Psych TEST 3 Content

Gertrude has been admitted to the hospital for depression and concurrent alcohol abuse. During the assessment, Gertrude gives the nurse detailed accounts about several somatic symptoms she has had that "they've never been able to find a medical reason for." Based on the data provided, which of the following would be an appropriate nursing diagnosis? 1) Ineffective coping 2) Knowledge deficit 3) Impaired memory 4) Risk for suicide

1) Ineffective coping

A client experiencing lower extremity paralysis is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder? 1) Conversion disorder 2) Factitious disorder 3) Illness anxiety disorder 4) Somatic symptom disorder

1) Conversion disorder

Sally was admitted to the hospital with paralysis of her right arm. Medical tests reveal the absence of physiological explanations for her symptom. Her family reports that Sally struck her infant son last week, shortly before the symptom developed, but that she sees no connection between the two events. Which of the following would be appropriate nursing interventions in Sally's plan of care? Select all that apply. 1) Ensure that children's services agencies are involved to evaluate the child's safety in the home. 2) Assist Sally with all activities of daily living, since the paralysis is real to her. 3) Encourage Sally to discuss her fears and anxieties. 4) Monitor ongoing physical assessment to ensure that organic pathology is clearly ruled out. 5) Confront Sally with the evidence that she is intentionally feigning her paralysis.

1) Ensure that children's services agencies are involved to evaluate the child's safety in the home. 3) Encourage Sally to discuss her fears and anxieties. 4) Monitor ongoing physical assessment to ensure that organic pathology is clearly ruled out.

Flo has been seeing the nurse at the mental health center because she has been struggling with intense fear of becoming ill. She spends much of her day checking her temperature and palpating lymph nodes for signs of a lump even though there have never been positive findings of illness. Which of the following are appropriate nursing interventions in response to Flo's concerns? Select all that apply. 1) Refer all new physical complaints to the physician. 2) Help the client explore thoughts and feelings associated with her excessive fears. 3) Gently but firmly tell the client from the outset that you will not permit discussion of illnesses. 4) Help the client identify coping strategies she thinks will be useful during times when anxiety and fear are exacerbated.

1) Refer all new physical complaints to the physician.

A 30-year-old law school graduate is to take the bar examination tomorrow and is suddenly paralyzed but expresses no distress. History reveals no recent injury or neurological impairment. What data presented in the question reflect a conversion disorder? Select all that apply. 1) Sudden onset 2) Age of the graduate 3) Negative neurological findings 4) Upcoming bar examination 5) Lack of concern

1) Sudden onset 3) Negative neurological findings 4) Upcoming bar examination 5) Lack of concern

A client diagnosed with generalized anxiety disorder complains of feeling out of con- trol 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. Ask the client, "Are you thinking about harming yourself?"

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. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 5. Discuss client feelings surrounding the obsessions and compulsions.

What contributes to the difficulty in creating a therapeutic alliance with clients with personality disorders? Select all that apply. 1. Client's suspiciousness 2. Aloofness from clients 3. Secretive style and hostility of clients 4. Transference from the nurse 5. Setting limits

1. Client's suspiciousness 2. Aloofness from clients 3. Secretive style and hostility of clients

Which nursing intervention has priority in the plan of care for a client with antisocial personality disorder who shows defensive behaviors? 1. Help the client accept responsibility for his own decisions and behaviors. 2. Work with the client to feel better about himself by taking care of basic needs. 3. Teach the client to identify the defense mechanisms used to cope with distress. 4. Confront the client about the disregard of social rules and the feelings of others.

1. Help the client accept responsibility for his own decisions and behaviors.

Which nursing intervention has priority for a client with borderline personality disorder? 1. Maintain consistent, realistic limits. 2. Give instructions for meeting basic self-care needs. 3. Engage in daytime activities to stimulate wakefulness. 4. Have the client attend group therapy on a daily basis.

1. Maintain consistent, realistic limits.

A client with paranoid personality disorder works toward the goal of increasing social interaction. Which behavior indicates that the client is meeting this goal? 1. The client develops and follows a schedule of group activities. 2. The client verbalizes aggressive feelings to the nurse. 3. The client visits the consumer center to use the Internet. 4. The client explores somatic complaints with the staff.

1. The client develops and follows a schedule of group activities.

What is the most appropriate goal for a client with antisocial personality disorder with a high risk for violence directed at others? 1. The client will discuss the desire to hurt others rather than act. 2. The client will be given something to destroy to displace the anger. 3. The client will develop a list of resources to use when anger escalates. 4. The client will understand the difference between anger and physical symptoms.

1. The client will discuss the desire to hurt others rather than act.

What would be an important guideline for nurses working with clients with borderline personality disorder? 1. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment. 2. Try to prevent or reduce untoward effects of manipulation. 3. Remain neutral and avoid engaging in power struggles. 4. Respect a client's need for social isolation.

1. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment.

Which nursing intervention is of highest priority for L, a client with bulimia nervosa? 1. assist client to identify triggers to binge eating 2. communicate empathy and focusing on feelings 3. assess for signs of anxiety and depression 4. explore alternative coping strategies

1. assist client to identify triggers to binge eating

S, age 18, has been diagnosed with anorexia nervosa. A short-term goal related to the nursing diagnosis: Imbalanced nutrition: less than body requirements would be: client will 1. gain 1 to 2 pounds each week 2. state she feels better about her situation within 2 weeks 3. identify two emotional supports within 3 weeks 4. identify an alternative coping skill prior to discharge

1. gain 1 to 2 pounds each week

Clients diagnosed with illness anxiety disorder often "doctor shop." Which defense mechanism is at the root of this behavior? 1) Suppression 2) Denial 3) Projection 4) Rationalization

2) Denial

Martha, a 93-year-old woman who is being cared for by her daughter, is hospitalized for the third time in a month with complaints of nausea and vomiting. Medical tests have been unable to identify a physical cause. When the daughter is witnessed putting syrup of ipecac in her mother's coffee, which of the following diagnoses is likely to be made? 1) Factitious disorder 2) Factitious disorder by proxy 3) Malingering 4) Conversion disorder

2) Factitious disorder by proxy

Which of the following responses from the nurse would enhance a therapeutic relationship with a client with a personality disorder? 1. " What would you like to do today?" 2. " After you attend the morning community meeting, you may work on your homework." 3. " You remind me of a friend of mine." 4. " We will have you get comfortable on the unit first before we have you work on any homework."

2. " After you attend the morning community meeting, you may work on your homework."

A client with antisocial personality disorder says, "I always want to blow things off." Which response by the nurse is most appropriate? 1. " Try to focus on what needs to be done and just do it." 2. " Let's work on considering some options and strategies." 3. " Procrastinating is a part of your illness that we'll work on." 4. " The best thing to do is decide on some useful goals to accomplish."

2. " Let's work on considering some options and strategies."

Which statement made by a client with paranoid personality disorder shows that teaching about social relationships is effective? 1. " As long as I live, I won't abide by social rules." 2. " Sometimes, I can see what causes relationship problems." 3. " I'll find out what problems others have so I won't repeat them." 4. " I don't have problems in social relationships; I never really did."

2. " Sometimes, I can see what causes relationship problems."

The psychiatric clinical nurse specialist decides to use cognitive therapy techniques as she works with S, a client with anorexia nervosa. Which statement by the nurse is consistent with the use of cognitive therapy principles? 1. "You seem to feel much better about yourself when you eat something." 2. "Being thin doesn't seem to solve your problems, since you're thin, now, and still unhappy." 3. "It must be difficult to talk about private matters to someone you just met." 4. "What are your feelings about not eating the food that you prepare?"

2. "Being thin doesn't seem to solve your problems, since you're thin, now, and still unhappy."

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."

2. "I paced the halls until I felt my anxiety was under control."

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. Ask the client, "Do you have a plan to commit suicide?"

A nursing diagnosis formulated for L, a client with bulimia nervosa, was Ineffective coping related to feelings of loneliness and isolation, as evidenced by use of overeating as a comfort measure followed by self-induced vomiting. Which short-term goal is related to this nursing diagnosis? 1. Client will verbalize the importance of eating a balanced diet within 2 weeks. 2. Client will identify two alternative methods of coping with loneliness and isolation within 2 weeks. 3. Client will verbalize two positive things about herself within 2 weeks. 4. Client will appropriately express angry feelings within 2 weeks.

2. Client will identify two alternative methods of coping with loneliness and isolation within 2 weeks.

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 medica- tion toxicity.

2. Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks.

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. Reinforce the use of learned relaxation techniques.

The nurse is expecting the psychiatrist to order an antidepressant for a client with borderline personality disorder. Which of the following would be best for this client? 1. Monoamine oxidase inhibitors (MAOIs) work best for those with a borderline personality disorder because the effects are felt very quickly. 2. Selective serotonin reuptake inhibitors (SSRIs) in addition to an atypical antipsychotic treat dysphoria, mood instability, and impulsivity in clients with borderline personality disorder. 3. Antipsychotics treat illusions, ideas of reference, paranoid thinking, anxiety, and hostility in clients. 4. Anxiolytics will reduce the anxiety seen in borderline personality disorder clients.

2. Selective serotonin reuptake inhibitors (SSRIs) in addition to an atypical antipsychotic treat dysphoria, mood instability, and impulsivity in clients with borderline personality disorder.

Which of the following behaviors can a nurse expect to see in a client with a personality disorder? Select all that apply. 1. Compliance with the rules of the unit 2. Tendency to provoke interpersonal conflict 3. Inflexibility 4. Maladaptive responses to stress 5. Trouble in social and professional relationships 6. Personal boundaries are blurred

2. Tendency to provoke interpersonal conflict 3. Inflexibility 4. Maladaptive responses to stress 5. Trouble in social and professional relationships 6. Personal boundaries are blurred

A client with paranoid personality disorder responds aggressively during a psychoeducational group therapy session to something another client said about him. The nurse interprets this behavior as indicating which of the following? 1. The client doesn't want to participate in the group. 2. The client took the statement as a personal criticism. 3. The client is impulsive and was acting out of frustration. 4. The client was attempting to handle emotional distress.

2. The client took the statement as a personal criticism.

What nursing intervention would relate to a client goal that S, a client with anorexia nervosa, will gain 1 to 2 pounds per week? 1. assessing for depression and suicidal ideation 2. observing for adverse side effects of refeeding 3. communicating empathy for S's feelings 4. focusing with client on objective facts comparing energy expenditure and caloric intake

2. observing for adverse side effects of refeeding

A client has a history of multiple somatic complaints involving several organ systems. Diagnostic studies revealed no physiological cause. Which diagnosis would the nurse expect the physician to assign this client? 1) Thought disorder 2) Bipolar disorder 3) Somatic symptom disorder 4) Depersonalization-derealization disorder

3) Somatic symptom disorder

A nurse tells a client with a personality disorder that he must clean his room before he can go to the dayroom. The client asks if he can play one game of pool first. What is the most appropriate response by the nurse? 1. " You can play one quick game. Then you have to clean your room." 2. " No, you may not." 3. " No, you may not play pool first. The rules were explained to you." 4. " Yes, you may play a quick game. But don't tell the other clients about this."

3. " No, you may not play pool first. The rules were explained to you."

A client with antisocial personality disorder is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. What is the best response by the nurse? 1. " I believe we need to sit down and talk about this." 2. " Don't you know better than to try to bend the rules?" 3. " What you're asking me to do for you is unacceptable." 4. " Why don't you bring this request to the community meeting?"

3. " What you're asking me to do for you is unacceptable."

S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss. To assess S's eating patterns, what questions might the nurse ask? 1. "Do you often feel fat?" 2. "Who plans the family meals?" 3. "What do you eat in a typical day?" 4. "What do you think about your present weight?"

3. "What do you eat in a typical day?"

S, a client with anorexia nervosa, is particularly resistant to the idea of weight gain. The nurse decides to encourage S to agree to a treatment contract. What is the rationale for establishing a contract with S in which she agrees to participate in measures designed to produce a specified weekly weight gain? 1. Because severe anxiety concerning eating is to be expected, objective and subjective data must be routinely collected. 2. A team approach to planning diet ensures that physical and emotional needs will be met. 3. Client involvement in decision making increases sense of control and promotes compliance with treatment. 4. Because there is increased risk of physical problems with refeeding, client permission is essential.

3. Client involvement in decision making increases sense of control and promotes compliance with treatment.

A nurse is performing a thorough health history on a client suspected of having hypochondriasis. Which information, elicited by the nurse, should enable a physician to distinguish between hypochondriasis and somatization disorder? A) Pain B) Gender distribution C) Persistent fear D) Impaired functioning

C) Persistent fear

A client with antisocial personality disorder is trying to manipulate the health care team. What is the best strategy for the staff to implement? 1. Focus on how to teach the client more effective behaviors for meeting basic needs. 2. Help the client verbalize underlying feelings of hopelessness and learn coping skills. 3. Remain calm and don't emotionally respond to the client's manipulative actions. 4. Help the client eliminate the intense desire to have everything in life turn out perfectly.

3. Remain calm and don't emotionally respond to the client's manipulative actions.

A client with borderline personality disorder states that he doesn't know how to deal with his impulsive behavior. Which intervention should the nurse implement? 1. Teach the client that impulsive behavior is part of his illness. 2. Explore how depression influences impulsive situations. 3. Select an example of an impulsive situation and explore it. 4. Decrease interactions in which impulsive behavior occurs.

3. Select an example of an impulsive situation and explore it.

"Client, age 28, admitted to unit with diagnosis of antisocial personality disorder and suicide attempt after cutting his right wrist. Right wrist dressing appears dry and intact. Client states, "I don't want to be here and I'm not following your treatment plan or any of your rules. I'm going to tell everyone here not to follow your rules" 1. The client requires psychotropic drugs to treat his condition, which he refuses. 2. The client manipulates other clients but not his family. 3. The client may not be motivated to change his behavior or his lifestyle. 4. The client could quickly make behavior changes if motivated.

3. The client may not be motivated to change his behavior or his lifestyle.

C is admitted to the eating disorders unit. As she undresses, she removes layer after layer of clothing. The nurse realizes that she is extremely thin. Her skin has a yellow cast, her hair is limp and dry, and her body is covered by fine downy hair. Her weight is 70 pounds and her height is 5 feet 4 inches. C remains quiet and sullen during the physical assessment. In the nurse's written assessment of C's physical condition, which of the following should be recorded? 1. amenorrhea 2. alopecia 3. lanugo 4. Stupor

3. lanugo

When a nurse is working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action? 1) Avoid discussing social and personal problems. 2) Focus on the physical symptoms. 3) Always meet the client's dependency needs. 4) Gradually minimize time spent focusing on physical symptoms.

4) Gradually minimize time spent focusing on physical symptoms.

It has been determined that Susan, who thought she was pregnant, is experiencing a conversion disorder. The nurse correctly documents this conversion symptom as which of the following? 1) Aphonia 2) Anosognosia 3) Anosmia 4) Pseudocyesis

4) Pseudocyesis

A client is experiencing pain that has no organic etiology. This pain allows the client to avoid an unpleasant activity. What best describes what this client is experiencing? 1) The client is experiencing altered social interaction. 2) The client is experiencing disturbed thought processes. 3) The client is experiencing secondary gain. 4) The client is experiencing primary gain.

4) The client is experiencing primary gain.

Which characteristic does the nurse understand is central in somatic symptom disorders? 1) The presence of delusions 2) The presence of pain 3) The presence of paranoia 4) The presence of physical symptoms

4) The presence of physical symptoms

A client with antisocial personality disorder talks about personal life changes that need to occur. Which client statement shows group therapy is having a positive therapeutic effect? 1. " I'm not doing as bad as I thought I was." 2. " I wish I could believe I can change, but it's probably too late." 3. " I see all the problems, but I'm not sure there are good solutions." 4. " I'm finally learning how to live my life without living on the edge."

4. " I'm finally learning how to live my life without living on the edge."

What is the most appropriate short-term goal for a client with paranoid personality disorder and impaired social skills? 1. Obtain feedback from other people. 2. Discuss anxiety-provoking situations. 3. Address positive and negative feelings about self. 4. Identify personal feelings that hinder social

4. Identify personal feelings that hinder social

A client with paranoid personality disorder is discussing current problems with a nurse. What is the most important intervention for the nurse to implement? 1. Have the client look at sources of frustration. 2. Have the client focus on ways to interact with others. 3. Have the client discuss the use of defense mechanisms. 4. Have the client clarify thoughts and beliefs about an event.

4. Have the client clarify thoughts and beliefs about an event.

A client with borderline personality disorder is learning how to verbalize, rather than act on, the desire to hurt himself. What is the most appropriate nursing intervention? 1. Explain how pain triggers intense anger and causes the client to act out. 2. Determine how problems with the client's family cause him to act aggressively. 3. Teach the client that being volatile is a normal reaction to unfair events. 4. Have the client work on identifying speech and behavior that accompany anger.

4. Have the client work on identifying speech and behavior that accompany anger.

A client with a paranoid personality disorder makes an inappropriate and unreasonable report to a nurse. What is the most appropriate intervention by the nurse? 1. Use logic to address the client's concern. 2. Confront the client about the stated misperception. 3. Use nonverbal communication to address the issue. 4. Tell the client matter-of-factly that you don't share his interpretation.

4. Tell the client matter-of-factly that you don't share his interpretation.

The nurse is developing long-term goals for a client with paranoid personality disorder who is trying to improve peer relationships. What is the most appropriate goal? 1. The client will verbalize a realistic view of self. 2. The client will take steps to address disorganized thinking. 3. The client will become appropriately interdependent on others. 4. The client will become involved in activities that foster social relationships.

4. The client will become involved in activities that foster social relationships.

What behavior on the part of the nurse caring for a client with anorexia nervosa would indicate a need for supervision? 1. being consistent and reliable 2. using an accepting, nonjudgmental manner 3. being matter-of-fact and neutral 4. being flexible about limits for the client

4. being flexible about limits for the client

S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss and cessation of menses. The nurse ascertains that S perceives herself as grossly overweight and needing to lose more weight. Based on what is currently known about S, what nursing diagnosis can be established? Imbalanced nutrition: less than body requirements related to: 1. abuse of laxatives, as evidenced by electrolyte imbalances 2. physical exertion in excess of energy produced through caloric intake, as evidenced by weight loss 3. self-induced vomiting, as evidenced by swollen parotid glands 4. refusal to eat, as evidenced by loss of more than 15% of body weight

4. refusal to eat, as evidenced by loss of more than 15% of body weight

How should a nurse psychotherapist who is operating from a psychoanalytic paradigm explain the presence of hypochondriasis to a client? A) "Physical complaints are the expression of low self-esteem and feelings of worthlessness because it is easier to believe that something is wrong with the body than to believe that something is wrong with the self." B) "Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it is within society or within the family." C) "When emotional arousal precipitates somatic symptoms, the symptoms are incorrectly assessed and misinterpreted and negative cognitive meanings are attached to them." D) "Evidence indicates an increased prevalence of hypochondriasis among identical twins and other first-degree relatives."

A) "Physical complaints are the expression of low self-esteem and feelings of worthlessness because it is easier to believe that something is wrong with the body than to believe that something is wrong with the self."

A client complaining of leg paralysis is admitted to a medical unit. Extensive tests and workups confirm the client's disability but fail to indicate any underlying organic pathological condition. This is most suggestive of which disorder? A) Conversion disorder B) Hypochondriasis C) Malingering D) Somatization disorder

A) Conversion disorder

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." B. "Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not." C. "Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not." D. "Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not."

A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not."

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy

A. Awareness training B. Competing response training C. Social Support

The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol

A. Clomipramine

Personality disorders differ from personality traits in that personality disorders: A. Interfere with role functioning B. Remain stable over time C. Assist clinicians in predicting behavior D. May cause distress in other people

A. Interfere with role functioning

Which of the following personality disorders fall under cluster A (select all that apply) A. Paranoid personality disorder B. Schizoid personality disorder C. Schizotypal personality disorder D. Antisocial personality disorder E. Borderline personality disorder F. Histrionic personality disorder

A. Paranoid personality disorder B. Schizoid personality disorder C. Schizotypal personality disorder

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

A. Provide external limits on client behavior.

The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder: A. Psychoeducation about their disorder B. Ordering neuroimaging to determine activity in the cingulate cortex. C. Psychopharmacology including an SSRI D. Cognitive-behavioral therapy

A. Psychoeducation about their disorder

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduced her probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept

A. Relieves her anxiety

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

A. Risk for violence: directed toward others R/T suspicious thoughts

A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? A. Stay with the client and reassure safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down. D. Encourage the client to talk about what triggered the attack.

A. Stay with the client and reassure safety

Which psychodynamic theory describes the underlying symptoms of conversion disorder? A) Relief from despair B) Repression of anger C) Unconscious resolution of internal conflicts D) Cognitive deficit

C) Unconscious resolution of internal conflicts

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

A. The client will identify two alternative methods of dealing with isolation by day 3.

A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries.

A. The emesis produced during purging is acidic and corrodes the tooth enamel.

A physician describes a client as "malingering." The nurse knows this means the client A. is falsely claiming to have the symptoms. B. experiences symptoms that cannot be explained medically. C. experiences symptoms that have a physiological basis. D. is seeking medication to ease pain of psychological origin

A. is falsely claiming to have the symptoms.

All of the following are considered Cluster B personality disorders, EXCEPT: A) Antisocial personality disorder B) Avoidant personality disorder C) Histrionic personality disorder D) Narcissistic personality disorder

B) Avoidant personality disorder

Patients with personality disorders are grouped into three categories depending on the disorder. Cluster b patients most often described as: (select all that apply) A) Withdrawn B) Expansive C) Anxious D) Odd/eccentric E) Emotional

B) Expansive E) Emotional

What is an appropriate outcome for clients experiencing somatization disorders? A) Will admit to feigning physical symptoms to gain benefits such as attention or absence from role responsibilities B) Will effectively use adaptive coping strategies during stressful situations without resorting to physical symptoms C) Will comply with medical treatments for physical symptoms D) Will seek assistance from multiple care providers or specialists to decrease the burden on any given person

B) Will effectively use adaptive coping strategies during stressful situations without resorting to physical symptoms

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not effective for generalized anxiety disorder." B. "Buspirone must be taken daily to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."

B. "Buspirone must be taken daily to be effective." B. "Buspirone must be taken daily to be effective."

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply? A. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." C. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." D. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve."

The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder: A. " The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort." B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." C. "Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath." D. "The average onset of panic disorder is in the late 20s."

B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation."

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

B. A client diagnosed with borderline personality disorder

The nurse looks for which of the following characteristics in a client diagnosed with a personality disorder? A. Flexibility and adaptability to stress B. A tendency to evoke some form of interpersonal conflict C. A concomitant physical disorder D. A desire for interpersonal relationships

B. A tendency to evoke some form of interpersonal conflict

A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity

B. Altered nutrition: less than body requirements R/T inadequate food intake

A client tends to be deceitful and irresponsible, engages in abusive behaviors, is easily irritable, and does not have a sense of remorse for others. When bored, the client acts out in aggression towards staff and other clients on the unit. Which personality disorder will the nurse suggest that the client may have? A. Narcissistic B. Antisocial C. Paranoid D. Histrionic

B. Antisocial

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa? A. Provide privacy during meals. B. Remain with the client for at least 1 hour after the meal. C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

B. Remain with the client for at least 1 hour after the meal.

Which nursing diagnosis should be investigated for clients with somatoform disorders? A. Deficient fluid volume B. Self-care deficit C. Disturbed personal identity D. Delayed growth and development

B. Self-care deficit

Which neurotransmitter has been implicated as a possible causative factor in both pain disorder and body dysmorphic disorder? A. Dopamine B. Serotonin C. Norepinephrine D. Acetylcholine

B. Serotonin

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the ct's bathroom locked so she can't wash her hands all the time. B. Structure the ct's schedule so that she has plenty of time for washing her hands. C. Place the ct in isolation until she promises to stop washing her hands so much. D. Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.

B. Structure the ct's schedule so that she has plenty of time for washing her hands.

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan

B. To emphasize that the client is capable of consuming food without purging

Therapeutic intervention for a client with a somatoform disorder would include A. steering conversation away from client feelings. B. conveying interest in the client rather than in symptoms. C. encouraging the client in liberal use of benzodiazepines. D. encouraging the client to refer to the nurse for meeting client needs.

B. conveying interest in the client rather than in symptoms.

The nurse would expect the chief complaint of the client with hypochondriasis to be A. "I feel confused and disoriented." B. "I feel spaced out, as though I'm outside my body watching what is happening." C. "I know I have cancer, but the doctors just cannot find it." D. "I woke up one morning and my left leg was paralyzed from the knee down."

C. "I know I have cancer, but the doctors just cannot find it."

Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C. Fluoxetine (Prozac)

The nurse places highest priority on which of the following nursing interventions when caring for a client diagnosed with antisocial personality disorder? A. Supporting the development of insight B. Encouraging socialization C. Maintaining consistent limits D. Monitoring for suicidal ideations

C. Maintaining consistent limits

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. C. Set limits on the amount of time Sandy may engage in the ritualistic behavior. D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.

C. The client demonstrates healthy coping mechanisms that decrease anxiety.

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.

C. The client will gain 2 pounds prior to the next weekly appointment.

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

C. The client will perceive an ideal body weight and shape as normal.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

C. The home environment is overprotective and demands perfection.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

C. The nurse who refuses to engage in power struggles related to food consumption

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

C. This therapy will provide the client with control over behavioral choices.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

C. To promote the processing of anxiety associated with eating

An example of a somatoform disorder is A. depersonalization. B. dissociative fugue. C. conversion disorder. D. dissociative identity disorder.

C. conversion disorder.

A woman has to take her real estate examination tomorrow but suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband "Don't worry, dear. Things will all work out." Her attitude is an example of A. regression. B. depersonalization. C. la belle indifference. D. dissociative amnesia.

C. la belle indifference.

9. Somatization disorders are most often linked with which emotion? A) Euphoria B) Guilt C) Anger D) Anxiety

D) Anxiety

When working with a client with a somatization disorder, which is the most appropriate nursing intervention? A) Avoiding discussion of physical symptoms B) Allowing the client to freely explore the meaning of the physical symptoms C) Confronting the client on the validity of the physical symptoms D) Gradually limiting the focus on physical symptoms

D) Gradually limiting the focus on physical symptoms

A psychiatric nurse often cares for clients with somatoform disorders. Which characteristic is common to all somatoform disorders? A) Delusions B) Pain C) Paranoia D) Physical symptoms

D) Physical symptoms

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects the underlying etiology of this disorder? A. "Skaters need to be thin to improve their daily performance." B. "All the skaters on the team are following an approved 1,200-calorie diet." C. "When I lose skating competitions, I also lose my appetite." D. "I am angry at my mother. I can only get her approval when I win competitions."

D. "I am angry at my mother. I can only get her approval when I win competitions."

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

D. "I didn't have the money for the ring, so I just took it.

What statement by a client would indicate that goals for treatment of her somatization disorder are being achieved? A. "I feel less anxiety that before." B. "My memory is better than it was a month ago." C. "I take my medications just as the physician prescribed." D. "I don't find myself thinking about my symptoms all the time as I used to."

D. "I don't find myself thinking about my symptoms all the time as I used to."

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

D. "I don't know why people are worried. I need to lose this weight."

Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder? A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders: A. Increased seratonin, decreased norepinephrine, and decreased GABA. B. Increased seratonin, decreased norepinephrine, and increased GABA. C. Decreased seratonin, decreased norepinephrine, and decreased GABA. D. Decreased seratonin, increased norepinephrine, and decreased GABA.

D. Decreased seratonin, increased norepinephrine, and decreased GABA.

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

D. Inconsistency by the maternal figure during individuation

What symptom characterizes body dysmorphic disorder? A. Severe pain with psychological origins B. Fear of having a life-threatening illness C. Multiple physical symptoms spanning many years D. Preoccupation with an imagined defect in appearance

D. Preoccupation with an imagined defect in appearance

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises. B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced. D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.

D. These programs allow clients to maintain control.

Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder

D. narcissistic personality disorder

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a. "I check where my car keys are eight times." b. "My legs often feel weak and spastic." c. "I'm embarrassed to go out in public." d. "I keep reliving a car accident."

a. "I check where my car keys are eight times."

A nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment is most likely from this patient? a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think I'm getting seriously dehydrated." c. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."

A patient says, "I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring? a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking." b. "Let's see whether any other explanations for your vomiting are possible." c. "You seem so worried. Let's talk about how you're feeling." d. "We'll talk about something else."

a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking."

In planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? a. Binge eating b. Memory loss c. Cult membership d. Delusional thinking

a. Binge eating

A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included? Select all that apply. a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach

a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives

A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? Select all that apply. a. Impulsiveness b. Lability of mood c. Ritualistic behavior d. psychomotor retardation e. self-destructive behavior

a. Impulsiveness b. Lability of mood e. self-destructive behavior

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. b. Advise the student to discuss this experience with a health care provider. c. Encourage the student to begin antioxidant vitamin supplements. d. Listen attentively, using silence in a therapeutic way.

a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects.

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual? Select all that apply. a. Ineffective home maintenance b. Situational low self-esteem c. Chronic low self-esteem d. Disturbed body image e. Risk for injury

a. Ineffective home maintenance c. Chronic low self-esteem e. Risk for injury

Which of the following nursing interventions has priority for a client with borderline personality disorder? a. Maintain consistent and realistic limits b. Give instructions for meeting basic self-care needs c. Engage in daytime activities to stimulate wakefulness d. Have the client attend group therapy on a daily basis

a. Maintain consistent and realistic limits

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest? Select all that apply. a. Use a calm manner and low voice. b. Maintain simplicity in the environment. c. Avoid repetition in what is said to the child. d. Minimize opportunities for exercise and play. e. Explain and reinforce reality to avoid distortions.

a. Use a calm manner and low voice. b. Maintain simplicity in the environment. e. Explain and reinforce reality to avoid distortions.

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of a. antisocial personality disorder. b. borderline personality disorder. c. schizotypal personality disorder. d. narcissistic personality disorder.

a. antisocial personality disorder.

Characteristics the nurse will assess in the client with antisocial personality disorder are a. deceitfulness, impulsiveness, and lack of empathy. b. perfectionism, preoccupation with detail, and verbosity. c. avoidance of interpersonal contact and preoccupation with being criticized. d. need for others to assume responsibility for decision-making and seeks nurture.

a. deceitfulness, impulsiveness, and lack of empathy.

The causes of somatic system disorders may be related to: a. faulty perceptions of body sensations. b. traumatic childhood events. c. culture-bound phenomena. d. depressive equivalents.

a. faulty perceptions of body sensations.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to: a. provide for the patient's safety. b. encourage clarification of feelings. c. respect the patient's personal space. d. offer an outlet for the patient's energy.

a. provide for the patient's safety.

A client tells the nurse, "You are so much nicer than that mean nurse on the nightshift." This statement would be associated with which personality disorder? a.) Borderline b.) Histrionic c.) Schizoid d.) Avoidant

a.) Borderline

Which is characteristic of the diagnosis of anorexia nervosa? a) Obsession with weight gain b) Body image disturbance c) Disregard for the feelings of others d) Healthy family relationships

b) Body image disturbance

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? Select all that apply. a. "Are there certain social situations that cause you to feel especially uncomfortable?" b. "Are there others in your family who must do things in a certain way to feel comfortable?" c. "Have you been a victim of a crime or seen someone badly injured or killed?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

b. "Are there others in your family who must do things in a certain way to feel comfortable?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia? a. "I'm sure I will get over not wanting to leave home soon. It takes time." b. "Being afraid to go out seems ridiculous, but I can't go out the door." c. "My family says they like it now that I stay home most of the time." d. "When I have a good incentive to go out, I can do it."

b. "Being afraid to go out seems ridiculous, but I can't go out the door."

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? a. "I won't get involved in another relationship." b. "I'm determined to look for the perfect partner." c. "I've decided to use better communication skills." d. "I'm going to be an equal partner in a relationship."

b. "I'm determined to look for the perfect partner."

A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably: a. Readily seek psychiatric counseling. b. Be resistant to accepting psychiatric help. c. Attend psychotherapy sessions without encouragement. d. Be eager to discover the true reasons for physical symptoms.

b. Be resistant to accepting psychiatric help.

A person comes to the clinic reporting, "I wear a scarf across my lower face when I go out but because of my ugly appearance." Assessment reveals an average appearance with no actual disfigurement. Which problem is most likely? a. Dissociative identity disorder b. Body dysmorphic disorder c. Pseudocyesis d. Malingering

b. Body dysmorphic disorder

A woman is 5'7", 160 lbs, and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Social anxiety disorder b. Body dysmorphic disorder c. Separation anxiety disorder d. Obsessive-compulsive disorder due to a medical condition

b. Body dysmorphic disorder

A patient with blindness related to a functional neurological (conversion) disorder says, "All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital don't find me interesting." Which nursing diagnosis is most relevant? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance

b. Chronic low self-esteem

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention? a. Offering hope allays and defuses the patient's anxiety. b. Concerns stated aloud become less overwhelming and help problem solving begin. c. Anxiety is reduced by focusing on and validating what is occurring in the environment. d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.

b. Concerns stated aloud become less overwhelming and help problem solving begin.

A patient with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will: a. Assume roles and functions of the other family members. b. Demonstrate a resumption of former roles and tasks. c. Focus energy on problems occurring in the family. d. Rely on family members to meet his or her personal needs.

b. Demonstrate a resumption of former roles and tasks.

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping? a. Allow the patient to set a hand-washing schedule. b. Encourage the patient to participate in social activities. c. Encourage the patient to discuss hand-washing routines. d. Focus on the patient's symptoms rather than on the patient.

b. Encourage the patient to participate in social activities.

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? a. Verify the patient's learning style. b. Lower the patient's current anxiety. c. Create outcomes and a teaching plan. d. Assess how the patient uses defense mechanisms.

b. Lower the patient's current anxiety.

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

b. Moderate

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Present the information again in a calm manner using simple language. c. Tell the patient that staff is prepared to promote recovery. d. Encourage the patient to express feelings to family.

b. Present the information again in a calm manner using simple language.

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results are normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect? a. Functional neurologic (conversion) disorder b. Prominent health anxiety (hypochondriasis) c. Predominant (pain) disorder d. Dissociative fugue

b. Prominent health anxiety (hypochondriasis)

Which treatment modality should a nurse recommend to help a patient with pain disorder cope more effectively? a. Flooding b. Relaxation c. Response prevention d. Systematic desensitization

b. Relaxation

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis has the highest priority? a. Fear b. Risk for injury c. Self-care deficit d. Disturbed thought processes

b. Risk for injury

A nurse counsels a patient diagnosed with body dysmorphic disorder. Which nursing diagnosis would be a priority for the plan of care? a. Anxiety b. Risk for suicide c. Disturbed body image d. Ineffective role performance

b. Risk for suicide

A patient has blindness related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should: a. establish a "buddy" system with other patients who can feed the patient at each meal. b. expect the patient to feed him- or herself after explaining the arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed self unassisted. d. address the needs of other patients in the dining room, and then feed this patient.

b. expect the patient to feed him- or herself after explaining the arrangement of the food on the tray.

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic? a. buspirone (BuSpar) b. lorazepam (Ativan) c. amitriptyline (Elavil) d. desipramine (Norpramin)

b. lorazepam (Ativan)

A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient? The patient is: a. suppressing accurate feelings regarding the problem. b. relieving anxiety through the physical symptom. c. meeting needs through hospitalization. d. refusing to disclose genuine fears.

b. relieving anxiety through the physical symptom.

Playing one staff member against another is an example of a. devaluation. b. splitting. c. impulsiveness. d. social ineptitude.

b. splitting.

Ron has been having serious issues with his mother, not wanting to leave her side, fear of being abandoned. As a young child he was raped and has recently been having suicidal ideations, yet he calls his mother before he decides to take his medication. Which disorder is this most likely conveying? a)Antisocial b)Schizoid c)Borderline d)Schizotypal

c)Borderline

A young, handsome man with a diagnosis of antisocial personality disorder is being discharged from the hospital next week. He asks the nurse for her phone number so that he can call her for a date. The nurse's best response would be: a. "We are not permitted to date clients." b. "No, you are a client and I am a nurse." c. "I like you, but our relationship is professional." d. "It's against my professional ethics to date clients."

c. "I like you, but our relationship is professional."

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a. "What would you like me to do to help you?" b. "Why do you suppose you are feeling anxious?" c. "I'm not sure I understand. Give me an example." d. "You must get your feelings under control before we can continue."

c. "I'm not sure I understand. Give me an example."

A woman is 5'7" tall, weighs 160 pounds, and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." The patient tries to buy shoes to make her feet look smaller, and in social settings conceals both feet under a table or chair. Which health problem is likely? a. Dissociative fugue b. Prominent pain disorder c. Body dysmorphic disorder d. Depersonalization disorder

c. Body dysmorphic disorder

Which of the following interventions is important for a client with paranoid personality disorder taking olanzapine (Zyprexa)? a. Explain effects of serotonin syndrome b. Teach the client to watch for extrapyramidal adverse reactions c. Explain that the drug is less effective if the client smokes d. Discuss the need to report paradoxical effects such as euphoria.

c. Explain that the drug is less effective if the client smokes

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? a. Antisocial behavior b. Suspicious behavior c. Relationship problems d. Auditory hallucinations

c. Relationship problems

A patient with predominant pain disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess: a. Mood b. Cognitive style c. Secondary gains d. Identity and memory

c. Secondary gains

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

c. Severe

A 19 y/o F client with a dx of anorexia nervosa wants to help serve dinner trays to other clients on a psychiatric unit. What action should the nurse take? a. Encourage the client's participation in unit activities by asking her to pass trays for the rest of the week. b. Provide an additional challenge by asking the client to also help feed the older clients. c. Suggest another way for this client to participate in unit activities. d. Tell the client that the hospital policy doesn't permit her to pass trays.

c. Suggest another way for this client to participate in unit activities.

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action. a. Ask, "I'm not sure what you mean. Give me an example." b. Capture the patient in a basket-hold to increase feelings of control. c. Tell the patient, "Stop running and take a deep breath. I will help you." d. Assemble several staff members and say, "We will take you to seclusion to help you regain control."

c. Tell the patient, "Stop running and take a deep breath. I will help you."

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? a. The client is overly dramatic after hearing the facts b. The client focuses on self to not become over-anxious c. The client responds from a rational, objective point of view d. The client doesn't spend time thinking about the information.

c. The client responds from a rational, objective point of view

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis? a. feelings of responsibility for the health of family members b. approval-seeking behavior from friends and family c. persistent thoughts about bacteria, germs, and dirt d. needs to avoid interactions with others

c. persistent thoughts about bacteria, germs, and dirt

To assist a patient with a somatic system disorder, a nursing intervention of high priority is to: a. imply that somatic symptoms are not real. b. help the patient suppress feelings of anger. c. shift the focus from somatic symptoms to feelings. d. investigate each physical symptom as it is offered.

c. shift the focus from somatic symptoms to feelings.

A client is 5'8'' tall and weighs 105 pounds. The client has been taking laxatives daily, and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? a) Ineffective denial b) Disturbed body image c) Low self-esteem d) Imbalanced nutrition, less than body requirements

d) Imbalanced nutrition, less than body requirements

Which assessment finding would the nurse expect in clients diagnosed with bulimia? a) They are below normal weight. b) They binge when they experience hunger. c) They will be highly motivated to seek help. d) They are within their normal weight range.

d) They are within their normal weight range.

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? a. "Have you been a victim of a crime or seen someone badly injured or killed?" b. "Do you feel especially uncomfortable in social situations involving people?" c. "Do you repeatedly do certain things over and over again?" d. "Do you find it difficult to control your worrying?"

d. "Do you find it difficult to control your worrying?"

A nurse assessing a patient with a somatic system disorder is most likely to note that the patient: a. Readily sees a relationship between symptoms and interpersonal conflicts. b. Rarely derives personal benefit from the symptoms. c. Has little difficulty communicating emotional needs. d. Has altered comfort and activity needs.

d. Has altered comfort and activity needs.

Personality disorders differ from personality traits in that personality disorders a. May cause distress in other people b. Assist nurse in predicting behavior c. Remains stable over time d. Interfere with role functioning.

d. Interfere with role functioning.

A patient who fears serious heart disease was referred to the mental health center by a cardiologist after extensive diagnostic evaluation showed no physical illness. The patient says, "I have tightness in my chest and my heart misses beats. I'm frequently absent from work. I don't go out much because I need to rest." Which health problem is most likely? a. Dysthymic disorder b. Antisocial personality disorder c. Simple somatic symptom disorder d. Prominent health anxiety (hypochondriasis)

d. Prominent health anxiety (hypochondriasis)

For a patient experiencing panic, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Prepare to implement physical controls. d. Provide calm, brief, directive communication.

d. Provide calm, brief, directive communication.

To plan effective care for patients with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms: a. Are generally chronic. b. Have a physiological basis. c. Can be voluntarily controlled. d. Provide relief from health anxiety.

d. Provide relief from health anxiety.

When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: a. Controlling anxiety b. terminating the session on time c. Accepting the psychiatric diagnosis d. Setting mutual goals for the relationship

d. Setting mutual goals for the relationship

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate? a. Help the person use online video calls to provide interaction with others. b. Advise the person to accept the situation and use a companion. c. Ask the person to explain why the fear is so disabling. d. Teach the person to use positive self-talk techniques.

d. Teach the person to use positive self-talk techniques.

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of: a. flooding. b. desensitization. c. relaxation technique. d. cognitive restructuring.

d. cognitive restructuring.

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as: a. culturally influenced. b. displacement. c. trait anxiety. d. mild anxiety.

d. mild anxiety.

A Client diagnosed with Borderline Personality Disorder is admitted to a psychiatric unit. What behavior pattern would the nurse expect to observe? a.) Social isolation b.) Suspicion of others c.) Bizarre speech patterns d.) Generating conflict among the staff

d.) Generating conflict among the staff