Psych Exam 3 Practice Qs

Since admission, a patient diagnosed with antisocial personality disorder has been highly manipulative and constantly tests staff. Now, the patient insists on watching a late movie instead of complying with the bedtime. Select the nurse's best response. a. "It's a unit rule that bedtime is at 10 P.M." b. "I will not allow you to manipulate me again." c. "If you ask again, tomorrow's bedtime will be 9 P.M." d. "I understand your sleep problems and can allow it just this once."

A Attempts at manipulation can be successfully handled by firm, matter-of-fact reiteration of unit policies and consistently adhering to them. The other responses are defensive, retaliative, or permissive.

When caring for a patient diagnosed with dependent personality disorder, the nurse should positively reinforce which behavior? a. Choosing which clothing to wear b. Asking another patient for advice c. Sitting next to the nurse at a community meeting d. Concealing anger with a family member

A Dependent patients find it difficult to make even simple decisions. They often ask advice; thus, independently choosing their own attire is a behavior to be reinforced. The other options are behaviors that reflect dependent needs and are not desirable.

A patient demonstrating borderline personality disorder says, "When I met him, he was perfect and gave me everything. Now I know how bad he really is. He left me alone tonight to go out with others, so I had to cut myself." Which feature is evident? a. Splitting b. Paranoia c. Grandiosity d. Submissiveness

A Splitting involves the inability to integrate the good and bad aspects of an object, so her boyfriend is seen as perfect or entirely bad, not as a person with some traits that she likes and some that she dislikes. Paranoid tendencies involve feelings of persecution. There is no indication that the patient is submissive or grandiose.

Which characteristic of individuals diagnosed with personality disorders in the dramatic-erratic cluster makes it advisable for staff to have frequent patient-centered meetings? a. Manipulating others to avoid limits b. Behaving responsibly in the peer group c. Withdrawing from interactions with others d. Depending excessively on others for support

A The group of dramatic-erratic personality disorders includes antisocial and borderline personality disorders. These patients are particularly skillful at manipulating others to get their needs met. The distracters list characteristics that would not require frequent meetings.

Patients diagnosed with dependent personality disorders behave submissively and cling to others. What is the best explanation of this behavior? a. The patients are afraid of being alone or functioning without direction. b. The patients adhere to strict standards and fear failure. c. The patients have little regard for the rights of others. d. The patients are suspicious of the motives of others.

A The individual with a dependent personality disorder has a pervasive and excessive need to be taken care of, which leads to submissive and clinging behaviors. The other options are characteristic of individuals with obsessive-compulsive personality disorder, antisocial personality disorder, and paranoid personality disorder.

Which behaviors create interpersonal relationship problems for an individual diagnosed with narcissistic personality disorder? (Select all that apply.) a. Grandiose self-importance b. Sense of entitlement c. Lack of empathy d. Risk-taking e. Shyness

A, B, C The individual with narcissistic personality disorder has difficult interpersonal relationships because of characteristic behaviors and tendencies toward grandiose self-importance, a sense of entitlement, and lack of empathy. Evidence does not suggest the other characteristics as behaviors or traits of individuals with this personality disorder.

A patient diagnosed with borderline personality disorder impulsively self-mutilates and has severe mood lability with explosive outbursts, poor interpersonal relations, and inability to sustain employment. Which referrals should the nurse consider for the patient? (Select all that apply.) a. Dialectic behavior therapy b. Alcoholics Anonymous c. Vocational rehabilitation d. Desensitization therapy e. Anger management

A, C, E Referral to dialectic behavior therapy will address self-mutilation and interpersonal relations and might address mood lability. Vocational counseling can help with employment problems. Assertiveness training and anger management will address the explosive outbursts. Desensitization therapy is used for patients with phobias. There is no evidence of alcohol abuse.

6. A patient approaches the nurse in the clinic waiting room and says, "I want to talk to you about a sexual matter." The nurse can best facilitate the discussion by providing which response? a. "Let's go to my office." b. "I want to help. Go ahead. I'm listening." c. "Let's schedule an appointment with more time." d. "Let's move to a private area in the waiting room."

ANS: A A discussion of sexual concerns requires privacy. Suggesting use of office space is preferable to using the waiting room, where others cannot help but overhear sensitive material. Offering to schedule an appointment blocks communication.

14. A community health nurse assesses four patients between ages 70 and 80. Which patient has the highest risk for alcohol dependence? a. Patient with no history of alcohol-related problems until retirement but now drinks alcohol daily to distract himself from arthritis pain. b. Patient who drank socially throughout adult life and continues this pattern, saying "I'm old enough to drink if I want to." c. Patient who abused alcohol between ages 30 and 45 but now abstains and occasionally attends AA meetings. d. Patient with intermittent problems of alcohol misuse early in life. Now drinks one glass of wine nightly with dinner.

ANS: A Alcohol dependence can develop at any age, and the geriatric population is particularly at risk. The geriatric problem drinker is defined as someone who has no history of alcohol-related problems but develops an alcohol abuse pattern in response to the stresses of aging.

6. A pregnant patient experiencing insomnia reports taking diazepam and wine in increasing amounts to be able to sleep. The nurse should teach the patient about what risk associated with this habit? a. Central nervous system (CNS) depression b. Acetaldehyde toxicity c. Fetal alcohol syndrome d. Miscarriage

ANS: A Alcohol ingested with another CNS depressant can produce lethal depressant effects. The other options are not relevant based on the information given in the scenario nor the effects of combining the medication and alcohol.

10. A 10-year-old boy is diagnosed with gender identity disorder. Which assessment finding would the nurse expect? a. Having tea parties with dolls b. A compromised sexual response cycle c. Identifying with other boys who are athletic d. Intense urges to watch his parents having sex

ANS: A An individual with gender identity disorder feels trapped in the body of the "wrong" gender and at odds with the roles associated with that gender. A child with this diagnosis is likely to engage in play associated with the opposite gender. The other options are not age appropriate or characteristically seen in children with gender identity disorder.

13. An adult who exposed himself to a group on strangers tells the nurse, "I had just lost my job and was afraid; I just did it without thinking". Which intervention would have the greatest benefit for this person? a. Stress management b. Problem-solving c. Sex education d. Social skills

ANS: A Because the individual demonstrated the exhibitionistic behavior during a period of increased stress, providing stress management would be beneficial. The other interventions may be acceptable but would not have the relevance that stress management would have.

11. A child diagnosed with attention-deficit hyperactivity disorder (ADHD) will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications prescribed to help manage the associated behaviors? a. Central nervous system stimulants b. Tricyclic antidepressants c. Antipsychotics d. Anxiolytics

ANS: A Central nervous system stimulants, such as methylphenidate and pemoline, increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with A

15. An older adult patient diagnosed with depression is prescribed a selective serotonin reuptake inhibitor (SSRI). Nursing assessment should include careful collection of what information to best assure patient safety? a. Other prescribed medications and over-the-counter remedies used b. Evidence of pseudo-parkinsonism or tardive dyskinesia c. History of psoriasis and other skin disorders d. History of diarrhea and electrolyte imbalances

ANS: A Drug interactions, both prescription and over-the-counter, can be problematic for the geriatric patient taking an SSRI. Careful collection of information is important. The distracters do not pose problems with SSRI drugs.

18. A nurse assesses a 25-year-old man with a suspected eating disorder. Which comment is most likely from this patient when the nurse asks about the patient's sexuality? a. "I just don't have much of a sex drive anymore." b. "I'm here because my girlfriend is worried about how much I exercise." c. "I am sexually active, but I sometimes have trouble maintaining an erection." d. "I've been involved in a satisfying relationship with my girlfriend for 3 years."

ANS: A In anorectic men, low sex drive and low testosterone levels might be the equivalent of amenorrhea in female patients. None of the remaining options reflect this concern.

4. While volunteering at a homeless shelter, a nurse observes a known pedophile leaving the restroom with a small child. Select the nurse's priority action. a. Report the observation to authorities by the child abuse hotline. b. Protect the child without interacting with the perpetrator. c. Notify staff of the homeless shelter to address the situation. d. Continue to observe the interaction and document findings.

ANS: A In every state, nurses are mandated reporters of child abuse. The nurse is obligated legally and morally to report the incident so that proper authorities can follow up. The distracters do not fulfill the nurse's ethical or legal responsibilities.

11. A man tells the nurse, "I have trouble maintaining an erection." This comment indicates which possible sexual disorder? a. Erectile disorder b. Desire disorder c. Pain disorder d. Orgasm disorder

ANS: A In sexual erectile disorders, the individual cannot maintain the physiologic requirements for sexual intercourse. The patient's statement does not provide data to suggest one of the other options.

17. The clinic nurse sees a new patient with vague sexual complaints. Select the best question for the nurse to help the patient express these concerns more clearly. a. "What are your concerns and feelings about your sexuality?" b. "Patients are frequently embarrassed to talk about sexuality." c. "Don't be embarrassed. Our conversation is completely private." d. "As a clinician, I am accustomed to talking to patients about personal matters."

ANS: A Individuals with sexual concerns may need help and support to express the problem. Approaching the subject directly is most appropriate. The patient is not concerned with the problems of other patients or the nurse's level of comfort.

9. An individual experiencing a heroin overdose has been given one dose of naloxone intravenously. What the priority nursing intervention is to assure patient safety? a. Close observation to determine the need for an additional dose of naloxone b. Seizure precautions for 2 hours immediately after administration of naloxone c. Acidification of urine by encouraging the patient to drink cranberry juice d. A nonstimulating environment and administration of oral fluids

ANS: A Naloxone, a narcotic antagonist, permits the individual to respond and respirations to improve. However, because most opioids have a longer lasting effect than naloxone, the effects of naloxone will wear off before the effects of the opioid. The administration of naloxone might have to be repeated. If it is not, the individual is in danger of death due to respiratory depression. None of the remaining options would support client safety when considering the effects of a heroin overdose.

19. One bed is available on the inpatient eating disorders unit. Assessment findings for four patients are listed as follows. Which patient has priority for admission? a. Weight decreased from 150 to 102 lb in 4 months. Vital signs are T 96.9°F; P 46 beats/min; BP 68/48 mm Hg. Amenorrhea for 8 months. b. Weight decreased from 110 to 86 lb in 4 months. Vital signs are T 97.5°F; P 60 beats/min; BP 80/66 mm Hg. Amenorrhea for 2 months. c. Weight decreased from 120 to 90 lb in 3 months. Vital signs are T 98°F; P 50 beats/min; BP 70/50 mm Hg. Menstruation scant for 3 months. d. Weight decreased from 90 to 78 lb in 5 months. Vital signs are T 97.7°F; P 62 beats/min; BP 74/52 mm Hg. Menstruation irregular for 6 months.

ANS: A Physical findings indicative of an acute status include amenorrhea for 3 consecutive menstrual cycles, weight loss more than 30% of body weight within 6 months, hypothermia, pulse less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

15. A nurse cares for a patient demonstrating paraphilia. The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors by decreasing libido? a. Selective serotonin reuptake inhibitor (SSRI) b. Erectile dysfunction medication c. Atypical antipsychotic d. Mood stabilizer

ANS: A SSRIs are reported to have a positive effect on paraphilia since they can cause decreased libido, impair orgasms, and interfere with ejaculation. The other medications are not indicated for this disorder.

9. Contemporary cultural rejection of certain sexual behaviors is determined primarily based on what characteristic of the sexual act? a. Involving coercion rather than consent b. Associated with homosexual contacts c. Using artificial devices d. Resulting in orgasm

ANS: A Sexual acts that are forced on another are considered both morally and legally unacceptable. The other options are used less often as evaluation criteria.

14. Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? a. The child has been raised by a parent with chronic major depression. b. The child's best friend has developed a chronic illness c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

ANS: A Statistics indicate that children raised by a depressed parent have an increased risk of developing an emotional disorder. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk enhancing.

7. A child being treated for which medication has a high risk for suicide and should be monitored closely? a. Depression with fluoxetine b. ADHD with methylphenidate c. Bipolar disorder with aripiprazole d. Asperger disorder with social skills training

ANS: A The child being treated for depression with fluoxetine is at risk for behavioral activation, a drug side effect. Increased suicide risk is part of the behavioral activation complex. The drugs mentioned in the other options do not place the individual in the same risk category as fluoxetine. D

7. Which information is most important to obtain during assessment of an older adult with a mental disorder? a. Functional ability and emotional status b. Chronologic age and sexual functioning c. Economic status and sources of income d. Developmental history, interests, and activities

ANS: A These data provide an overview of patient problems and ability to function. They guide the selection of interventions and services to meet identified needs. The other options reflect information of relevance but are not of highest priority.

1. The nurse suspect that a patient has developed a tolerance for alcohol. Which patient statement supports that suspicion? says, The nurse assesses this phenomenon as related to: a. "I felt good from drinking a six-pack a few months ago. Now I need a few extra cans to get the same high." b. withdrawal. c. co-dependency. d. abstinence syndrome.

ANS: A Tolerance refers to the need for increasing amounts of a substance to achieve the same effects. The other terms are not related to needing more of a substance to achieve the same effect.

4. What should the nurse consider as the initial step in the nurse-patient relationship for a patient diagnosed with anorexia nervosa? a. Formulate the nurse-patient contract. b. Place limits on the family involvement in treatment. c. Identify a therapeutic group of similar aged patients. d. Use confrontation to establish boundaries and limits.

ANS: A Trust is the foundation to the nurse's effectiveness. A contract is formulated early in therapy to give the patient the opportunity to participate in treatment. This increases the patient's sense of control. By establishing contractual behavioral limits, manipulation and power struggles can be minimized. Recommending a therapeutic group and using confrontation to attack denial are later interventions. Family members are encouraged to take part actively in the treatment of the patient.

3. A patient diagnosed with Wernicke-Korsakoff syndrome has the nursing diagnosis impaired memory, related to neurotoxicity of alcohol. Which statement made by the patient confirms the presences of a defining characteristic that applies to this diagnosis? a. "I sometimes make up a story to cover up for something I can't remember." b. "I often hear voices that others claim they don't hear." c. "All of a sudden, I'll have a vivid memory of the accident that killed my son." d. "Regardless of what you say, I know that the mob or CIA is out to kill me."

ANS: A Wernicke-Korsakoff syndrome is a mental disorder characterized by amnesia, clouding of consciousness, confabulation (falsification of memory) and memory loss, and peripheral neuropathy. Confabulation is a symptom typically displayed by an individual with Wernicke-Korsakoff syndrome. The individual attempts to make up for memory loss by filling in the blanks with false memories. Auditory hallucinations are often described as hearing voices that no one else can hear. Paranoid delusions are characterized by an unrealistic or unsubstantiated belief that one is in danger. None of these options are symptoms of memory impairment associated with Wernicke-Korsakoff syndrome.

2. A school nurse uses a participative approach to teach about safety to a group of third graders. Which questions should the nurse pose to the students? (Select all that apply.) a. "What would you do if a stranger told you to get in his or her car because your parents were hurt?" b. "If you were playing on the Internet, and someone invited you into a private chat room, what would you do?" c. "If your parents told you that your pet was hurt, would you go with them to the veterinarian?" d. "Has anyone ever touched you in a way that embarrassed or frightened you?" e. "Which members of your family can you trust?"

ANS: A, B Teaching about the risk of sexual misconduct is important for school-age children. Trickery, bribes, and the Internet are sources of potential danger. It would not be appropriate to ask students in a group setting if they had been inappropriately touched or which family members were trustworthy.

3. A nurse assesses a patient recently diagnosed with pedophilia. Which assessment findings are most likely to be identified? (Select all that apply.) a. History of childhood sexual abuse b. Antisocial personality traits c. Limbic system abnormalities d. An endocrine disorder e. Grandiosity

ANS: A, B, C Pedophiles commonly have a history of sexual abuse, limbic system abnormalities, and traits of some personality disorders. Endocrine problems are not associated with pedophilia. Self-confidence is lacking; grandiosity would not be expected.

1. Which behaviors are indicative of bullying by a child? (Select all that apply.) a. Recruits other children to avoid a child who wears glasses. b. Consistently calls another child "fat" and "stupid." c. Trips another children, because "it's fun." d. Repeatedly steals another child's lunch money. e. Plays a practical joke on another child.

ANS: A, B, C, D Bullying can be verbal, relational, or physical. It is repetitive and intentionally produces harm or pain in another person. Playful teasing, one-time aggression, and joking do not meet the criteria for bullying.

1. Which assessment findings related to the same patient help confirm a diagnosis of anorexia nervosa? (Select all that apply.) a. Patient reports amenorrhea for 9 months b. Patient is 5 feet 4 inches tall and weighs 85 lb c. Blood pressure (BP) 70/42 mm Hg d. Skin turgor is poor e. Pulse 68 beats/min

ANS: A, B, C, D Data confirming amenorrhea, low weight related to height, hypotension and poor skin turgor are consistent with the medical diagnosis of anorexia nervosa. A pulse rate of 68 beats/min is low normal.

7. How is substance dependence best defined? (Select all that apply.) a. A compulsion to use a substance b. Loss of control over use of a substance c. A physiological need to use a substance d. Continued use of a substance despite adverse consequences e. A substance-specific syndrome due to recent ingestion of a substance

ANS: A, B, C, D Dependence is marked by multiple criteria defined in the DSM-V. A substance-specific syndrome due to recent ingestion of the substance refers to substance intoxication.

1. Which interventions should the nurse implement to facilitate an effective assessment of an older adult? (Select all that apply.) a. Allow time for client to formulate answers. b. Use open-ended questions to encourage conversation. c. Ensure privacy to help minimize unwillingness to share information. d. Speak loudly to assure client's ability to hear the questions clearly. e. Explain the purpose of the assessment.

ANS: A, B, C, E The general rules of interviewing apply. In addition, older adults respond better to open-ended questions than to a barrage of direct questions. Because it might take the older adult longer to formulate an answer, the nurse should allow time for the patient to answer. Making sure that the patient uses his or her glasses and hearing aid is advisable. Information should be obtained directly from the patient if possible. Direct questions might seem intrusive. Speaking loudly is necessary only if the patient has a hearing deficit. Setting a brisk pace and interrupting might frustrate the patient.

3. Which assessment findings related to a 68-year-old patient should be identified as risk factors for late-onset alcohol abuse and dependence? (Select all that apply.) a. Chronic obstructive pulmonary disease b. Insomnia c. Male gender d. Boredom and loneliness e. Recent loss of spouse

ANS: A, B, D, E Insomnia or chronic medical illness might lead the individual to use alcohol to self-medicate. Loss of a spouse, boredom, and loneliness often result in alcohol use to escape emotional distress. Statistics show that more women than men develop late-onset problem drinking.

2. Which remarks by a 72-year-old patient should prompt the nurse to assess for depression? (Select all that apply.) a. "Lately I have had a lot of aches and pains and just haven't felt very well." b. "My appetite is better than usual, and I am sleeping about 9 hours a night." c. "People are in and out of my room all day and all night taking my things." d. "Don't ask me to eat. I can't because my stomach is upset all the time." e. "Life is more organized now that I don't live in my own home."

ANS: A, C, D Any of the remarks listed as correct should be enough to trigger use of an assessment tool for depression. Somatic symptoms, delusions of persecution, and nihilistic delusions are more common in late-onset depression than in early-onset depression. The other options do not suggest symptoms of mental disorder.

2. What priority nursing assessments should be made early in the refeeding process for a patient with anorexia nervosa? (Select all that apply.) a. Vital signs b. Skin integrity c. Peripheral edema d. Lung and heart sounds e. Level of consciousness

ANS: A, C, D, E If refeeding results in too rapid weight gain, the cardiovascular system might be compromised, giving rise to symptoms such as pulse irregularities, peripheral edema, abnormal heart sounds, and moist lung sounds. Alterations in oxygenation and cardiac perfusion would produce changes in the level of consciousness. Changes in skin integrity would not be a priority.

5. Naltrexone is prescribed for a patient diagnosed with alcohol dependency. What information should the nurse provide to the patient? (Select all that apply.) a. "This medication is part of a total program to help you remain abstinent from alcohol." b. "Do not use alcohol-containing products, such as aftershave lotion and mouthwash." c. "Avoid foods that contain tyramine, such as aged cheeses and meats." d. "This medication will help reduce the likelihood of a relapse." e. "This medication will eliminate your desire for alcohol."

ANS: A, D Naltrexone, like any drug for treatment of chemical dependence, is only part of a total treatment program. It will help decrease the pleasure associated with alcohol, but it will not eliminate the desire. It reduces craving, which in turn will help reduce the likelihood of relapses. The distracters relate to disulfiram and monoamine oxidase inhibitors.

3. The nurse should assure that the milieu for a patient admitted for a hallucinogen overdose should have which features? (Select all that apply.) a. Focused attention on safety b. Well lighted c. Social interaction d. Mentally challenging e. Low sensory stimuli

ANS: A, E Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

1. What are the most important interventions for the nurse to implement with caring for a client experiencing barbiturate withdrawal? (Select all that apply.) a. Monitoring level of consciousness b. Supporting effective respirations c. Medicating for nausea d. Monitoring for tachycardia e. Seizure precautions

ANS: A, E Delirium and seizures are considered serious withdrawal symptoms requiring seizure precautions and frequent monitoring of levels of consciousness. Nausea may be experienced but is not considered a serious side effect of withdrawal. Depressed respirations and increased heart rate are signs of barbiturate overdose.

6. Which statements accurately portray differences in the effects of alcohol between men and women? (Select all that apply.) a. Women's gastrointestinal systems have less alcohol dehydrogenase, so less ethanol is oxidized on first pass before it enters the bloodstream. b. Hot coffee increases the metabolic rate and speeds oxidation of ethanol more in men than in women. c. Women have higher proportions of body fat, which absorbs alcohol and releases it slowly. d. The microsomal ethanol-oxidizing system in women is less efficient than in men. e. Women become intoxicated more easily than men.

ANS: A, E The alcohol dehydrogenase in the gastrointestinal tissue of men who are not dependent on alcohol oxidizes a significant amount of CH3CH2OH in the gut before it enters the bloodstream. The inability of women's bodies to undergo this first-pass metabolism accounts for their enhanced vulnerability to alcohol. The remaining options do not reflect accurate research findings.

14. A patient asks, "How does Alcoholics Anonymous (AA) work?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be given a sponsor who will plan your treatment program."

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

1. A patient living in community housing for older adults says, "I don't go to the senior citizens club. They play cards and talk about the past, because that's all they can do." The nurse suspects that these remarks represent what personal behavior? a. Failure to achieve developmental tasks b. Thinking associated with ageism c. Hypercritical behavior d. Paranoid thinking

ANS: B Ageism is negative stereotyping and devaluation of people based on their age. Older adults might be as guilty of using ageism as younger individuals. The other options are not substantiated by the information given in the scenario.

10. A 65-year-old patient is diagnosed with late-onset schizophrenia. Both positive and negative symptoms of the disorder are present. The patient has a history of atrial fibrillation. The nurse should prepare patient education materials related to what medication? a. Chlorpromazine b. Risperidone c. Thioridazine d. Haloperidol

ANS: B Atypical antipsychotics such as risperidone are effective against both positive and negative symptoms of schizophrenia and have the most favorable side effect profile. The distracters are typical antipsychotics. Chlorpromazine and thioridazine may cause cardiovascular side effects. Haloperidol may cause neurologic side effects.

3. A kindergartener is disruptive to the class. This child is unable to sit for expected lengths of time, inattentive to the teacher, and aggressive toward others, bursting out talking while the teacher is talking. Other children shun this child. The nurse plans interventions designed to address which of the child's needs? a. Provide inpatient treatment for the child. b. Reduce loneliness and increase self-esteem. c. Improve language and communication skills. d. Promote individuation and integration of self-concept.

ANS: B Because of their disruptive behaviors, children with attention-deficit hyperactivity disorder (ADHD) often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These same behaviors lead peers to avoid the child with ADHD, who seems reckless and impulsive, and can rarely finish games, leaving the child with ADHD vulnerable to loneliness. The other options might or might not be relevant but are not the priority. The child does not need inpatient treatment at this time.

13. An 80-year-old patient comes to the clinic reporting frequent headaches. As the nurse begins the assessment, which initial action should be taken to maximize the effectiveness of the assessment? a. Move the interview to a darkened room to reduce stimulation. b. Ask if the patient can hear clearly as the nurse speaks. c. Ask the patient to rate the level of pain. d. Initiate a neurologic assessment.

ANS: B Before proceeding with any further assessment, the nurse should assess the patient's ability to hear questions. Impaired hearing could lead to inaccurate answers.

8. What high priority assessment should a nurse caring for an older adult who self-administer medications preform? a. Use of stimulants b. Overuse of benzodiazepines c. Misuse of antihypertensive medications d. Trading medications with acquaintances

ANS: B Benzodiazepines are among the most widely prescribed medications. They are often prescribed in high doses and for prolonged periods, leading to tolerance, physical dependence, and psychological dependence. The other options are relevant but are not of the highest priority.

13. To meet DSM-V criteria for bulimia nervosa, the patient's history must reveal episodes of binge eating and compensatory behaviors occurring at least how often? a. Once a week for 6 months b. Once weekly for 3 months c. Three times weekly for a year d. Four times weekly for 6 months

ANS: B Bulimia nervosa is characterized by three behaviors: recurrent episodes of binge eating, continuing inappropriate compensatory behaviors to avoid weight gain, and an evaluation of self that is significantly influenced by body weight and shape. These behaviors must be present an average of at least once per week, for a minimum of 3 months according to the DSM-V criteria.

5. An older adult patient is severely suicidal and the patient's physical condition is declining. When it is apparent that traditional interventions are ineffective, the nurse should prepare for which intervention? a. Insertion of a feeding tube b. Electroconvulsive therapy (ECT) c. Behavior modification d. Bright-light therapy

ANS: B ECT is the treatment of choice for severe depression in older adults when a rapid response is necessary. Bright-light therapy and behavior modification will take too long. The patient does not have assessment findings that indicate enteral feeding is needed.

10. A cocaine abuser complains, "There are bugs crawling under my skin." Which term should the nurse use to document this finding? a. Confabulation b. Formication c. Synesthesia d. Euphoria

ANS: B Formication is the term used when an individual describes feeling bugs crawling under the skin. It is seen in cocaine use. The other options refer to altered sensory perceptions of sight and sound or to inventing stories to make up for memory deficit.

14. A nurse cares for a man diagnosed with pedophilia. Medroxyprogesterone acetate was prescribed. One month later, which statement by the patient indicates that the medication is having a therapeutic effect? a. "I feel a lot less depressed since taking this drug." b. "My sexual desire has practically disappeared." c. "I can sustain an erection longer than before." d. "There's no pain during intercourse now."

ANS: B Medroxyprogesterone acetate is an antiandrogen. When testosterone is reduced, sexual desire is decreased. The statement that sexual desire has "practically disappeared" suggests that the medication is having the desired effect. The distracters are unrelated to the desired effect of this drug.

3. A nurse plans a staff education program for employees of a senior living community. Which topic has priority when considering client safety? a. Late-onset schizophrenia b. Depression and suicide c. Dementia d. Delirium

ANS: B Older Americans frequently experience undiagnosed depression and are disproportionately more likely to commit suicide. Educating staff about signs and symptoms of high-risk patients and early intervention strategies will decrease

8. A nurse caring for a patient who experienced an opioid overdose will give priority to which focused assessment? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

ANS: B Opioid overdose causes respiratory depression, which is the primary cause of death among opioid abusers. The assessment of the other body systems is not the priority.

8. A pedophile receiving treatment tells the nurse, "I feel so guilty and shameful over molesting a child. My family will be so disgusted with me. I could save them from embarrassment if I were gone." What is the nurse's priority action? a. Set limits on the patient's disclosures. b. Further assess the patient's suicidality. c. Administer a PRN medication for anxiety. d. Explore the patient's feelings of guilt and shame.

ANS: B Patients who describe guilt, shame, and the idea that others would be better off without them are suicide risks. The nurse should further assess the patient's comments, document, report the data, and consider the need for suicide precautions. The other options do not fully consider the primary issue of patient safety.

4. A resident in a senior community has lost weight, feels depressed, and has lost interest in former social activities. The nurse asks, "When you last saw your doctor, did you share these problems?" The resident replies, "Yes, but the doctor said I shouldn't expect to feel good every day." Which barrier to mental health care is evident? a. Legislative failures to provide services for older adults b. The physician's inadequate mental health assessment c. The resident's inadequate description of symptoms d. Economic obstacles to adequate programming

ANS: B Primary-care physicians are often hurried and have little time to spend with patients. In addition, they are more attuned to and more comfortable treating physical problems than mental disorders. They often miss depressive symptoms in older adults, thus creating a barrier to effective treatment. The patient's description of symptoms was adequate. Economic and legislative policies are not discussed in the scenario.

12. Reducing aggressive outbursts on a unit for older adults with mental disorders can be best achieved by implementing which intervention? a. Administering antipsychotic medication when signs of aggression are first noted b. Redirecting a client who demonstrates verbal aggression c. Limiting diversional activities to manage stimuli d. Restricting the clients' personal space to help facilitate visual observation of the group.

ANS: B Redirection and diversion are effective techniques to prevent and/or manage aggressive outbursts. Liberal use of medication will result in oversedation. Diversional activity can provide constructive outlets, so it should not be restricted. Control over one's personal space reduces aggression. Real or imagined threats to personal space might incite aggression.

6. A nurse planning care for a patient diagnosed with bulimia nervosa should recommend the use of what for therapy? a. Psychodynamic group therapy. b. Cognitive-behavioral therapy. c. Pharmacotherapy. d. Psychodrama.

ANS: B Research findings indicate that cognitive-behavioral therapy is effective in the treatment of both anorexia nervosa and bulimia nervosa. There is no evidence to suggest that the other options are as useful.

12. A nurse is engaged in psychoeducational activities with a hospitalized teenage patient diagnosed with bulimia nervosa. What response should the nurse provide when a patient asks, "What should I do when I feel the need to vomit?" a. "Do vigorous aerobic exercise until the urge goes away." b. "Seek out a staff member to talk about your feelings." c. "Call your parents on the phone to show you care." d. "Allow yourself to vomit, but avoid purging."

ANS: B Resistance to the urge to vomit or purge can be strengthened by reporting it to a nurse and talking about the feelings that the individual experienced before the urge and the feelings being experienced presently. Once feelings are identified, the patient can begin to work on alternate coping strategies. The other options are not helpful.

6. Which finding necessitates immediate nursing action for a child being treated for depression with a selective serotonin reuptake inhibitor (SSRI)? a. A weight gain of 10 lb in 4 weeks b. Repeatedly hitting a younger sibling c. Frequently reports being tired and just wanting to sleep d. Has fallen three times as a result of "being dizzy"

ANS: B Selective serotonin reuptake inhibitors (SSRIs) are frequently used in children and adolescents. Some aggressive and out of control behaviors, and even suicidality have been linked to these serotonin-enhancing drugs. The other drug side effects are associated with tricyclic antidepressants.

17. An adolescent in a residential program threatens to throw a pool ball at another adolescent. Which comment by the nurse would effectively set limits? a. "You will be taken to seclusion if you throw that ball." b. "Do not throw the ball. Put it back on the pool table." c. "Attention everyone: We're all going to the gym." d. "Please do not lose control of your behavior."

ANS: B Setting limits uses clear, sharp statements about which behavior is not allowed and guidance for performing a behavior that is expected. The distracters represent a threat, use of restructuring (which would be inappropriate in this instance), and a direct appeal to the child's developing self-control that may be ineffective.

5. A desired outcome for a 12-year-old diagnosed with autism spectrum disorder (ASD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy b. Social skills group c. Response prevention d. Insight-oriented group therapy

ANS: B Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser to no impact on peer relationships.

13. A patient in the emergency department says, "I took a drug that makes me feel like I'm outside my body looking at the world while making colors move like music." What question should the nurse ask to assess for the possible cause of the patient's experience? a. "Have you ever been diagnosed with schizophreniform disorder?" b. "Did you knowly ingest a hallucinogenic substance?" c. "Are you currently taking an antidepressant?" d. "Have you ever experienced anything like this before?"

ANS: B Symptoms of hallucinogen use (e.g., LSD) include depersonalization, loss of reality, hallucinations, synesthesia, panic, paranoid thinking, and loss of contact with reality and synesthesia, which is the blending of senses (e.g., smelling a color or tasting a sound). Data given in the scenario do not support a schizophreniform disorder or formication (abnormal crawling sensations under the skin). While an appropriate assessment question, determining if this ever happened before doesn't focus on cause.

16. A child shares with the school nurse about painful verbal bullying by an aggressive classmate. What should be the nurse's initial action? a. Give notice to the chief administrator at the school regarding the events. b. Support the victimized child to share feelings about the experience. c. Encourage the victimized child to ignore the bullying behavior. d. Discuss the events with the aggressive classmate.

ANS: B The behaviors by the bullying child create emotional pain and present the risk for physical pain. The nurse should first listen to the child's complaints and validate the child for reporting the events. Later, school authorities should be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior should not be ignored; it will only get worse.

7. A man experiencing premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner. Can you help me?" What is the nurse's best response? a. "Sex therapy is not my specialty, but I will try to help." b. "I can refer you to a practitioner with experience regarding this problem." c. "Have you asked your health care provider for prescription medication?" d. "There are several techniques described in this pamphlet that might be helpful."

ANS: B The primary role of the nurse is to perform basic assessment and make appropriate referrals. The other options do not clarify the nurse's role.

6. When assessing older adults, the nurse should pay particular attention to which demographic group with the highest suicide risk? a. Hispanic men b. Caucasian men c. Caucasian women d. African-American women

ANS: B The suicide rate for Caucasian male older adults is higher than for any of the groups listed in the other options. Although women make more suicide attempts, men have a higher suicide attempt-to-completion ratio than women.

16. A patient diagnosed with bulimia nervosa has not responded to psychotherapeutic management. The health care provider is likely to prescribe a drug from which classification? a. Mood stabilizer b. Selective serotonin reuptake inhibitor (SSRI) antidepressant c. Typical antipsychotic d. Monoamine oxidase inhibitor antidepressant

ANS: B There is some evidence that SSRIs might be effective as adjunctive treatment of bulimia. The other drugs would not be considered appropriate.

12. When caring for patients withdrawing from cocaine and amphetamines, the nurse should plan measures recognizing what unique characteristic of this withdrawal process? a. Physical withdrawal is severe and often fatal. b. Psychological withdrawal is more severe than physical. c. Physical and psychological withdrawal are equally severe. d. Physical withdrawal is a problem only if the individual used injection.

ANS: B These drugs are highly addictive. Psychological craving during withdrawal is intense. The physical signs/symptoms of withdrawal, however, are relatively mild. The degree of withdrawal signs/symptoms are not necessarily associated with the route of drug administration.

17. A patient diagnosed with an eating disorder refuses to be weighed and says, "I just drank a big glass of water." What is the nurse's best response to the patient's comment? a. "Call me after you have emptied your bladder." b. "Being weighed today is not negotiable." c. "I will weigh you tomorrow." d. "You know the rules."

ANS: B This response is matter-of-fact and reinforces the established limits. The distracters allow the patient to manipulate the nurse, are overly controlling, or use bargaining.

9. What assessment question asked by the nurse planning care for an older client best minimizes the risk for ineffective medication administration by the client and impaired medication effectiveness? a. "What do you expect this medication will do for you?" b. "Can you explain how and when you should take your medication?" c. "How many medications do you take each day?" d. "Will you be able to easily get your medication prescriptions refilled?"

ANS: B While many factors contribute to the effective self-administration of medications, an adequate understanding of the instructions related to the medications' administration is of primary importance to achieving medication-related goals.

4. A patient is about to begin detox for an opioid addiction. Which statements by the patient demonstrate an understanding of the signs/symptoms of the withdrawal process? (Select all that apply.) a. "I've been told to expect to be constipated." b. "My nose is going to run like I have a bad cold." c. "My legs are going to spasm painfully." d. "I'll have erection issues for several weeks." e. I'm going to have goose bumps from the chills."

ANS: B, C, E Opioid withdrawal symptoms include yawning, rhinorrhea (runny nose), sweating, chills, piloerection (goose bumps), tremor, restlessness, irritability, leg spasm, bone pain, diarrhea, and vomiting. Sexually erection is not generally affected.

1. When considering the definition of pedophila, which individuals are at highest risk of being sexually victimized by a 25-year-old pedophile? (Select all that apply.) a. Male, age 15 b. Male, age 12 c. Female, age 13 d. Female, age 8 e. Either gender, age 5

ANS: B, D, E By definition, the victim of pedophilia must be younger than 13 years old, and the pedophile must be 16 years old or older and at least 5 years older than the victim. Pedophilic behavior can be expressed for opposite-sex children, same-sex children, or both.

4. A nurse will prepare teaching materials regarding which drug for the parents of a child diagnosed with ADHD? a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine

ANS: C Central nervous system (CNS) stimulants are the drugs of choice for treating children with ADHD. Methylphenidate and dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

11. A patient diagnosed with an eating disorder asks to be excused from a meal to use the restroom. What is the nurse's best response to the patient's request? a. "No one is permitted to leave the table during meals." b. "You may go after you've finished your meal." c. "I will go with you to the restroom." d. "No. I know you want to vomit."

ANS: C Close observation is necessary to prevent patients with eating disorders from purging during and after meals. Patients should be accompanied to the bathroom and observed while in the bathroom to prevent purging. Bargaining, lying, and judgmental confrontation are not appropriate responses.

7. A patient has a history of alcohol abuse. Which prescription drug would cause the nurse to be most concerned about of its risk for cross-dependency? a. Hydrochlorothiazide b. Benztropine c. Chlordiazepoxide d. Olanzapine

ANS: C Cross-addiction occurs with CNS depressant drugs. Chlordiazepoxide is a benzodiazepine, so cross-dependence is expected. The other drugs will not produce cross-dependence.

12. Which behavior would relevant to a potential diagnosis of Exhibitionism? a. Engaging in "Peeping Tom" behaviors b. Going out in public dressed as a member of the opposite gender c. Exposing one's genitalia while in a movie theater d. Engaging in strangulating behaviors to enhance sexual pleasure

ANS: C Exhibitionism is obtaining sexual pleasure from exposing one's genitalia to unsuspecting strangers. Voyeurism refers to obtaining sexual pleasure from observing people who are naked. The primary characteristic of transvestic disorder is sexual arousal derived from cross-dressing or dressing as the opposite sex. Sexual masochism sometimes involves erotic asphyxiation as a means of enhancing arousal.

2. Which behavior indicates that the treatment plan for a 5-year-old child diagnosed with autistic disorder has been effective? a. Is content to play with one toy for hours. b. Repeats words spoken by a parent. c. Holds the parent's hand while walking. d. Finds enjoyment in clapping his or her hands while walking.

ANS: C Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The other options reflect behaviors that are consistent with autistic disorder.

16. The clinic nurse sees a patient with a long-standing diagnosis of pedophilia who was recently arrested and released on bail. Which perspective about pedophilia would the nurse expect from this patient? a. Extreme remorse for traumatizing a child to meet his or her own needs. b. Desire to be placed in jail to prevent acting on the sexual impulses. c. The belief that the child was given valuable knowledge and pleasure. d. A feeling of victimization related to genetic and environmental factors.

ANS: C Individuals with pedophilia frequently do not believe that their behavior is harmful to the child. Instead, they point to having provided teaching and pleasure for the child. The other options are not characteristic of the thinking of the pedophile.

2. Which characteristic fits the profile of an individual who is a pedophile? a. Homosexual b. High self-esteem c. Seeks access to children d. Self-confident and expressive

ANS: C It is known that pedophiles usually place themselves in jobs, activities, or relationships that provide easy access to children. They often become trusted by both parents and children. The other characteristics have no particular relationship to pedophilia.

11. A nurse demonstrates an understanding of milieu management associated with the care of older client's diagnosed with psychiatric disorders when implementing which interventions? a. Provide cognitive-behavior therapy (CBT) for all patients. b. Provide unconditional acceptance of all client behaviors. c. Prevent clients from self-isolating. d. Limit time clients spend reminiscing.

ANS: C Nurses have a responsibility to facilitate optimal function. Attention to the milieu can increase psychological functioning and prevent deterioration resulting from withdrawal and disuse of skills. Unconditional acceptance of the individual is appropriate, but not all behavior must be accepted. It would be impractical to provide CBT for all patients. Reminiscence is a positive activity that should be encouraged and integrated into a plan of care.

7. Which personality characteristic would the nurse expect in a patient diagnosed with an eating disorder? a. Grandiosity b. Impulsivity c. Perfectionism d. Suspiciousness

ANS: C Often, the individual with an eating disorder is seen as compliant, perfectionist, introverted, and having self-esteem and relationship problems. The other characteristics are rarely seen among patients with eating disorders.

5. Prior to working with patients regarding sexual concerns, a prerequisite for providing nonjudgmental care would require what personal characteristic? a. Sympathy b. Assertiveness training c. Sexual self-awareness d. Effective communication

ANS: C Only when a nurse has accepted his or her own feelings and values related to sexuality can he or she provide fully nonjudgmental care to a patient. If the nurse is uncomfortable, the patient might misinterpret discomfort as disapproval. The distracters are not prerequisites.

5. A patient diagnosed with anorexia nervosa spills milk over a plate of partially eaten food. What is the nurse's best response to facilitate effective patient care? a. "That won't work. You are manipulating." b. "You are deliberately making mealtime difficult." c. "I will get you a fresh plate of food so you can finish." d. "You must eat your meal. I'll wait until you finish."

ANS: C Patients with anorexia nervosa often use strategies to hide food, spill food, or discard it to avoid eating. The nurse can best handle these behaviors with nonjudgmental confrontation and adherence to established limits. Only the correct answer is a nonjudgmental response. The other options are judgmental or punitive.

18. A senator develops a sexual relationship with a 20-year-old receptionist. Which adjective most likely applies to this relationship? a. Harmonious b. Consensual c. Coercive d. Illegal

ANS: C Relationships between powerful and less powerful persons usually have a coercive element. They are not illegal unless the less powerful person is a minor. The relationship may be harmonious and consensual in the minds of the involved parties.

3. A patient's medical record documents sexual masochism. Which behavior supports this diagnosis? a. Arousal is possible only when masturbating with women's underwear. b. Organism is achieved by inflicting pain on a sexual partner. c. Sexual pleasure is a result of sexually humiliated by a partner. d. Arousal results from the sexual touching of a nonconsenting person.

ANS: C Sexual masochism is sexual pleasure derived from being humiliated, beaten, or otherwise made to suffer. The distracters refer to fetishism, sexual sadism, and frotteurism.

17. Loneliness, related to unacceptable interpersonal behaviors is the nursing diagnosis for a patient in an alcohol rehabilitation program. Which AA step is most directly related to this problem? a. Admitted powerlessness over alcohol b. Turned our lives over to a higher power c. Made amends to persons we had harmed d. Tried to carry the AA principles to alcoholics

ANS: C Steps 8 and 9, making amends, could restore relationships and reduce social isolation from family and former friends. The other steps are less clearly related to this goal.

2. A patient diagnosed with anorexia nervosa has the nursing diagnosis imbalanced nutrition, less than body requirements, related to inadequate food intake. What is an appropriate long-term goal of the treatment plan for this patient? a. Gain 1 to 3 lb weekly. b. Exhibit fewer signs of malnutrition. c. Restore healthy eating patterns and normalize weight. d. Identify cognitive distortions about weight and shape.

ANS: C The goal directly related to the nursing diagnosis is to restore healthy eating patterns and normalize weight. The distracters are short-term or vague or are not directly related to the nursing diagnosis.

9. A child diagnosed with attention-deficit hyperactivity disorder (ADHD) had this nursing diagnosis—impaired social interaction, related to excessive neuronal activity, as evidenced by aggressiveness and dysfunctional play with others. Which finding indicates the plan of care was effective? a. Improved ability to identify anxiety and use self-control strategies. b. Increased expressiveness in communication with others. c. Engages in cooperative play with other children. d. Increased responsiveness to authority figures.

ANS: C The goal should be directly related to the defining characteristics of the nursing diagnosis; in this case improvement in the child's aggressiveness and play. The distracters are more relevant for a child with pervasive developmental disorder or anxiety disorder.

2. How is a blackout is described? a. A comatose period related to alcohol withdrawal. b. A comatose episode associated with alcohol intoxication and poisoning. c. A time period in which a person who has used alcohol is unresponsive to the environment. d. An episode in which a person under the influence of alcohol functions normally but later is unable to remember.

ANS: D A blackout is defined as a period of time in which a drinker functions socially but for which there is no memory. The distracters omit aspects of a blackout.

4. Which assessment findings would prompt the nurse to suspect a disulfiram reaction? a. Skin rash, itching, and urticaria b. Pallor, hypotension, and muscle cramping c. Dry skin, bradycardia, fatigue, and headache d. Headache, dyspnea, nausea, vomiting, and flushing

ANS: D A disulfiram reaction consists of any combination of the following symptoms: flushing, sweating, rapid pulse, hypotension, throbbing headache, nausea, vomiting, palpitations, dyspnea, tremor, and weakness. The patient is acutely uncomfortable. The other options do not characterize the disulfiram/alcohol reaction.

11. The nurse assesses a patient who admits to abusing large quantities of amphetamines. Assessment findings are likely to be similar to which psychiatric disorder? a. Wernicke-Korsakoff syndrome b. Bipolar disorder, manic phase c. Generalized anxiety disorder d. Paranoid schizophrenia

ANS: D Amphetamines enhance dopamine activity. The psychosis that is induced by amphetamines closely mimics the symptoms of paranoid schizophrenia. The other disorders have less to do with dopamine dysregulation.

15. What assessment finding supports a diagnosis of anorexia rather than bulimia? a. Body weight near normal for height b. Fluid and electrolyte imbalances are present c. Engages in strenuous exercise daily d. Eating disorder begin at age 14

ANS: D Anorexia tends to begin at an earlier age than bulimia. Engaging in strenuous exercise can occur in both disorders. The other options related to bulimia rather than anorexia.

9. A nurse teaches a class about bulimia nervosa to high school biology students. The nurse should provide what neurotransmitter process as a possible cause of this eating disorder? a. Hypersensitivity of norepinephrine b. Excessive dopamine activity c. Overproduction of GABA d. Serotonin deficits

ANS: D Based on a few research studies, current thinking suggests that deficits in serotonin might play a role in bulimia nervosa. There is no research to support the correctness of any of the other options.

1. Which assessment finding would the nurse document as subjective evidence of anorexia nervosa? a. Presence of lanugo on body b. Bradycardia notes upon regular assessment c. 25-lb weight loss over 3-month period d. Patient states fear of gaining weight

ANS: D Fear of weight gain is a subjective symptom, because it is voiced by the patient. The distracters are objective signs.

13. A 14-year-old is sent to a residential program after arrests for truancy and assault. At the program, the teen refused to participate in scheduled activities and pushed a staff member, causing a fall. Which statement made by the nurse demonstrates an effective strategy to manage the client effectively? a. "I've enrolled you in the unit's social skills training group to help you interact with others better." b. "What will it take to get you to obey unit rules?" c. "If you don't want to go to movie night you don't have too." d. "There is a loss of privileges following any refusal to comply with unit rules."

ANS: D Firm limits are necessary to ensure physical safety and emotional security. Limit-setting will also protect other patients from the teen's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.

1. Which factor presents the most imminent risk for the development of a childhood psychiatric disorder? a.Having an uncle diagnosed with schizophrenia b. Living in a low-income family c. Being the oldest child in a family d. Living with an alcoholic parent

ANS: D Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition. Neither being in a low-income family nor being the oldest child are considered psychosocial adversity situations. While having an extended family history of schizophrenia presents a risk, the negative childhood events associated with having an alcoholic parent present a higher level of risk.

16. An unconscious patient is brought to the emergency department with a suspected heroin overdose. Which vital signs support the suspected diagnosis? a. Blood pressure (BP) 200/100 mm Hg; pulse (P) 92 beats/min; respirations (R) 22 breaths/min b. BP 150/85 mm Hg; P 76 beats/min; R 28 breaths/min c. BP 110/70 mm Hg; P 84 beats/min; R 20 breaths/min d. BP 70/40 mm Hg; P 100 beats/min; R 10 breaths/min

ANS: D Heroin is a CNS depressant. It causes respiratory depression and lowered BP, with a compensatory rise in the pulse rate. Only the correct option follows this pattern.

14. School nurses should be particularly vigilant for signs of eating disorders related to what timeline? a. Fourth-graders who have never attended another school. b. Rebellious, aggressive girls at any age. c. Pre and post holidays and prior to summer break. d. At transitions between elementary, middle, and high school.

ANS: D Junior high and high school students are at particular risk for eating disorders, based on our culture's emphasis on thinness and the adolescent's need for peer approval. Stress makes the adolescent more vulnerable. Times of particular stress are moving from one school to another—thus, the need for vigilance on the part of the school nurse. Risk is lower in the other options since stress is not generally associated with these characteristics.

5. During the rehabilitation phase of alcoholism treatment, naltrexone is prescribed. Which statement by the client demonstrates that the medication is achieving. It's intented goal to reduce the pleasurable effects of drinking alcohol. The nurse can expect to teach the patient about what medication? a. "I sleep much better than I have in years." b. "I get really sick if I drink now." c. "I'm not as nervous as I was." d. "I don't crave alcohol like I did."

ANS: D Naltrexone is an opioid receptor antagonist. It compromises the pleasurable effects of alcohol and reduces craving. Naltrexone does not affect sleep or anxiety nor is it an anxiolytic drug that makes drinking uncomfortable.

15. Family members of an individual undergoing a 30-day alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search-and-destroy tactics to keep the home alcohol free." c. "Prevent embarrassment by covering for your loved one's lapses." d. "Make your loved one responsible for the consequences of his or her behavior."

ANS: D Often the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors. Learning to face those consequences is part of the recovery process. The other options are co-dependent behaviors or are of no help.

1. Paraphilia is defined as involving what behavior? a. Engaging in homosexual sexual behaviors b. Having difficulty maintaining a sexual arousal c. Feeling discomfort with one's biological sexual gender d. Experiencing climax only when sexual behavior is illegal

ANS: D Paraphilias are conditions in which the sexual instinct is expressed in ways that are socially prohibited or unacceptable or are biologically undesirable. The distracters characterize other sexual behaviors.

15. The child most likely to receive risperidone to manage symptoms is one diagnosed with what mental health disorder? a. Attention-deficit hyperactivity disorder (ADHD) b. Posttraumatic stress disorder (PTSD) c. Anxiety d. Autism

ANS: D Risperidone is useful for relieving irritability and labile affect demonstrated by some autistic children. It is not indicated in any of the other disorders.

8. Which information about a patient diagnosed with bulimia nervosa should the nurse document as subjective data? a. Scarred fingers b. Sores around mouth c. Loss of tooth enamel d. Feeling out of control

ANS: D The distracters represent objective data, whereas the correct answer reflects feelings the patient has revealed.

8. The parent of an 8-year-old says, "My child is in constant motion, talking all the time but is out of bed every morning before I am and into trouble." This description supports which mental health diagnosis? a. Bipolar disorder (BPD) b. Disruptive mood dysregulation disorder (DMDD) c. Oppositional defiant disorder (ODD) d. Attention-deficit hyperactivity disorder (ADHD)

ANS: D The excessive motion, distractibility, and excessive talkativeness are seen in ADHD. The behaviors presented in the scenario do not suggest the other possible choices. oppositional defiant disorder (ODD) in children and adolescents is defined as a pattern of angry/irritable mood symptoms. Bipolar disorder (BPD) in children differs from the adult type in that irritability is a more prominent symptom, and there are often high rates of co-occurring attention problems and anxiety. The diagnosis of disruptive mood dysregulation disorder (DMDD) was established in DSM-5 to help account for youngsters who are very irritable or angry much of the day, nearly every day, and who have severe recurrent temper outbursts.

10. In the waiting room a 5-year-old child diagnosed with attention-deficit hyperactivity disorder (ADHD) bounces out of a chair, runs over to another child, and slaps the other child. What action implemented by the nurse would be most effective in therapeutically managing the situation? a. Direct the aggressive child to stop immediately. b. Call for emergency assistance from other staff. c. Instruct the parents to take the child home. d. Take the child to another waiting area.

ANS: D The nurse should manage the milieu with structure and limit-setting. Removing the aggressive child to another waiting area is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency situation. Intervention is needed rather than sending the child away.

10. Which finding indicates that a patient diagnosed with anorexia nervosa has met a major objective of psychotherapeutic management? a. The patient's residual volume is less than 30 mL before tube feedings. b. The patient says, "I am no longer fearful of gaining weight." c. The patient reads cookbooks and plans nutritious meals. d. The patient weighs 90% of average body weight.

ANS: D The three objectives are increasing self-esteem, increasing weight to 90% of average body weight, and re-establishing appropriate eating behavior. Reading cookbooks or planning nutritious meals may be evidence of manipulation. A low residual volume simply indicates that the patient is utilizing the feedings and there is no intestinal obstruction. Lack of fear does not translate to proper eating or an improved self-esteem.

2. A community health nurse visits an older adult whose spouse died 6 months ago and notes several vodka bottles are in the trash. The person says, "I get lonely and drink a little to help me forget." What is the nurse's most therapeutic intervention? a. Teach the person about alcoholism, and suggest other coping strategies. b. Request a mental health consultation to assess for alcohol dependency. c. Advise the person not to drink alone, because the risks for injury increase. d. Arrange for the person to attend an Alcoholics Anonymous (AA) meeting for older adults.

ANS: D This patient needs help with alcohol abuse as well as social involvement. The AA meeting for older adults will provide an opportunity for peer bonding and reminiscing as well as strategies for coping with stress without abusing alcohol. The other options are unnecessary or ineffective.

3. The nurse interviews a patient who restricts food and is 25% underweight. When the patient says, "I still need to lose weight. I'm not thin enough" which defense mechanism is being implemented? a. Rationalization b. Projection c. Splitting d. Denial

ANS: D When the individual with anorexia nervosa insists that being 25% underweight is not a problem (and thinking that she is too fat, when in fact she is emaciated), the defense mechanism responsible is denial. Rationalization involves making excuses, projection involves blaming others, and splitting involves the inability to integrate good and bad in one concept.

2. Which assessment findings support a nurse's suspicion that a patient has possibly been abusing inhalants? (Select all that apply.) a. Perforated nasal septum b. Hypertension c. Pinpoint pupils d. Confusion e. Ataxia

ANS: D, E Inhalants are usually CNS depressants, giving rise to confusion and ataxia. The other options relate to cocaine snorting and opioid use.

A psychiatric nursing assistant says, "I get annoyed with patients who self-mutilate over things other people would ignore. I think they just do it to get attention." What is the nurse's best response to take advantage of this teachable moment? a. "Many people feel the way you do. If you are unable to come to terms with the issue, we can transfer you." b. "Self-mutilation is a serious problem. Patients with this personality disorder may complete suicide." c. "We have to consider each case individually. Some are manipulative, and others are serious." d. "You seem to be having difficulty empathizing and remaining nonjudgmental."

B Every patient is entitled to respectful care. The nurse must respond by teaching the staff member that what they consider a minor problem is actually a major mental health problem. The nurse should identify the risk for completed suicide. The other options do not capitalize on this teaching opportunity.

A distinctive characteristic in a patient with antisocial personality disorder is manifested in which behavior? a. Expressing a high degree of guilt and remorse b. Showing no regret over stealing another's patient's ring c. Unwillingness to comply with prescribed antipsychotic therapy d. Requiring frequent reinforcement of personal self-worth

B Individuals with antisocial personality disorders have no concern for what is right or wrong or for the rights of others. They frequently violate others' rights and frequently break laws in their "me first" thinking. These individuals exhibit no guilt or remorse, show no improvement from antipsychotics, and walk all over anyone who is not able to set firm limits.

A person recently sustained a paper cut on a finger and called an ambulance. Later when discussing the incidence the person says, "I can't believe my supervisor denied my sick leave request." This behavior is most related to which mental health diagnosis? a. Dependent personality disorder b. Histrionic personality disorder c. Antisocial personality disorder d. Borderline personality disorder

B Individuals with histrionic personality disorder dramatize all events and draw attention to themselves. Patients might use somatic complaints to avoid responsibility and support dependency.

A nurse caring for a person diagnosed with schizoid personality disorder demonstrates an understanding of the disorder when making what statement? a. "I need to be alert for demonstrates of socially aggressive behavior." b. "The client will not engage in much conversation with either staff or with other clients." c. "Staff will need to be accepting of the client's odd personal behaviors." d. "I expect the client to be socially cold and standoffish."

B Individuals with schizoid personality disorder do not want to be involved in relationships. They are shy and introverted, speak little, and prefer fantasy and daydreaming to being involved with real people. The distracters characteristically apply to antisocial personality disorder, schizotypal personality disorder, and paranoid personality disorder.

Which statement made by a client demonstrates the characteristics associated with personality disorders? a. "My problem involves only my work relationships." b. "I follow rules regardless of the situation." c. "What people think of me is really important to me." d. "I can't concentrate when I'm around people who don't agree with me."

B Patients with personality disorders suffer lifelong inflexible and dysfunctional patterns of relating and behaving. The patient experiences subjective distress, usually based on others' reactions to him or her, and functioning is impaired. More than one aspect of personality is involved: personality disorders are described as pervasive. Behaviors are complex and difficult to manage.

Which patient behavior demonstrates the best outcome for a patient with schizotypal personality disorder? a. Adhering willingly to program norms b. Talking to a stranger in a social situation c. Reporting decreased incidence of impulses to self-mutilate d. Demonstrating fewer attempts at splitting or manipulating staff

B Schizotypal individuals have poor social skills. Social situations are uncomfortable for them. It is desirable for the individual to develop the ability to meet and socialize with others. Individuals with schizotypal personality disorder usually have no issues with adherence to unit norms, nor are they self-mutilating or manipulative.

A patient has had long-term conflicts with two siblings over their parents' wills. The patient reacts quickly with anger, suspicious that the siblings are plotting to take all the inheritance. These characteristics are most consistent with which personality disorder? a. Schizoid b. Paranoid c. Borderline d. Narcissistic

B The characteristics mentioned in the scenario fit the description of paranoid personality disorder. Schizoid personality is characterized by shyness, withdrawal, and poor social relationships. Borderline personality is characterized by problems with identity, self-image, mood, and impulsivity. Narcissistic personality is characterized by self-importance, grandiosity, and a sense of entitlement.

A clinic nurse encounters a new patient diagnosed with schizoid personality disorder. What is the best initial nursing intervention? a. Set firm limits. b. Engage in trust building. c. Involve the patient in group activities. d. Encourage identification of feelings.

B Trust building is essential to developing a nurse-patient relationship. Firm limit-setting is rarely necessary when working with a patient with schizoid personality disorder. Involvement in activities might be difficult at first, because the patient will be highly uncomfortable around people. The patient must trust the nurse before responding to encouragement to express feelings.

Which intervention demonstrates the nurse's understanding of the management of behaviors demonstrated by a patient diagnosed with borderline personality disorder? a. Scheduling the client for group grief counseling b. Arranging for short interactions with unit staff c. Frequent discussions concerning unit rules and expectations d. Helping the client de-escalate both verbal and physical anger

C Characteristic behaviors of individuals with borderline personality disorder include rapid mood shifts, impulsive acting out, and manipulation of others, as well as problems with identity, dependency, self-mutilation, and unstable, intense interpersonal relationships.

An adult has a history of intoxication and promiscuity. After stealing money from a grandparent, this person says, "I deserved that money. My family had no right to press charges against me." The scenario depicts features of which personality disorder? a. Histrionic b. Narcissistic c. Antisocial d. Borderline

C Individuals with antisocial personality disorder have no concern for what is right or wrong or for the rights of others. They frequently violate others' rights and frequently break laws in their "me first" thinking. These individuals exhibit no guilt or remorse. Narcissistic personality disorder is characterized by grandiosity and a sense of entitlement. Borderline personality disorder is characterized by identity disturbances, impulsivity, self-mutilation, and affective instability.

Which assessment data is commonly noted among clients diagnosed with avoidant personality disorders? a. Claims to enjoy risk-taking behaviors. b. Regularly acts impulsively. c. Displays evidence of poor self-confidence. d. Demonstrates helplessness as a means of manipulation.

C Individuals with avoidant personalities desire relationships but keep their anxiety at a low level by avoiding situations in which they might experience rejection. They are timid, uncertain, and often withdrawn. The other options describe behaviors that would not be seen in patients with avoidant personality disorder.

A patient diagnosed with borderline personality disorder has demonstrated self-mutilation and inappropriate expressions of anger. Which statement by the patient would the nurse evaluate as an improvement? a. "I think you are the nicest nurse on the unit." b. "I got drunk last night, but I won't ever do it again." c. "I felt like cutting myself, so I came to talk to you." d. "I hate my friends. They never help me when I need it."

C Ordinarily, the patient would impulsively engage in self-mutilation. When he or she is able to delay the action and seek the more adaptive coping strategy of talking with the nurse, the nurse can correctly evaluate the patient as showing improvement. The other responses suggest use of idealization, manipulation, impulsive behavior, and devaluation, all symptomatic of the disorder.

Which personality traits most likely describe a patient diagnosed with obsessive-compulsive personality disorder? a. Friendly; generous b. Dramatic; impulsive c. Perfectionist; inflexible d. Suspicious; submissive

C The individual with obsessive-compulsive personality disorder is perfectionist, rigid, preoccupied with rules and procedures, and afraid of making mistakes. The other options refer to behaviors or traits not usually associated with this personality disorder.

When contrasting schizophrenia and schizotypal personality disorder with other staff members, which statement made by the nurse demonstrates an understanding of the disorder? a. "In schizotypal personality disorder, the patient remains psychotic much longer." b. "The patient with schizophrenia has better social skills and is not usually overtly psychotic." c. "The person with schizotypal personality disorder may have cognitive distortions but not psychosis." d. "Schizotypal personality disorder is associated with more frequent and prolonged hospitalizations."

C The patient with schizotypal personality disorder might have problems thinking, perceiving, and communicating and might have an odd, eccentric appearance; however, overt psychotic symptoms are usually absent. The individual with schizophrenia is more likely to display psychotic symptoms, remain ill for longer periods, have poorer social skills, and have more frequent and prolonged hospitalizations.

The history of an individual diagnosed with borderline personality disorder often includes what assessment data? a. The loss of a parent at an early age b. A family history of bipolar disorder c. A dysfunctional, abusive childhood d. An overindulged childhood with few limits

C There is no clear-cut cause for borderline personality disorder. It is probably multifactorial. Environmental factors include childhood neglect and abuse. Biologic theories suggest neurotransmitter dysregulation. Object losses, family history of bipolar disorder, and overindulgence as a child have not been identified as causative factors.

Which nursing intervention is most likely to result in heightened self-awareness for a patient diagnosed with a personality disorder in the dramatic-erratic cluster? a. Setting firm limits on behavior b. Providing clear expectations for acceptable behavior c. Using confrontational approaches to reduce self-mutilation d. Encouraging the patient to keep a daily journal to be shared with the nurse

D Patients can be helped to understand themselves and their feelings by keeping a journal. Sharing the journal with the nurse fosters greater understanding and a sense of autonomy and responsibility. The other options do not heighten self-awareness.

Characteristic behaviors a nurse would expect when working with a patient diagnosed with narcissistic personality disorder are: a. preoccupied with details; perfectionism. b. socially isolated; odd, eccentric behavior. c. dramatic expression; easily influenced by others. d. grandiosity; sense of entitlement; lack of empathy.

D The individual with narcissistic personality disorder displays grandiosity about self-importance and achievements, does not empathize or understand the feelings of others, exhibits a sense of entitlement, and expects special treatment. The other options reflect characteristics of histrionic personality disorder, obsessive-compulsive personality disorder, and schizotypal personality disorder.

12. A nurse assesses a 3-year-old child diagnosed with autism spectrum disorder (ASD). Which finding is most associated with the child's disorder? a. Cries when frustrated. b. Inability to identify colors. c. Shows no interest in playing with other children. d. Anxiety when separated from a parent.

NS: C Autistic disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers nearly always mention the child's failure to develop interpersonal skills. The distracters are expected behaviors for a 3-year-old child.