NUR 162 - Final Exam

12. The following NANDA-I nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. Which assessment data most likely led to the development of this problem statement? 1. The client is receiving ECT and is diagnosed with Parkinsonism. 2. The client has a history of four suicide attempts in adolescence. 3. The client expresses hopelessness and helplessness and isolates self. 4. The client has disorganized thought processes and delusional thinking.

1

A client is taking a monoamine oxidase inhibitor (MAOI). When teaching the client about diet, which foods will the nurse caution the client to avoid? 1. Pepperoni pizza and red wine 2. Bagels with cream cheese and tea 3. Apple pie and coffee 4. Potato chips and diet cola

1

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

1

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

1

A nurse applies extra physical restraints to a client who yells obscenities and threatens harm to the nurse. The nurse's coworker observes this action and feels that this is an inappropriate use of restraints, but fears of retaliation if action is taken against the nurse in question. Which is true about this scenario? 1. The coworker may experience a great deal of emotion. 2. The nurse values the client's autonomy. 3. The coworker is exhibiting beneficence. 4. The client values justice.

1

A nurse would expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Tourette syndrome 4. Parkinson's disease

1

A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not completely eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

1

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

1

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

1

An adolescent diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which response should the nurse make? 1. "Your child has a chemical imbalance of the brain, which leads to altered perceptions." 2. "Your child's hallucinations are caused by medication interactions." 3. "Your child has too little serotonin in the brain, causing delusions and hallucinations." 4. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

1

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

1

In the treatment of anxiety disorders, benzodiazepines (such as Ativan and Xanax) are indicated for ______ use and have a ______ abuse potential. 1. short-term; high 2. long-term; high 3. short-term; low 4. long-term; low

1

The client diagnosed with bipolar disorder: manic episode has a goal of gaining 2 lbs. (0.91 kg.) by the end of the week. Which action would the nurse take to achieve this outcome? 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1

The client diagnosed with posttraumatic stress disorder (PTSD) has a nursing diagnosis of posttrauma syndrome R/T surviving a workplace shooting. Which nursing intervention would the nurse add to this client's plan of care? 1. Monitor for substance use 2. Alternate staff members 3. Use a firm approach 4. Offer social skill training

1

The client with panic disorder says, "When an attack happens, I feel like I am going to die." Which response should the nurse make? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

1

The nurse is answering a phone call in which the person is asking if a client has recently been admitted to a psychiatric facility. Which nursing response reflects appropriate legal and ethical obligations? 1. The nurse refuses to give any information to the caller, citing rules of confidentiality. 2. The nurse immediately hangs up on the caller. 3. The nurse confirms that the person has been at the facility but adds no additional information. 4. The nurse suggests that the caller speak to the client's therapist.

1

The nurse is caring for a client diagnosed with binge eating disorder (BED). Which medication should the nurse administer to the client to decrease binging? 1. Lisdexamfetamine (Vyvanse) 2. Chlorpromazine (Thorazine) 3. Haloperidol (Haldol) 4. Diazepam (Valium)

1

The nurse is preparing a presentation about Beck's cognitive theory. Which cognitive distortion would the nurse include in the teaching session? 1. Negative expectation of the environment 2. Negative expectation of the present 3. Negative expectation of the career 4. Negative expectation of the family

1

The nurse is providing discharge teaching to a client about benzodiazepines. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

1

To which client would the nurse most likely administer a benzodiazepine? 1. One with alcohol withdrawals 2. One taking cough medicine 3. One with schizophrenia 4. One taking opioid pain agents

1

When planning care for a client, which medication classification would a nurse recognize as effective in the treatment of Tourette's syndrome? 1. Antipsychotic medications 2. Antimanic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications

1

Which action should the nurse take when a depressed client refuses electroconvulsive therapy (ECT)? 1. Accept the client's decision 2. Inform the client that the procedure is mandatory 3. Tell the client that the signature verifies informed consent 4. Call the family to receive approval

1

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

1

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

1

Which client would the nurse instruct to obtain routine blood-level monitoring? 1. A client taking lithium 2. A client taking buspirone 3. A client taking chlorpromazine 4. A client taking paroxetine

1

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

1

Which information would be included in a lesson about domestic violence? 1. Power and control are central to the dynamic of domestic violence. 2. Poor communication and social isolation are central to the dynamic of domestic violence. 3. Erratic relationships and vulnerability are central to the dynamic of domestic violence. 4. Emotional injury and learned helplessness are central to the dynamic of domestic violence.

1

Which is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? 1. Clarify personal attitudes, values, and beliefs. 2. Obtain thorough assessment data. 3. Determine the client's length of stay. 4. Establish personal goals for the interaction.

1

Which mental illness would a nurse identify as being associated with an increase in prolactin level? 1. Depression 2. Psychosis 3. Anorexia nervosa 4. Alzheimer's disease

1

Which of the following is the most commonly used treatment for clients with adjustment disorder (AD) and its appropriate rationale? 1. Psychotherapy; to examine the stressor and confront unresolved issues 2. Selective serotonin reuptake inhibitors; to stabilize mood and resolve symptoms 3. Eye movement desensitization therapy; to reprocess traumatic events 4. Antianxiety agents; a first-line treatment to address symptoms of anxiety

1

Which statement by a client who is beginning tricyclic antidepressant therapy indicates successful teaching? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I will start to see results in about 2 weeks." 3. "I will continue to smoke." 4. "I will start to cut down on my alcohol intake and have only one glass of wine at supper."

1

Which statement indicates a nurse has a correct understanding about how eye movement desensitization and reprocessing (EMDR) achieves its therapeutic effect? 1. "The exact biological mechanism is unknown." 2. "It causes an increase in imagery vividness." 3. "This therapy decreases memory access." 4. "EMDR disrupts the fear associated with trauma."

1

The nurse is caring for a client who has been found to have decreased levels of thyroid-stimulating hormone (TSH). Which symptoms would like the client likely exhibit? (Select all that apply.) 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

1, 2

The nurse is caring for a client with anorexia nervosa. Which nursing interventions would the nurse add to the plan of care? (Select all that apply.) 1. Minimize the focus on food and eating 2. Limit mealtime to 30 minutes 3. Monitor for 30 minutes after eating 4. Weigh client weekly 5. If weight loss occurs, bargain for restrictions

1, 2

Which information should the nurse include when teaching parents who have children or adolescents with symptoms of bipolar disorder? (Select all that apply.) 1. First-line treatment is a second-generation antipsychotic. 2. In children and adolescents with bipolar disorder there is a high risk of relapse. 3. There is a direct link between development of bipolar disorder and attention deficit/hyperactivity disorder. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant.

1, 2

15. The nurse attempts to understand the story of a newly admitted client. Which of the following nursing actions reflect the appropriate use of the Tidal Model? (Select all that apply.) 1. The nurse leans in and makes eye contact when listening to the client's story. 2. The nurse asks for clarification of certain points while listening to the client's story. 3. The nurse offers more precise words when the client cannot seem to articulate fully. 4. The nurse commits the time to hear the client's whole story without interruption. 5. The nurse uses the story to develop a plan of care in collaboration with other caretakers.

1, 2, 4

14. Which of the following are behavior assessment categories in the Broset Violence Checklist? (Select all that apply.) 1. Confusion 2. Paranoia 3. Boisterousness 4. Panic 5. Irritability

1, 3, 5

After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department. The client threatens suicide. Which of the following criteria would enable this client to be considered for involuntary commitment? (Select all that apply.) 1. Being dangerous to others 2. Being homeless 3. Being disruptive to the community 4. Being gravely disabled and unable to meet basic needs 5. Being suicidal

1, 4, 5

The client has been diagnosed with generalized anxiety disorder (GAD). Which symptoms would the nurse observe upon assessment? (Select all that apply.) 1. Muscle tension 2. Paresthesia 3. Hyperventilation 4. Restlessness 5. Procrastination

1, 4, 5

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

2

A client diagnosed with posttraumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of "broad openings"? 1. "What occurred prior to the rape, and when did you go to the emergency department?" 2. "What would you like to talk about?" 3. "I notice you seem uncomfortable discussing this." 4. "How can we help you feel safe during your stay here?"

2

A client diagnosed with schizophrenia is hospitalized for an exacerbation of psychosis related to nonadherence to antipsychotic medications. Which level of care does the client's hospitalization reflect? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

2

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

2

A client was recently admitted to the inpatient unit after a suicide attempt and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which sign or symptom would the nurse include in the teaching session about serotonin syndrome? 1. Constipation 2. Myoclonus 3. Hypothermia 4. Impotence

2

A client with a history of cerebrovascular accident is brought to an emergency department experiencing memory problems, confusion, and disorientation. Based on this client's assessment data, on which medical diagnosis would the nurse focus the plan of care? 1. Delirium due to adverse effects of cardiac medications 2. Vascular neurocognitive disorder 3. Neurocognitive disorder due to Huntington's disease 4. Alzheimer's disease

2

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

2

A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

2

A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? 1. S 2. O 3. L 4. E

2

A nurse questions the charge nurse about an order for fluvoxamine (Luvox) 300 mg daily in two divided doses for a client diagnosed with obsessive-compulsive disorder (OCD). Which charge nurse response is most accurate? 1. "High doses of tricyclic medications will be required for effective treatment of OCD." 2. "High doses of selective serotonin reuptake inhibitor (SSRI), above what is effective for depression, may be required for OCD." 3. "The dose of Luvox is low because of the side effect of daytime drowsiness." 4. "The dose of this SSRI is outside the therapeutic range and needs to be brought to the psychiatrist's attention."

2

A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention would a nurse include in this client's plan of care?A preschool child diagnosed with autism spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? 1. Place client in restraints until the aggression subsides. 2. Sedate the client with antipsychotic medications. 3. Hold the client's head steady and apply a helmet. 4. Distract the client with a variety of games and puzzles. 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.

2

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

2

According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? 1. A client rudely complaining about limited visiting hours 2. A client exhibiting aggressive behavior toward another client 3. A client stating that no one cares 4. A client verbalizing feelings of failure

2

According to the U.S. Census Bureau, which term would the nurse use to describe a 70-year-old client? 1. Older 2. Elderly 3. Aged 4. Very old

2

After 5 months of taking nortriptyline (Aventyl) for depressive symptoms, a client reports that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "When did you last eat yogurt?"

2

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

2

As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include? 1. Avoid foods high in tyramine. 2. Maintain a consistent sodium intake. 3. Consume at least 3,000 to 3,500 mL of fluid per day. 4. Watch for signs of tardive dyskinesia.

2

At which point would the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection.

2

During a hiring interview, which response by a nursing applicant would indicate that the applicant operates from an ethical egoism framework? 1. "I would want to be treated in a caring manner if I were mentally ill." 2. "This job will pay the bills, and the workload is light enough for me." 3. "I will be happy caring for the mentally ill. Working in med/surg kills my back." 4. "It is my duty in life to be a psychiatric nurse. It is the right thing to do."

2

The client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 2 nights and a 13-lb. (5.9 kg.) weight loss over the past 2 weeks. Which nursing diagnosis is priority? 1. Knowledge deficit R/T bipolar disorder 2. Imbalanced nutrition: less than body requirements R/T hyperactivity 3. Risk for suicide R/T powerlessness 4. Altered sleep patterns R/T mania

2

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

2

The client has a nursing diagnosis of complicated grieving related to the death of multiple family members from a tornado. Which action should the nurse take first? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client's concerns. 4. Suggest attending a grief therapy group.

2

The client has been extremely anxious ever since relocating to another state because of a job transfer. When assessing for the diagnosis of adjustment disorder (AD), within what time frame should the nurse expect the client to exhibit symptoms? 1. Within 1 year of the move 2. Within 3 months of the move 3. Within 6 months of the move 4. Within 9 months of the move

2

The client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which signs and symptoms of a potentially fatal side effect will the nurse teach the client about? 1. Blurring vision, dry mouth, and constipation 2. Sore throat, fever, and malaise 3. Tremor, shuffling gait, and rigidity 4. Fine tremor, tinnitus, and nausea

2

The nurse discovers the client purposefully inserted a contaminated catheter into the urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder? 1. Illness anxiety disorder 2. Factitious disorder 3. Functional neurological symptom disorder 4. Depersonalization-derealization disorder

2

The physician prescribes an additional medication for a client taking an antipsychotic agent. The medication is to be administered "prn for EPS." When will the nurse plan to administer this medication? 1. When the client's white blood cell count falls below 3,000/mm3 2. When the client exhibits tremors and a shuffling gait 3. When the client reports having a dry mouth 4. When the client experiences a seizure

2

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

2

When used in combination with anxiolytic medication, alcohol leads to ______ effects, and caffeine leads to ______ effects. 1. increased; increased 2. increased; decreased 3. decreased; decreased 4. decreased; increased

2

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

2

Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

2

Order the description of the progressive phases of Walker's model of the "cycle of battering." (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. This phase is the most violent and the shortest, usually lasting up to 24 hours. 2. In this phase, the man's tolerance for frustration is declining. 3. In this phase, the batterer becomes extremely loving, kind, and contrite.

2, 1, 3

9. A client who is newly admitted to an inpatient psychiatric unit reports that newly prescribed medication is exacerbating her anxiety and paranoia. The nurse is attending an interdisciplinary team meeting regarding the client. Which members of the interdisciplinary team would be able to alter this client's prescription? (Select all that apply.) 1. Psychiatric nurse 2. Psychiatrist 3. Psychiatric nurse practitioner 4. Psychiatric technician 5. Psychiatric social worker

2, 3

A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client's belief system, the nurse would conclude which client would potentially be at higher risk for suicide than the other clients? 1. Roman Catholic 2. Protestant 3. Atheist 4. Muslim

3

An aging client has difficulty communicating because of decreased sensory capabilities. Which nursing intervention is appropriate to improve communication during assessment? 1. Discourage attempts at verbal communication owing to increased client frustration. 2. Increase the volume of the communication. 3. Look directly at client when communicating. 4. Encourage the client to communicate by writing.

3

For which physiological problem would the nurse question the order for an antidepressant for an older client with symptoms of major depressive disorder? 1. Altered cortical and intellectual functioning 2. Altered respiratory and gastrointestinal functioning 3. Altered liver and kidney functioning 4. Altered endocrine and immune system functioning

3

The client diagnosed with neurocognitive disorder (NCD) is disoriented and ataxic and wanders. Which is the priority nursing diagnosis? 1. Disturbed thought processes 2. Self-care deficit 3. Risk for trauma 4. Altered health care maintenance

3

The client is diagnosed with anxiety disorder. Which medication would the nurse administer for anxiety? 1. Chlorpromazine (Thorazine) 2. Clozapine (Clozaril) 3. Diazepam (Valium) 4. Methylphenidate (Ritalin)

3

The client living in a riverfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. The psychiatric nurse practitioner decides to try systematic desensitization. Which best explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety while in a relaxed state." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

3

The client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." The nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97°F (36°C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? 1. Denial 2. Fluid volume excess 3. Imbalanced nutrition: less than body requirements 4. Ineffective individual coping

3

The client with major depressive episode is experiencing command hallucination for self-harm. Which intervention should be the nurse's priority at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations 4. Encouraging client to express feelings related to suicide

3

The client's altered body image is evidenced by claims of "being obese," even though the client is emaciated. Which outcome criterion is appropriate for this client's problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will verbally state a misperception of body image as "fat." 4. The client will not express a preoccupation with food.

3

The college student has severe test anxiety. Instead of studying for finals, the student relieves stress by attending a movie. Which priority nursing diagnosis should the campus nurse assign for this student? 1. Non-adherence R/T test taking 2. Ineffective role performance R/T helplessness 3. Ineffective coping R/T anxiety 4. Powerlessness R/T fear

3

The nurse assesses a client with major depressive disorder. Which assessment finding would the nurse observe? 1. Sadness subsides quickly 2. Promiscuous behaviors 3. Unable to feel any pleasure 4. Excessive spending sprees

3

The nurse discovers a client has a history of divorce, job loss, family estrangement, and cocaine abuse. Which theory explains the etiology of this client's depressive symptoms? 1. Psychoanalytic theory 2. Object loss theory 3. Learning theory 4. Cognitive theory

3

Which client statement reflects an understanding of circadian rhythms? 1. "When I dream about my mother's horrible train accident, I become hysterical." 2. "I get really irritable during my menstrual cycle." 3. "I'm a morning person. I get my best work done before noon." 4. "Every February, I tend to experience periods of sadness."

3

Which client statement would a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? 1. "I can't bear the thought of leaving here and failing." 2. "I might have a hard time working with you because you remind me of my mother." 3. "I really don't want to talk any more about my childhood abuse." 4. "I'm not sure that I can count on you to protect my confidentiality."

3

Which criteria according to the DSM-5 would need to be present for a client to be diagnosed with dissociative fugue? 1. An inability to recall important autobiographical information 2. Clinically significant distress in social and occupational functioning 3. Sudden unexpected travel or bewildered wandering 4. "Blackouts" related to alcohol toxicity

3

Which data in the history would the nurse expect to find in a client diagnosed with substance-induced psychotic disorder? 1. Had delirium 2. Had less severe withdrawal symptoms 3. Has an opioid use disorder 4. Has a fluid and electrolyte imbalance

3

Which factor differentiates a client diagnosed with schizotypal personality disorder from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with schizotypal personality disorder are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with schizotypal personality disorder experience generalized anxiety. 3. Clients diagnosed with schizotypal personality disorder experience social anxiety from paranoid fears, whereas clients diagnosed with schizoid personality disorder would isolate themselves on a continual basis. 4. Clients diagnosed with schizoid personality disorder have magical thinking and depersonalization, whereas clients diagnosed with schizotypal personality disorder do not.

3

Which historical perspective would the nurse include when teaching about the home environment and the development of anorexia nervosa? 1. Maintains loose personal boundaries 2. Places an overemphasis on food 3. Is overprotective with emphasis on perfection 4. Condones corporal punishment

3

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

3

Which of the following is most critical to assess when determining risk for suicide for a client newly admitted to an inpatient psychiatric unit? 1. Family history of depression 2. The client's orientation to reality 3. The client's history of suicide attempts 4. Family support systems

3

Which statement best describes the classification of suicide? 1. Suicide is a DSM-5 diagnosis. 2. Suicide is a mental disorder. 3. Suicide is a behavior. 4. Suicide is an antisocial affliction.

3

Which statement by the client indicates successful teaching about taking lithium carbonate (Lithobid) for the treatment of bipolar disorder? 1. "I should decrease my intake of sodium." 2. "Drinking ten large glasses of water a day is good for me." 3. "Weight gain is a common, but troubling, side effect." 4. "Diarrhea should be expected while using this drug."

3

Which symptom should the nurse observe in a client diagnosed with obsessive-compulsive personality disorder? 1. Intrusive and persistent thoughts 2. Unwanted, repetitive ritualistic behavior 3. Lack of spontaneity when dealing with others 4. Feelings of "sixth sense" that are externally imposed

3

Which therapeutic communication technique is being used in the following nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" 1. Encouraging comparison 2. Making observations 3. Formulating a plan of action 4. Giving recognition

3

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

3

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

3

11. Which nursing action would be identified with Stage IV of Roberts' Seven-stage Crisis Intervention Model? 1. Collaboratively implement an action plan. 2. Help the client identify the major problems or crisis precipitants. 3. Help the client deal with feelings and emotions. 4. Collaboratively generate and explore alternatives.

3

15. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Which group is this nurse most qualified to lead? 1. A psychodrama group 2. A psychotherapy group 3. A parenting group 4. A family therapy group

3

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client? 1. Ineffective coping R/T situational crisis AEB powerlessness 2. Anxiety R/T fear of failure 3. Risk for self-directed violence R/T hopelessness 4. Risk for low self-esteem R/T loss events AEB suicidal ideations

3

5. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? 1. CIWA scale 2. GGT 3. BMSE 4. CAPS scale

3

7. The client in an inpatient unit expresses doubt in the importance of the treatments. The nurse provides the client with copies of all documents related to the plan of care in order to reveal the significance of the treatments. This nurse is employing which commitment in the Tidal Model of Recovery? 1. Know that change is constant 2. Reveal personal wisdom 3. Be transparent 4. Give the gift of time

3

8. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? 1. Health teacher 2. Case manager 3. Milieu manager 4. Psychotherapist

3

A brother calls to speak to his sister, who has been admitted to a psychiatric unit. The nurse connects him to the community phone, and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken? 1. The National Alliance for the Mentally Ill Act 2. The Tarasoff Ruling 3. The Health Insurance Portability and Accountability Act 4. The Good Samaritan Law

3

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

3

A client diagnosed with Alzheimer's disease (AD) exhibits diminished cognitive functioning, verbal aggression upon experiencing frustration, and has a nursing diagnosis of inability to provide self-care. Which nursing intervention is most appropriate? 1. Organize a group activity to present reality. 2. Minimize environmental lighting. 3. Schedule structured daily routines. 4. Explain the consequences for aggressive behaviors.

3

A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? 1. A client makes inappropriate sexual innuendos to a staff member. 2. A client constantly demands attention from the nurse by begging, "Help me get better." 3. A client physically attacks another client after being confronted in group therapy. 4. A client refuses to bathe or perform hygienic activities.

3

A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation would cause a nurse to question the validity of the informed consent? 1. The client is paranoid. 2. The client is 87 years old. 3. The client incorrectly reports his or her spouse's name, date, and time of day. 4. The deaf client relies on his or her spouse to interpret the information

3

A fourth-grade boy teases and makes jokes about a cute girl in his class. A nurse would recognize this behavior as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation

3

14. Which characteristics of accurately developed client outcomes would a nurse identify? (Select all that apply.) 1. Client outcomes are specifically formulated by nurses. 2. Client outcomes are not restricted by time frames. 3. Client outcomes are specific and measurable. 4. Client outcomes are realistically based on client capability. 5. Client outcomes are formally approved by the psychiatrist.

3,4

A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of histamine 3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine

4

A client is taking phenelzine (Nardil). Which statement by the client should cause the nurse to intervene? 1. "I cannot use over-the-counter medications for my colds." 2. "I have to cut out eating my raisin bran every morning." 3. "I will have to avoid pepperoni pizza when eating with my friends." 4. "I am taking diet pills to lose weight for my friend's wedding."

4

A home care nurse notices the client who startles easily is exhibiting signs of posttraumatic stress disorder. The nurse asks, "Have you ever made a suicide attempt?" to which the client responds, "Yes, I have." Which response should the nurse make next? 1. Notify the primary care provider 2. Gently touch the client's arm 3. Say, "Why would you do that? I am here to help you." 4. Ask, "Are you having thoughts of suicide right now?"

4

A nurse is caring for a client with decreased norepinephrine levels. Which mental illness is the client most likely at risk for? 1. Bipolar disorder: mania 2. Schizophrenia 3. Generalized anxiety disorder 4. Major depressive episode

4

A nurse notes that a client is extremely withdrawn, delusional, and emotionally exhausted. The nurse assesses the client's anxiety as which level? 1. Mild anxiety 2. Moderate anxiety 3. Severe anxiety 4. Panic anxiety

4

According to statistics, which ethnic group is at highest risk for suicide? 1. African American 2. Alaskan Native 3. Asian 4. White

4

An involuntarily committed client is verbally abusive to the staff, repeatedly threatening to sue. The client records the full names of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? 1. Verbally redirect the client and then refuse one-on-one interaction. 2. Involve the hospital's security division as soon as possible. 3. Notify the client that documenting personal staff information is against hospital policy. 4. Continue professional attempts to establish a positive working relationship with the client.

4

An older client has recently moved to a nursing home. The client has a sad affect, trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication would the nurse most likely administer to the client? 1. Haloperidol (Haldol) 2. Donepezil (Aricept) 3. Diazepam (Valium) 4. Sertraline (Zoloft)

4

During a one-to-one session with a client, the client states, "Nothing will ever get better," and, "Nobody can help me." Which nursing diagnosis is most appropriate for this client? 1. Powerlessness R/T altered mood AEB client statements 2. Risk for injury R/T altered mood AEB client statements 3. Risk for suicide R/T altered mood AEB client statements 4. Hopelessness R/T altered mood AEB client statements

4

The nurse asks the client with schizophrenia spectrum disorder, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Loose associations 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

4

The nurse is preparing an antidepressant medication for a 13-year-old client who is experiencing major depressive disorder. Which FDA-approved medication should the nurse administer? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

4

The nurse is teaching a client diagnosed with anxiety about treatment options. Which statement by the client indicates effective teaching? 1. "There is nothing that I can do to that will reduce anxiety." 2. "Medication is available, but only for those who have had anxiety for a year or more." 3. "If I ignore the symptoms of anxiety, it will go away." 4. "Practicing yoga or meditation may help reduce my anxiety."

4

The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision? 1. No previous admissions for major depressive disorder 2. Vital signs stable; no psychosis noted 3. Adheres to medication regimen; able to problem-solve life issues 4. Participates in a plan for safety; family agrees to constant observation

4

Which advice would the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? 1. Have ready access to a gun and learn how to use it. 2. Research lawyers that can aid in divorce proceedings. 3. File charges of assault and battery. 4. Access to the number of a safe house for battered women.

4

The nurse is teaching a client about the eight-phase process of eye movement desensitization and reprocessing (EMDR). In which order should the nurse list the phases, starting with the early phases and ending with the last (1-4)? (Enter the number of the phases in the proper sequence, using comma and space format, such as 1, 2, 3, 4) 1. Installation 2. Body scan 3. Reevaluation 4. Desensitization

4, 1, 2, 3

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

6

17. ______ is a diagrammatic teaching and learning strategy that allows students and faculty to visualize interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments.

Concept mapping

12. A scientific structuring of the environment in order to affect behavioral changes and to improve the psychological health and functioning of the individual is defined as ______ therapy.

milieu

16. A sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem, can be defined as a ______.

crisis

19. A ______ is a collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose.

group

3. Which student statement indicates that further teaching is needed regarding the guiding principles of the recovery model? 1. "Recovery occurs via many pathways." 2. "Recovery emerges from strong religious affiliations." 3. "Recovery is supported by peers and allies." 4. "Recovery is culturally based and influenced."

2

4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. Which does the milieu provide that may be missing in the home environment? 1. Peer pressure 2. Structured programming 3. Visitor restrictions 4. Mandated activities

2

16. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? 1. "Psychodrama provides a safe setting in which to discuss painful issues." 2. "In psychodrama, the client is the antagonist." 3. "In psychodrama, the client observes actor interactions from the audience." 4. "Psychodrama facilitates resolution of interpersonal conflicts."

2

2. A wife brings her husband to an emergency department (ED) after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? 1. Maturational/developmental crisis 2. Psychiatric emergency crisis 3. Anticipated life transition crisis 4. Traumatic stress crisis

2

18. Order the following leadership expectations that occur in the three phases of the group development process. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. The leader encourages members to provide feedback to each other about individual progress and to review goals and discuss outcomes. 2. The leader promotes an environment of trust and ensures that rules established by the group do not interfere with fulfillment of the goals. 3. The leader helps to resolve conflict and fosters cohesiveness, while ensuring that members do not deviate from the intended task.

3, 1, 2

Place the following stages of the codependency recovery process according to Cermak beginning with the first stage (1-4). (Enter the number of each stage in the proper sequence, using comma and space format, such as: 1, 2, 3, 4) 1. The Core Issues Stage 2. The Reintegration Stage 3. The Survival Stage 4. The Reidentification Stage

3, 4, 1, 2

Which client assessment finding would alert the nurse to question a diagnosis of brief psychotic disorder? 1. Has impaired reality testing for a 24-hour period. 2. Has auditory hallucinations for the past 3 hours. 3. Has bizarre behavior for 1 day. 4. Has confusion for 3 weeks.

2

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

1, 3, 3

The client is diagnosed with functional neurological symptom disorder. Which symptoms would the nurse most likely observe? (Select all that apply.) 1. Anosmia 2. Abreaction 3. Akinesia 4. Aphonia 5. Amnesia

1, 3, 4

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

1, 3, 4

11. A client states, "My illness is so devastating, I feel like my life has come to a standstill." The nurse recognizes that this client is in which stage of the Psychological Recovery Model, as described by Andresen and associates? 1. Moratorium 2. Awareness 3. Preparation 4. Rebuilding

1

13. A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. Which would the nurse expect to find when assessing this client? 1. A client who feels confident about achieving goals in life. 2. A client who recognizes the need to set goals in life. 3. A client who is willing to take risks to re-establish a sense of self. 4. A client who sets realistic goals and pursues recovery at his or her pace.

1

14. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, which might explain this behavior? 1. They are experiencing problems with termination, leading to feelings of abandonment. 2. They did not think any new material would be covered at the last session. 3. They were angry with the leader for not extending the length of the group. 4. They were bored with the material covered in the group.

1

2. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? 1. Democratic 2. Autocratic 3. Laissez-faire 4. Bureaucratic

1

3. A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing response? 1. "The purpose of group therapy is to learn and practice new coping skills." 2. "Group therapy is mandatory. All clients must attend." 3. "Group therapy is optional. You can go if you find the topic helpful and interesting." 4. "Group therapy is an economical way of providing therapy to many clients concurrently."

1

4. The nurse would recognize which acronym as representing problem-oriented charting? 1. SOAPI 2. APIE 3. DAR 4. PQRST

1

5. A client diagnosed with obsessive-compulsive disorder states, "I really think my relationship with my family will improve because of this treatment. My relationship with my kids is going to be a lot better from now on." Which guiding principle of recovery has assisted this client? 1. Recovery emerges from hope. 2. Recovery is person-driven. 3. Recovery occurs via many pathways. 4. Recovery is holistic.

1

5. A client is brought to an emergency department by police after threatening to jump off a bridge several hours ago. To assess for suicide potential, which question would a nurse ask first? 1. "Are you currently thinking about harming yourself?" 2. "Why do you want to harm yourself?" 3. "Have you thought about the consequences of your actions?" 4. "Who is your emergency contact person?"

1

5. To promote self-reliance, how would a psychiatric nurse best conduct medication administration? 1. Encourage clients to request their medications at the appropriate times. 2. Refuse to administer medications unless clients request them at the appropriate times. 3. Allow the clients to determine appropriate medication times. 4. Take medications to the clients' bedside at the appropriate times.

1

6. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's therapeutic factor of imparting information? 1. "I found a Web site explaining the different types of brain tumors and their treatment." 2. "My brother also had a brain tumor and now is completely cured." 3. "I understand your fear and will be by your side during this time." 4. "My mother was also diagnosed with cancer of the brain."

1

8. During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to a nurse leader that the client is assuming which group role? 1. The group role of aggressor 2. The group role of initiator 3. The group role of gatekeeper 4. The group role of blocker

1

9. The following outcome was developed for a client: "Client will list five personal strengths by the end of day one." Which correctly written nursing diagnostic statement most likely generated the development of this outcome? 1. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements 2. Self-care deficit R/T altered thought process 3. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 4. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

1

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

1

A client at the mental health clinic tells the case manager, "I can't think about living another day, but don't tell anyone about the way I feel. I know you are obligated to protect my confidentiality." Which case manager response is most appropriate? 1. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care." 2. "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk." 3. "You seem to be preoccupied with self. You should concentrate on hope for the future." 4. "This information is secure with me because of client confidentiality."

1

A client diagnosed recently with Alzheimer's disease (AD) is prescribed donepezil (Aricept). The client's spouse inquires, "How does this work? Will this cure him?" Which response by the nurse is appropriate? 1. "This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." 2. "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease." 3. "This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." 4. "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

1

A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to Alcoholics Anonymous (AA), would be most appropriate for a nurse to discuss with the client during discharge teaching? 1. To immediately attend AA meetings at least weekly. 2. To rely on an AA sponsor to help control alcohol cravings. 3. To incorporate family in AA attendance. 4. To seek appropriate deterrent medications through AA.

1

A client diagnosed with major depression and substance use disorder has an altered sleep pattern and demands a psychiatrist prescribe a sedative. Which rationale explains why the nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics decrease the production of needed liver enzymes. 3. Sedative-hypnotics lengthen necessary REM (rapid eye movement, dream) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

1

A client requests information on several medications in order to make an informed choice about management of depression. A nurse would provide this information to facilitate which ethical principle? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

1

A client with depression and substance abuse has an interrupted sleep pattern and demands a sedative. Which teaching would the nurse provide about sedative-hypnotics? 1. "Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them." 2. "Sedative-hypnotics work best in combination with other techniques." 3. "Sedative-hypnotics are not permitted for use in clients with substance abuse disorders." 4. "Sedative-hypnotics are not as effective as the antidepressant medications for treating sleep disturbances."

1

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which potentially fatal side effect will the nurse teach the client about? 1. Agranulocytosis 2. Akathisia 3. Pseudoparkinsonism 4. Akinesia

1

A health-care provider prescribes computerized electroencephalography mapping for a client with suspected schizophrenia. Which statement made by the client accurately describes the procedure? 1. "Electrodes will be placed on my scalp and measure and mark waves of activity in my brain." 2. "X-rays will be taken to detect any lesions I might have in my brain." 3. "This test will use magnetic imaging and show if I have any swelling in my brain." 4. "After receiving an injection of a radioactive substance, an image will measure brain functioning and produce an image."

1

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year to feel better. Which term should the nurse use in report to best describe this individual's situation? 1. Psychological addiction 2. Codependence 3. Substance induced disorder 4. Intoxication

1

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

1

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

1

Based upon the research with Vietnam veterans, which factors are the best predictors of posttraumatic stress disorder (PTSD)? (Select all that apply.) 1. The severity of the stressor 2. The degree of ego strength 3. The degree of psychosocial isolation in the recovery environment 4. The attitudes of society regarding the experience 5. The presence of preexisting psychopathology

1, 3

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

1

A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? 1. The more specific the plan is, the more likely the client will attempt suicide. 2. Clients who talk about suicide rarely actually commit it. 3. Clients who threaten suicide should be observed every 15 minutes 4. After a brief assessment, the nurse would avoid the topic of suicide.

1

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

1

A son who recently brought his extremely confused parent to a nursing home for admission reports feelings of guilt. Which is the appropriate nursing response? 1. "Support groups are held here on Mondays for children of residents in similar situations." 2. "You did what you had to do. I wouldn't feel guilty if I were you." 3. "Support groups are available to low-income families." 4. "Your parent is doing just fine. We'll take very good care of him."

1

Logan, age 8 years, takes methylphenidate (Ritalin) for attention deficit/hyperactivity disorder. His mother reports to the nurse that Logan has a very poor appetite, and she struggles to help him gain weight. Which teaching will the nurse provide? 1. Administer Logan's medication immediately after meals. 2. Give Logan's medication at bedtime. 3. Skip a dose of the medication when Logan does not eat anything. 4. Assure Logan's mother that Logan will eat when he is hungry.

1

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which action would the nurse take? 1. Deal with physical symptoms in a detached manner. 2. Challenge the validity of physical symptoms. 3. Meet dependency needs until the physical limitations subside. 4. Encourage a discussion of feelings about the lower-extremity problem.

1

The client diagnosed with bipolar disorder intentionally overdoses on antidepressants. Family members report that the client has experienced a relationship break-up, anorexia, and a recent job loss. Which nursing diagnosis is the priority based upon the client's signs and symptoms? 1. Risk for self-directed violence R/T multiple losses 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T hopelessness

1

The client diagnosed with schizophrenia refuses medication at one regularly scheduled home visit from a home-health nurse. Which nursing intervention is ethically appropriate? 1. Allow the client to decline the medication and document the decision. 2. Tell the client that if the medication is refused, hospitalization will occur. 3. Arrange with a relative to add the medication to the client's morning orange juice. 4. Call for help to hold the client down while the injection is administered.

1

The client diagnosed with schizophrenia spectrum disorder is prescribed an antipsychotic. Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? 1. Sore throat and malaise 2. Light-colored urine and bradycardia 3. Anosognosia and avolition 4. Dry mouth and urinary retention

1

The client is prescribed alprazolam (Xanax) for acute anxiety. Which client finding should cause a nurse to question this order? 1. History of alcohol use disorder 2. History of personality disorder 3. History of schizophrenia 4. History of hypertension

1

The client with a myocardial infarction tells the intensive care nurse, "You won't have to care for me pretty soon. I will not be a burden to you or others." Which initial action should the nurse take? 1. Screen the client for suicide 2. Transfer the client to the medical unit 3. Allow the client some private, quiet time 4. Teach the client that he or she will be able to care for himself or herself

1

The clinic nurse is triaging clients. The nurse should require which client with nonsuicidal self-injuring behavior to be seen immediately? 1. Is self-cutting in response to command hallucinations 2. Has a history of borderline personality disorder 3. Is on leave from the military 4. Has thoughts of being detached from the body

1

The geriatric nurse is teaching the client's family about the possible cause of delirium. Which information should the nurse include in the teaching session? 1. "Taking multiple medications may lead to adverse interactions or toxicity." 2. "Age-related cognitive changes may lead to alterations in mental status." 3. "Lack of rigorous exercise may lead to decreased cerebral blood flow." 4. "Decreased social interaction may lead to profound isolation and psychosis."

1

The nurse is assessing a client diagnosed with hoarding disorder. Which statement would the nurse expect to hear from the client? 1. "I am a perfectionist." 2. "I get obsessive about cleaning my counter tops." 3. "I donate my clothing to charities." 4. "I prefer to have wide walkways in my home."

1

The nurse is teaching a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide? 1. The emesis is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.

1

Which client is most likely to be admitted to an inpatient facility for self-destructive behaviors? 1. One with antisocial personality disorder 2. One with borderline personality disorder 3. One with schizoid personality disorder 4. One with paranoid personality disorder

2

Which finding would a nurse expect when assessing a child diagnosed with separation anxiety disorder? 1. The child has a history of antisocial behaviors. 2. The child's mother was stressed during the pregnancy. 3. The child previously had an extroverted temperament. 4. The child's mother and father have an inconsistent parenting style.

2

Which finding would alert the nurse that a client is exhibiting selective amnesia? 1. Cannot relate any lifetime memories. 2. Can describe driving to Iowa but cannot remember the car accident that occurred. 3. Can explain abstract concepts. 4. Cannot provide personal demographic information during admission assessment.

2

A client diagnosed with schizophrenia is experiencing frequent hallucinations. What altered component of the nervous system would a nurse recognize as being responsible for this behavior? 1. Increase in serotonin 2. Decrease in histamine 3. Increase in dopamine 4. Decrease in acetylcholine

3

The nurse is teaching about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia. Which information should the nurse include? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

1

The nurse is working with a client diagnosed with somatic symptom disorder (SSD). Which distinguishing criterion is present in SSD but absent in illness anxiety disorder (IAD)? 1. Experiences significant physical symptoms 2. Has a change in the quality of self-awareness 3. Has a perceived disturbance in body image or appearance 4. Experiences anxiety about acquiring an illness

1

The nursing instructor is teaching about medications used to treat clients diagnosed with panic disorder. Which student statement indicates teaching has been effective? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clonidine (Catapres) is used off-label in long-term treatment of panic disorder." 3. "Atenolol (Tenormin) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

1

Which client action would a nurse expect during the working phase of the nurse-client relationship? 1. The client gains insight and incorporates alternative behaviors. 2. The client establishes rapport with the nurse and mutually develops treatment goals. 3. The client explores feelings related to reentering the community. 4. The client explores personal strengths and weaknesses that impact behavioral choices.

1

Which information will help the nurse differentiate the diagnosis of posttraumatic stress disorder (PTSD) from the diagnosis of adjustment disorder (AD)? 1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2. AD is more common in women, whereas PTSD is more common in men. 3. AD can occur from severe motor vehicle accidents, while PTSD can occur from the birth of a stillborn. 4. PTSD occurs more often when compared to AD.

1

Which nursing diagnosis is the priority for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1

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

1

Which statement by the nurse indicates a correct understanding of psychopharmacology for somatic disorders? 1. "Somatization disorders with depression can be treated with selective serotonin reuptake inhibitors." 2. "Anxiety associated with these disorders can be treated long-term with benzodiazepines." 3. "Conversion disorder can be treated with intravenous administration of antidepressants." 4. "First-line treatment for depersonalization-derealization disorder is antianxiety agents."

1

Which strategy is most important to implement initially with a suicidal client? 1. Ask a direct question such as, "Do you ever think about killing yourself?" 2. Ask the client, "Please rate your mood on a scale from 1 to 10." 3. Establish a trusting nurse-client relationship. 4. Apply the nursing process to the planning of client care.

1

Which therapeutic communication technique is being used in the following nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." 1. Restating 2. Offering general leads 3. Focusing 4. Accepting

1

Which therapeutic intervention would a nurse anticipate will be ordered for an older client with major depressive disorder not responding to antidepressant medications? 1. Electroconvulsive therapy (ECT) 2. Neuroleptic therapy 3. An antiparkinsonian agent 4. An anxiolytic agent

1

Which type of touch is described as functional-professional? 1. A nurse performing an assessment 2. Shaking the hand of an acquaintance 3. A child laying their head on the mother's lap 4. Hugging a good friend and former coworker good-bye

1

Which information would the nurse include in a teaching session about predisposing factors in the development of bipolar disorder, mania episode? (Select all that apply.) 1. There are excessive levels of glutamate. 2. Mania has greater right-side reduction in brain activity. 3. Steroids are the most common medication to trigger a manic response. 4. Expression of gene ANK3 is decreased in manic episodes. 5. Dopamine levels are decreased in mania.

1, 2, 3

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

1, 2, 3

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

1, 2

12. Which nursing statements or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.) 1. "Tell me what happened." 2. "Which coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened." 4. "Let's focus on the current problem." 5. "I'll assist you in selecting functional coping strategies."

1, 2, 3

A father finds his teenage child has carried out suicide by hanging the morning after they have an argument. Which paternal grief responses would a nurse anticipate? (Select all that apply.) 1. "I can't believe this is happening." 2. "If only I had been more understanding." 3. "How dare he do this to me!" 4. "I'm just going to have to accept that he was gay." 5. "Well, that was a selfish thing to do."

1, 2, 3

Which conditions have been known to precipitate delirium in some individuals? (Select all that apply.) 1. Febrile illness 2. Seizures 3. Migraine headaches 4. Gallstones 5. Temporomandibular joint syndrome

1, 2, 3

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

1, 2, 3

The clinic nurse is caring for a client with ulcerative colitis who has signs of depression. Which additional conditions should the nurse assess for in this client? (Select all that apply.) 1. Mania 2. Cardiovascular disease 3. Metabolic syndrome 4. Diabetes 5. Emphysema

1, 2, 3, 4

The diagnosis of catatonic disorder due to another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which conditions? (Select all that apply.) 1. Epilepsy 2. Hypothyroidism 3. Hyperadrenalism 4. Encephalitis 5. Hyperaphia

1, 2, 3, 4

The nurse is admitting a client who has been diagnosed with posttraumatic stress disorder (PTSD). Which symptoms might the nurse observe upon assessment? (Select all that apply.) 1. Feelings of guilt that precipitate social isolation 2. Aggressive behavior that affects job performance 3. Relationship problems 4. High levels of anxiety 5. Escalating symptoms lasting less than one month

1, 2, 3, 4

The nurse is preparing a staff development presentation to improve the screening, intervention, and referral process for clients in the geriatric community center. Which information should the nurse identify as barriers to this initiative? (Select all that apply.) 1. Patient concerns about privacy 2. Competing workload demands 3. New nurses 4. The staff's attitude 5. Changing screening requirements

1, 2, 3, 4

The nurse is preparing to assess a client before the physician prescribes a regimen of psychopharmacological therapy. Which components will the nurse assess? (Select all that apply.) 1. Medical history 2. Physical examination findings 3. Ethnocultural characteristics 4. Current medication 5. Marital status

1, 2, 3, 4

Which individuals are communicating a message? (Select all that apply.) 1. A mother spanking her son for playing with matches 2. A teenage boy isolating himself and playing loud music 3. A biker sporting an eagle tattoo on his biceps 4. A teenage girl writing, "No one understands me" 5. A father checking for new email on a regular basis

1, 2, 3, 4

Which medications have been known to precipitate delirium in clients? (Select all that apply.) 1. Antineoplastic agents 2. H2-receptor antagonists 3. Antihypertensives 4. Corticosteroids 5. Lipid-lowering agents

1, 2, 3, 4

The client diagnosed with an adjustment disorder says, "Tell me about medications that will cure this problem." Which responses by the nurse are appropriate? (Select all that apply.) 1. "Medications can interfere with your ability to find a more permanent solution." 2. "Medications may mask the real problem at the root of this diagnosis." 3. "Adjustment disorders are not commonly treated with medications." 4. "Psychoactive drugs carry the potential for physiological and psychological dependence." 5. "Psychoactive drugs will be prescribed only if your problems persist for more than three months."

1, 2, 3, 4,

14. Which of the following has SAMHSA described as major dimensions of support for a life of recovery? (Select all that apply) 1. Health 2. Community 3. Home 4. Religion 5. Purpose

1, 2, 3, 5

The depressed client is prescribed a monoamine oxidase inhibitor (MAOI). Which statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food labels." 4. "I'm going to drink my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

1, 2, 3, 5

11. Which scenarios reflect a therapeutic community, based on Skinner's seven basic assumptions? 1. The nurse asks each patient to articulate a personal strength that they will focus on improving. 2. When a patient is consistently late to group activities, the other group members ask that individual to be more punctual. 3. A patient who behaves inappropriately is restricted from group activities for three months. 4. A patient is encouraged to hang personal artwork above her bed. 5. When group members ignore an individual's inappropriate behavior, the nurse respects their choice not to address it.

1, 2, 4

13. Which of the following interventions would a nurse use when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.) 1. Maintain a calm demeanor. 2. Clearly delineate the consequences of the behavior. 3. Use therapeutic touch to convey empathy. 4. Set limits on the behavior. 5. Teach the client to avoid "I" statements related to expression of feelings.

1, 2, 4

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

1, 2, 4

The nurse is a manager of a pediatric unit. Which actions should the nurse manager take to equip staff to address neuropsychiatric symptoms in pediatric clients? (Select all that apply.) 1. Encourage use of screening tools 2. Provide education of staff members 3. Keep referrals to a minimum 4. Increase social contact with individuals with mental illness 5. Promote defensive medicine

1, 2, 4

The nurse is assessing a client for antisocial personality disorder. According to the DSM-5, which symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Age of at least 18 years old 2. Deceitful for personal gain 3. Frequent feelings of being down, remorseful, or hopeless 4. Disregard for and failure to honor financial obligations 5. Avoidance of social events and interaction with others

1, 2, 4

Which nursing statements exemplify the process that must be completed by a nurse in the pre-introductory phase prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

1, 2, 4

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

1, 2, 4

Which modalities should a nurse recognize as integral parts of a treatment program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.) 1. Group therapy 2. Medication management 3. Deterrent therapy 4. Supportive family therapy 5. Social skills training

1, 2, 4, 5

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

1, 2, 4, 5

An attractive female client with a diagnosis of body dysmorphic disorder (BDD) presents with high anxiety levels because of her belief that her facial features are large and grotesque. Which additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. Stereotypic movement 4. History of delusional thinking 5. Skin picking

1, 2, 5

Which information about mild IDD would the nurse include when teaching the child's mother? 1. Children with mild IDD need constant supervision. 2. Children with mild IDD develop academic skills up to a sixth-grade level. 3. Children with mild IDD appear different from their peers. 4. Children with mild IDD have significant sensory-motor impairment.

2

Which of the following information would a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) 1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. 2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. 3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is a possible correlation between increased levels of prolactin and anorexia nervosa. 5. There is a possible correlation between high levels of oxytocin and anorexia nervosa.

1, 3

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

1, 3, 4, 5

The nurse is caring for a client diagnosed with generalized anxiety disorder. Which activities would the nurse encourage for this client? (Select all that apply.) 1. Recognize the signs of escalating anxiety. 2. Avoid any situation that causes stress. 3. Employ newly learned relaxation techniques. 4. Cognitively reframe thoughts about situations that generate anxiety. 5. Avoid caffeinated products.

1, 3, 4, 5

The nurse is reviewing the DSM-5 definition of a mental health disorder and notes the definition includes a disturbance in which areas? (Select all that apply.) 1. Cognition 2. Physical 3. Emotional regulation 4. Behavior 5. Developmental

1, 3, 4, 5

A nurse is about to meet with a client suffering from codependency. Which data would the nurse expect to find during the assessment of this client? (Select all that apply.) 1. Has a long history of focusing thoughts and behaviors on other people 2. As a child, experienced overindulgent and overprotective parents 3. Is a people pleaser and does almost anything to gain approval 4. Exhibits helpless behaviors but actually feels very competent 5. Can achieve a sense of control through fulfilling the needs of others

1, 3, 5

A nursing supervisor is offering an impaired staff member information regarding a peer assistance program. Which facts should the supervisor include? (Select all that apply.) 1. A hot-line number will be available in order to call for help. 2. A verbal contract detailing the method of treatment will be initiated prior to the program. 3. Peer support is provided through regular contact with the impaired nurse. 4. Contact to provide peer support will last for one year. 5. One of the program goals is to intervene early in order to reduce hazards to clients.

1, 3, 5

The client is diagnosed with illness anxiety disorder (IAD). Which symptoms would the client most likely exhibit? (Select all that apply.) 1. Doctor shopping 2. Pseudocyesis 3. Anxiety 4. Flat affect 5. Avoids hospitals

1, 3, 5

The client is exhibiting symptoms of generalized amnesia. Which questions should the nurse ask to help confirm this diagnosis? (Select all that apply.) 1. "Have you taken any new medications recently?" 2. "Have you recently traveled away from home?" 3. "Have you recently experienced any traumatic event?" 4. "Have you ever felt detached from your environment?" 5. "Have you had any history of memory problems?"

1, 3, 5

The nurse is admitting a client with a diagnosis of schizotypal personality disorder. Which client findings would make the nurse question this diagnosis? (Select all that apply.) 1. Is the center of attention 2. Has unusual perceptual experiences 3. Has a bipolar disorder 4. Is odd and eccentric but not delusional 5. Has autism spectrum disorder

1, 3, 5

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

1, 3, 5

Which would the nurse include in teaching about symptoms of alcohol overdose? (Select all that apply.) 1. Vomiting 2. Warm skin 3. Shallow respirations 4. Slow pulse 5. Coma

1, 3, 5

An older adult client has a diagnosis of dysthymic disorder. Which signs and symptoms should the nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

1, 4

Place the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe (1-4). (Enter the number of each disorder in the proper sequence, using comma and space format, such as: 1, 2, 3, 4) 1. Delusional disorder 2. Schizophrenia 3. Schizophreniform disorder 4. Substance-induced psychotic disorder

1, 4, 3, 2

The nurse is teaching about the diagnosis disruptive mood dysregulation disorder (DMDD). Which information should the nurse include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

1. 2, 3

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. The nurse would assess which symptoms and behaviors? (Select all that apply.) 1. Stressful situations precipitate gambling behaviors. 2. Anticipation and restlessness can only be relieved by placing a bet. 3. Winning brings about feelings of sexual satisfaction. 4. Gambling is used as a coping strategy. 5. Compulsive gambling began in early adolescence.

1. 2. 4

Which information should the nurse include in a staff education program about the history of psychopharmacology? 1. Some antipsychotic medications can cure mental illnesses. 2. Psychotropic medications are used as adjunctive therapy. 3. Antidepressants were the first type of mental health drugs. 4. Mood stabilizers help eliminate bipolar mental disorders.

2

Which information should the nurse share with the client about tricyclic antidepressant medications? 1. Strong or aged cheese should not be eaten while taking them. 2. Their full therapeutic potential may not be reached until 4 weeks. 3. They may cause hypomania or recent memory impairment. 4. They should not be given with antianxiety agents.

2

1. Which student statement indicates that further teaching is needed regarding recovery as it applies to mental illness? 1. "The goal of recovery is improved health and wellness." 2. "The goal of recovery is expedient, comprehensive behavioral change." 3. "The goal of recovery is the ability to live a self-directed life." 4. "The goal of recovery is the ability to reach full potential."

2

10. A nursing instructor is teaching about components of the recovery process that led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed? 1. "A client has a better chance of recovery if he or she truly believes that recovery can occur." 2. "If a client is willing to give the responsibility of treatment to the health-care team, they are likely to recover." 3. "A client who has a positive sense of self and a positive identity is likely to recover." 4. "A client has a better chance of recovery if he or she has purpose and meaning in life."

2

10. How would a nurse prioritize nursing diagnoses? 1. By the established goal of care 2. By the life-threatening potential 3. By the physician's priority of care 4. By the client's preference

2

12. A client states, "This disease has not paralyzed me. I can still be myself and not just an ill person." The nurse recognizes that this client is in which stage of the Psychological Recovery Model, as described by Andresen and associates? 1. Moratorium 2. Awareness 3. Preparation 4. Rebuilding

2

3. Which function is exclusive to the advanced practice psychiatric nurse? 1. Teaching about the side effects of neuroleptic medications 2. Using psychotherapy to improve mental health status 3. Using milieu therapy to structure a therapeutic environment 4. Providing case management to coordinate continuity of health services

2

3. Which situation would a nurse identify as an example of an autocratic leadership style? 1. The president of Sigma Theta Tau assigns members to committees to research problems. 2. Without faculty input, the dean mandates that all course content be delivered via the Internet. 3. During a community meeting, a nurse listens as clients generate solutions. 4. The student nurses' association advertises for candidates for president.

2

4. A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to SAMHSA, which dimension of recovery is supporting this client? 1. Health 2. Home 3. Purpose 4. Community

2

5. A client diagnosed with alcohol use disorder experiences a first relapse. During an Alcoholics Anonymous (AA) meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's therapeutic factors does this illustrate? 1. Imparting of information 2. Instillation of hope 3. Catharsis 4. Universality

2

6. The nurse maintains a client's confidentiality, addresses the client appropriately, and does not discriminate based on gender, age, race, or religion. Which guiding principle of recovery has this nurse employed? 1. Recovery is culturally based and influenced. 2. Recovery is based on respect. 3. Recovery involves individual, family, and community strengths and responsibility. 4. Recovery is person-driven.

2

7. Which describes the primary purpose of a registered nurse gathering client information? 1. It enables the nurse to modify behaviors related to personality disorders. 2. It enables the nurse to make sound clinical judgments and plan appropriate care. 3. It enables the nurse to prescribe the appropriate medications. 4. It enables the nurse to assign the appropriate Axis I diagnosis.

2

8. A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing response is most appropriate? 1. "I'm confident you know what's best for you." 2. "This may not be the best time for you to make such an important decision." 3. "Your children will be terribly disappointed." 4. "Tell me why you want to make this change."

2

8. Which is the priority focus of recovery models? 1. Empowerment of the health-care team to bring their expertise to decision-making 2. Empowerment of the client to make decisions related to individual health care 3. Empowerment of the family system to provide supportive care 4. Empowerment of the physician to provide appropriate treatments

2

9. An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior would alert a nurse to escalating anger and aggression? 1. The client requests prn medications. 2. The client has a tense facial expression. 3. The client refuses to eat lunch. 4. The client sits in group with back to peers.

2

9. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? 1. "It's hard for me to tell my story when I'm not sure about the reactions of others." 2. "I think Joe's Antabuse suggestion is a good one and might work for me." 3. "My situation is very complex, and I need professional, not peer, advice." 4. "I am really upset that you expect me to solve my own problems."

2

The nurse attended a seminar about neurocognitive disorders (NCD). Which information from the nurse indicates a correct understanding of the differences between NCD and pseudodementia (depression)? 1. NCD has a rapid onset, whereas pseudodementia does not. 2. NCD symptoms include disorientation to time and place, and pseudodementia does not. 3. NCD symptoms improve as the day progresses, but symptoms of pseudodementia worsen. 4. NCD causes decreased appetite, whereas pseudodementia does not.

2

A child has been diagnosed with autism spectrum disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing response is most appropriate? 1. "Researchers really don't know what causes autism spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored." 2. "Poor parenting doesn't cause autism spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control." 3. "Research has shown that the mother appears to play a greater role in the development of autism spectrum disorder than the father." 4. "Lack of early infant bonding with the mother has shown to be a cause of autism spectrum disorder. Did you breastfeed or bottle-feed?"

2

A client diagnosed with major neurocognitive disorder (NCD) is exhibiting behavioral problems on a daily basis. At change of shift, the client's behavior escalates from pacing to screaming and flailing. Which action should be a nursing priority? 1. Consult the psychologist regarding behavior-modification techniques. 2. Medicate the client with prn antianxiety medications. 3. Assess environmental triggers and potential unmet needs. 4. Anticipate the behavior and restrain when pacing begins.

2

A client has been diagnosed with major depressive episode. After treatment with an antidepressant, the client exhibits pressured speech and flight of ideas. Based on this symptom change, which information should the nurse share with the health-care provider? 1. Ask to increase the dosage of the antidepressant. 2. Ask that the client be reevaluated. 3. Ask to order benztropine (Cogentin) for the extrapyramidal symptoms. 4. Ask that another class of antidepressants be used.

2

A client has been given a diagnosis of human immunodeficiency virus (HIV). Which statement made by the client does the nurse recognize as the bargaining stage of grief? 1. "I hate my partner for giving me this disease I will die from!" 2. "If I don't do intravenous (IV) drugs anymore, God won't let me die." 3. "I am going to support groups and learn more about the disease." 4. "Can you please re-draw the test results, I think they may be wrong?"

2

A client is admitted to an inpatient unit after a suicide attempt. The health-care provider prescribes amitriptyline (Elavil) for the client. Which would the nurse expect to be initiated to maintain this client's safety upon discharge? 1. Provide a 6-month supply of Elavil to ensure long-term compliance. 2. Provide a 3-day supply of Elavil with refills contingent on follow-up appointments. 3. Provide a pill dispenser as a memory aid. 4. Provide education regarding the avoidance of foods containing tyramine.

2

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

2

A client was recently admitted to the inpatient unit after a suicide attempt and has not responded to SSRIs or tricyclic antidepressants. The client asks the nurse, "Why can't monoamine oxidase inhibitors (MAOIs) be added to what I am on now?" Which response should the nurse make? 1. "Electroconvulsive therapy is your best option at this point." 2. "Combined use can lead to a life-threatening condition called hypertensive crisis." 3. "There is no reason why an MAOI couldn't be added to your therapy." 4. "They can't be used together because their mechanisms of action are very different."

2

A client with a history of alcohol use disorder is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client sign or symptom should be the nurse's first priority? 1. Hearing and visual impairment 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 on numeric scale 4. Dehydration

2

A client with schizophrenia spectrum disorder presents with bizarre behaviors and delusions. Which nursing action should be prioritized to maintain this client's safety? 1. Monitor for medication nonadherence. 2. Note escalating behaviors immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors.

2

A family asks why their father is attending activity groups at the long-term care facility. The son states, "My father worked hard all of his life. He just needs some rest at this point." Which is the appropriate nursing response? 1. "I'm glad we discussed this. We'll excuse him from the activity groups." 2. "The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation." 3. "The groups are optional. Only clients at high functioning levels would benefit." 4. "If your father doesn't go to these activity groups, he will be at high risk for developing cognitive problems."

2

A homeless client comes to an emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease would a nurse suspect? 1. Meningitis 2. Tuberculosis 3. Encephalopathy 4. Mononucleosis

2

A mother rescues two of her four children from a house fire. The other two children die in the house fire. In an emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? 1. "The smoke was too thick. You couldn't have gone back in." 2. "You're experiencing feelings of guilt, because you weren't able to save your children." 3. "Focus on the fact that you could have lost all four of your children." 4. "It's best if you try not to think about what happened. Try to move on."

2

A son is seeking advice about his mother who seems to worry unnecessarily about everything. The son states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Worry and anxiety are complex phenomena and are effectively treated only with psychotropic medications."

2

A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? 1. "Your grieving will subside within 1 year; until then, I recommend antidepressants." 2. "Support groups are available specifically for survivors of suicide, and I would be glad to work with the health-care provider to locate one in this area." 3. "The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them." 4. "Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

2

After a teaching session about grief, a client says to the nurse, "I seem to be stuck in the bargaining stage of grieving over the loss of my daughter." In which phase of the nursing process would this occur, and how would the nurse interpret this statement? 1. Assessment phase; nursing actions have been successful in achieving accurate data. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving accurate data.

2

After years of dialysis, an 84-year-old client states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question would the nurse ask the client's spouse when preparing a discharge plan of care? 1. "Have there been any changes in appetite or sleep?" 2. "How often is your spouse left alone?" 3. "Has your spouse been following a diet and exercise program consistently?" 4. "How would you characterize your relationship with your spouse?"

2

In response to a student's question regarding choosing a psychiatric specialty, a charge nurse states, "Mentally ill clients need to feel compassion and care. If I were in that position, I'd want a caring nurse also." From which ethical framework is the charge nurse operating? 1. Kantianism 2. Christian ethics 3. Ethical egoism 4. Utilitarianism

2

Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse would recognize that this situation validates which study perspective? 1. Neuroendocrinology 2. Psychoneuroimmunology 3. Diagnostic technology 4. Neurophysiology

2

The client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions during the assessment interview. Which response would the nurse make? 1. "You are very disrespectful. You need to learn to control yourself." 2. "I understand that you are angry, but this behavior will not be tolerated." 3. "What behaviors could you modify to improve this situation?" 4. "Which antipersonality disorder medications have helped you in the past?"

2

The client diagnosed with obsessive-compulsive disorder has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

2

The client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which information best explains the childhood nurturance of this client's personality disorder? 1. Was provided from many sources, and independent behaviors were encouraged 2. Was provided exclusively from one source, and independent behaviors were discouraged 3. Was provided exclusively from one source, and independent behaviors were encouraged 4. Was provided from many sources, and independent behaviors were discouraged

2

The client has extensive mental health problems that require medication and counseling. To which mental health-care professional should the nurse refer the client? 1. Psychologist 2. Psychiatrist 3. Licensed independent social worker 4. Peer support specialist

2

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

2

The client receiving eye movement desensitization and reprocessing (EMDR) therapy says, "After only three sessions, I am feeling great. Now I can stop and get on with my life." Which response by the nurse is most appropriate? 1. "I am thrilled that you have responded so rapidly to EMDR." 2. "To achieve lasting results, all eight phases of EMDR must be completed." 3. "If I were you, I would complete the EMDR and comply with the health-care provider's orders." 4. "How do you feel about continuing the therapy?"

2

The client with bipolar disorder refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which anticonvulsant medication should the nurse be prepared to administer? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Verapamil (Calan) 4. Lurasidone (Latuda)

2

The depressed client is receiving light therapy. Which instruction would the nurse share with the client? 1. "White LED lights will be used with protective glasses to block ultraviolet rays." 2. "You will sit in front of the light box with your eyes open." 3. "The light sessions will start out at 5 minutes and work up to 30 minute intervals." 4. "Vagal stimulation from the light waves will help release melatonin in the brain."

2

The family of a teenager diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting to implement the Maudsley approach. Which is the appropriate nursing response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "For the plan to be successful, we need your involvement. The parents establish the rules and guidelines around eating." 3. "While the client is the primary focus, this meeting will provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

2

Which characteristic would help a nurse distinguish between dysthymia and major depressive disorder (MDD)? 1. Dysthymia is associated with the menstrual cycle. 2. Dysthymia is a chronically depressed mood. 3. MDD lasts for at least 2 years. 4. MDD does not have delusions or hallucinations.

2

The nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 50 attempts within a 15-minute period. Which is the best rationale for assessing this client for substance addiction? 1. Narcotic pain medication is contraindicated for all clients with active substance use disorders. 2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control. 3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance. 4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

2

The nurse has just met a new client and is beginning to get to know to the client. Which would be the priority nursing action during this phase of the nurse-client relationship? 1. Acknowledge the client's actions and generate alternative behaviors. 2. Establish rapport and develop treatment goals. 3. Attempt to find alternative placement for the client. 4. Explore how thoughts and feelings about this client may adversely impact nursing care.

2

The nurse is building a therapeutic relationship with a client. During their interaction, the nurse feels the individual is not always honest or open during their interactions. Which characteristic would a nurse identify as missing? 1. Respect 2. Genuineness 3. Sympathy 4. Rapport

2

The nurse is caring for a client with a postpartum emotional disorder. Which postpartum disorder is correctly matched with its presenting symptoms? 1. Baby blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Moderate postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Maternity blues (overprotection of infant, severe guilt, depressed mood, lack of concentration) 4. Postpartum depression with psychotic features (transient depressed mood, decisive, abnormal fear of child abduction, suicidal ideations)

2

The nurse is caring for a client with major depressive disorder who is withdrawn, uncommunicative, and secludes self in room. Which nursing diagnosis should the nurse add to the plan of care? 1. Spiritual distress 2. Social isolation 3. Low self-esteem 4. Powerlessness

2

The nurse is caring for a client with schizophrenia spectrum disorder who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? 1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. 2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. 3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. 4. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

2

The nurse is preparing a presentation about the onset of symptoms for agoraphobia. Which information should the nurse include in the teaching session? 1. Occurs in early adolescence and persists until midlife 2. Occurs in the 20s and 30s and persists for many years 3. Occurs in the 40s and 50s and persists until death 4. Occurs after the age of 60 and persists for at least 6 years

2

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

2

The nurse is teaching the depressed client about bupropion (Wellbutrin). Which statement by the client indicates effective teaching? 1. "I will begin to wear short sleeves when outdoors." 2. "I will not take two pills if I miss a dose." 3. "I will discontinue the medication when my depression is gone." 4. "I will stand up smoothly and quickly to keep my balance."

2

The nurse is teaching the staff about specific phobias. Which statement from a staff member indicates teaching has been effective? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident." 4. "These clients exhibit symptoms of tachycardia, dysphagia, and diaphoresis."

2

The nurse is working in a long-term care facility. Which action by the nurse demonstrates attention to a priority issue for screening for all clients in the facility? 1. Performing crisis intervention 2. Assessing a client for trauma 3. Determining presence of hallucinations 4. Monitoring for anxiety disorders

2

The nurse performs a full physical health assessment on an older adult client admitted with a diagnosis of major depressive disorder. What is the rationale for the nurse's assessment? 1. The attention during the assessment is beneficial in decreasing social isolation in the elderly. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed geriatric clients avoid addressing physical health and ignore medical problems.

2

The unit manager's policy is that clients can make a choice about whether or not to attend group therapy in an inpatient psychiatric unit. Which ethical principle does the unit manager's policy preserve? 1. Justice 2. Autonomy 3. Veracity 4. Beneficence

2

Which action would the nurse take to establish a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? 1. Establish personal contact with family members 2. Be reliable, honest, and consistent during interactions 3. Share limited personal information 4. Sit close to the client to establish rapport

2

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

2

Which would be the initial nursing intervention for an older adult attending an adult day care program suddenly reporting dizziness, weakness, and confusion? 1. Implement complete bedrest. 2. Complete a physical assessment. 3. Address self-esteem needs. 4. Advocate for individual psychotherapy.

2

A nursing supervisor is about to meet with a staff nurse suspected of diverting clients' pain medications. Which assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.) 1. Is frequently absent from work 2. Experiences mood swings 3. Makes elaborate excuses for behavior 4. Frequently uses the restroom 5. Has a flushed face

2, 3, 4, 5

Which information would the nursing instructor include about suicide in the elderly population when teaching nursing students? 1. Elderly people use less lethal means to commit suicide. 2. Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3. Suicide is the second leading cause of death among the elderly. 4. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

2

Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self? 1. The client will not physically harm self. 2. The client will express three positive self-attributes by day four. 3. The client will reveal a suicide plan. 4. The client will establish a trusting relationship.

2

Which is an example of an intentional tort? 1. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome. 2. A nurse physically places an irritating client in four-point restraints. 3. A nurse makes a medication error and does not report the incident. 4. A nurse gives patient information to an unauthorized person.

2

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

2

Which neurotransmitters would a nurse expect to be elevated in a client with a diagnosis of catatonic schizophrenia? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

2

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

2

Which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Rotate staff members who work with the client. 3. Teach about antianxiety medications to improve medication compliance. 4. Offer sympathy when client engages in self-mutilation.

2

Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality.

2

Which outcome would the nurse add to the plan of care for an inpatient client diagnosed with somatic symptom disorder (SSD)? 1. The client will admit to fabricating physical symptoms to gain benefits by day three. 2. The client will list three potential adaptive coping strategies to deal with stress by day two. 3. The client will identify the connection between function loss and severe stress by day three. 4. The client will maintain a sense of reality during stressful situations by day four.

2

Which potential client would a nurse identify as a candidate for involuntary commitment? 1. The client living under a bridge 2. The client threatening to commit suicide 3. The client who never bathes and wears a wool hat in the summer 4. The client who eats waste out of a garbage can

2

Which premise is basic to the recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication compliance 2. Independent management 3. Total absence of symptoms 4. Improved psychosocial relationships

2

Which situation exemplifies both assault and battery? 1. The nurse becomes angry, calls the client offensive names, and withholds treatment. 2. The nurse threatens to "tie down" the client and then does so, against the client's wishes. 3. The nurse hides the client's clothes and medicates the client to prevent elopement. 4. The nurse restrains the client without just cause and communicates this to family.

2

Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? 1. Medical history is of little significance and can be eliminated from the nursing assessment. 2. Assessment provides a holistic view of the client, including biopsychosocial aspects. 3. Comprehensive assessments can be performed only by advanced practice nurses. 4. Psychosocial evaluations are gained by subjective reports rather than objective observations.

2

Which statement made by a family member of a hospice client requires correction by the nurse? 1. "My mom will receive pain management and be kept as comfortable as possible." 2. "My mom will receive aggressive treatment as a final attempt to cure the disease to give her more time to spend with us." 3. "The dietician can work with us to help plan some high calorie meals incorporating foods my mom will eat." 4. "There is a nurse or staff member available 24/7 in case my mom needs assistance."

2

Which student statement indicates that learning has occurred regarding case management? 1. "Case management is a method used to achieve independent client care." 2. "Case management provides coordination of services required to meet client needs." 3. "Case management exists mainly to facilitate client admission to needed inpatient services." 4. "Case management is a method to facilitate health-care provider reimbursement."

2

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

2

Which would a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

2

Which statement is true regarding a 7-year-old client's perception of death? (Select all that apply). 1. They believe their behavior caused another person to die. 2. They are old enough to understand the actual cause of death. 3. They may believe the "bogey man" took the person. 4. They may associate death with old age. 5. They understand death to be inevitable.

2, 3, 4

Which statement(s) by the nurse indicates that teaching has been effective regarding the environmental theory? (Select all that apply.) 1. "Personality characteristics in old age are correlated with early life characteristics." 2. "Carcinogens can affect aging." 3. "Trauma can affect the aging process." 4. "The effects of sunlight can have an effect on the aging process." 5. "Decline in the immune system can affect the aging process."

2, 3, 4

The nurse is discussing treatment options with a client who has arachnophobia. Which commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Competing response training 5. Habit reversal training

2, 3

Order the goals of the levels of prevention as they progress through the public health model set forth by Gerald Caplan. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness 2. Services aimed at reducing the residual defects that are associated with severe and persistent mental illness 3. Services aimed at reducing the incidence of mental disorders within the population

2, 3, 1

17. Which of the following behavioral skills would a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.) 1. Encourage members to provide feedback to each other about individual progress. 2. Ensure that group rules do not interfere with goal fulfillment. 3. Work with group members to establish rules that will govern the group. 4. Emphasize the need for, and importance of, confidentiality within the group. 5. Help the leader to resolve conflicts and foster cohesiveness within the group.

2, 3, 4

15. Put the nursing interventions in the order in which they would proceed in the steps of the nursing process. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Determine if an antianxiety medication is decreasing a client's stress. 2. Measure a client's vital signs and review past history. 3. Encourage deep breathing and teach relaxation techniques. 4. Aim, with client collaboration, for a seven-hour night's sleep. 5. Recognize and document the client's problem.

2, 5, 4, 3, 1

16. Place the six steps of The Wellness Recovery Action Plan (WRAP) Model in the correct order. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Daily Maintenance List 2. Things Are Breaking Down or Getting Worse 3. Crisis Planning 4. Develop a Wellness Toolbox 5. Early Warning Signs 6. Triggers

2, 5, 6, 1, 4, 3

Parents ask the nurse why their daughter was diagnosed with posttraumatic stress disorder (PTSD) and others survivors of the terrorist attack were not. Which information should the nurse offer? (Select all that apply.) 1. An individual's stated religious affiliation can affect response to trauma. 2. Responses are affected by how an individual handled previous trauma. 3. Protectiveness of family and friends can help an individual deal with trauma. 4. Control over the possibility of recurrence can affect the response to trauma. 5. The duration of how long the trauma lasted can affect the individual's response.

2, 3, 4, 5

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

2, 3, 4, 5

Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.) 1. Meeting the psychological needs of the nurse and the client 2. Ensuring therapeutic termination 3. Promoting client insight into problematic behavior 4. Collaborating to set appropriate goals 5. Meeting both the physical and psychological needs of the client

2, 3, 4, 5

The client experiences sadness and melancholia in September continuing through November. Which factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities 2. Increased production of melatonin 3. Hyposecretion of cortisol 4. Less exposure to natural sunlight 5. Blockade of histamine reuptake

2, 4

The nurse is teaching about the DSM-5 criteria for the diagnosis of binge eating disorder. Which statements by the staff indicate successful teaching? (Select all that apply.) 1. "Binge eating occurs exclusively during the course of bulimia nervosa." 2. "Binge eating occurs, on average, at least once a week for three months." 3. "Binge eating occurs because of an intense fear of becoming fat." 4. "Marked distress regarding binge eating is present." 5. "Marked distress regarding purging is present."

2, 4

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

2, 4

Which of the following findings would a nurse identify that would contribute to a client's development of ADHD? (Select all that apply.) 1. The client's father was a smoker. 2. The client had a low birth weight. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

2, 4

The client diagnosed with posttraumatic stress disorder (PTSD) asks, "Why did my health-care provider prescribe an antidepressant rather than an antianxiety drug for me?" Which explanations should the nurse make? (Select all that apply.) 1. "I'm not sure, because antianxiety drugs have been approved by the FDA for PTSD." 2. "Antidepressants are now considered first-line treatment choice for PTSD." 3. "Many people experience side effects to antianxiety drugs." 4. "Because of their addictive properties, antianxiety drugs are less desirable." 5. "That is strange because antipsychotics have provided the best results for treatment of PTSD."

2, 4, 5

Which describes a defense mechanism an individual may use to relieve anxiety in a stressful situation? (Select all that apply.) 1. Homework 2. Smoking 3. Itching 4. Nail biting 5. Sleeping

2, 4, 5

10. Which of the following conditions promote a therapeutic community? (Select all that apply.) 1. The unit schedule includes unlimited free time for personal reflection. 2. Unit responsibilities are assigned according to client capabilities. 3. A flexible schedule is determined by client needs. 4. The individual is the sole focus of therapy. 5. A democratic form of government exists.

2, 5

Which are biological implications of both bipolar disorder and panic disorder? (Select all that apply.) 1. Increased levels of dopamine 2. Increased levels of thyroid hormones 3. Decreased cortisol levels 4. Decreased GABA activity 5. Increased levels of norepinephrine

2, 5

Place in order the Kübler Ross stages of grief from 1-5. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Bargaining 2. Denial 3. Acceptance 4. Depression 5. Anger

2, 5, 1, 4, 3

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which statements by nursing students about hepatic encephalopathy indicate successful teaching? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

2. 4. 5

1. An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" Which response by the nurse responds would be guided by which basic assumption of milieu therapy? 1. "Let's find a way to avoid this conflict in the future." 2. "I'll fix this right away." 3. "I can see that you are upset. Let's talk about ways to resolve this." 4. "It would be best for you to bring this up during group therapy later this week."

3

1. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? 1. The nurse requires that all group members reveal an embarrassing personal situation. 2. The nurse asks for a show of hands to determine group topic preference. 3. The nurse sits silently as the group members stray from the assigned topic. 4. The nurse shuffles through papers to determine the facility policy on length of group.

3

11. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB MNA, DFA, and daytime napping. Which is a correctly written and appropriate outcome for this client? 1. The client will avoid daytime napping and attend all groups. 2. The client will exercise, as needed, before bedtime. 3. The client will sleep seven uninterrupted hours by day four of hospitalization. 4. The client's sleep habits will improve during hospitalization.

3

12. When planning group therapy, a nurse would identify which configuration as most optimal for a therapeutic group? 1. Open-ended membership; circle of chairs; group size of 5 to 10 members 2. Open-ended membership; chairs around a table; group size of 10 to 15 members 3. Closed membership; circle of chairs; group size of 5 to 10 members 4. Closed membership; chairs around a table; group size of 10 to 15 members

3

13. Which response by the instructor most accurately answers the student's question regarding how to best develop nursing outcomes for clients? 1. "You can use NIC, a standardized reference for nursing outcomes." 2. "Look at your client's problems and set a realistic, achievable goal." 3. "With client collaboration, outcomes would be based on client problems." 4. "Copy your standard outcomes from a nursing care plan textbook."

3

2. Which statement regarding nursing interventions would a nurse identify as accurate? 1. Nursing interventions are independent from the treatment team's goals. 2. Nursing interventions are solely directed by written physician orders. 3. Nursing interventions are comprehensive and reflect current clinical nursing practice 4. Nursing interventions are standardized by policies and procedures.

3

6. Which is being assessed when a nurse asks a client to identify name, date, residential address, and situation? 1. Mood 2. Perception 3. Orientation 4. Affect

3

7. Prayer group members at a local Baptist church are meeting with a poor, homeless family whom they are supporting. Which member statement is an example of Yalom's therapeutic factor of altruism? 1. "Social services might be able to help you find a job." 2. "The last time we helped a family, they got back on their feet and prospered." 3. "I can give you all of my baby clothes for your little one." 4. "I can appreciate your situation. I had to declare bankruptcy last year."

3

7. The nurse is tending to a new client who has made several suicide attempts. The client reports having persistent, strong suicidal intentions. Which intervention by the nurse is most appropriate while still promoting a therapeutic hospital environment? 1. The nurse supervises the patient at all times by seating the patient alone at meal times 2. The nurse allows the patient to have unsupervised free time to visit with other group members. 3. The nurse removes any potential tools for self-harm from the patient's room and keeps the door locked. 4. The nurse brings the patient to impromptu group therapy sessions so the patient is never alone for long periods of time.

3

8. A client is to undergo psychological testing. Which member of the interdisciplinary team would a nurse consult for this purpose? 1. The psychiatrist 2. The psychiatric social worker 3. The clinical psychologist 4. The clinical nurse specialist

3

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago and asks why he has gained 12 lbs. (5.4 kg.) since then. Which response by the nurse is appropriate? 1. "I'm surprised you have gained; weight loss is the typical pattern when taking lithium." 2. "Your weight gain is more likely related to food intake than medication." 3. "Weight gain is a common but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." 4. "There's not much you can do about the weight gain. It's better than being emotionally unstable, though."

3

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the physician to treat this disorder. The nurse would give the client information on which medications? 1. Escitalopram (Lexapro) and clozapine (Clozaril) 2. Citalopram (Celexa) and olanzapine (Zyprexa) 3. Lithium carbonate (Lithobid) and naltrexone (ReVia) 4. Haloperidol (Haldol) and ziprasidone (Geodon)

3

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. Which would be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while monitoring suicidal ideations 4. Encouraging the client to express feelings related to suicide

3

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? 1. The side effects of medications 2. Deep breathing techniques to decrease stress 3. How to make eye contact when communicating 4. Behaviors needed to be a leader

3

A client diagnosed with schizophrenia spectrum disorder states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? 1. "Did you take your medicine this morning?" 2. "You are not going to hell. You are a good person." 3. "The voices must sound scary, but I do not hear any voices." 4. "The devil only talks to people who are receptive to his influence."

3

A client exhibiting dependent behaviors says, "Do you think I should move out of my parents' house and get a job?" Which nursing response is most appropriate? 1. "It would be best to do that in order to increase independence." 2. "Why would you want to leave a secure home?" 3. "Let's discuss and explore all of your options." 4. "I'm afraid you would feel very guilty leaving your parents."

3

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

3

A client is diagnosed in stage 7 of Alzheimer's disease (AD). To address the client's symptoms, which nursing intervention should take priority? 1. Improve cognitive status by encouraging involvement in social activities. 2. Decrease social isolation by providing group therapies. 3. Promote dignity by providing comfort, safety, and self-care measures. 4. Facilitate communication by providing assistive devices.

3

A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide? 1. Encouraging participation in the milieu to promote hope 2. Developing a strong personal relationship with the client 3. Observing the client at intervals determined by assessed data 4. Encouraging and redirecting the client to concentrate on happier times

3

A client is prescribed transdermal selegiline (Emsam) for depressive symptoms. Which action would the nurse take to administer this medication? 1. Apply new patch to the lower abdomen. 2. Apply new patch to inner surface of upper arm. 3. Place new patch on dry, intact skin. 4. Place direct heat to new patch for a tight seal.

3

A client who has been raped answers a nurse's questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How would the nurse interpret this client's responses? 1. The client may be fabricating details of the incident. 2. The client may be experiencing a silent rape reaction. 3. The client may be demonstrating a controlled response pattern. 4. The client may be having a compounded rape reaction.

3

A client who is being treated for chronic kidney disease complains to the health-care provider that he does not like the food available to him while hospitalized. The health-care provider insists that the client strictly adhere to the diet plan. What action can be expected is the client uses the defense mechanism of displacement? 1. The client assertively confronts the health-care provider. 2. The client insists on being discharged and goes for a long, brisk walk. 3. The client snaps at the nurse and criticizes the nursing care provided. 4. The client hides his anger by explaining the logical reasoning for the diet to his spouse.

3

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action would be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase frequency of client observation. 4. Request that the psychiatrist reevaluate the current medication protocol.

3

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which response by the nurse is therapeutic? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

3

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

3

A nurse assesses a female client whose partner died 13 months ago. The client isolates herself, screams at her deceased partner, and is increasingly restless. According to Bowlby, this client is in which stage of the grieving process? 1. Stage I: Numbness or protest 2. Stage II: Disequilibrium 3. Stage III: Disorganization and despair 4. Stage IV: Reorganization

3

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

3

A nurse is preparing a staff education session about the impaired nurse and the consequences of this impairment. Which statement by a staff member indicates successful teaching? 1. "The state board of nursing must be notified with subjective documentation of impairment." 2. "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice." 3. "Some state boards of nursing administer the treatment programs themselves, while others refer the nurse to other resources." 4. "After a return to practice, a recovering nurse may be closely monitored for several days."

3

A nurse would identify which part of the nervous system as playing a major role during a stressful situation? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

3

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? 1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. 4. Provide thiamin supplements to prevent Wernicke-Korsakoff syndrome.

3

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

3

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

3

A woman comes to an emergency department with a broken nose and multiple bruises after being physically assaulted by her husband. She states, "The beatings have been getting worse, and I'm afraid next time he will kill me." Which is the appropriate nursing response? 1. "People in general do not change their behaviors. He will likely never change." 2. "There are things you can do to prevent him from losing control." 3. "Let's talk about your options so that you don't have to go home." 4. "Why don't we call the police so that they can confront your husband with his behavior?"

3

According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? 1. Maintaining a long-term, faithful, intimate relationship 2. Achieving a sense of self-confidence 3. Possessing a feeling of self-fulfillment and realizing full potential 4. Developing a sense of purpose and the ability to direct activities

3

After one week of continuous mental confusion, an older African American client is admitted with a preliminary diagnosis of Alzheimer's disease (AD). What should cause the nurse to question this diagnosis? 1. AD does not typically occur in African American clients. 2. The symptoms presented are more indicative of Parkinsonism. 3. AD does not develop suddenly. 4. There have been no liver function studies ordered.

3

An aging client with chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol) for hypertension and an antipsychotic. Given the combined side effects of these drugs, what teaching should the nurse provide? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3

An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? 1. "Why did you use the client's name on your clinical worksheet?" 2. "You were very careless to refer to your client by name on your clinical worksheet." 3. "Surely you didn't do this deliberately, but you breached confidentiality by using names." 4. "It is disappointing that after being told you're still using client names on your worksheet."

3

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

3

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? 1. Anxiety 2. Altered thought processes 3. Complicated grieving 4. Altered sensory perception

3

At 11:30 p.m. the client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate? 1. "Go ahead and use the phone. I know this pending divorce is stressful." 2. "You know better than to break the rules. I'm surprised at you." 3. "It is after the 10 p.m. phone curfew. You will be able to call tomorrow." 4. "A divorce shouldn't be considered until you have had a good night's sleep."

3

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife would indicate to a nurse that the client is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so mad that the children and I had to put up with him as long as we did." 3. "Yes, it was a difficult relationship, but I think I have learned from the experience." 4. "I have a difficult time getting out of bed most days."

3

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It is just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section."

3

During her uncle's wake, a 5-year-old girl runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out her hair, resulting in hair loss. Which nursing diagnosis should the nurse assign to this child? 1. Fear 2. Altered family processes 3. Ineffective impulse control 4. Disturbed body image

3

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

3

In which setting should the nurse be aware that the client with a substance use disorder would most likely seek initial treatment? 1. Psychiatric hospital 2. Addiction treatment center 3. Urgent care clinic 4. Inpatient psychiatric unit

3

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

3

Parents ask a nurse how they should reply when their son, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which nursing response is appropriate? 1. "Tell him to stop discussing the voices." 2. "Ignore what he is saying, while attempting to discover the underlying cause." 3. "Focus on the feelings generated by the hallucinations and present reality." 4. "Present objective evidence that the voices are not real."

3

The aging client takes an antipsychotic for schizophrenia spectrum disorder and a beta-adrenergic blocking agent for hypertension. Based on an understanding of the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3

The client diagnosed with bulimia nervosa has been attending an outpatient mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. Gained two pounds in one week 2. Focused conversations on nutritious food 3. Demonstrated healthy coping mechanisms that decreased anxiety 4. Verbalized an understanding of the etiology of the disorder

3

The client diagnosed with dissociative identity disorder (DID) switches personalities when confronted by the nurse about inappropriate actions. The nurse recognizes that this dissociation serves which function? 1. It is a means to attain secondary gain. 2. It is a means to explore feelings of excessive and inappropriate guilt. 3. It serves to isolate painful events so the person's awareness and anxiety are decreased. 4. It serves to establish personality boundaries and limit inappropriate impulses.

3

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

3

The client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill his ex-spouse. Which nursing diagnosis is priority for this client? 1. Disturbed sensory perception 2. Altered thought processes 3. Risk for violence: directed toward others 4. Risk for injury

3

The client diagnosed with schizophrenia spectrum disorder tells the nurse, "I'm sad that the voice is telling me to stop seeing my psychiatrist." Which symptom is the client exhibiting? 1. Magical thinking 2. Persecutory delusions 3. Command hallucinations 4. Altered thought processes

3

The client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a brightly lit room. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

3

The client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority? 1. Encourage exploration of sexual abuse. 2. Suggest guided imagery. 3. Establish trust and rapport. 4. Administer antianxiety medications.

3

The nurse develops the following outcomes for a client diagnosed with bipolar disorder: manic episode: 1. Maintain nutritional status. 2. Interact appropriately with peers. 3. Remain free from injury. 4. Sleep 6 to 8 hours a night. In which order would the nurse prioritize the outcomes, starting with the highest and ending with the lowest priority outcome? 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

3

The nurse discovers a client's suicide note that details the time, place, and means to commit suicide. Which would be the priority nursing intervention and the rationale for this action? 1. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note 2. Establishing room restrictions, because the client's threat is an attempt to manipulate the staff 3. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide 4. Calling an emergency treatment team meeting, because the client's threat must be addressed

3

The nurse is assessing a client diagnosed with somatic symptom disorder (SSD). Which findings would the nurse expect to observe? 1. Presence of multiple personalities, depersonalization, derealization, and "gaps" in memory 2. Aphonia, la belle indifference, paralysis with no physical reason, and possible hallucinations 3. Anxious, seeing several health-care providers simultaneously, overmedicates, and vague symptoms 4. Pretends to be ill, aggravates existing symptoms, inflicts self-injury and has many hospitalizations

3

The nurse is assessing a client who has a diagnosis of schizophrenia and takes an antipsychotic agent daily. Which finding requires further nursing assessment immediately? 1. Respirations of 20 breaths/minute 2. Weight gain of 8 lbs. (3.6 kg.) in 2 months 3. Temperature of 101oF (38.3 oC) 4. Excess salivation

3

The nurse is assisting with electroconvulsive therapy (ECT). What is the rationale for administering 100% oxygen to a client during and after ECT? 1. To prevent brain damage from the electrical impulse of the procedure 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

3

The nurse is caring for a client diagnosed with posttraumatic stress disorder (PTSD). Which realistic goal should be included in this client's plan of care? 1. The client will have no flashbacks. 2. The client will be able to feel a full range of emotions by discharge. 3. The client will not require medication to obtain adequate sleep by discharge. 4. The client will refrain from discussing the traumatic event.

3

The nurse is caring for a client whose diagnosis has been linked to an abnormal secretion of growth hormone. Which illness does the client most likely have? 1. Acute mania 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

3

The nurse is caring for clients in a free community clinic. Which technique should the nurse use to conduct a trauma screening? 1. Quickly assessing the overall situation 2. Implementing a thorough head-to-toe assessment 3. Interviewing in a secluded area 4. Using empathy with the family members

3

The nurse is describing the Transactional Model of Stress and Adaptation. When using this model, which factor would the nurse categorize as intrapersonal? 1. Occupational opportunities 2. Economic conditions 3. Degree of flexibility 4. Availability of social supports

3

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

3

The nurse is preparing a staff education session about depression in adolescents. Which statement by a staff member indicates teaching has been effective? 1. "Adolescents are not likely to suffer from depression." 2. "Depressed adolescents normally seek immediate treatment." 3. "Many symptoms are attributed to normal adjustments of adolescents." 4. "Suicide is not common among depressed adolescents."

3

The nurse is providing care to a depressed, introverted client who is receiving outpatient surgery for a fractured hip. Which action should the nurse take to provide patient-centered care? 1. Refer the client for involuntary hospitalization 2. Allow the client plenty of solitude time to prepare for surgery 3. Involve the client in choosing a blue or green gown to wear 4. Develop a partnership with the spouse who is not withdrawn

3

The nurse is working in an emergency department. With which client should the nurse use the screening, brief intervention, and referral to treatment approach (SBIRT)? 1. Has suicidal thoughts 2. Has nonsuicidal self-injuring behavior 3. Has an opioid addiction 4. Has been raped

3

The nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates teaching has been effective? 1. "How clients perceive events and view the world affects their response to trauma." 2. "Psychic numbing in PTSD is a result of negative reinforcement." 3. "The individual becomes addicted to the trauma owing to an endogenous opioid response." 4. "Believing that the world is meaningful and controllable can protect an individual from PTSD."

3

The nursing instructor is teaching about bipolar disorders. Which symptom should the instructor include that is present during a manic episode but is absent in hypomania? 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. Psychosis 4. Flight of ideas or racing thoughts

3

The psychiatrist prescribes haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg at bedtime for a client with schizophrenia spectrum disorder. Which client behavior would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Muscle rigidity 4. Reports of hearing disturbing voices

3

What is the first step the nurse should take to reduce stigma of mental health clients? 1. Increase social contact with mental health clients 2. Attend on-the-job training about mental health clients 3. Have a willingness to interact with mental health clients 4. Understand the person as a mental health client

3

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

3

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

3

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? 1. Phase I: The tension-building phase 2. Phase II: The acute battering incident phase 3. Phase III: The honeymoon phase 4. Phase IV: The resolution and reorganization phase

3

Which action would the nurse take to provide trauma-informed care to a homeless client who is combative? 1. Place the client in seclusion 2. Apply soft wrist restraints 3. Allow the client some control 4. Encourage dependent behavior

3

Which client data indicates that a suicidal client is participating in a plan for safety? 1. Compliance with antidepressant therapy 2. A mood rating of 9/10 3. Disclosing a plan for suicide to staff 4. Expressing feelings of hopelessness to nurse

3

Which information would a nurse include in client teaching about social anxiety disorder? 1. Obsessions are the underlying reason for clients to avoid social situations. 2. These people avoid social interactions because of a perceived physical flaw. 3. Individuals with social anxiety disorder avoid performing in front of others. 4. People with this disorder avoid social gatherings because of fear of separation.

3

Which information would the nurse include in a staff teaching session about the differences between mild neurocognitive disorder (NCD) and major NCD? 1. Major NCD involves disorientation that develops suddenly, whereas mild NCD develops more slowly. 2. Major NCD involves impairment of abstract thinking and judgment, whereas mild NCD does not. 3. Major NCD criteria requires substantial cognitive decline from a previous level of performance, and mild NCD requires modest decline. 4. Major NCD criteria requires decline from a previous level of performance in three of the listed domains, and mild NCD requires only one.

3

Which is an example of offering a "general lead" when interviewing a newly admitted psychiatric client? 1. "Do you know why you are here?" 2. "Are you feeling depressed or anxious?" 3. "Yes, I see. Go on." 4. "Can you order the specific events that led to your admission?"

3

Which medication treatment should the nurse administer to clients diagnosed with generalized anxiety disorder (GAD)? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with propranolol (Inderal) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

3

Which medication would the nurse most likely administer to treat the extrapyramidal side effects of antipsychotic medications? 1. Diazepam (Valium) 2. Amitriptyline (Elavil) 3. Benztropine (Cogentin) 4. Methylphenidate (Ritalin)

3

Which physically healthy adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? 1. Meets social needs by contact with 15 cats 2. Has a history of depending on intense relationships to meet basic needs 3. Lives with parents and relies totally on public transportation 4. Is serious, inflexible, and lacks spontaneity

3

Which situation reflects a violation of the ethical principle of veracity? 1. A nurse discusses with a client another client's impending discharge. 2. A nurse refuses to give information to a physician who is not responsible for the client's care. 3. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. 4. A nurse does not treat all of the clients equally, regardless of illness severity.

3

1. A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse would note that this type of crisis is precipitated by 1. Unexpected external stressors. 2. Preexisting psychopathology. 3. An acute response to an external situational stressor. 4. Normal life-cycle transitions that overwhelm the client.

4

10. Which describes the rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place in an inpatient unit? 1. Reinforce unit rules with the client population. 2. Create protocols for the future release of tensions associated with anger. 3. Process client feelings and alleviate fears of undeserved seclusion and restraint. 4. Discuss the situation that led to inappropriate expressions of anger.

4

10. Which group leader activity would a nurse identify as being most effective in the final, or termination, phase of group development? 1. The group leader establishes the rules that will govern the group after discharge. 2. The group leader encourages members to rely on each other for problem solving. 3. The group leader presents and discusses the concept of group termination. 4. The group leader helps the members to process feelings of loss.

4

11. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? 1. "There is little research to support AA's effectiveness." 2. "Self-help groups used to be the treatment of choice, but their popularity is waning." 3. "These groups have no external regulation, so clients need to be cautious." 4. "Members themselves run the group, with leadership usually rotating among the members."

4

13. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, which is the role of the group leader? 1. The leader would referee the debate. 2. The leader would adamantly oppose physical disciplining measures. 3. The leader would redirect the group to a less controversial topic. 4. The leader would positively reinforce the behavior of collective problem solving.

4

2. A client on an inpatient unit angrily says to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? 1. "I'll talk to Peter and present your concerns." 2. "Why are you overreacting to this issue?" 3. "You should bring this to the attention of your treatment team." 4. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

4

2. Which situation exemplifies the basic concept of a recovery model? 1. The client's family is encouraged to make decisions in order to facilitate discharge. 2. A social worker, discovering the client's income, changes the client's discharge placement. 3. A psychiatrist prescribes an antipsychotic drug based on observed symptoms. 4. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.

4

3. A client comes to a psychiatric clinic experiencing sudden extreme fatigue, decreased sleep, and decreased appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. Which long-term outcome is realistic in addressing this client's crisis? 1. The client will change his type-A personality traits to more adaptive ones within one week. 2. The client will list five positive self-attributes. 3. The client will examine how childhood events led to his overachieving orientation. 4. The client will return to previous adaptive levels of functioning by week six.

4

4. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's therapeutic factors does this illustrate? 1. Imparting of information 2. Instillation of hope 3. Altruism 4. Universality

4

6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. Which would the nurse identify as an appropriate group topic? 1. Dream analysis 2. Creative cooking 3. Paint by number 4. Stress management

4

6. An involuntarily committed client purposely pushes a dinner tray off the bedside table onto the floor. Which nursing intervention would a nurse implement to address this behavior? 1. Initiate forced medication protocol. 2. Help the client to explore the source of anger. 3. Ignore the act to avoid reinforcing the behavior. 4.With staff support, set firm limits on the behavior.

4

7. A college student, who was nearly raped while out jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? 1. "You've really been helpful. Can I count on you for continued support?" 2. "I work out in the college gym rather than jogging outdoors." 3. "I'm really glad I didn't go home. It would have been hard to come back." 4. "I carry mace when I jog. It makes me feel safe and secure."

4

9. A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model would be employed, and which action reflects this step? 1. Step 3: Triggers that cause distress or discomfort are listed. 2. Step 4: Signs indicating relapse are identified and plans for responding are developed. 3. Step 5: A specific plan to help with symptoms is formulated. 4. Step 6: Following client-designed plan, caregivers now become decision-makers.

4

A 22-year-old client and a 62-year-old client were involved in motor vehicle accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which client would be predisposed to the diagnosis of adjustment disorder? 1. The 62-year-old, because of memory deficits 2. The 62-year-old, because of uncomplicated bereavement 3. The 22-year-old, because of decreased cognitive processing 4. The 22-year-old, because of lack of developmental maturity

4

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an emergency department reveals no pathology. Which nursing diagnosis should be the nurse's first priority? 1. Fear 2. Powerlessness 3. Altered role performance 4. Anxiety

4

A client diagnosed with Alzheimer's disease (AD) can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent moaning. The nurse recognizes these symptoms as indicative of which stage of the illness? 1. Stage 4: Moderate Cognitive Decline 2. Stage 5: Moderately Severe Cognitive Decline 3. Stage 6: Severe Cognitive Decline 4. Stage 7: Very Severe Cognitive Decline

4

A client diagnosed with Alzheimer's disease (AD) has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority? 1. Present evidence of objective reality to improve cognition. 2. Design a bulletin board to represent the current season. 3. Label the client's room with name and number. 4. Assist with bathing and toileting.

4

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? 1. "The occipital lobe governs perceptions, judging them as positive or negative." 2. "The parietal lobe has been linked to depression." 3. "The medulla regulates key biological and psychological activities." 4. "The limbic system is largely responsible for one's emotional state."

4

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

4

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist recognizes the role of circadian rhythms in the client's condition. 2. The client has an alteration in neurotransmitters. 3. The therapist is attempting to increase the client's acetylcholine levels. 4. The client is susceptible to illness because of effects of stress on the immune system.

4

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

4

A female client takes a maintenance dosage of lithium carbonate for bipolar disorder. She has come to the community health clinic, stating that she "has had the flu for several days." She describes her symptoms as muscle weakness, coughing, headache, fever, and gastrointestinal upset. Her temperature is 100.9°F (38.3°C). Which situation does the nurse anticipate? 1. She has consumed some foods high in tyramine while taking lithium carbonate. 2. She has stopped taking her lithium carbonate. 3. She has probably developed a tolerance to the lithium carbonate. 4. She has signs and symptoms of toxicity from the lithium carbonate.

4

A geriatric client is confused and wandering in and out of every door of a care facility. Which scenario reflects the least restrictive alternative for this client? 1. The client is placed in seclusion. 2. The client is placed in a geriatric chair with tray. 3. The client is placed in soft Posey restraints. 4. The client is monitored by an ankle bracelet.

4

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which chart entry would the nurse document for this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood irritability. Exhibiting magical thinking. Nervousness." 3. "Blunted affect. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

4

A male client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client's safety? 1. His wife works from home in telecommunication. 2. The client has worked the nightshift his entire career. 3. His wife has minimal family support. 4. The client smokes one pack of cigarettes per day.

4

A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? 1. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." 2. "It is important for you to discontinue these ritualistic behaviors." 3. "Why are you asking for help if you won't participate in unit therapy?" 4. "Let's figure out a way for you to attend unit activities and still wash your hands."

4

A nurse is assessing a client who experiences occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How would the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are inappropriate, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

4

A nurse says to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? 1. The therapeutic technique of giving advice 2. The therapeutic technique of defending 3. The nontherapeutic technique of presenting reality 4. The nontherapeutic technique of giving reassurance

4

A suicidal client says to the nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? 1. "Why don't you consider doing volunteer work in a homeless shelter?" 2. "Let's discuss the negative aspects of your life." 3. "Things will look better in the morning." 4. "It sounds like you are feeling pretty hopeless."

4

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

4

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

4

After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize? 1. Arguing and annoying older sibling over the past year 2. Angry and resentful behavior over a 3-month period 3. Initiating physical fights for more than 18 months 4. Arguing with authority figures for more than 6 months

4

An adolescent is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. Which body mass index (BMI) measurement would the nurse observe upon assessment of this client? 1. 30 2. 24 3. 20 4. 16

4

An elderly client has been diagnosed with major depression and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which side effect would the nurse monitor for in this client? 1. Diarrhea 2. Pseudoparkinsonism 3. Hypertensive crisis 4. Hyponatremia

4

An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which ethical principle would a nurse determine has been violated based on these actions? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

4

During an interview, which client statement should alert the nurse to a potential diagnosis of schizotypal personality disorder? 1. "I don't have a problem. My family is inflexible, and my relatives are out to get me." 2. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" 3. "I spend all my time tending my bees. I know a whole lot of information about bees." 4. "I am getting a message from the beyond that we have been involved with each other in a previous life."

4

During the planning of care for a suicidal client, which correctly written outcome would be a nurse's first priority? 1. The client will not physically harm self. 2. The client will express hope for the future by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during the hospital stay.

4

In which way does partial hospitalization differ from traditional inpatient hospitalization? 1. Partial hospitalization does not provide medication administration and monitoring. 2. Partial hospitalization does not use an interdisciplinary team. 3. Partial hospitalization does not offer a comprehensive treatment plan. 4. Partial hospitalization does not provide supervision 24 hours a day.

4

Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "When I can't control my cravings, I will faithfully attend Narcotic Anonymous." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

4

On which task would a nurse place highest priority during the working phase of relationship development? 1. Establishing a contract for intervention 2. Examining feelings about working with a particular client 3. Establishing a plan for continuing aftercare 4. Promoting the client's insight and perception of reality

4

The adolescent diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "Since going back to school, I am nervous, get apprehensive, and have a hard time eating food." Which nursing diagnosis would take priority at this time? 1. Imbalanced nutrition: less than body requirements 2. Disturbed body image/Low self-esteem 3. Impaired verbal communication 4. Anxiety

4

The client is newly diagnosed with obsessive-compulsive disorder and spends 50 minutes folding clothes and rearranging them in drawers. Which nursing action would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

4

The client is receiving eye movement desensitization and reprocessing (EMDR) treatments. The nurse is most likely caring for which client? 1. One with schizophrenia 2. One with borderline personality disorder 3. One with manic episodes 4. One with posttraumatic stress disorder

4

The client is taking selective serotonin reuptake inhibitor (SSRI). Which finding indicates the client is having a therapeutic effect from the SSRI? 1. Psychosis is reduced. 2. Neuropathy pain is relieved. 3. Panic attacks are prevented. 4. Obsessions are controlled.

4

The client taking lithium carbonate (Lithobid) presents to an emergency department with a temperature of 101°F (38°C), severe diarrhea, blurred vision, and tinnitus. Which interpretation should the nurse make regarding these symptoms? 1. Symptoms indicate spending too much time outdoors without sunblock. 2. Symptoms indicate antipsychotic withdrawal syndrome. 3. Symptoms indicate the development of neutropenia. 4. Symptoms indicate lithium carbonate toxicity.

4

The client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which laboratory result would reveal a potentially fatal side effect of this medication? 1. Elevated white blood cell count 2. Elevated bleeding times 3. Low platelet count 4. Low absolute neutrophil count

4

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information would the nurse provide? 1. Address only serious suicide threats to avoid the possibility of secondary gain. 2. Promote trust by verbalizing a promise to keep suicide attempt information within the family. 3. Offer a private environment to provide needed time alone at least once a day. 4. Be available to actively listen, support, and accept feelings.

4

The health-care provider prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa) for a client with severe manic episodes. The client's spouse asks the nurse how Zyprexa works. Which response would the nurse make? 1. "Zyprexa in combination with Eskalith cures bipolar disorder symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms the agitation associated with mania."

4

The male client is experiencing a psychotic episode. He is in good physical health but has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Which antipsychotic medication would be contraindicated for the client? 1. Haloperidol, because it is used only in elderly clients 2. Clozapine, because it is a typical, first generation antipsychotic 3. Risperidone, because it exacerbates symptoms of depression 4. Thioridazine, because of cross sensitivity among phenothiazines

4

The nurse determines that a depressed client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits, because she thinks I don't care." 4. "Growing plants is so easy. Any old fool can grow a rose."

4

The nurse holds the hand of a client who is experiencing alcohol withdrawal. The nurse is assessing for which condition? 1. Emotional strength 2. Wernicke-Korsakoff syndrome 3. Tachycardia 4. Coarse tremors

4

The nurse in the emergency department (ED) is assessing a client who with a long history of depression. The nurse finds that the client has gained weight, has dry skin, and has cold sensitivity. The nurse determines the client's depression is exacerbating, further examination and testing reveal the client has hypothyroidism. Which phenomenon occurred? 1. Depression screening 2. Social distancing 3. Trauma-informed caring 4. Diagnostic overshadowing

4

The nurse is asked why there seems to be more people diagnosed with neurocognitive disorders (NCD). Which rationale would the nurse offer? 1. Increased numbers of neurotransmitters have been implicated in the proliferation of NCD. 2. Similar symptoms of NCD and depression lead to misdiagnoses, increasing numbers of NCD. 3. Societal stress contributes to the increase in this diagnosis. 4. More people now survive into the high-risk period for neurocognitive disorders.

4

The nurse is caring for a client diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client? 1. To recover memories while improving thinking patterns 2. To prevent social isolation 3. To decrease anxiety and need for secondary gain 4. To collaborate among subpersonalities to improve functioning

4

The nurse is caring for a client who lost a child in a car accident. The client states she does not want to go on living. Which nursing statement conveys empathy for the client? 1. "This situation is very sad, but time is a great healer." 2. "You are sad, but you must be strong for your other children." 3. "Once you cry it all out, things will seem so much better." 4. "It must be horrible to lose a child, and I'll stay with you until your husband arrives."

4

The nurse is caring for a client with a diagnosis of adjustment disorder unspecified from a divorce after over 30 years of marriage. Which signs and symptoms would the nurse observe? 1. Re-experiences spouse asking for a divorce, is hyperalert, and has nightmares 2. Has anxiety, begins to shoplift, and exhibits reckless driving 3. Is belligerent, violates others' rights, and defaults on legal responsibilities 4. Reports many physical ailments, refuses to socialize, and has unproductive work performance

4

The nurse is caring for an older male client who states, "You remind me so much of my late wife." During subsequent encounters with the client, he expresses overwhelming feelings of affection toward the nurse and states "I don't know what I would do if you weren't my nurse. No one cares for me like you do." How should the nurse respond? 1. Promote safety and immediately terminate the relationship with the client. 2. Encourage the client to ignore these thoughts and feelings. 3. Immediately reassign the client to another staff member. 4. Help the client to clarify the meaning of the relationship.

4

The nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. What is the priority rationale for this treatment? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's psychotic behaviors. 4. It allows clients to maintain control.

4

The nurse is teaching about the etiology of illness anxiety disorder (IAD) from a psychodynamic perspective. Which statement by a staff member about clients diagnosed with this disorder indicates that learning has occurred? 1. "When there is a familial predisposition to this disorder, they may develop this disorder." 2. "When the sick role relieves them from stressful situations, their physical symptoms are reinforced." 3. "They misinterpret and cognitively distort their physical symptoms." 4. "They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems."

4

The nurse is teaching about trauma- and stressor-related disorders. Which statement by one of the staff members indicates that follow-up instruction is needed? 1. "The trauma that women experience is more likely to be sexual assault and child sexual abuse." 2. "The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury." 3. "After exposure to a traumatic event, less than 10 percent of victims develop posttraumatic stress disorder (PTSD)." 4. "Research shows that PTSD is more common in men than in women."

4

The nurse presents a staff development session about the various challenges in the treatment of clients diagnosed with bipolar disorder. Which factor should the nurse include that is an essential component of relapse prevention? 1. Methods to treat insomnia 2. Inability to control irritability 3. Lack of insight 4. Medication adherence

4

The nurse tells a client diagnosed with obsessive-compulsive personality disorder that the nursing staff will start alternating weekend shifts. Which response should the nurse expect from this client? 1. "You really don't have to go by that schedule. I'd just stay home sick." 2. "There has got to be a hidden agenda behind this schedule change." 3. "Who do you think you are? I expect to interact with the same nurse every Saturday." 4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

4

The nurse would associate the fight-or-flight response with which neurotransmitter? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine

4

The nursing instructor is teaching about the DSM-5 diagnostic criteria for depersonalization-derealization disorder. Which student statement indicates a need for follow-up instruction? 1. "Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time." 2. "Clients with this disorder can experience unreality or detachment with respect to their surroundings." 3. "During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted." 4. "During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning."

4

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

4

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

4

When under stress, a client routinely uses alcohol to excess. When the client's husband finds her drunk, the husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!"

4

Which are examples of primary and secondary gains that a client diagnosed with SSD: predominately pain, may experience? 1. Primary: chooses to seek a new health-care provider; Secondary: euphoric feeling from new medications 2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new health-care provider 3. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion 4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

4

Which client response would reflect the impulsive self-destructive behavior that is commonly associated with borderline personality disorder when the day-shift nurse leaves the unit? 1. The client suddenly leans on the nurse's arm and whispers, "The night nurse is evil. You have to stay." 2. The client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." 3. The client suddenly grabs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." 4. The client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

4

Which client statement indicates a knowledge deficit related to a substance use disorder? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously." 4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

4

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1. Anxiety, feelings of hopelessness, and worry 2. Truancy, vandalism, and fighting 3. Nervousness, worry, and jitteriness 4. Depressed mood, tearfulness, and hopelessness

4

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

4

Which documented intervention would the nurse implement first when caring for a severely depressed client? 1. Communicate therapeutically. 2. Observe the client. 3. Provide a hazard-free environment. 4. Assess suicide risk.

4

Which guideline should the nurse use to help differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Depression is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is absent in GAD but is commonly seen in panic disorder.

4

Which highest priority outcome would the nurse add to the plan of care for a depressed client? 1. The client will promise to remain safe. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will not harm self during hospital stay.

4

Which medications would the nurse most likely administer to a client who has a history of opiate withdrawal? 1. Haloperidol (Haldol) and acamprosate (Campral) 2. Naloxone (Narcan) and naltrexone (ReVia) 3. Disulfiram (Antabuse) and lorazepam (Ativan) 4. Methadone (Dolophine) and clonidine (Catapres)

4

Which nursing diagnosis is priority when providing nursing care to a client diagnosed with avoidant personality disorder? 1. Risk for violence: directed toward others R/T suspicious thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T fear of rejection

4

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

4

Which nursing intervention would be most appropriate when caring for an agitated, suspicious client diagnosed with schizophrenia spectrum disorder? 1. Supply neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

4

Which statement made by a nursing student indicates that learning regarding suicide has been successful? 1. "Suicidal threats and gestures would be considered manipulative and/or attention-seeking." 2. "Suicide is the act of a psychotic person." 3. "All suicidal individuals are mentally ill." 4. "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

4

Which statement would a nurse identify as correct regarding a client's right to refuse treatment? 1. Clients can refuse pharmacological but not psychological treatment. 2. Clients can refuse any treatment at any time. 3. Clients can refuse only electroconvulsive therapy (ECT). 4. Professionals can override treatment refusal by an actively suicidal or homicidal client.

4

Which student statement indicates that further instruction is needed regarding developmental characteristics of individuals with moderate IDD? 1. "These clients can work in a sheltered workshop setting." 2. "These clients can perform some personal care activities." 3. "These clients may have difficulties relating to peers." 4. "These clients can successfully complete elementary school."

4

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant to a client with alcohol withdrawal? 1. Antagonist treatment 2. Deterrent therapy 3. Codependency therapy 4. Medication-assisted treatment

4

Which would the nurse identify as risk factors related to family dynamics for predisposition to a conduct disorder? 1. Stable residence 2. Consistency in discipline 3. Excessive supervision 4. Economic stressors

4

Order the stages of normal grief, according to J. William Worden. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Finding an enduring connection with the lost entity in the midst of embarking on a new life 2. Accepting the reality of the loss 3. Adjusting to a world without the lost entity 4. Processing the pain of grief

4, 1, 3, 2

Prioritize the depressive disorders and their predominant affective symptoms from least to most severe (1-4). (Enter the number of each disorder in the proper sequence, using comma and space format, such as 1, 2, 3, 4.) 1. Dysthymic disorder (helplessness, powerlessness, pessimistic outlook, low self-esteem) 2. Uncomplicated grieving (feelings of anger, anxiety, guilt, helplessness) 3. Major depressive episode (total despair, worthlessness, flat affect, apathy) 4. Transient depression (sadness, dejection, feeling downhearted, having "the blues")

4, 2, 1, 3

Order the stages of normal grief, according to John Bowlby. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Reorganization 2. Disequilibrium 3. Disorganization and despair 4. Numbness/protest

4, 2, 3, 1

The nurse is assessing a teenaged client diagnosed with cyclothymic disorder. Which DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

4, 5

15. Order the stages of Roberts' Seven-stage Crisis Intervention Model. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Deal with feelings and emotions. 2. Generate and explore alternatives. 3. Rapidly establish rapport. 4. Psychosocial and lethality assessment. 5. Identify the major problems or crisis precipitants. 6. Follow up. 7. Implement an action plan.

4, 5, 2, 1, 3, 7, 6

17. ______ from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Recovery

16. A ______ provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.

nursing diagnosis