work with the client later to slowly set limits on the frequency of the action.

The nursing student is learning about depersonalization disorder. Which student statement indicates that learning has occurred? 1. "Depersonalization disorder has an alteration in the perception of the external environment." 2. "The symptoms of depersonalization are rare, and few adults experience transient episodes." 3. "Depersonalization disorder is characterized by temporary change in the quality of self-awareness." 4. "The alterations in perceptions are experienced as relaxing and are rarely accompanied by other symptoms."

3 1. Derealization, not depersonalization, is an alteration in the perception of the external environment. If derealization occurs, objects in the environment are perceived as altered in size or shape. Other people in the environment may seem automated or mechanical. 2. The symptoms associated with depersonalization are common, but depersonalization disorder is diagnosed only if the symptoms cause significant distress or impairment in functioning. It is estimated that approximately half of all adults experience transient episodes of the symptoms of depersonalization. 3. Clients diagnosed with depersonalization disorder experience temporary changes in the quality of self-awareness. These changes may include feelings of unreality, changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body. 4. The alterations in perceptions are experienced as bothersome, not relaxing, and are commonly accompanied by anxiety, depression, fear of going insane, obsessive thoughts, somatic complaints, and disturbances in subjective sense of time. TEST-TAKING HINT: The test taker must understand the difference between the symptoms of depersonalization and depersonalization disorder to answer this question correctly.

Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder? 1. Encourage the client to evaluate the power of distorted thinking. 2. Ask the client to include his or her family in scheduled therapy sessions. 3. Discuss the overuse of ego defense mechanisms and their impact on anxiety. 4. Teach the client about the effect of blood lactate level as it relates to the client's panic attacks.

3 1. Encouraging the client to evaluate the power of distorted thinking is based on a cognitive, not psychodynamic, perspective. 2. Asking the client to include his or her family in scheduled therapy sessions is based on an interpersonal, not psychodynamic, perspective. 3. The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder. 4. Teaching the client the effects of blood lactate on anxiety is based on the biological, not psychodynamic, perspective. TEST-TAKING HINT: When answering this question, the test taker must be able to differentiate among various theoretical perspectives and their related interventions

A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities with peers by day 3." Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this outcome? 1. Offer PRN lorazepam (Ativan) 1 hour before group begins. 2. Attend group with client to assist in decreasing anxiety. 3. Encourage discussion about fears related to socialization. 4. Role-play scenarios that may occur in group to decrease anxiety

3 1. Offering PRN lorazepam (Ativan) before group is an example of a biological, not intrapersonal, intervention. 2. Attending group with the client is an example of an interpersonal, not intrapersonal, intervention. 3. Encouraging discussion about fears is an intrapersonal intervention. 4. Role-playing a scenario that may occur is a behavioral, not intrapersonal, intervention. TEST-TAKING HINT: It is important to understand that interventions are based on theories of causation. In this question, the test taker needs to know that intrapersonal theory relates to feelings or developmental issues. Only "3" deals with client feelings. 8. 1. Encouraging

Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? 1. Suppression. 2. Repression. 3. Undoing. 4. Denial.

3 1. Suppression, the voluntary blocking from one's awareness of unpleasant feelings and experiences, is not a defense mechanism commonly used by individuals diagnosed with OCD. 2. Repression, the involuntary blocking of unpleasant feelings and experiences from one's awareness, is not a defense mechanism commonly used by individuals diagnosed with OCD. 3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation. 4. Denial, the refusal to acknowledge the existence of a real situation or the feelings associated with it or both, is not a defense mechanism commonly used by individuals diagnosed with OCD. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the underlying reasons for the ritualistic behaviors used by individuals diagnosed with OCD

On an in-patient psychiatric unit, the nurse helps the client practice various techniques of assertive communication and gives positive feedback for attempting to improve passive-aggressive interactions. This interaction would occur in which phase of the nurse-client relationship? 1. Pre-interaction phase. 2. Orientation (introductory) phase. 3. Working phase. 4. Termination phase

3 1. The pre-interaction phase involves preparation for the first encounter with the client, such as reading previous medical records and exploring feelings regarding working with that particular client. Goal: Explore self-perception. 2. The orientation phase involves creating an environment that establishes trust and rapport. Another task of this phase includes establishing a contract for interventions that details the expectations and responsibilities of the nurse and the client. Goal: Establish trust and formulate contract for intervention. 3. The working phase includes promoting the client's insight and perception of reality, problem solving, overcoming resistant behaviors, and continuously evaluating progress toward goal attainment. In this example, the client works toward better communication and is guided and encouraged with positive feedback by the nurse. Goal: Promote client change. 4. The termination phase occurs when progress has been made toward attainment of mutually set goals, a plan for continuing care is mutually established, and feelings about termination are recognized and explored. Goal: Evaluate goal attainment and ensure therapeutic closure. TEST-TAKING HINT: To assist the test taker to answer this question correctly, the test taker should review the phases of the nurse-client relationship and think of examples of behaviors and interactions that occur in each phase

On an in-patient unit, a client is isolating self in room and refusing to attend group therapy. Which is an appropriate short-term outcome for this client? 1. Client participation will be expected in one group session. 2. Provide opportunities for the client to increase self-esteem by discharge. 3. The client will communicate with staff by the end of the 3-to-11 shift. 4. The client will demonstrate socialization skills when in the milieu.

3 Client outcomes need to be realistic, specific, and client-centered, and must have a timeframe to be measurable. This client is exhibiting signs and symptoms of social isolation. 1. Client participation in group therapy is an appropriate outcome for this client, but because this outcome does not have a timeframe, it is not measurable. 2. This statement is focused on the nurse's interventions, not the expected client outcome. This statement is not client focused. 3. This outcome is correctly written because it is client-centered, short-term, realistic, and measurable. 4. It is important for the client to socialize while in the milieu to counteract social isolation; however, this outcome does not have a timeframe and is not measurable. TEST-TAKING HINT: The test taker needs to understand that client outcomes must be realistic, specific, and client-centered, and have a timeframe to be measurable. Without any one component, the answer choice is incorrect.

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam (Klonopin) is to be used for long-term therapy in conjunction with buspirone (BuSpar). 2. The client verbalizes that buspirone (BuSpar) can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam (Klonopin) is to be used short-term until the buspirone (BuSpar) takes full effect. 4. The client verbalizes that tolerance can result with long-term use of buspirone (BuSpar)

3 Clonazepam, a benzodiazepine, is a central nervous system (CNS) depressant; buspirone, an antianxiety medication, does not affect the CNS. 1. Clonazepam is used in the short-term, not long-term, while waiting for buspirone to take full effect, which can take 4 to 6 weeks. 2. Buspirone does not cause sedation because it is not a CNS depressant. 3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks. 4. Tolerance can result with long-term use of clonazepam, but not with buspirone. TEST- TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients prescribed different classifications of antianxiety medications

A client is diagnosed with agoraphobia without panic disorder. Which type of therapy is most effective for this illness? 1.Insight therapy. 2.Group therapy. 3.Behavior therapy. 4.Psychoanalysis.

3. The nurse should suggest behavior therapy, which is most successful for clients with phobias. Systematic desensitization, flooding, exposure, and self-exposure treatments are most therapeutic for clients with phobias. Self-exposure treatment is being increasingly used to avoid frequent therapy sessions. Insight therapy, exploration of the dynamics of the client's personality, is not helpful because the process of anxiety underlies the disorder. Group therapy or psychoanalysis, which deals with repressed, intrapsychic conflicts, is not helpful for the client with phobias because it does not help to manage the underlying anxiety or disorder.

A newly admitted client diagnosed with depersonalization disorder has a nursing diagnosis of anxiety R/T family stressors. Which nursing intervention would be most helpful in building a trusting nurse-client relationship? 1. Identify stressors that increase anxiety levels. 2. Encourage use of adaptive coping mechanisms to decrease stress. 3. Discuss events surrounding episodes of depersonalization. 4. Reassure the client of safety and security during periods of anxiety

4 1. Although it is important to identify stressors early in treatment, this nursing intervention does not directly address the establishment of a trusting nurse-client relationship. 2. Although it is important to encourage the use of adaptive coping mechanisms to decrease stress, this nursing intervention does not directly address the establishment of a trusting nurse-client relationship. 3. It is important for the nurse to discuss events surrounding episodes of depersonalization to gain further assessment data. Compared with the other interventions presented, however, this intervention would not be the most helpful in building a trusting nurse-client relationship. 4. For the nurse to build a trusting nurse client relationship, the nurse must assure the client of safety and security during periods of anxiety. When safety has been established, other interventions may be implemented. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that the question asks for an intervention that would be most helpful in building a trusting nurse-client relationship. Clients need to feel safe and secure before any relationship can be established and any further interventions can be implemented effectively

A client diagnosed with an obsessive-compulsive personality disorder has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do what I need to do." Which short-term outcome is appropriate for this client? 1. The client will refrain from hand washing during a 3-hour period after admission to unit. 2. The client will wash hands only at appropriate intervals; that is, bathroom and meals. 3. The client will refrain from hand washing throughout the night. 4. The client will verbalize signs and symptoms of escalating anxiety within 72 hours of admission.

4 1. Although this short-term outcome is stated in observable and measurable terms, abstaining from ritualistic hand washing on admission is an unrealistic outcome. To do this would heighten, rather than lower, the client's anxiety level. 2. This outcome has no specific measurable timeframe. Although this might be a reasonable client outcome if started after treatment has begun, it might be an unreasonable expectation if implemented too soon after admission. Only after the client has learned new coping skills can ritualistic behaviors be decreased without increasing anxiety levels. 3. Although this may eventually be a reasonable client expectation, there is no mention of a timeframe, so this outcome cannot be measured. 4. This short-term outcome is stated in observable and measurable terms. This outcome sets a specific time for achievement (within 72 hours). It is short and specific (signs and symptoms), and it is written in positive terms. When the client can identify signs and symptoms of increased anxiety, the next step of problem solving can begin. TEST-TAKING HINT: To answer this question correctly, the test taker must note that realistic outcomes need to be modest and attainable for clients diagnosed with personality disorder to achieve success. An outcome that may be inappropriate on admission may be attainable and appropriate by discharge.

From a cognitive theory perspective, which is a possible cause of panic disorder? 1. Inability of the ego to intervene when conflict occurs. 2. Abnormal elevations of blood lactate and increased lactate sensitivity. 3. Increased involvement of the neurochemical norepinephrine. 4. Distorted thinking patterns that precede maladaptive behaviors

4 1. Inability of the ego to intervene when conflict occurs relates to the psychoanalytic, not cognitive, theory of panic disorder development. 2. Abnormal elevations of blood lactate and increased lactate sensitivity relate to the biological, not cognitive, theory of panic disorder development. 3. Increased involvement of the neurochemical norepinephrine relates to the biological, not cognitive, theory of panic disorder development. 4. Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development. TEST-TAKING HINT: The test taker should note important words in the question, such as "cognitive." Although all of the answers are potential causes of panic disorder development, the only answer that is from a cognitive perspective is "4."

A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time? 1. The client will use a thought-stopping technique to eliminate obsessive/compulsive behaviors. 2. The client will stop obsessive and/or compulsive behaviors. 3. The client will seek assistance from the staff to decrease obsessive or compulsive behaviors. 4. The client will use one relaxation technique to decrease obsessive or compulsive behaviors

4 1. It is unrealistic to expect the client to use a thought-stopping technique totally to eliminate obsessive or compulsive behaviors by day 4 of treatment. 2. It is unrealistic for clients diagnosed with obsessive-compulsive disorder to abruptly stop obsessive or compulsive behaviors. 3. It is desirable for the client to seek assistance from the staff to decrease the amount of obsessive or compulsive behaviors. However, this outcome should be prioritized earlier than day 4 of treatment. 4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome. TEST-TAKING HINT: The test taker must recognize the importance of time-wise interventions when establishing outcomes. In the case of clients diagnosed with obsessive-compulsive disorder, expectations on admission vary greatly from outcomes developed closer to discharge.

Which of the following statements explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective? 1. Individuals diagnosed with OCD have weak and underdeveloped egos. 2. Obsessive and compulsive behaviors are a conditioned response to a traumatic event. 3. Regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD. 4. Abnormalities in various regions of the brain have been implicated in the cause of OCD.

4 1. The belief that individuals diagnosed with obsessive-compulsive disorder (OCD) have weak and underdeveloped egos is an explanation of OCD etiology from a psychoanalytic, not biological, theory perspective. 2. The belief that obsessive and compulsive behaviors are a conditioned response to a traumatic event is an explanation of OCD etiology from a learning theory, not biological theory, perspective. 3. The belief that regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD is an explanation of OCD etiology from a psychoanalytic, not biological, theory perspective. 4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a biological theory perspective. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the different theories of OCD etiology. This question calls for a biological theory p

On an in-patient psychiatric unit, the goals of therapy have been met, but the client cries and states, "I have to keep coming back to therapy to handle my anger better." This interaction occurs in which phase of the nurse-client relationship? 1. Pre-interaction phase. 2. Orientation (introductory) phase. 3. Working phase. 4. Termination phase.

4 1. The pre-interaction phase involves preparation for the first encounter with the client, such as reading previous medical records and exploring feelings regarding working with that particular client. Goal: Explore self-perception. 2. The orientation phase involves creating an environment that establishes trust and rapport. Another task of this phase includes establishing a contract for interventions that details the expectations and responsibilities of the nurse and the client. Goal: Establish trust and formulate contract for intervention. 3. The working phase includes promoting the client's insight and perception of reality, problem solving, overcoming resistant behaviors, and continuously evaluating progress toward goal attainment. Goal: Promote client change. 4. The termination phase occurs when progress has been made toward attainment of mutually set goals, a plan for continuing care is mutually established, and feelings about termination are recognized and explored. In this example, the nurse must establish the reality of separation and resist repeated delays by the client because of dependency needs. Goal: Evaluate goal attainment and ensure therapeutic closure. TEST-TAKING HINT: The question states that "the goals of therapy have been met." This information indicates a description of the termination phase of the nurse-patient relationship. The test taker also should recognize the client statement as indicative of feelings experienced during termination.

The client diagnosed with a fear of eating in public places or in front of other people has finished eating lunch in the dining area in the nurse's presence. Which of the following statements by the nurse should reinforce the client's positive action? 1."It wasn't so hard, now was it?" 2."At supper, I hope to see you eat with a group of people." 3."You must have been hungry today." 4."It is progress for you to eat in the dining room with me."

4. It's a sign of progress to eat in the dining area with me," conveys positive reinforcement and gives the client hope and confidence, thus reinforcing the adaptive behavior. Stating, "It wasn't so hard, now was it," decreases the client's self-worth and minimizes his accomplishment. Stating, "At supper, I hope to see you eat with a group of people," will overwhelm the client and increase anxiety. Stating, "You must have been hungry today," ignores the client's positive behavior and shows the nurse's lack of understanding of the dynamics of the disorder.

The client diagnosed with agoraphobia refuses to walk down the hall to the group room. Which of the following responses by the nurse is appropriate? 1."I know you can do it." 2."Try holding onto the wall as you walk." 3."You can miss group this one time." 4."I'll walk with you."

4. The nurse should walk with the client to activate adaptive coping for the client experiencing high anxiety and decreased motivation and energy. Stating, "I know you can do it," "Try holding on to the wall," or "You can miss group this one time," maintains the client's avoidance, thus reinforcing the client's behavior, and does not help the client begin to cope with the problem

Number the following nursing interventions as they would proceed through the phases of the nurse-client relationship. ___ Plan for continued care. ___ Promote client's insight. ___ Examine personal biases. ___ Formulate nursing diagnoses

The correct order is 4, 3, 1, 2. (1) Examining personal biases occurs in the pre-orientation phase of the nurse-client relationship. (2) The formulation of nursing diagnostic statements occurs in the orientation phase. (3) The promotion of client insight is a task of the working phase. (4) Planning for continued care occurs in the termination phase.