Mental health study questions: Townsend

types of abuse

- intimate partner abuse - child abuse - sexual assault

what are predisposing biological theories to abusive bahaviors?

-neurophysiological influences -biochemical influences -genetic influences -disorders of the brain

what are predisposing psychological theories to abusive behaviors?

-psychodynamic theory -learning theory

The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. ___Disturbed sleep pattern evidenced by sleeping on 4 to 5 hours per night. ___Risk for injury related to manic hyperactivity ___Impaired social interaction evidenced by manipulation of others. ___Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor.

3. Disturbed sleep pattern evidenced by sleeping on 4 to 5 hours per night. 1. Risk for injury related to manic hyperactivity 4. Impaired social interaction evidenced by manipulation of others. 2. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor.

30. Which nursing statement reflects a common characteristic of a client diagnosed with paranoid personality disorder? A. "This client consistently criticizes care and has difficulty getting along with others." B. "This client is shy and fades into the background." C. "This client expects special treatment, and setting limits will be necessary." D. "This client is expressive during group and is very pleased with self."

ANS: A A client diagnosed with paranoid personality disorder has a pervasive distrust and suspiciousness of others. Anticipating humiliation and betrayal, the paranoid individual characteristically learns to attack first.

26. When a client on an acute care psychiatric unit demonstrates behaviors and verbalizations indicating a lack of guilt feelings, which nursing intervention would help the client to meet desired outcomes? A. Provide external limits on client behavior. B. Foster discussions of rationales for behavioral change. C. Implement interventions consistently by only one staff member. D. Encourage the client to involve self in care.

ANS: A Because the client, due to a lack of guilt, cannot or will not impose personal limits on maladaptive behaviors, these limits must be delineated and enforced by staff.

27. Which characteristics should a nurse recognize as being exhibited by individuals diagnosed with any personality disorder? A. These clients accept and are comfortable with their altered behaviors. B. These clients understand that their altered behaviors result from anxiety. C. These clients seek treatment to avoid interpersonal discomfort. D. These clients avoid relationships due to past negative experiences.

ANS: A Clients who are diagnosed with personality disorders accept and are comfortable with their altered behaviors. Personalities that develop in a disordered pattern remain somewhat unstable and unpredictable throughout the lifetime.

1. Who led reform efforts to correct types of inhumane practices in the care of criminals, those with mental disorders, and victims of the Civil War? a. Dorothea Dix b. Philippe Pinel c. Benjamin Rush d. Clifford Beers

ANS: A Dorothea Dix led reform efforts to correct types of inhumane practices in the care of criminals, those with mental disorders, and victims of the Civil War.

12. A client who was deinstitutionalized during the 1960s may have experienced difficulties living in the community because of: a. Insufficient community mental health services b. Difficulties connecting with community resources c. Lack of affordable housing d. Increased cost of care

ANS: A Families were not prepared for treatment responsibilities. There were no education and support programs for families. Staff in nursing homes lacked skills to treat people with mental disorders, and clients had little or no supervision in independent settings.

3. Many clients with mental disorders were institutionalized because: a. There was a continued fear of people with mental disorders. b. The success rate was higher with hospital treatment. c. It was easier to stabilize clients with psychotropic medications. d. It provided a less stressful environment for clients to recuperate.

ANS: A Many clients with mental disorders were institutionalized because of a continued fear of people with mental disorders.

23. When a nurse is involved with a group who advocates for improved and effective psychiatric services and consumer empowerment, the nurse is working with the: a. National Alliance for Mentally Ill (NAMI) Consumer Council b. National Mental Health Consumers Association (NMHCA) c. National Association of Psychiatric Survivors (NAPS) d. Consumer/Survivor Mental Health Research and Policy Work Group

ANS: A The NAMI Consumer Counsel advocates for improved and effective psychiatric services and consumer empowerment.

6. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? A. Being firm, consistent, and empathetic, while addressing specific client behaviors B. Promoting client self-expression by implementing laissez-faire leadership C. Using authoritative leadership to help clients learn to conform to societal norms D. Overlooking inappropriate behaviors to avoid promoting secondary gains

ANS: A 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 diagnosed 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.

9. Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply? A. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone." B. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, whereas clients diagnosed with avoidant personality disorder do not." C. "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant." D. "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, whereas clients diagnosed with avoidant personality disorder remain based in reality."

ANS: A The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, whereas clients diagnosed with schizoid personality disorder prefer to be alone. Avoidant personality disorder is characterized by an extreme sensitivity to rejection, which leads to social isolation. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships.

15. Which nursing diagnosis should be prioritized when providing care to a client diagnosed with paranoid personality disorder? A. Risk for violence: directed toward others R/T suspicious thoughts B. Risk for suicide R/T altered thought C. Altered sensory perception R/T increased levels of anxiety D. Social isolation R/T inability to relate to others

ANS: A The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T suspicious thoughts. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that may result in hostile actions to protect self. They are often tense and irritable, which increases the likelihood of violent behavior.

6. Why must a nurse have specialized knowledge and skills in mental health illness and problems in order to provide effective nursing care for this population? a. Services for people with mental disorders are inadequate. b. The effects of mental health are universal. c. Mental health disorders affect small sectors of the population. d. Current health objectives cannot be met without the influence of nursing.

ANS: A There are two universal truths that require nurses to have specialized knowledge and skills in this area: services for people with mental disorders are inadequate in all countries, and mental illness has a major impact on families, communities, and nations.

33. Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? Select all that apply. A. The client will relate one empathetic statement toward another client in group, by day 2. B. The client will identify one personal limitation by day 1. C. The client will acknowledge one strength that another client possesses by day 2. D. The client will list four personal strengths by day 3. E. The client will list two lifetime achievements by discharge.

ANS: A, B, C 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. An exaggerated sense of self-worth, a lack of empathy, and exploitation of others are characteristics of narcissistic personality disorder.

3. A nurse is referring a client with a mental illness to a community group for additional information and support. Where would the nurse most likely refer a client? Select all that apply. a. Alcoholics Anonymous b. Obsessive-Compulsive Foundation c. Schizophrenics Anonymous d. Anxiety Disorders Association of America

ANS: A, B, C, D Alcoholics Anonymous, Obsessive-Compulsive Foundation, Schizophrenics Anonymous, and Anxiety Disorders Association of America are all sources of information and help for people with mental illness.

MULTIPLE RESPONSE 1. According to the Surgeon Generals report, how can people receive assistance for mental health problems? Select all that apply. a. Specialty mental health systems b. General medical or primary care sectors c. Human service sectors d. Voluntary support networks

ANS: A, B, C, D The Surgeon Generals report defined specialty mental health systems, general medical or primary care sectors, human service sectors, and voluntary support networks as ways through which people could receive assistance.

2. A nurse is using Healthy People 2020 as a guide to develop community programming for mental health. Which objectives for mental health would be found in this document? Select all that apply. a. Reduce suicide rates. b. Increase employment of persons with severe mental illness. c. Increase the proportion of children treated for mental health problems. d. Decrease the number of juvenile facilities that screen new admissions for mental health problems.

ANS: A, C Reducing suicide attempts and increasing the proportion of children with mental health problems who receive treatment are two objectives for mental health targeted by Healthy People 2020.

34. A nurse is caring for a group of clients within the DSM-5 Cluster B category of personality disorders. Which factors should the nurse consider when planning client care? Select all that apply. A. These clients have personality traits that are deeply ingrained and difficult to modify. B. These clients need medications to treat the underlying physiological pathology. C. These clients use manipulation, making the implementation of treatment problematic. D. These clients have poor impulse control that hinders compliance with a plan of care. E. These clients commonly have secondary diagnoses of substance abuse and depression.

ANS: A, C, D, E The nurse should consider that individuals diagnosed with cluster B-type personality disorders have deeply ingrained personality traits, use manipulation, have poor impulse control, and often have secondary diagnoses of substance abuse and/or depression. This cluster includes antisocial, borderline, histrionic, and narcissistic personality disorders.

29. While improving, a client demands to have a phone installed in the intensive care unit (ICU) room. When a nurse states, "This is not allowed; it is a unit rule," the client angrily demands to see the doctor. Which approach should the nurse use in this situation? A. Provide an explanation for the necessity of the unit rule. B. Assist the client to discuss anger and frustrations. C. Call the physician and relay the request. D. Arrange for a phone to be installed in the client's unit room.

ANS: B Clients who demand special privileges may be diagnosed with narcissistic personality disorder. The best approach in this situation is for the nurse to identify the function that anger, frustration, and rage serve for the client. The verbalization of feelings may help the client to gain insight into his or her behavior.

7. An employee of the National Institute for Mental Health would most likely be involved in the: a. Expansion of psychiatric units in general hospitals b. Development of education programs for community mental health treatment c. Legislation and advocacy for the rights of people with mental disorders d. Deinstitutionalization of patients

ANS: B After the National Mental Health Act was passed in 1946, the National Institute of Mental Health (NIMH) administered its programs. Objectives included development of education and research programs for community mental health treatment approaches.

32. A client diagnosed with Cluster C traits sits alone and ignores other's attempts to converse. When ask to join a group the client states, "No, thanks." In this situation, which should the nurse assign as an initial nursing diagnosis? A. Fear R/T hospitalization B. Social isolation R/T poor self-esteem C. Risk for suicide R/T to hopelessness D. Powerlessness R/T dependence issues

ANS: B Clients diagnosed with Cluster C traits are described as anxious and fearful. The DSM-5 divides Cluster C personality disorders into three categories: avoidant, dependent, and obsessive-compulsive. Anxiety and fear contribute to social isolation.

5. A nurse working in a psychiatric institution during the hospital expansion era would have most likely worked in which location? a. Near small communities with access to families and activities b. In rural areas removed from family and social activities c. Near urban areas with access to families and low-paying jobs d. In urban areas without access to families and jobs

ANS: B During the hospital expansion era, most psychiatric institutions were located in rural areas removed from family and social activities.

22. Which intervention is most appropriate for a nurse to implement when working with older adults and their caregivers? a. Work with legislators to advocate for policies which support families. b. Refer clients and families to community support groups to reduce stress. c. Involve clients and families in case management programs to coordinate care. d. Conduct depression screenings with clients and families on a regular basis.

ANS: B Family caregivers and older adults are at risk for health disruptions. Involvement in a community support group can help reduce stress of caregiving and provide networking opportunities for the older adult.

9. According to the National Institutes of Mental Health (NIMH), which is the leading cause of disability among adults? a. Schizophrenia b. Major depression c. Obsessive-compulsive disorder d. Anxiety

ANS: B Major depression is pervasive and is the leading cause of disability among adults ages 15 to 44.

24. The nurse should recognize which factors that distinguish personality disorders from psychosis? A. Functioning is more limited in personality disorders than in psychosis. B. Major disturbances of thought are absent in personality disorders. C. Personality disordered clients require hospitalization more frequently. D. Personality disorders do not affect family relationships as much as psychosis.

ANS: B Major disturbances of thought are absent in personality disorders and are a classic symptom of psychosis.

24. A nurse who is working with persons with serious mental illness should recognize that: a. Persons with severe mental illness require institutionalization until they are functional. b. Inadequate community resources have caused problems with homelessness among this population. c. Serious mental illness originates from childhood events and therapy is ineffective. d. Motivation influences a persons ability to earn a living and purchase necessary medications.

ANS: B Many people with serious mental illness live in poverty because they lack the ability to maintain a suitable standard of living. Brief hospital stays and inadequate community resources have resulted in an increased number of persons with serious mental illness living on the streets or in jail.

8. A pessimistic client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which underlying cause of this client's personality disorder should a nurse recognize? A. "Nurturance was provided from many sources, and independent behaviors were encouraged." B. "Nurturance was provided exclusively from one source, and independent behaviors were discouraged." C. "Nurturance was provided exclusively from one source, and independent behaviors were encouraged." D. "Nurturance was provided from many sources, and independent behaviors were discouraged."

ANS: B Nurturance provided from one source and discouragement of independent behaviors can attribute to the etiology of dependent personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

16. An example of primary prevention concerning mental health is: a. Group psychotherapy b. Stress reduction education c. Case management d. Monitoring illness symptoms

ANS: B Primary prevention refers to the reduction of health risks, thus stress reduction education is the correct response. Group psychotherapy and case management are secondary preventions, and monitoring illness symptoms is a tertiary prevention.

25. Which intervention would a nurse most likely use when implementing relapse management? a. Use a holistic view of the system. b. Identify triggers. c. Understand the individuals personality. d. Provide crisis intervention.

ANS: B Recognizing triggers that may lead to illness helps the consumer manage the illness and promotes recovery. Examples of triggers are poor social skills, hopelessness, and poor symptom management.

11. A nurse is working with a client who is concerned about discrimination in the workplace based on a current mental health diagnosis. Which legislation has prohibited discrimination for persons with mental disorders? a. National Mental Health Act b. American with Disabilities Act c. Developmental Disabilities Act d. Protection and Advocacy for Mentally Ill Individuals Act

ANS: B The Americans with Disabilities Act prohibited discrimination and promoted opportunities for persons with mental disorders.

1. During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior? A. "You are very disrespectful. You need to learn to control yourself." B. "I understand that you are angry, but this behavior will not be tolerated." C. "What behaviors could you modify to improve this situation?" D. "What anti-personality-disorder medications have helped you in the past?"

ANS: B The appropriate nursing statement is to reflect the client's 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. Antidepressants and anxiolytics are used for symptom relief; however, there are no specific medications targeted for the treatment of a personality disorder.

11. 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? A. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." B. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." C. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." D. "They pay particular attention to details, which can frustrate the development of relationships."

ANS: B The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having shallow, fleeting interpersonal relationships that serve their dependency needs. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior. These individuals also have difficulty maintaining long-lasting relationships.

16. Using a behavioral approach, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder? A. Seclude the client when inappropriate behaviors are exhibited. B. Contract with the client to reinforce positive behaviors with unit privileges. C. Teach the purpose of antianxiety medications to improve medication compliance. D. Encourage the client to journal feelings to improve awareness of abandonment issues.

ANS: B 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.

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

ANS: B The nurse should expect that a client diagnosed with borderline personality disorder might use suicidal gestures to evoke a rescue response from others. Repetitive, self-mutilative behaviors are common in clients diagnosed with borderline personality disorders. These behaviors are generated by feelings of abandonment following separation from significant others.

21. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? A. A client diagnosed with antisocial personality disorder B. A client diagnosed with borderline personality disorder C. A client diagnosed with schizoid personality disorder D. A client diagnosed with paranoid personality disorder

ANS: B 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-mutilative behaviors. Most gestures are designed to evoke a rescue response.

5. 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? A. Allow the clients to apply the democratic process when developing unit rules. B. Maintain consistency of care by open communication to avoid staff manipulation. C. Allow the client spokesperson to verbalize concerns during a unit staff meeting. D. Maintain unit order by the application of autocratic leadership.

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

13. Which factor has influenced the advancement in the treatment of mental illness? a. The movement of clients out of mental institutions to the community b. A better understanding of the neurobiology of mental illness c. More interest in helping persons with mental illness d. A change in the culture about what constitutes mental illness

ANS: B Two major movements have influenced the treatment of mental illness: consumer advocacy and a better understanding of neurobiology

7. Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? A. A physically healthy client who is dependent on meeting social needs by contact with 15 cats B. A physically healthy client who has a history of depending on intense relationships to meet basic needs C. A physically healthy client who lives with parents and relies on public transportation D. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security

ANS: C A physically healthy adult client who lives with parents and relies 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 behavior.

8. Approximately what percentage of the adult population (ages 18 and older) suffers from a mental disorder in a given year in the United States? a. 6 b. 14 c. 26 d. 30

ANS: C Approximately 26% of the adult population has a mental disorder in the United States.

15. A nurse categorizes mental illness as a biopsychosocial disorder. What is meant by this classification? a. Mental illness is an abnormal brain vasculature that can be detected with angiography. b. Antipsychotic drugs can be used for all types of mental illness. c. Experience and psychosocial factors affect the etiology and treatment of mental illness. d. Mental illness can be cured with the right drugs and therapy.

ANS: C Biochemical changes of the brain are being studied as causes of mental illness.

28. A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit which characteristic? A. The client has many friends and associates but prefers to interact in small groups. B. The client has many brief but intense relationships. C. The client experiences incorrect interpretations of external events. D. The client exhibits lack of tender feelings toward others

ANS: C Clients who are diagnosed with schizotypal personality disorder experience odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms. This results in incorrect interpretations of external events.

21. When providing care to an African American population in the community, which would be the most appropriate intervention for the nurse to implement? a. Build on the cultural traditions of the community. b. Develop a support system in a nearby community. c. Integrate mental health services into primary care settings. d. Focus on migrant health issues.

ANS: C Nurses can promote the mental health of this population by integrating mental health services into primary care settings, providing services in community centers, collaborating with faith communities, providing education to decrease the stigma, working toward the provision of safer communities, and recruiting members of this population to work as community mental health providers. Focusing on migrant health issues would occur with the Latino population. Building on cultural traditions is important in the Native American population. Developing a support system outside of the community would not be an appropriate intervention for any population.

18. The nurse working in the role of educator with groups of clients may: a. Care for clients in acute care settings. b. Coordinate activities with staff members in community settings. c. Use learning principles to increase understanding about mental illness. d. Act as an advocate for mental health support groups.

ANS: C The educator role is foundational to health maintenance, health promotion, and community action.

3. A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? A. Provide objective evidence that violence is unwarranted. B. Initially restrain the client to maintain safety. C. Use clear, calm statements and a confident physical stance. D. Empathize with the client's paranoid perceptions.

ANS: C The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude avoids escalating the aggressive behavior and 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.

2. A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m., requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate? A. "Go ahead and use the phone. I know this pending divorce is stressful." B. "You know better than to break the rules. I'm surprised at you." C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." D. "The decision to divorce should not be considered until you have had a good night's sleep."

ANS: C The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. Because of the probability of manipulative behavior in this client population, it is imperative to maintain consistent application of rules.

4. A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data? A. Compulsive personality disorder B. Schizotypal personality disorder C. Histrionic personality disorder D. Manic personality disorder

ANS: C The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.

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

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

18. Looking at a slightly bleeding paper cut, the client screams, "Somebody help me, quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder? A. Schizoid personality disorder B. Obsessive-compulsive personality disorder C. Histrionic personality disorder D. Paranoid personality disorder

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

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

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

22. When planning care for clients diagnosed with personality disorders, what should be the anticipated treatment outcome? A. To stabilize pathology with the correct combination of medications B. To change the characteristics of the dysfunctional personality C. To reduce inflexibility of personality traits that interfere with functioning and relationships D. To decrease the prevalence of neurotransmitters at receptor sites

ANS: C The outcome 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.

2. The first major piece of legislation to influence mental health services in the United States was the: a. National Mental Health Act b. Mental Health Study Act c. Social Security Act d. Protection and Advocacy for Mentally Ill Individuals Act

ANS: C This was in response to economic and social problems of the era and shifted the responsibility of care for ill people from the state to the federal government.

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

ANS: D 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 unsociable.

25. Which client statement would demonstrate a common characteristic of Cluster "B" personality disorder? A. "I wish someone would make that decision for me." B. "I built this building by using materials from outer space." C. "I'm afraid to go to group because it is crowded with people." D. "I didn't have the money for the ring, so I just took it."

ANS: D Antisocial personality disorder is included in the Cluster "B" personality disorders. In this disorder there is a pervasive pattern of disregard for and violation of the rights of others.

31. A client exhibits dependency on staff and peers and expresses fear of abandonment. Using Mahler's theory of object relations, which should the nurse expect to note in this client's childhood? A. Lack of fulfillment of basic needs by parental figures B. Absence of the client's maternal figure during symbiosis C. Difficulty establishing trust with the maternal figure D. Inconsistency by the maternal figure during individuation

ANS: D During phase 3 (5 to 36 months) of Margaret Mahler's individuation theory, there should be a strengthening of the ego and an acceptance of "self" with independent ego boundaries. Inconsistency by the maternal figure during individuation may in later years result in feelings of helplessness when the client is alone because of exaggerated fears of being unable to care for self.

4. An individual living during which era would have viewed physical and mental illness as interrelated, resulting from physical conditions? a. Ancient times b. Middle Ages c. Colonial d. Greco-Roman

ANS: D During the ancient times, Middle Ages, and colonial times, mental illness was viewed as resulting from supernatural forces.

10. A client who has been diagnosed with major depression works with other mental health consumers to advocate for establishment of additional self-help services for individuals and families with mental illness in a community. This client is likely involved with which organization? a. Community Support Program (CSP) b. National Institute of Mental Health (NIMH) c. Mental Health Study d. National Alliance for the Mentally Ill (NAMI)

ANS: D NAMI was the first consumer group to advocate for better services. This consumer advocacy group worked to establish education and self-help services for individuals and families with mental illness.

17. An example of tertiary prevention concerning mental health is: a. Screening for anxiety b. Depression education c. Counseling following a natural disaster d. Coordination transition from the hospital to the community

ANS: D Tertiary prevention efforts attempt to restore and enhance functioning, thus coordination of transition from the hospital to the community is tertiary prevention. Screening and counseling are secondary prevention activities, and depression education is a primary prevention.

14. Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder? A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." D. 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: D The client's statement "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with the diagnosis of borderline personality disorder. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others.

14. A nurse considers the effects of biology and environment, or nature and nurture, on the development of mental illness when providing care for clients with mental illness. Which nursing model/theory is being applied? a. Community mental health model b. Holistic model c. Systems theory d. Diathesis-stress model

ANS: D The diathesis-stress model integrates the effects of biology and environment on the development of mental illness. Certain genes or genetic combinations produce a predisposition to a disorder. When an environmental stressor challenges an individual with a predisposition to a disorder, the expression of a mental disorder may result.

10. During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered? A. "I really don't have a problem. My family is inflexible, and every relative is out to get me." B. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" C. "I spend all my time tending my bees. I know a whole lot of information about bees." D. "I am getting a message from the beyond that we have been involved with each other in a previous life."

ANS: D The nurse should assess that a client who states that he or she is getting a message from the beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The individual experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

17. 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? A. "You really don't have to go by that schedule. I'd just stay home sick." B. "There has got to be a hidden agenda behind this schedule change." C. "Who do you think you are? I expect to interact with the same nurse every Saturday." D. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

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

19. Which role would be most appropriate for an undergraduate-level prepared nurse working with a mental health population? a. Prescribe medications and have hospital admission privileges. b. Work as a case manager for large groups of persons with mental illness. c. Assess clients in acute psychiatric hospital settings. d. Provide basic primary, secondary, and tertiary services.

ANS: D The undergraduate levelprepared nurse is prepared to implement primary, secondary, and tertiary services. Roles of the nurse may include clinician, educator, and coordinator.

23. The nurse plans to confront a client about secondary gains related to extreme dependency on her spouse. Which nursing statement would be most appropriate? A. "Do you believe dependency issues have been a lifelong concern for you?" B. "Have you noticed any anxiety during times when your husband makes decisions?" C. "What do you know about individuals who depend on others for direction?" D. "How have the specifics of your relationship with your spouse benefited you?"

ANS: D When a client goes to excessive lengths to obtain nurturance and support from others, the client is seeking secondary gains. Secondary gains provide clients the support and attention that they might not otherwise receive.

20. A nurse is counseling a client following an unexpected loss. If given adequate support and adaptation, the client will most likely: a. Recover from the crisis and become mentally ill b. Avoid the loss and potential mental illness c. Be able to ignore the grief d. Resume previous lifestyle in spite of sadness

ANS: D When people do not have adequate resources, there is an increased risk of altered mental health. However, when given adequate support and adaptation, most persons will resume their lifestyles.

what is the cycle of battering?

Phase 1= tension building phase phase 2= acute battering incident phase 3= calm, loving respite (honeymoon) phase

The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is: a. 1.0 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L

a. 1.0 to 1.5 mEq/L

Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Brandon's belief is an example of a: a. Delusion of persecution. b. Delusion of reference. c. Delusion of control or influence. d. Delusion of grandeur.

a. Delusion of persecution.

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply.) a. Olanzapine (Zyprexa) b. Oxycodone (OxyCotin) c. Carbamazepine (Tegretol) d. Gabapentin (Neuronrin) e. Tranylcypromine (Parnate)

a. Olanzapine (Zyprexa) c. Carbamazepine (Tegretol) d. Gabapentin (Neuronrin)

what are the different types off sexual assault?

acquaintance rape, date rape, marital rape, statutory rape

Margaret, a 68-year-old widow experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like i'm insane!" This behavior is an example of: a. A delusion of grandeur b. A delusion of persecution c. A delusion of reference. d. A delusion of control of influence.

b. A delusion of persecution

The primary goal in working with an actively psychotic, suspicious client would be to: a. Promote interaction with others. b. Decrease his anxiety and increase trust. c. Improve his relationship with his parents. d. Encourage participation in therapy activities.

b. Decrease his anxiety and increase trust.

Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to: a. Give him an injection of Thorazine b. Ensure a safe environment for him and others. c. Place him in restraints d. Order him a nutritious diet.

b. Ensure a safe environment for him and others.

Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she no longer needed it. Margaret is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. What is the priority nursing diagnosis for Margaret? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression

b. Risk for injury related to hyperactivity

A nurse is educating a client about his lithium therapy and explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

b. Tinnitus, severe diarrhea, ataxia

Margaret, age 68, is diagnosed with bipolar I disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to: a. Sit with her during meals to ensure that she eats everything on her tray. b. Have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes. c. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." d. Tell Margaret that she will be on room restriction until she starts gaining weight.

c. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run."

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain in her room

c. Quietly walk with her back to her room and help her change into something more appropriate.

A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition. b. Medication would be given for both conditions simultaneously. c. The bipolar condition would be stabilized before ADHD medication would be given. d. The ADHD would be treated before consideration of the bipolar disorder.

c. The bipolar condition would be stabilized before ADHD medication would be given.

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Why is chlorpromazine ordered? a. To reduce extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep

c. To decrease psychotic symptoms

Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That's ridiculous, Brandon. No one is going to hurt you." b. "The CIA isn't interested in people like you, Brandon." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, Brandon, but it's really hard for me to believe."

d. "I know you believe that, Brandon, but it's really hard for me to believe."

What is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention-deficit/hyperactivity disorder

d. Attention-deficit/hyperactivity disorder

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? a. The client's level of agitation increases. b. The client complains of a sore throat. c. The client's skin has a yellowish cast. d. The client develops muscle spasms

d. The client develops muscle spasms

what are characteristics of a father who sexually abuses their child?

domineering, impulsive, physically abusive

what is the difference between emotional abuse and neglect?

emotional abuse= is when the parent or caregiver shows behavior pattern that leaves child with impaired social, emotional or intellectual functioning. emotional neglect= is when the parent or caregiver fails to give the child love, hope, and support necessary for the development of a sound and health personality

what are indicators of abuse in a child?

extremes of behavior, delayed physical or emotional development, lack of attachment to parent

what are behavioral indicators of neglect?

frequent absences from school, begs or steals food or money, lack needed medical dental immunizations or glasses, consistently dirty or serious B.O, abuses alcohol or drugs,

what are examples of disorders of the brain that influence abusive behaviors?

neurocognitive disorders, brain tumors/trauma, encephalitis, temporal lobe epilepsy (TLE)

what are examples of biochemical influences for abusive behaviors?

norepinephrine, serotonin, dopamine

what are characteristics of a mother who sexually abuses their child?

passive, submissive, denigrates her role of wife/mother; uses denial of incest, keeps quite for fear of abuse from husband

what are the types of child abuse?

physical abuse, emotional abuse, physical neglect, emotional neglect.

what is the difference between physical abuse and neglect?

physical abuse= any nonaccidental physical injury caused by caregiver or parent physical neglect= refusal of or delay in seeking health care, abandonment, expulsion from the home

what are examples of genetic influences for abusive behaviors?

possible hereditary factor, genetic karyotype XYY has been implicated

what is an act of aggression not passion?

rape

what are predisposing sociocultural theories to abusive behaviors?

societal influences= Aggressive behavior is primarily a product of one's culture and social structure. The American culture was founded on a general acceptance of violence as a means of solving problems.

what are examples of nuerophysiological influences for abusive behaviors?

temporal lobe, limbic system, amygdaloid nucleus

what is the psychodynamic theory?

the abuser has unmet needs for satisfaction and security and aggression and violence supply the individual with power and prestige that increases self-esteem

what is the learning theory?

the abuser learned their abusive behavior most likely from childhood

profile of the rapist

the rapists mom was seductive but rejecting, but was quick to withdraw her "love" when the child goes against her wishes, they grow up in abusive homes; even when the abuse was conducted by the father the child anger was towards the mother for not doing anything

what are characteristics of a child that has been sexually abused?

they have difficulty walking or sitting, suddenly refuses to change for gym or to participate in physical activities, reports nightmares or bedwetting, experiences a sudden change in appetite, demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior