Psych Exam 4

33. A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves and crying, "The germs in here are going to kill me." Which nursing diagnosis addresses this client's problem? 1. Social isolation R / T fear of germs AEB continually refusing to leave the home. 2.Fear of germs R/T obsessive-compulsive disorder, resulting in dysfunctional isolation. 3. Ineffective coping AEB dysfunctional isolation R / T unrealistic fear of germs. 4. Anxiety R / T the inability to leave home, resulting in dysfunctional fear of germs.

1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must contain three essential components: (1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) description of a cluster of signs and symptoms known as "defining characteristics." The correct answer, "1," contains all three components in the correct order: health problem/NANDA stem (social isolation); etiology/cause, or R / T (fear of germs); and signs and symptoms, or AEB (refusing to leave home for the past year). Because this client has been unable to leave home for a year as a result of fear of germs, the client's behaviors meet the defining characteristics of social isolation.

17. A newly admitted client is diagnosed with hypochondriasis. Which short-term outcome is appropriate? 1. The client will rate anxiety as 3/10 by discharge. 2. The client will recognize a link between anxiety and somatic symptoms by day 2. 3. The client will participate in group therapy activities by discharge. 4. The client will recognize behaviors that generate secondary gains by day 2.

1. Anxiety is experienced by a client diagnosed with hypochondriasis because of an unfounded fear of contracting disease. Expecting the client to rate anxiety as 3/10 is an appropriate short-term outcome for clients diagnosed with this dis- order.

35. A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive- compulsive disorder. Which correctly stated nursing diagnosis takes priority? 1. Anxiety R / T obsessive thoughts AEB ritualistic behaviors. 2. Powerlessness R / T ritualistic behaviors AEB statements of lack of control. 3. Fear R / T a traumatic event AEB stimulus avoidance. 4. Social isolation R / T increased levels of anxiety AEB not attending groups.

1. Anxiety is the underlying cause of the diagnosis of obsessive compulsive disorder (OCD), therefore, anxiety R/T obsessive thoughts is the priority nursing diagnosis for the client newly admitted for the treatment of this disorder.

1. Which statement describes the etiology of hypochondriasis from a psychodynamic theory perspective? 1. The client expresses physical complaints, which are less threatening than facing underlying feelings of poor self-esteem. 2. Emotions associated with traumatic events are viewed as morally or ethically unacceptable and are transferred into physical symptoms. 3. The client's family has difficulty expressing emotions openly and resolving conflicts verbally; this is dealt with by focusing on the ill family member. 4. The deficiency of endorphins seems to correlate with an increase of incoming sensory stimuli.

1. Because clients diagnosed with hypochondriasis are less threatened by physical complaints than poor self-esteem, they tend to use somatic symptoms as ego defenses. This describes the etiology of hypochondriasis from a psychodynamic theory perspective.

5. A client admitted with dissociative fugue is being evaluated. Which assessment information would indicate that the client is ready for discharge? 1. The client is able to maintain reality during stressful situations. 2. The client is able to verbalize why the personalities exist. 3. The client is able to discuss feelings such as depersonalization. 4. The client is able to integrate subpersonalities into a whole personality.

1. Because stress is the underlying cause of dissociative fugue, the client's ability to maintain reality during stressful situations would indicate that the client meets dis- charge criteria.

29. In which situation is buspirone (BuSpar) used appropriately? 1. Long-term treatment of clients diagnosed with hypochondriasis. 2. Long-term treatment of clients diagnosed with dementia. 3. Short-term treatment of clients diagnosed with a conversion disorder. 4. Short-term treatment of clients diagnosed with a somatization pain disorder.

1. Buspirone (BuSpar) may be used in the long-term treatment of clients diagnosed with hypochondriasis.

15. Which of the following situations is a common reason for the elderly to experience sleep disturbances? Select all that apply. 1. Discomfort or pain or both. 2. Dementia. 3. Inactivity. 4. Anxiety. 5. Medications.

1. Chronic conditions, such as arthritis and joint and muscle discomfort and pain, represent some of the many reasons why elderly clients are at an increased risk for sleep disturbances. 2. Confusion and wandering as a result of dementia can be a reason why elderly clients are at an increased risk for sleep disturbances. 3. Inactivity and other psychosocial concerns, such as loneliness or boredom, can be a reason why elderly clients are at an increased risk for sleep disturbances. 4. Increased anxiety is a reason why elderly clients can be at an increased risk for sleep disturbances. 5. Medications have many side effects, including insomnia, and medications are metabolized differently in elderly clients. Many elderly clients, because of chronic conditions, experience polypharmacy, and so they are at higher risk for sleep disturbances.

56. Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply. 1. Clonidine hydrochloride (Catapres). 2. Fluvoxamine maleate (Luvox). 3. Buspirone (BuSpar). 4. Alprazolam (Xanax). 5. Haloperidol (Haldol).

1. Clonidine hydrochloride (Catapres) is used in the treatment of panic disorders and generalized anxiety disorder. 2. Fluvoxamine maleate (Luvox) is used in the treatment of obsessive-compulsive disorder. 3. Buspirone (BuSpar) is used in the treatment of panic disorders and generalized anxiety disorders. 4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxiety disorders.

47. A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority? 1. Maintain and reassure the client of his or her safety and security. 2. Encourage the client to express feelings. 3. Decrease extraneous external stimuli. 4. Use a nonjudgmental and matter-of-fact approach.

1. During a flashback, the client is experiencing severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or her safety and security. The client's anxiety needs to decrease before other interventions are attempted.

46. A client experiencing sleepwalking is newly admitted to an in-patient psychiatric unit. Which nursing intervention would take priority? 1. Equip the bed with an alarm that is activated when the bed is exited. 2. Discourage strenuous exercise within 1 hour of bedtime. 3. Limit caffeine-containing substances within 4 hours of bedtime. 4. Encourage activities that prepare one for sleep, such as soft music.

1. Equipping the bed with an alarm that activates when the bed is exited is a priority nursing intervention. During a sleepwalking episode, the client is at increased risk for injury, and interventions must address safety.

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

1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a timeframe.

45. A 10-year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply. 1. Involving the family in therapy to decrease stress within the family. 2. Using phototherapy to assist the client to adapt to changes in sleep. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both. 4. Giving central nervous system stimulants, such as amphetamines. 5. Using relaxation therapy, such as meditation and deep breathing techniques, to assist the client in falling asleep.

1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to assist in falling back to sleep after the nightmare occurs.

25. A client has been diagnosed with an exacerbation of tension headaches. Which behavioral intervention would assist the client during active symptoms? 1. Help the client to decrease stress by teaching assertiveness skills. 2. Help the client to acknowledge and address the source of anger. 3. Administer medications, such as propranolol (Inderal). 4. Discuss how personality type may affect exacerbations of tension headaches.

1. Helping the client to decrease stress by teaching assertiveness skills is an example of a behavioral approach. The ability to assert self can lead to decreased anxiety and a decrease in stress-related illnesses.

4. A client is suspected to be experiencing a conversion disorder. Which of the following would the nurse expect to assess? Select all that apply. 1. Deep tendon reflexes intact. 2. Muscle wasting. 3. The client is unaware of the link between anxiety and physical symptoms. 4. Physical symptoms are explained by a physiological cause. 5. A lack of concern toward the alteration in function.

1. Individuals diagnosed with conversion disorder would have intact deep tendon reflexes, whereas an individual with an actual impairment would not have intact deep tendon reflexes. 3. Individuals diagnosed with conversion disorders are unaware of the link between anxiety and physical symptoms. 5. Individuals diagnosed with conversion disorders exhibit lack of concern for functional alterations. This condition is referred to as "la belle indifference." Clients with an actual impairment would exhibit considerable concern regarding any alteration in function.

9. Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessive- compulsive disorder? 1. Ineffective coping R / T punitive superego. 2. Ineffective coping R / T active avoidance. 3. Ineffective coping R / T alteration in serotonin. 4. Ineffective coping R / T classic conditioning.

1. Ineffective coping R/T punitive superego reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder (OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development.

38. A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diag- nosis of ineffective coping R/T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem? 1. The client will recognize triggers that precipitate alcohol abuse by day 2. 2. The client will attend follow-up weekly therapy sessions after discharge. 3. The client will refrain from self-blame regarding the rape by day 2. 4. The client will be free from injury to self throughout the shift.

1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome should be developed mutually early in treatment.

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

1. It is important to empathize with individuals diagnosed with somatization pain dis- order; however, it is equally important to limit discussion of symptoms to avoid reinforcement and secondary gain. By telling the client that the nurse and client can discuss the client's complaints briefly at a future time, the nurse empathizes with the client and limits the client's monopolization of group.

16. A client has been diagnosed with insomnia. Which of the following data would the nurse expect to assess? Select all that apply. 1. Daytime irritability. 2. Problems with attention and concentration. 3. Inappropriate use of substances. 4. Nightmares. 5. Sleepwalking.

1. Lack of sleep results in daytime irritability. 2. Lack of sleep results in problems with attention and concentration. 3. Individuals diagnosed with insomnia may inappropriately use substances, including hypnotics for sleep and stimulants to counteract fatigue

5. A client is diagnosed with hypochondriasis. Which of the following assessment data validate this diagnosis? Select all that apply. 1. Preoccupation with disease processes and organ function. 2. Long history of "doctor shopping." 3. Physical symptoms are managed by using the defense mechanism of denial. 4. Depression and obsessive-compulsive traits are common. 5. Social and occupational functioning may be impaired.

1. Preoccupation with disease processes and organ function is common when a client is diagnosed with hypochondriasis. The nurse can differentiate hypochondriasis from somatization disorder because in somatization disorder the complaints are general in nature and cannot be connect- ed to specific disease processes or body systems. 2. A long history of "doctor shopping" is common when a client is diagnosed with hypochondriasis. Doctor shopping occurs because the client with hypochondriasis is convinced that there is a physiological problem and continues to seek assistance for this problem even after confirmation that no actual physiological illness exists. 4. Anxiety and depression are common, and obsessive-compulsive traits frequently are associated with hypochondriasis. 5. Clients diagnosed with hypochondriasis are convinced, and will insist, that their symptoms are related to organic pathology or loss of function. This impairs social and occupational functioning.

41. When a client experiences a panic attack, which outcome takes priority? 1. The client will remain safe throughout the duration of the panic attack. 2. The client will verbalize an anxiety level less than 2/10. 3. The client will use learned coping mechanisms to decrease anxiety. 4. The client will verbalize the positive effects of exercise by day 2.

1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client.

7. Which of the following diagnoses can be classified as psychophysiological disorders? Select all that apply. 1. Cancer. 2. Asthma. 3. Coronary artery disease. 4. Upper respiratory tract infection. 5. Sepsis.

1. Research shows that certain personality types (type C personality) are associated with the development of cancer. These clients tend to suppress versus express anxiety. Cancer can be classified as a psychophysiological disorder. 2. Research shows that individuals diagnosed with asthma are characterized as having excessive dependency needs, although no specific personality type has been identified. These individuals share the personality characteristics of fear, emotional lability, increased anxiety, and depression. Asthma can be considered a psychophysiological disorder. 3. Research shows that certain personality types (type A personality) are associated with the development of coronary artery disease. These clients tend to have an excessive competitive drive and a chronic continual sense of time urgency. Coronary artery disease can be classified as an psychophysiological disorder.

12. A client diagnosed with somatization disorder visits multiple physicians because of various, vague symptoms involving many body systems. Which nursing diagnosis takes priority? 1. Risk for injury R / T treatment from multiple physicians. 2. Anxiety R / T unexplained multiple somatic symptoms. 3. Ineffective coping R / T psychosocial distress. 4. Fear R / T multiple physiological complaints.

1. Risk for injury is increased when multiple physicians treat clients without fully understanding other physician treatment plans. It is common for a client diagnosed with somatization disorder to have the potential for dangerous combinations of medications or treatments or both.

8. Which client situation supports a potential diagnosis of a dissociative fugue? 1. A client enters the emergency department in New York City without understanding who he or she is or how he or she got there. 2. A client known as being shy and passive comes into the emergency department angry and demanding. 3. A client brought to the emergency department after a car accident is unable to recall his or her address or phone number. 4. A client seen in the emergency department complains of feeling detached from the current situation.

1. The characteristic feature of dissociative fugue is the inability to recall some or all of one's past. This is usually precipitated by severe, psychosocial stress. A situation in which a client has no idea who he or she is or how he or she arrived is an example of symptoms experienced during dissociative fugue.

44. A client diagnosed with generalized anxiety disorder has a nursing diagnosis of panic anxiety R/T altered perceptions. Which of the following short-term outcomes is most appropriate for this client? 1. The client will be able to intervene before reaching panic levels of anxiety by discharge. 2. The client will verbalize decreased levels of anxiety by day 2. 3. The client will take control of life situations by using problem-solving methods effectively. 4. The client will voluntarily participate in group therapy activities by discharge.

1. The client's being able to intervene before reaching panic levels of anxiety by dis- charge is measurable, relates to the stated nursing diagnosis, has a timeframe, and is an appropriate short-term outcome for this client.

16. A client diagnosed with a conversion disorder has a nursing diagnosis of disturbed sen- sory perception R/T anxiety AEB paralysis. Which short-term outcome would be appropriate for this client? 1. The client will demonstrate recovery of lost function by discharge. 2. The client will use one effective coping mechanism to decrease anxiety by day 3. 3. The client will express feelings of fear about paralysis by day 1. 4. The client will acknowledge underlying anxiety by day 4.

1. The client's demonstrating recovery of lost function by discharge is an appropriate short-term outcome for the stated nursing diagnosis of disturbed sensory perception. The outcome is client-specific, realistic, related to the stated nursing diagnosis, and measurable, and has a time- frame. When the nurse is dealing with a client diagnosed with a conversion disorder, the problem resolves itself as the client's anxiety decreases. It is realistic to expect this client to experience a significant decrease in anxiety by discharge and subsequent recovery of lost function.

51. A client diagnosed with generalized anxiety disorder complains of feeling out of control and states, "I just can't do this anymore." Which nursing action takes priority at this time? 1. Ask the client, "Are you thinking about harming yourself?" 2. Remove all potentially harmful objects from the milieu. 3. Place the client on a one-to-one observation status. 4. Encourage the client to verbalize feelings during the next group.

1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations.

7. A client who is self-identified as homosexual is discussing sexual orientation. Which client statement is true as it relates to this concept? 1. "The psychiatric community does not consider consensual homosexuality to be a mental disturbance." 2. "Homosexuality is described on Axis I of the DSM-IV-TR." 3. "Homosexuality is considered deviant behavior, and I will need therapeutic counseling." 4. "Altered levels of testosterone affect the diagnosis of homosexuality and must be corrected to deal with the symptoms of this disorder."

1. The psychiatric community does not consider consensual homosexuality to be a mental disturbance. The concept of homosexuality as a disturbance in sexual orientation no longer appears in the DSM. Instead, the DSM-IV-TR is concerned only with the individual who experiences "persistent and marked distress about his or her sexual orientation."

55. The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which statement by the client would indicate that the intervention has been successful? 1. "I reminded myself that the panic attack would end soon, and it helped." 2. "I paced the halls until I felt my anxiety was under control." 3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it." 4. "Thank you for staying with me. It helped to know staff was there."

1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention.

25. A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive- compulsive disorder. Which behavioral symptom would the nurse expect to assess? 1. The client uses excessive hand washing to relieve anxiety. 2. The client rates anxiety at 8/10. 3. The client uses breathing techniques to decrease anxiety. 4. The client exhibits diaphoresis and tachycardia.

1. Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with obsessive- compulsive disorder (OCD).

31. A client diagnosed with hypersomnia states, "I can't even function anymore; I feel worthless." Which nursing diagnosis would take priority? 1. Risk for suicide R / T expressions of hopelessness. 2. Social isolation R / T sleepiness AEB, "I can't function." 3. Self-care deficit R / T increased need for sleep AEB being unable to take a bath without assistance. 4. Chronic low self-esteem R / T inability to function AEB the statement, "I feel worth- less."

1. Verbalizations of worthlessness may indicate that this client is experiencing suicidal ideations. After assessing suicide risk further, the risk for suicide should be prioritized.

50. The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessive- compulsive disorder? Select all that apply. 1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 3. With the client's input, set limits on ritualistic behaviors. 4. Present the reality of the impact the compulsions have on the client's life. 5. Discuss client feelings surrounding the obsessions and compulsions.

1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. 2. Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are limited, anxiety levels increase. If the client had been hospitalized for a while, then, with the client's input, limits would be set on the compulsive behaviors. 5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission.

13. Which charting entry documents a subjective assessment of sleep patterns? 1. "Reports satisfaction with the quality of sleep since admission." 2. "Slept 8 hours during night shift." 3. "Rates quality of sleep as 3/10." 4. "Woke up three times during the night."

1. When the client reports satisfaction with the quality of sleep, the client is providing subjective assessment data. Good sleepers self-define themselves as getting enough sleep and feeling rested. These individuals feel refreshed in the morning, have energy for daily activities, fall asleep quickly, and rarely awaken during the night.

3. A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? 1. "I understand that the event I experienced, how I deal with it, and my support system all affect my disease process." 2. "I have learned to avoid stressful situations as a way to decrease emotional pain." 3. "So, natural opioid release during the trauma caused my body to become 'addicted.'" 4. "Because of the trauma, I have a negative perception of the world and feel hopeless."

1. When the client verbalizes understanding of how the experienced event, individual traits, and available support systems affect his or her diagnosis, the client demonstrates a good understanding of the psychosocial cause of posttraumatic stress disorder (PTSD).

24. Which of the following interventions should the nurse include when caring for a client experiencing migraine headaches? Select all that apply. 1. Monitor pain level using a pain scale. 2. Explore with the client how stress may trigger this disorder. 3. Encourage the client to document patterns of exacerbation triggers by journaling. 4. Assess for suicidal ideations. 5. Administer divalproex sodium (Depakote) as prescribed.

1. When working with a client diagnosed with migraine headaches, the nurse should include an assessment of pain by using a pain scale. A pain scale objectifies the subjective symptom of pain and assists the nurse in the evaluation of this symptom. 2. When working with a client diagnosed with migraine headaches, the nurse should explore with the client how stress may trigger this disorder. This awareness may encourage the client to avoid stressful situations and use stress-reducing techniques. 3. Encouraging the client to keep a journal documenting patterns of exacerbation triggers assists the client in recognizing the effects that stressful stimuli have on the incidence of migraine headaches. 5. When working with a client diagnosed with migraine headaches, administering divalproex sodium (Depakote), as prescribed, would be an appropriate intervention. Divalproex sodium (Depakote) is a vascular headache suppressant. Other preventive medications include propranolol, amitriptyline, fluoxetine, verapamil, and venlafaxine.

59. A client diagnosed with generalized anxiety disorder is prescribed paroxetine (Paxil) 30 mg QHS. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.

1.5 tablets -X tab/ 30mg = 1tab/20mg 20x = 30 x = 1.5 tabs

27. Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. 1. Chronic obstructive pulmonary disease. 2. Hyperthyroidism. 3. Hypertension. 4. Diverticulosis. 5. Hypoglycemia.

1.Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. 2. Hyperthyroidism (Graves's disease) involves excess stimulation of the sympathetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia.

60. A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maxi- mum daily dose of lorazepam should not exceed 4 mg QD. This client would be able to receive ______ PRN doses as the maximum number of PRN lorazepam doses.

2 -This client should receive 2 PRN doses. The test taker must recognize that medications are given three times in a 24-hour period when the order reads q8h: 1mg X 3 = 3 mg. The test takermust factor in the 0.5 mg qid = 2 mg. These two dosages together add up to 5 mg, 1 mg above the maximum daily dose of lorazepam (Ativan). The client would be able to receive only two of the three PRN doses of lorazepam.

22. Which of the following assessment data would support the disorder of acrophobia? 1. A client is fearful of basements because of encountering spiders. 2. A client refuses to go to Europe because of fear of flying. 3. A client is unable to commit to marriage after a 10-year engagement. 4. A client refuses to leave home during stormy weather.

2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to fly because of this fear.

48. A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? 1. Elopement precautions. 2. Suicide precautions. 3. Homicide precautions. 4. Fall precautions.

2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions.

20. When treating individuals with posttraumatic stress disorder, which variables are included in the recovery environment? 1. Degree of ego strength. 2. Availability of social supports. 3. Severity and duration of the stressor. 4. Amount of control over reoccurrence.

2. Availability of social supports is part of environmental variables. Others include cohesiveness and protectiveness of family and friends, attitudes of society regarding the experience, and cultural and subcultural influences.

2. Which statement describes the etiology of somatization pain disorder from a biochemical theory perspective? 1. Unexpressed emotions are translated into symptoms of pain. 2. A deficiency of endorphins affects incoming sensory stimuli. 3. There is an increased incidence of this disorder in first-degree relatives. 4. Harmony around the illness replaces discord within the family.

2. Decreased levels of serotonin and endorphins may play a role in the etiology of somatization pain disorder. This explains the etiology of somatization pain disorder from a biochemical theory perspective.

10. The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which intervention would be appropriate? 1. Encourage the client to attend a survivor's group. 2. Encourage expression of feelings during one-to-one interactions with the nurse. 3. Ask the client to challenge the irrational beliefs associated with the event. 4. Administer regularly scheduled paroxetine (Paxil) to deal with depressive symptoms.

2. Encouraging expressions of feelings during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD.

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

2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD.

4. Which would the nurse expect to assess in a client diagnosed with fetishism? 1. History of exposing genitalia to strangers. 2. History of sexually arousing fantasies involving nonliving objects. 3. History of urges to touch and rub against nonconsenting individuals. 4. History of fantasies involving the act of being humiliated, beaten, or bound.

2. Fetishism involves recurrent, intense, sexual urges or behaviors, of at least 6 months in duration, involving the use of nonliving objects. The sexual focus is commonly on objects intimately associated with the human body (e.g., shoes, gloves, or stockings).

18. A client diagnosed with somatization pain disorder has a nursing diagnosis of ineffec- tive coping R / T repressed anxiety. Which is an appropriate outcome for this client? 1. The client will verbalize a pain rating of 0/10 by the end of the day. 2. The client will substitute one effective coping strategy for one physical complaint by discharge. 3. The client will express a realistic perception of the client's distorted self-image by discharge. 4. The client will rate anxiety as less than 3/10.

2. If the client is able to use coping strategies instead of resorting to physical complaints, the client has learned to cope effectively with anxiety. This is a positive outcome related to the nursing diagnosis of ineffective coping R / T repressed anxiety.

14. Which nursing diagnosis takes priority when a client experiences an acute asthma attack precipitated by the death of the client's father? 1. Anxiety R / T loss AEB increased respirations. 2. Impaired gas exchange R / T stress AEB decreased O2 saturation levels. 3. Risk for suicide R / T grief. 4. Ineffective coping R / T grief AEB psychosomatic complaints.

2. Impaired gas exchange is the priority diagnosis for this client. Meeting the client's oxygen need is critical to maintaining viability. This life-threatening situation needs to be resolved before meeting any other client need.

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

2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4.

52. During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? 1. Teach the client relaxation techniques. 2. Ask the client, "Do you have a plan to commit suicide?" 3. Call the physician to obtain a PRN order for an anxiolytic medication. 4. Encourage the client to participate in group activities.

2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher risk than clients who may have vague suicidal thoughts.

58. Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg TID? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine need for additional buspirone (BuSpar) PRN. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working.

6. A client is diagnosed with male orgasmic disorder. Which assessed behavior supports this diagnosis? 1. Inability to maintain an erection. 2. A delay in or absence of ejaculation following normal sexual excitement. 3. Premature ejaculation. 4. Dyspareunia.

2. Male orgasmic disorder is characterized by persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity, which the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.

9. A 65-year-old woman with a history of prostitution is seen in the emergency department experiencing a recent onset of auditory hallucinations and bizarre behaviors. Which diagnosis would the nurse expect to document? 1. Schizophrenia. 2. Tertiary syphilis. 3. Gonorrhea. 4. Schizotypal personality disorder.

2. One of the symptoms of the tertiary stage of syphilis is insanity. The client's symptoms of auditory hallucinations and bizarre behaviors would be reflective of this diagnosis. Although there can be other reasons for these symptoms, the client's history of prostitution and recent onset of symptoms would warrant investigation into the possible diagnosis of tertiary syphilis.

3. Which statement describes the etiology of somatization disorder from a learning theory perspective? 1. Studies have shown that there is an increase in the predisposition of somatization disorder in first-degree relatives. 2. Positive reinforcement of somatic symptoms encourages behaviors to continue. 3. A client views self as "bad," and considers physical suffering as deserved and required for atonement. 4. The use of physical symptoms is a response to repressed severe anxiety.

2. Positive reinforcement of somatic com- plaints virtually guarantees the repetition of these learned behaviors. This describes the etiology of somatization disorder from a learning theory perspective.

2. An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the ___________________ theory of generalized anxiety disorder development.

2. Psychodynamic -An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the psychodynamic theory of generalized anxiety disorder development.

2. A frightened client diagnosed with dissociative fugue tells the nurse, "I don't know where I am or how I got here. What is wrong with me?" Which nursing response reflects a neurobiological perspective? 1. "You appear to have repressed distressing feelings from your conscious awareness." 2. "Sometimes these symptoms are found in individuals with temporal lobe epilepsy or severe migraine headaches." 3. "When individuals have experienced some sort of trauma, the primary self needs to escape from reality." 4. "It has been found that these symptoms are seen more often when first-degree relatives have similar symptoms."

2. Some clinicians have suggested a possible correlation between neurological alterations and dissociative disorders. This nurse's response relates the relationship between temporal lobe epilepsy or severe migraine headaches or both to the diagnosis of dissociative fugue and is from a neurobiological perspective.

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

2. Sweating and palpitations are physical symptoms of a panic attack.

13. A client is experiencing a high level of occupational stress and has a history of migraine headaches. Which nursing diagnosis takes priority? 1. Pain. 2. Anxiety. 3. Activity intolerance. 4. Ineffective role performance.

2. The client in the question currently is experiencing anxiety as a result of high levels of occupational stress. Anxiety is a priority nursing diagnosis and if not addressed may lead to a migraine headache episode.

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

2. The outcome of verbalizing alternate ways of dealing with stress would apply to the nursing diagnosis of ineffective coping R/T overwhelming anxiety.

39. Which client would the charge nurse assign to an agency nurse who is new to a psychiatric setting? 1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks. 2. A newly admitted client diagnosed with generalized anxiety disorder beginning benzodiazepines for the first time. 3. A client admitted 4 days ago with the diagnosis of algophobia. 4. A newly admitted client with obsessive-compulsive disorder.

3. A client admitted 4 days ago with a diag- nosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a

42. The nurse has received evening report. Which client would the nurse need to assess first? 1. A newly admitted client with a history of panic attacks. 2. A client who slept 2 to 3 hours last night because of flashbacks. 3. A client pacing the halls and stating that his anxiety is an 8/10. 4. A client diagnosed with generalized anxiety disorder awaiting discharge.

3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others.

17. What is the most common form of breathing-related sleep disorders? 1. Parasomnia. 2. Hypersomnia. 3. Apnea. 4. Cataplexia.

3. Apnea refers to the cessation of breathing during sleep. To be so classified, the apnea must last for at least 10 seconds and occur 30 or more times during a 7-hour period of sleep. Apnea is classified as a breathing-related sleep disorder.

11. A client diagnosed with hypochondriasis states, "I have so many symptoms, and yet no one can find out what is wrong with me. I can't do this anymore." Which nursing diagnosis would take priority? 1. Altered role performance R / T multiple hospitalizations. 2. Knowledge deficit R / T the link between anxiety and expressed symptoms. 3. Risk for suicide R / T client statement, "I can't do this anymore." 4. Self-care deficit R / T client statement, "I can't do this anymore."

3. Because depression is common in individuals diagnosed with hypochondriasis, the client statement, "I can't do this anymore," alerts the nurse to the possibility of suicidal ideations. This nursing diagnosis would take priority.

21. A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? 1. Recurrent, distressing flashbacks. 2. Intense fear, helplessness, and horror. 3. Diminished participation in significant activities. 4. Detachment or estrangement from others.

3. Diminished participation in significant activities is a behavioral symptom of PTSD.

18. Which would the nurse expect to assess in a client suspected to have sleep terror disorder? 1. The client, on awakening, is able to explain the nightmare in vivid detail. 2. The client is easily awakened after the night terror. 3. The client experiences an abrupt arousal from sleep with a piercing scream or cry. 4. The client, when awakening during the night terror, is alert and oriented.

3. During a sleep terror, the client does experience an abrupt arousal from sleep with a piercing scream or cry.

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

3. Encouraging discussion about fears is an intrapersonal intervention.

28. Which assessment data would support a physician's diagnosis of an anxiety disorder in a client? 1. A client experiences severe levels of anxiety in one area of functioning. 2. A client experiences an increased level of anxiety in one area of functioning for a 6-month period. 3. A client experiences increased levels of anxiety that affect functioning in more than one area of life over a 6-month period. 4. A client experiences increased levels of anxiety that affect functioning in at least three areas of life.

3. For a client to be diagnosed with an anxiety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symptoms must be experienced for durations of 6 months or longer.

30. A client diagnosed with hypochondriasis is prescribed clonazepam (Klonopin) for underlying anxiety. Which teaching should be included in this client's plan of care? 1. Monitor blood pressure and pulse. 2. Administer the medication to the client at night to avoid daytime sedation. 3. Encourage the client to avoid drinking alcohol while taking the medication. 4. Remind the client to wear sunscreen to address photosensitivity.

3. It is important to teach the client to avoid drinking alcohol while taking clonazepam (Klonopin). Clonazepam and alcohol are central nervous system depressants and taken together produce an additive central nervous system depressant effect, placing the client at risk for injury. Because of the risk for injury, this intervention is prioritized.

26. A client with a history of generalized anxiety disorder enters the emergency depart- ment complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct? 1. The client is exhibiting signs and symptoms of an exacerbation of generalized anxiety disorder. 2. The client's signs and symptoms are due to an underlying medical condition. 3. A physical examination is needed to determine the etiology of the client's problem. 4. The client's anxiolytic dosage needs to be increased.

3. Physical problems should be ruled out before determining a psychological cause for this client's symptoms.

34. A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority? 1. Ineffective breathing patterns R / T hyperventilation. 2. Impaired spontaneous ventilation R / T panic levels of anxiety. 3. Social isolation R / T fear of spontaneous panic attacks. 4. Knowledge deficit R / T triggers for panic attacks.

3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses antic- ipatory fear of unexpected attacks, which affects the client's ability to interact with others.

37. A client has a nursing diagnosis of disturbed sleep patterns R / T increased anxiety AEB inability to fall asleep. Which short-term outcome is appropriate for this client? 1. The client will use one coping skill before bedtime to assist in falling asleep. 2. The client will sleep 6 to 8 hours a night and report a feeling of being rested. 3. The client will ask for prescribed PRN medication to assist with falling asleep by day 2. 4. The client will verbalize his or her level of anxiety as less than a 3/10.

3. The client's being able to ask for prescribed PRN medication to assist with falling asleep by day 2 is a short-term out- come that is specific, has a timeframe, and relates to the stated nursing diagnosis.

53. A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of disturbed sleep patterns R / T nightmares. Which evaluation would indicate that the stat- ed nursing diagnosis was resolved? 1. The client expresses feelings about the nightmares during group. 2. The client asks for PRN trazodone (Desyrel) before bed to fall asleep. 3. The client states that the client feels rested when awakening and denies nightmares. 4. The client avoids napping during the day to help enhance sleep.

3. The client's feeling rested on awakening and denying nightmares are the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns R/T nightmares has been resolved.

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

3. The nurse discussing the overuse of ego defense mechanisms illustrates a psycho- dynamic approach to address the client's behaviors related to panic disorder.

22. A client who complains of vague weakness and multisystem symptoms has been diagnosed with a somatoform disorder. Which nursing intervention takes priority? 1. Discuss the client's symptoms to provide secondary gains. 2. Discuss the stressor that the client is experiencing. 3. Monitor signs and symptoms, vital signs, and lab tests. 4. Teach the client appropriate coping mechanisms to deal with stress.

3. The nurse first must rule out signs and symptoms of an actual physical condition before assuming that the disorder is somatoform in nature. Monitoring signs and symptoms, vital signs, and lab tests can rule out a physiological problem.

10. A client fearful of an upcoming deployment to Iraq develops a paralytic conversion disorder. Which nursing diagnosis takes priority? 1. Impaired skin integrity R / T muscle wasting. 2. Body image disturbance R / T immobility. 3. Anxiety R / T fears about a combat injury. 4. Activity intolerance R / T paralysis.

3. The underlying cause of a conversion disorder is anxiety. In this case, the paralytic condition is caused by anxiety related to the risk of possible combat injury. Anxiety must be prioritized over all other nursing diagnoses.

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

3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation.

57. A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h PRN for agitation. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ PRN doses of alprazolam within a 24-hour period.

4 -The client can receive 4 PRN doses. Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg 4 6 mg. The test taker must factor in 2 mg bid 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alprazolam (Xanax), and so the client can receive all 4 PRN doses.

54. The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful? 1. The client eliminates anxiety by using the breathing technique. 2. The client performs activities of daily living independently by discharge. 3. The client recognizes signs and symptoms of escalating anxiety. 4. The client maintains a 3/10 anxiety level without medications.

4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce anxiety.

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

4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia.

14. Which is important when assessing an individual for a sleep disturbance? 1. Limit caffeine intake in the evening hours. 2. Teach the importance of a bedtime routine. 3. Keep the client's door locked during the day to avoid napping. 4. Check the chart to note the client's baseline sleeping habits per night.

4. An important nursing assessment for a client experiencing a sleep disturbance is to note the client's baseline sleep patterns. These data allow the nurse to recognize alterations in normal patterns of sleep and to intervene appropriately.

28. In which situation is lorazepam (Ativan) used appropriately? 1. Long-term treatment of clients diagnosed with a conversion disorder caused by anxiety. 2. Long-term treatment of clients diagnosed with hypochondriasis. 3. Short-term treatment of clients diagnosed with hypertension caused by atherosclerosis. 4. Short-term treatment of clients diagnosed with body dysmorphic disorder.

4. Because anxiety is the underlying cause of body dysmorphic disorder, lorazepam (Ativan) may be used for short-term treatment of clients diagnosed with this disorder.

36. During an assessment, a client diagnosed with generalized anxiety disorder rates anxi- ety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R / T anxiety AEB client's stating, "Nothing ever seems to work out." 2. Ineffective coping R / T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R / T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R / T expressing thoughts of suicide.

4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems.

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

4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome.

20. A client diagnosed with hypochondriasis complains to the nurse about others' doubting the seriousness of the client's disease. The client is angry, frustrated, and anxious. Which nursing intervention takes priority? 1. Remind the client that lab tests showed no evidence of physiological problems. 2. Document client's unwillingness to accept anxiety as the source of the illness. 3. Discuss with the client's family ways to avoid secondary gains associated with physical complaints. 4. Acknowledge the client's frustration without fostering continued focus on physical illness.

4. Clients diagnosed with hypochondriasis are so convinced that their symptoms are related to organic pathology that they adamantly reject, and are often angry and frustrated by, anyone doubting their illness. Empathizing with the client about anger and frustration assists in building a therapeutic relationship. The nurse-client relationship is the foundation for all other interventions and takes priority at this time.

1. Which statement supports a psychodynamic theory in the etiology of dissociative disorders? 1. Dysfunction in the hippocampus affects memory. 2. Dissociate reactions may be precipitated by excessive cortical arousal. 3. Coping capacity is overwhelmed by a set of traumatic experiences. 4. Repression is used as a way to protect the client from emotional pain.

4. Dissociative behaviors occur when individuals repress distressing mental contents from conscious awareness. The repression of mental contents is perceived as a coping mechanism for protecting the client from emotional pain that has arisen from disturbing external circumstances or anxiety- provoking internal urges and feelings. This supports a psychodynamic theory in the etiology of dissociative disorders.

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

4. Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development.

27. A client diagnosed with hypochondriasis has a nursing diagnosis of ineffective coping R/T repressed anxiety AEB expressions of physical illness. The client states, "I have decided to exercise so that when I get sick next time, I will be in better shape." Which evaluates this client's statement accurately? 1. The client is experiencing a positive outcome because the client is using exercise to cope effectively with the expressed physical symptoms. 2. The client is experiencing a positive outcome exhibited by understanding the link between anxiety and the illness. 3. The client is experiencing a negative outcome because exercise is irrelevant in avoiding future illnesses. 4. The client is experiencing a negative outcome based on the continual focus on physical illness, rather than dealing with the underlying cause of physical symptoms.

4. Expecting a reccurrence of physical illness would indicate a negative outcome for the nursing diagnosis of ineffective coping. By the client's continuing focus on coping with illness, the client has not developed the understanding that anxiety is the underlying cause of the physical illness.

3. Various biological and psychosocial theories have been proposed regarding homosexuality. Which etiological factor has emerged consistently? 1. Homosexual behavior is an individual preference. 2. Homosexual behavior is the result of negative Oedipal position. 3. Homosexual behavior is based on the orientation of the individual. 4. Homosexual behavior has no definitive etiological evidence supporting either biologic or psychosocial theories.

4. No one knows for sure why individuals become homosexual or heterosexual. Various theories have been proposed regarding the issue, but no single etiological factor has emerged consistently. Many contributing factors likely influence the development of sexual orientation.

4.Counselors have been sent to a location that has experienced a natural disaster to assist the population to deal with the devastation. This is an example of __________________ prevention.

4. Primary -Sending counselors to a natural disaster site to assist individuals to deal with the devastation is an example of primary prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the population by helping individuals to cope more effectively with stress early in the grieving process. Primary prevention is extremely important for individuals who experience any traumatic event, such as a rape, war, hurricane, tornado, or school shooting.

32. A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? 1. Posttrauma syndrome R / T a distressing event AEB flashbacks and nightmares. 2. Social isolation R / T anxiety AEB isolating because of fear of flashbacks. 3. Ineffective coping R / T flashbacks AEB alcohol abuse and dependence. 4. Risk for injury R / T exhaustion because of sustained levels of anxiety.

4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flash- backs, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety.

23. A client has a nursing diagnosis of knowledge deficit R/T relationship of anxiety to hypertension. Which intervention addresses this client's problem? 1. Assess the client for suicidal or homicidal ideations. 2. Encourage the client to verbalize feelings about anxiety. 3. Role-play situations in which anxiety is experienced. 4. Teach the client about the mind-body connection.

4. Teaching the client about the mind-body connection is an intervention that directly supports the nursing diagnosis of knowledge deficit R/T relationship of anxiety to hypertension.

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

4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a bio- logical theory perspective.

11. A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? 1. Denial. 2. Social isolation. 3. Anger. 4. Survivor's guilt.

4. The client in the question is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others died and the individual survived.

15. A client diagnosed with body dysmorphic disorder has a nursing diagnosis of disturbed body image R / T reddened face. Which is a long-term outcome for this client? 1. The client will recognize the exaggeration of a reddened face by day 2. 2. The client will acknowledge the link between anxiety and exaggerated perceptions. 3. The client will use behavioral modification techniques to begin accepting reddened face. 4. The client will verbalize acceptance of reddened face by scheduled 3-month follow- up appointment.

4. The long-term outcome of the verbalization of acceptance of reddened face by scheduled 3-month follow-up appointment is an outcome that is client-specific, measurable, and attainable, and has a stated timeframe.

8. Which would the nurse expect to assess in a client with long-term maladaption to stressful events? 1. Diarrhea. 2. Pulse 100, blood pressure 150/94 mm Hg. 3. Profuse diaphoresis. 4. Ulcerative colitis.

4. Ulcerative colitis, which is defined as an ulceration of the mucosa of the colon, can lead to hemorrhage and perforation. This medical diagnosis may occur when a client experiences maladaption to long-term stress.

26. The nurse is teaching a client diagnosed with somatization disorder ways to assist in recognizing links between anxiety and somatic symptoms. Which client statement would indicate that the intervention was effective? 1. "My anxiety is currently 2 out of 10." 2. "I would like you to talk with my family about my problem." 3. "I would like assertiveness training to communicate more effectively." 4. "Journaling has helped me to understand how anxiety effects me physically."

4. When the client states that awareness of feelings has been accomplished through journaling, the client is communicating recognition of the link between anxiety and somatic symptoms. This recognition is evidence that teaching in this area has been successful.

6. After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.

6. Learning -When examining theories of phobia etiology, this situation would be reflective of learning theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear.

19. It is documented in the client's chart "R/O somatization disorder." The client com- plains of diarrhea, stomach cramping, and "feeling warm." Number the following nursing actions in the priority order in which the nurse would complete them. ___ Monitor vital signs. ___ Assess level of understanding about the effects of anxiety on the body. ___ Assess the level of anxiety, using an anxiety scale of 1 to 10. ___ Encourage the client to write down his or her feelings. ___ Teach and encourage the practice of relaxation techniques, and note effectiveness.

The order of priority is 1, 3, 2, 4, 5. (1) The nurse first must assess the situation and monitor vital signs to see if there are any alterations and to detect an actual physical problem. (2) Next, the nurse must attempt to determine if anxiety is the cause of the somatic complaints by objectively assessing anxiety levels with an anxiety scale. (3) The nurse then assesses the client's understanding of the link between anxiety and the expressed somatic complaints to plan effective teaching. (4) The nurse encourages journaling to assist the client to begin linking feelings to the expression of physical symptoms. (5) Finally, the nurse teaches the client relaxation techniques, encourages their use, and notes their effectiveness. This teaching gives the client a tool to reduce anxiety levels.

19. Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply. 1. Dissociative events. 2. Intense fear and helplessness. 3. Excessive attachment and dependence toward others. 4. Full range of affect. 5. Avoidance of activities that are associated with the trauma.

1. A client diagnosed with posttraumatic stress disorder (PTSD) may have dissociative events in which the client feels detached from the situation or feelings. 2. A client diagnosed with PTSD may have intense fear and feelings of helplessness. 5. A client diagnosed with PTSD avoids activ- ities associated with the traumatic event.

29. Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply. 1. Excessive worry about items difficult to control. 2. Muscle tension. 3. Hypersomnia. 4. Excessive amounts of energy. 5. Feeling "keyed up" or "on edge."

1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. 2. A client diagnosed with GAD would experience muscle tension. 5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge."

9. When true tissue damage is caused by the effects of anxiety, the result can be classified as a ___________________ response.

Psychophysiological -When true tissue damage is caused by the effects of anxiety, the result can be classified as a psychophysiological response. Psychophysiological responses to anxiety are responses in which it has been determined that psychological factors contribute to the initiation or exacerbation of the physical condition. With these conditions, evidence does exist to support the presence of organic pathology or a known pathophysiological process.

6. A client diagnosed with somatoform pain disorder states, "I want to thank the staff for being so understanding when I am in pain." This is an example of a ______________ gain.

Secondary - This is an example of a secondary gain. Secondary gains occur when clients obtain atten- tion or support that they might not otherwise receive. This client's statement indicates that the client has received attention from staff members as a result of complaints of pain.