NUR 316: Nursing Concepts for Psychiatric/Mental Health Exam 3

What is the most important question to ask parents about a child who is suspected to be suffering from conduct disorder?

"Has your son been exhibiting signs of cruelty towards animals?"

Which statement made by an older adult best reflects the wear-and-tear theory of biological aging? A. "Everything about me is tired and showing its old age." B. "The stress I've experienced during my life has aged me." C. "No one on my father's side of the family was healthy in old age." D. "My immune system doesn't work very well now that I'm aging."

A. "Everything about me is tired and showing its old age."

Which extrapyramidal symptom manifests as extreme restlessness? A. Akathisia B. Acute dystonia C. Pseudoparkinsonism D. Tardive dyskinesia

A. Akathisia

John frequently manipulates others, displays total disregard for others, is extremely deceitful and impulsive, and acts aggressively in most situations. He seeks immediate gratification and acts recklessly. John would likely be diagnosed with: A. Antisocial personality disorder B. Borderline personality disorder C. Obsessive-compulsive personality disorder D. Narcissistic personality disorder

A. Antisocial personality disorder

Sue often engages in self-mutiliation by burning her arms with cigarettes. She frequently seeks out sexual encounters with strangers and avoids responsibility for her actions. She has been arrested on three separate occasions for shoplifting various items. Sue would likely be diagnosed with: A. Borderline personality disorder B. Conduct disorder C. Dependent personality disorder D. Antisocial personality disorder

A. Borderline personality disorder

Extrapyramidal symptoms (EPS) and neuroleptic malignant syndrome (NMS) result from a deficiency of which neurotransmitter in the brain? A. Dopamine B. GABA C. Norepinephrine D. Serotonin

A. Dopamine

Positive symptoms of schizophrenia include which of the following? A. Hallucinations, delusions, and disorganized thinking B. Somatic delusions, echolalia, and a flat affect C. Waxy flexibility, alogia, and apathy D. Flat affect, avolition, and anhedonia

A. Hallucinations, delusions, and disorganized thinking

Janis dresses in provocative clothing and expresses desire to always be the center of attention. She presents with irrational emotional outbursts when she does not get her way and often behaves in a bizarre manner, resulting in dysfunctional interpersonal relationships. Janis would likely be diagnosed with: A. Histrionic personality disorder B. Borderline personality disorder C. Conduct disorder D. Narcissistic personality disorder

A. Histrionic personality disorder

Raymond is 42, and is an architect in a large firm. He is known for his attention to details. It is hard for him to complete an entire project because of his attention to detail. Others refuse to work with him because he insists they follow his directions exactly. The firm values Raymond, and puts up with his quirks like his extensive collection of broken pencils, eraser stubs, and used envelopes. However, his rigidity has limited his advancement in the firm. Raymond would likely be diagnosed with: A. Obsessive-compulsive personality disorder B. Antisocial personality disorder C. Paranoid personality disorder D. Dependent personality disorder

A. Obsessive-compulsive personality disorder

The initial intervention when beginning the management of care for an individual diagnosed with a maladaptive eating disorder is for the nurse to: A. Personally reflect on weight-related biases. B. Establish a therapeutic client-focused relationship. C. Evaluate the individual's current state of physical and emotional health. D. Assure the individual that the treatment plan will be mutually agreed upon.

A. Personally reflect on weight-related biases.

The defense mechanism that involves offering a socially acceptable or apparently logical explanation to justify or make acceptable otherwise unacceptable impulses, feelings, behaviors, or motives is defined as ___. A. Rationalization B. Sublimation C. Splitting D. Reaction formation

A. Rationalization

The defense mechanism that involves viewing people and situations as either all good or all bad and the failure to integrate the positive and negative qualities of oneself is defined as ___. A. Splitting B. Displacement C. Identification D. Rationalization

A. Splitting

The nurse is interviewing a client diagnosed with obesity. In order to identify possible emotional causes for the weight problem the nurse asks: A. "Do you eat when you are depressed?" B. "Do you ever get up at night just to eat?" C. "Is eating a form of personal reward for you?" D. "Have you ever been diagnosed with bulimia?"

B. "Do you ever get up at night just to eat?"

When a 13-year-old begins to engage in self-mutilation, the nurse appropriately attempts to identify the root of the behavior by asking: A. "Do you hear voices telling you to hurt yourself?" B. "Have you ever been physically or sexually abused?" C. "How does hurting yourself make you feel better?" D. "Would you describe yourself as being depressed?"

B. "Have you ever been physically or sexually abused?"

The nurse is performing a physical assessment of an adolescent. Which question will assess for appropriate biological development? A. "Are your menstrual periods regular?" B. "How much taller are you now than two years ago?" C. "Would you say that you are comfortable with your weight?" D. "Did you start noticing facial hair by your fourteenth birthday?"

B. "How much taller are you now than two years ago?"

Which statement made by an 11-year-old who recently experienced the loss of his father best demonstrates the characteristic of resilience? A. "Mommy and I will see daddy every night in our dreams." B. "I'll really miss my daddy but I know mom and I will be okay." C. "Now that daddy is gone, I'll take care of mommy like he did." D. "Daddy wouldn't want me to cry so I'll be a big boy for him."

B. "I'll really miss my daddy but I know mom and I will be okay."

The nurse is discussing the needs of a newborn with her parents. The child's future self-worth will be best directed by the statement: A. "Love yourself and your child and she will grow to love both you and herself." B. "Your infant's needs should be met quickly, effectively, and in a caring manner." C. "The period between 3 and 18 months is critical to the formation of good self-worth." D. "Self-worth is a factor that will affect much of your child's ability to lead a happy, productive life."

B. "Your infant's needs should be met quickly, effectively, and in a caring manner."

The nurse is interviewing a female teenager who is being treated for hypotension as a result of an eating disorder. Which assessment data would support the possible manifestation of bulimia nervosa? A. Amenorrhea for the last 6 months B. A potassium level of 3 mEq/L C. Chronic constipation D. Cold intolerance

B. A potassium level of 3 mEq/L

Which extrapyramidal symptom manifests as acute contraction of the tongue, face, neck, back, or oculogyric crisis? A. Akathisia B. Acute dystonia C. Pseudoparkinsonism D. Tardive dyskinesia

B. Acute dystonia

Dennis is 37, single, and works as a clerk in the accounting department of a bank. He is shy, dependable, and goes about his job quietly, trying to please his superiors. He has worked at the bank for 5 years, but has made few friends and has little social contact outside of work. He is reluctant to go to parties, fearing he will do something embarrassing. He recently turned down a promotion that would have required more responsibility and involvement with bank customers. Dennis would likely be diagnosed with: A. Antisocial personality disorder B. Avoidant personality disorder C. Narcissistic personality disorder D. Obsessive-compulsive personality disorder

B. Avoidant personality disorder

Eli often goes into fits of intense anger and rage. He describes feeling "constantly alone and empty" and self-mutilates by cutting. He is worried that his wife will soon leave him, so he often resorts to manipulation. Eli would likely be diagnosed with: A. Antisocial personality disorder B. Borderline personality disorder C. Bipolar disorder D. Dependent personality disorder

B. Borderline personality disorder

Emily is 24. She recently arrived in a new city to begin graduate school. She moved into an apartment with 3 other women. It went well at first, then she became very attached to one of the women and started to dress like her. She seemed to need constant attention, complained of feeling bored and empty. She had intense mood swings. One night, after she broke up with her boyfriend, her roommate walked into the bathroom and found Emily cutting on her thigh with a razor blade. Emily's thigh was scarred from multiple cuts in the past. Emily would likely be diagnosed with: A. Antisocial personality disorder B. Borderline personality disorder C. Schizoid personality disorder D. Dependent personality disorder

B. Borderline personality disorder

Carla is 35, divorced, and is a part of the local art scene. She often meets others in a coffee house where she is known for her dramatic entrances. She has opinions about everything and delivers them with exaggerated phrases and dramatic gestures. She is sexually provocative with young men, but distances herself if someone responds to her overtures. Carla would likely be diagnosed with: A. Antisocial personality disorder B. Histrionic personality disorder C. Borderline personality disorder D. Narcissistic personality disorder

B. Histrionic personality disorder

When managing the care of a young adult diagnosed with anorexia, the nurse adds which intervention to the client's care plan to assist in identifying a likely co-morbid psychiatric condition? A. Teach stress reduction techniques. B. Monitor bathroom use after meals. C. Assess for suicidal ideation twice daily. D. Set limits to minimize manipulative behaviors.

B. Monitor bathroom use after meals.

Roger is admitted to an alcohol treatment program. He says he is not like all those "skid row bums," he can stop drinking anytime, but the "vacation" from his "high-powered job" where he is an "important executive" will do him good. He says he will need access to a computer and to a private phone while in treatment. He doesn't want a roommate, and doesn't want "just anyone" for a counselor. He has asked to work directly with the "man who runs this place" because "maybe I can give him some advice about how to run it better." Roger would likely be diagnosed with: A. Antisocial personality disorder B. Narcissistic personality disorder C. Borderline personality disorder D. Histrionic personality disorder

B. Narcissistic personality disorder

Adolescence can be a confusing, unsettling time for families with developing children. The nurse suggests that the quest to balance the struggle between peer pressure and a need to separate from parents can be facilitated by the: A. Adolescent being held responsible for assuming responsibility for setting and achieving personal goals. B. Parents recognizing that healthy emotional development of the adolescent is based on peer acceptance. C. Parents establishing fair, consistent limits and expectations that are communicated clearly. D. Adolescent being given responsibilities and privileges more reflective of becoming mature.

B. Parents recognizing that healthy emotional development of the adolescent is based on peer acceptance.

Which recently engaged-in behavior demonstrates that the adolescent is addressing an appropriate task for the adolescent stage of development? A. Saving money to pay for cosmetic nose surgery B. Preparing to take college entrance examinations C. Spending afterschool time with only his best "guy" friends D. Looking to her parents for advice whenever a decision is to be made

B. Preparing to take college entrance examinations

The defense mechanism often used by patients diagnosed with personality disorders that involves patients projecting parts of themselves onto others, who are often not aware or this and may begin to behave like the projected parts, is defined as ___. A. Splitting B. Projective identification C. Displacement D. Projection

B. Projective identification

What is the most effective way to increase the dietary intake of an anorexic patient? A. Monitor the patient every time she eats B. Provide small meals several times each day C. Provide large meals that are calorie- and nutrient-dense to promote weight gain D. Reward the patient for every pound of weight she gains

B. Provide small meals several times each day

A large percentage of elderly adults are cared for by their adult children. The greatest positive impact on their care comes from: A. Effectively utilizing the available community resources and services. B. Providing effective education and support for the adult child acting as caregiver. C. Encouraging the elderly individual to participate in the planning of his or her own health care. D. Having health care providers who are trained to deal with the issues of the aging population.

B. Providing effective education and support for the adult child acting as caregiver.

A married woman who feels attracted to one of her husband's friends treats him rudely. This is an example of the defense mechanism ___. A. Splitting B. Reaction formation C. Sublimation D. Rationalization

B. Reaction formation

The defense mechanism that involves development of conscious attitudes and behavior patterns that are opposite to what one really feels or would like to do is defined as ___. A. Splitting B. Reaction formation C. Sublimation D. Rationalization

B. Reaction formation

Which child has the highest risk for developing a psychiatric problem as an adult? A. The 10-year-old whose leg is amputated as a result of bone cancer B. The 5-year-old who anxiously calls for his mother who died in a car accident C. The 3-year-old whose father has been diagnosed with obsessive-compulsive disorder (OCD) D. The 8-year-old whose foster grandfather was diagnosed with paranoid schizophrenia at age 15

B. The 5-year-old who anxiously calls for his mother who died in a car accident

When working with older adults newly diagnosed with depression, the nurse must recognize the unique need to consider: A. The role of the family in an individual's ability to manage a mental illness. B. The effects of normal aging on an individual's ability to learn about his condition. C. How to incorporate community resources in the care plan to support autonomy. D. How a diagnosis of mental illness is likely to affect the individual's perception of self.

B. The effects of normal aging on an individual's ability to learn about his condition.

A mother is engaging in the psychological abuse of her children when she regularly: A. Keeps them home from school as a punishment. B. Threatens to leave if the children misbehave. C. Punishes them by not feeding them dinner. D. Describes them as lazy and stupid.

B. Threatens to leave if the children misbehave.

What medication is given for patients exhibiting the extrapyramidal side effects pseudoparkinsonism, akathisia, or acute dystonia due to antipsychotic pharmacotherapy?

Benzatropine (Cogentin)

Which interview question demonstrates that the nurse has an understanding of the factors that have a negative effect on the long-term prognosis of anorexia nervosa? A. "Has anyone else in your immediate family been diagnosed with anorexia nervosa?" B. "When did your problem with body image and eating first begin?" C. "Have you ever been told you drink too much alcohol?" D. "Do you ever experience dizziness and fainting?"

C. "Have you ever been told you drink too much alcohol?"

The diagnosis that a client has a problem with forming interdependent relations is reinforced when he states: A. "My teenage children seem to think that they should make all their own decisions." B. "If my wife wants a new refrigerator, she will have to cut back on some household expenses." C. "I believe that it is my responsibility to make the decisions since my wife never had to as a child." D. "Families cannot be ruled like a democracy; if everyone had a vote nothing would ever get decided."

C. "I believe that it is my responsibility to make the decisions since my wife never had to as a child."

A 10-year-old child has been diagnosed with acute depression after the death of a beloved grandparent. His parents ask how it is that someone so young can become depressed. The nurse responds: A. "He was obviously very attached to his grandfather; his grief will pass as will the depression." B. "Depression is triggered by many different events; the loss of a loved one is a primary one for your son." C. "We can have a predisposition to being depressed; when the right trigger happens the depression occurs." D. "Everyone gets depressed; age and gender really have little importance on whether we experience depression or not."

C. "We can have a predisposition to being depressed; when the right trigger happens the depression occurs."

The nurse is preparing to manage the care of a client diagnosed with a borderline personality disorder. The nurse demonstrates an understanding of therapeutic interventions that focus on the characteristics of such disorders when making which statement to the client? A. "You must feel threatened when staff is involved with the problems of the other clients." B. "When you feel the triggers of your agitation starting, come to me so I can help you de-escalate." C. "When you want my attention, please explain that to me rather than resorting to manipulative behavior." D. "We are here to keep you safe, so I will ask you several times a day whether you feel the need to harm yourself."

C. "When you want my attention, please explain that to me rather than resorting to manipulative behavior."

Fred frequently engages in pitting individuals against each other for his own enjoyment. He describes having seven relationships in the past year that all ended in explosive separations. Fred would likely be diagnosed with: A. Histrionic personality disorder B. Bipolar disorder C. Borderline personality disorder D. Antisocial personality disorder

C. Borderline personality disorder

What is the best plan of treatment for a client with anxiety? A. Psychotherapy B. SSRIs and benzodiazepines C. Combination of SSRIs and therapy D. Lithium

C. Combination of SSRIs and therapy

Which of the following actions demonstrates a potential problem with an adolescent's establishment of ego competency skills? A. Saving all his birthday money and most of his allowance so he can go to camp next summer B. Spending the weekend with grandparents working on a school science project C. Deciding to quit music lessons after a few weeks so he can join the track team D. Writing each night in a personal diary

C. Deciding to quit music lessons after a few weeks so he can join the track team

Florence is 33, married for 10 years. She and her husband met in college while Florence lived at home and married right after graduation. She defers to her husband, no matter what he says. She is afraid if she doesn't, he will get mad and leave her. When her husband works late or goes on a business trip, she is afraid that she will be unable to care for herself or that he will find another woman and leave her. Florence would likely be diagnosed with: A. Antisocial personality disorder B. Avoidant personality disorder C. Dependent personality disorder D. Borderline personality disorder

C. Dependent personality disorder

A patient presents with excessive emotionality, temper tantrums, attention seeking, dysphoric moods when needs are not met, exaggerated expression, and a lack of sincerity and emotional commitment. He is likely exhibiting signs of: A. Antisocial personality disorder B. Borderline personality disorder C. Histrionic personality disorder D. Bipolar disorder

C. Histrionic personality disorder

Regarding appropriate care, the primary reason a thorough mental status examination is included in the assessment of a confused older Asian adult is that: A. Dementia is very prevalent among the older adult population. B. Confusion is often misinterpreted in individuals of diverse cultures. C. If the symptoms are related to delirium, treatment must be started. D. The older adult population is seldom open to mental health care.

C. If the symptoms are related to delirium, treatment must be started.

The behavior that poses the greatest immediate risk for injury for a teenager recently prescribed a selective serotonin reuptake inhibitor (SSRI) is: A. Averaging only 3 to 4 hours of sleep a night. B. Increasing a cigarette habit to two packs a day. C. Impulsively shoplifting several candy bars. D. Refusing to eat anything but chicken and fries.

C. Impulsively shoplifting several candy bars.

A patient arrives at the clinic complaining of muscle rigidity and "feeling really warm." Upon further inspection, the nurse notes that the client is sweating profusely and seems to have an altered mental state. Lab tests indicate elevated CPK and renal failure. What does the nurse suspect this client is suffering from? A. Serotonin syndrome B. Tardive dyskinesia C. Neuroleptic malignant syndrome (NMS) D. Extrapyramidal symptoms (EPS)

C. Neuroleptic malignant syndrome (NMS)

Which extrapyramidal symptom manifests as stiffness or rigidity, tremor, pill rolling, and cogwheeling? A. Akathisia B. Acute dystonia C. Pseudoparkinsonism D. Tardive dyskinesia

C. Pseudoparkinsonism

Mr. R does not recall hitting his wife when she was pregnant. This is an example of the defense mechanism ___. A. Sublimation B. Suppression C. Repression D. Rationalization

C. Repression

The defense mechanism that involves involuntary exclusion of a painful or conflicted thought, impulse, or memory from awareness that is the primary ego defense is defined as ___. Other mechanisms tend to reinforce it. A. Sublimation B. Suppression C. Repression D. Rationalization

C. Repression

Brad is a 33-year-old man who has always liked rats and computers. As a teenager he began breeding rats in his basement. After high school he went to college where he majored in computer science. Rather than get rid of his rates, Brad moved from his dorm room to an apartment. After college Brad worked as a computer programmer. He did well, working on the night shift. He remained detached from others, had few or no friends, and spent little time with his family. Brad would likely be diagnosed with: A. Antisocial personality disorder B. Dependent personality disorder C. Schizoid personality disorder D. Avoidant personality disorder

C. Schizoid personality disorder

Which data obtained during a family assessment could be considered an early indicator of the greatest potential for family-focused abuse? A. The oldest child is legally blind. B. The children often play violent video games. C. The mother's brother is in jail for assault and battery. D. The father travels for his work and is home only on weekends.

C. The mother's brother is in jail for assault and battery.

A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? A. Restlessness, difficulty sitting still, and pacing B. Involuntary rolling of the eyes C. Tremors, shuffling gait, and masklike face D. Extremity and neck spasms, facial grimacing, and jerky movements

C. Tremors, shuffling gait, and masklike face

What medication is most commonly used to treat patients diagnosed with antisocial personality disorder? A. Lithium B. Lamotrigine (Lamictal) C. Carbamazepine (Tegretol) D. Valproic acid (Depakote)

Carbamazepine (Tegretol)

Which anticonvulsant medication is associated with agranulocytosis and can be helpful for patients with a history of rapid cycling (more than four episodes of mania or depression in a year)?

Carbamazepine (Tegretol)

Which atypical antipsychotic medication initially requires a weekly WBC count for 6 months and may cause agranulocytosis, seizures, or myocarditis?

Clozapine (Clozaril)

Which atypical antipsychotic requires weekly blood draws due to its high risk for causing agranulocytosis?

Clozapine (Clozaril)

Which childhood disorder is converted to antisocial personality disorder when the individual reaches 18 years of age?

Conduct disorder

Parents are concerned that their third-grade child has been displaying behaviors similar to those of attention-deficit/hyperactivity disorder (ADHD). Which assessment question demonstrates an understanding of the similarities between behaviors of other likely diagnoses? A. "Were you able to quit smoking during your pregnancy?" B. "Do you think that your child gets enough rest at night?" C. "How much alcohol did you drink during your pregnancy?" D. "Does your child seem particularly irritable?"

D. "Does your child seem particularly irritable?"

Which statement demonstrates the greatest indication that the speaker has a healthy degree of satisfaction from her interpersonal relationships? A. "I couldn't live without my mother's support and approval." B. "Being in a relationship means that you don't have to be alone." C. "My partner has faults but at least I don't worry about being abused." D. "My partner and I talk about what's bothering us regardless of what it is."

D. "My partner and I talk about what's bothering us regardless of what it is."

A 15-year-old male has yet to experience the expected growth spurt of adolescence and is expressing great concern over "being the smallest guy on the soccer team." Which statement by the nurse will likely have the greatest positive impact on helping to minimize the child's anxiety? A. "Please don't worry; you'll get bigger, it will just take a little longer." B. "Being big isn't important when it comes to being a good soccer player." C. "My brother grew 6 inches in one year; I hope that makes you feel better." D. "Teenage growth spurts are an individual thing; they occur when your body is ready."

D. "Teenage growth spurts are an individual thing; they occur when your body is ready."

Your client is taking clozapine (Clozaril) and complains of a sore throat. This symptom may be an indication of which adverse reaction? A. Extrapyramidal reaction B. Tardive dyskinesia C. Reye's syndrome D. Agranulocytosis

D. Agranulocytosis

Alan is a charming, intelligent, and charismatic 28-year-old individual; however, he becomes involved in fights frequently and has a long history of criminal activity. He uses his charm to manipulate others and act irresponsibly. Alan would likely be diagnosed with: A. Borderline personality disorder B. Conduct disorder C. Histrionic personality disorder D. Antisocial personality disorder

D. Antisocial personality disorder

Vince is an unemployed 25-year-old male who has been repeatedly arrested for running illegal card games. His victims are usually tourists. He has a history of rebellious behavior, including lying to his parents, stealing money, and shoplifting. He started using drugs at age 13. He has held several jobs for a few weeks at a time, but was unable to comply with job requirements. Vince would likely be diagnosed with: A. Avoidant personality disorder B. Borderline personality disorder C. Bipolar disorder D. Antisocial personality disorder

D. Antisocial personality disorder

When planning care for a woman who has been in an abusive relationship for 5 years, the nurse facilitates the woman's sense of empowerment when: A. Offering the woman several different suggestions regarding how to stop the abuse. B. Asking the woman to identify behaviors that trigger her partner's violence. C. Suggesting that the woman needs to leave the abuser immediately. D. Assisting the woman in developing a plan to assure her safety.

D. Assisting the woman in developing a plan to assure her safety.

Javier exhibits intense attachment and controlling of everyone he meets. He lacks empathy and establishes relationships to avoid being alone, though they are usually superficial and transient. He demands payback for any act of kindness he makes. Javier would likely be diagnosed with: A. Antisocial personality disorder B. Narcissistic personality disorder C. Dependent personality disorder D. Borderline personality disorder

D. Borderline personality disorder

Ron has maxed out four credit cards. He describes having five different jobs in the past year and "not caring" about his behaviors. He has been through two marriages, both of which lasted less than one year. He reports abusing methamphetamine and hallucinogens on a weekly basis. Ron would likely be diagnosed with: A. Antisocial personality disorder B. Bipolar disorder C. Obsessive-compulsive personality disorder (OCPD) D. Borderline personality disorder

D. Borderline personality disorder

From a psychosocial perspective, the nurse is most troubled when witnessing the parents of 6-year-old twins ignoring the boys being physically aggressive toward each other because this behavior: A. Suggests that the family has very weak social skills. B. Indicates a severe lack of parental attachment to the children. C. Greatly increases the risk of the children being physically injured. D. Can lead to the children developing violence as a coping mechanism.

D. Can lead to the children developing violence as a coping mechanism.

What is the most common defense mechanism exhibited by patients with a history of substance abuse? A. Rationalization B. Sublimation C. Projection D. Denial

D. Denial

What psychiatric illness are patients diagnosed with eating disorders at risk for? A. Generalized anxiety disorder (GAD) B. Substance abuse C. Bipolar disorder D. Depression

D. Depression

A 4-year-old boy is angry because he has just been punished by his mother for drawing on his bedroom walls. He begins to play war with his soldier toys and has them fight with each other. This is an example of the defense mechanism ___. A. Projection B. Rationalization C. Sublimation D. Displacement

D. Displacement

The defense mechanism that involves a shift of emotion from a person or object to another, usually neutral or less dangerous, person or object is defined as ___. A. Projection B. Rationalization C. Sublimation D. Displacement

D. Displacement

Neil is a 28-year-old man who has worked as a car mechanic for the last 2 years. He is considered a reasonably good mechanic, but is difficult to work with because he is touchy, suspicious, and easily feels "slighted" by others. This has led to a number of confrontations with other mechanics and supervisors. His boss is reluctant to fire him because good mechanics are hard to find. Neil would likely be diagnosed with: A. Schizoid personality disorder B. Borderline personality disorder C. Antisocial personality disorder D. Paranoid personality disorder

D. Paranoid personality disorder

Lucy is 32 and lives alone on welfare in a small apartment. She has few friends. Her neighbors consider her "peculiar" and the children in the neighborhood tease her about her appearance (clothes slightly askew, unusual makeup). Sometimes Lucy watches the neighborhood children from her window, partially hidden behind the curtains. She is generally suspicious of others and often makes gestures as she passes people on the street. Lucy would likely be diagnosed with: A. Paranoid personality disorder B. Avoidant personality disorder C. Borderline personality disorder D. Shizotypal personality disorder

D. Shizotypal personality disorder

Which extrapyramidal symptom manifests as tongue protrusion, lip smacking, facial distortion, or purposeless movement of the limbs or trunk? A. Akathisia B. Acute dystonia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia

The nurse is physically assessing a 7-year-old who is suspected of being physically abused. Which observation supports this diagnosis? A. The child stutters when answering questions. B. The father refuses to leave his child alone with the nurse. C. The mother informs the nurse that the child is very clumsy. D. The child has bruises in various stages of healing on her arms.

D. The child has bruises in various stages of healing on her arms.

The nurse is performing an initial interview with an older adult whose family is concerned that she is demonstrating early signs of dementia. Which intervention best demonstrates that the nurse understands how to effectively communicate with a cognitively impaired individual? A. The interview is postponed until a family member can be present. B. The nurse is careful to avoid medical terminology during the interview. C. The older adult is provided with a list of written questions that will be addressed. D. The nurse restates the question if the older adult appears to hesitate when answering.

D. The nurse restates the question if the older adult appears to hesitate when answering.

What criteria dictate the need for someone to be involuntarily admitted to a psychiatric unit?

Danger to self Danger to others Inability to perform ADLs and take care of self

What are the negative symptoms of schizophrenia?

Deficit in functioning: Flat affect Apathy Alogia (poverty of speech) Avolition Anhedonia

What hormonal imbalances precipitate psychotic symptoms in patients diagnosed with schizophrenia?

Dopamine excess Increased serotonin

What are the positive symptoms of schizophrenia?

Excess or distortion of normal functioning: Delusions Hallucinations Disorganized speech or behavior

What is the most important intervention to consider for clients diagnosed with conduct disorder?

Give logical consequences for actions

What is the most effective intervention for a patient diagnosed with attention deficit hyperactivity disorder (ADHD)?

Have patient complete simple tasks broken down into small steps Ex.: start with brushing teeth, then add tasks gradually

What are the signs of neuroleptic malignant syndrome (NMS)?

Hyperthermia Severe muscle rigidity Altered mental state Profuse sweating Elevated CPK Renal failure Seizures, death

What is the priority nursing diagnosis for persons diagnosed with personality disorders?

Impaired socialization

A patient with agranulocytosis with a decreased white blood cell (WBC) and neutrophil count is at increased risk for ___.

Infection

Why must the nurse immediately stop treatment with an antipsychotic if a patient is exhibiting signs of tardive dyskinesia?

No known treatment; potentially irreversible

In persons with (OCD/OCPD), the individual recognizes that thoughts and behaviors are unreasonable.

Obsessive-compulsive disorder (OCD)

In persons with (OCP/OCPD), the individual does not believe that his or her actions are irrational whatsoever and often rationalizes behaviors.

Obsessive-compulsive personality disorder (OCPD)

What medication is used most commonly to treat attention deficit hyperactivity disorder (ADHD) in children?

Ritalin

What type of medication is most effective for persons diagnosed with personality disorders?

SSRIs

What is the priority for a patient diagnosed with borderline personality disorder who is exhibiting signs of self-mutiliation, including cutting and burning?

Safety!

What interventions are best used for patients with antisocial personality disorder?

Set limits Enforce rules & confront inappropriate behaviors Be firm and consistent Do not seek approval or coax, do not argue, bargain, or rationalize Use concerned, matter-of-fact approach

Which symptoms indicate that a patient is experiencing the blood dyscrasia agranulocytosis?

Sore throat Fever Malaise

A friend tells you that you are the most wonderful person in the world one day and how much she hates you the next day. This is an example of the defense mechanism ___.

Splitting

What two common defense mechanisms do patients with personality disorders often employ?

Splitting & projective identification

Why is elder abuse very underreported?

The perpetrator is usually someone the elder knows and they are ashamed of it

What does cognitive impairment cause?

Thinking problems

What is the primary reason that nurses work with clients to develop contracts?

To decrease misinterpretation of what's expected Keeps patients safe and instills control