Psych/Mental Health Quizzes

Which approach would the nurse use for a client who describes delusions in minute detail? A. Changing the topic to reality-based events B. Continuing to discuss the delusion with the client C. Getting the client involved in a social project with peers D. Disputing the perceptions with the use of logical thinking

A Rationale: The nurse would change the topic to reality-based events. Decreasing time spent on delusions prevents reinforcement of psychotic thinking. Discussing reality-based events improves contact with reality. Encouraging discussion will give validity to the delusion. The client will have difficulty getting involved in a social activity with peers; this activity will not stop the delusion and may make the situation worse. Challenging the client by disputing the perceptions will increase anxiety.

Which statement by the nurse accurately describes the DSM-5 criteria for conduct disorder? Select all that apply. A. "The client often initiates fights." B. "Others' basic rights are violated." C. "Three of 15 criteria must be present." D. "One criterion must be present in the past 6 months." E. "The behavior has caused the child to be suspended from school." F. "In adolescent onset, there are no symptoms before 10 years of age."

A, B, C, D, E, F Rationale: Conduct disorder is diagnosed when there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Conduct disorder is manifested by the presence of at least 3 of 15 criteria in the past 12 months, with at least one criterion present in the past 6 months. Criteria include aggression to people and animals, destruction of property, deceitfulness or theft, and serious rule violations. In adolescent onset, no symptoms occur before 10 years of age. In childhood onset, individuals show at least one symptom characteristic of the disorder before 10 years of age.

Which substance is considered addictive in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)? Select all that apply. A. Alcohol B. Caffeine C. Cannabis D. Gambling E. Hallucinogens F. Antianxiety medications

A, B, C, E, F Rationale: Alcohol, caffeine, cannabis, hallucinogens, and antianxiety medications are all considered substances of abuse in the DSM-5. Tobacco, opioids, inhalants, sedatives, hypnotics, and stimulants are also listed. Gambling is a behavior rather than a substance.

Which signs indicate cocaine intoxication? Select all that apply. A. Euphoria B. Agitation C. Panic attacks D. Slurred speech E. Hypervigilance F. Impaired judgment

A, B, E, F Rationale: Cocaine is an alkaloid stimulant; euphoria, agitation or anger, hypervigilance, and impairment of judgment and social function are all associated with cocaine intoxication. Panic attacks are associated with hallucinogens. Slurred speech is associated with opioids.

Which explanation would the nurse give to the family when an older widow, who is in the terminal stages of lung cancer, exhibits mood changes and anger toward the family? A. "She is attempting to avoid the reality of the situation." B. "She is trying to cope with her impending death." C. "She wants to reduce the family's dependence on her." D. "She is sad because the family will not take her home to die."

B Rationale: Anger is associated with one of the stages of dying; understanding the stages leading to the acceptance of death may help the family accept the client's moods and anger. Avoiding the situation reflects the stage of denial; anger is not common in this stage. The nurse would conduct additional assessment before telling the family that the client is trying to reduce family's dependence on her or that she wants to go home to die.

Which client in a psychiatric unit needs immediate therapeutic intervention? A. A 25-year-old man is mimicking the use of a machine gun in front of the nurse's station. B. A 45-year-old man is sitting quietly in the corner, watching the movements of other clients. C. A 50-year-old woman is pacing back and forth and picking fights with other clients. D. A 33-year-old woman is wandering aimlessly around the unit, saying, "I feel so lost."

C Rationale: The pacing client is demonstrating increased agitation and poses an immediate threat to the safety of other clients. The client mimicking the use of a gun is probably hallucinating; he should be observed for signs of escalation. The watchful client and the wandering client currently present no danger to self or to others.

Which approach would the nurse use for an older adult client with Alzheimer disease who frequently switches from being pleasant and happy to being hostile and unhappy without apparent external cause? A. Pointing out reality to the client B. Providing nursing care when the client is receptive C. Encouraging the client to talk about personal feelings D. Restraining the client when hostility is being exhibited

B Rationale: The nurse would provide nursing care when the client is receptive. Because clients with Alzheimer disease experience lability of mood, it is best to attempt to establish a relationship and give care when they are feeling receptive. Although the mood swings may be pointed out to the client, the client with Alzheimer disease may not remember what happened previously. Also, repeated attempts to reorient the client may increase the hostile outbursts. Encouraging the client to talk about personal feelings may be of limited help; the client with Alzheimer disease may be unable to do this, the loss of recent recall may limit the benefit of this intervention. Restraining the client when hostility is being exhibited is the last resort. Clients with Alzheimer disease can be redirected or distracted more easily than restraining the client, which will increase agitation and hostility.

Which approach would the nurse use for a client with an inoperable temporal lobe tumor who is experiencing frightening auditory hallucinations, especially when alone? A. Moving the client to a room closer to the nurses' station B. Suggesting that the client turn on the radio or television when alone C. Working out a schedule for visitors so the client will never be alone D. Having family or friends remain with the client until the hallucinations stop

B Rationale: The nurse would suggest that the client turn on the radio or television when alone. Stimuli such as a television or radio encourage the client to remain reality oriented; research has shown that competing stimuli are useful in controlling hallucinations. Moving the client to a room closer to the nurses' station does not ensure that the client's needs will be met; the problem is controlling the hallucinations, not observation. Working out a schedule for visitors so the client will never be alone or having family or friends remain with the client until hallucinations stop is not realistic and fosters greater dependency; both solutions are focused on the client's inability to cope with the problem and will increase the client's fear of being alone.

Which behavior is expected in a child with reactive attachment disorder? A. Protects self against possible physical abuse B. Tries to cling to the mother on separation C. Is emotionally withdrawn and inhibited D. Seeks comfort from nurse when upset or scared

C Rationale: Children who have experienced attachment difficulties with primary caregivers are not able to trust others; they are emotionally withdrawn. Physical abuse is a possibility but not a necessity for this diagnosis. The child probably will not cling or react when separated from the mother. The child is unlikely to seek comfort from the nurse or any other adults.

When an uncoordinated person who wishes to be athletic excels in a musical career, which defense mechanism could this be related to? A. Sublimation B. Identification C. Compensation D. Rationalization

C Rationale: Compensation is replacing a weak area or trait with a desirable one. Sublimation is rechanneling unacceptable desires and drives into activities that are socially acceptable. Identification is attributing to self or taking on the characteristics of another. Rationalization is the use of justification to make tolerable certain feelings, behaviors, and motives.

Which verbalization from a client with a dissociative identity disorder, who is to be discharged after a 2-week hospitalization, would indicate effectiveness of the short-term therapy? A. The ability to deal openly with feelings B. That many of the personalities can be ignored C. The need for long-term outpatient psychotherapy D. That the personalities serve no protective purpose

C Rationale: The nurse would expect the client to verbalize the need for long-term outpatient psychotherapy. A dissociative identity disorder is a complex, multifaceted problem that requires long-term therapy to achieve integration of the personalities. Although the ability to deal openly with feelings is important, it is a long-term goal. Each personality has the ability to deal openly with feelings, but the personalities need to be integrated. None of the personalities can be ignored, because their presence must be dealt with before integration can occur. The multiple personalities do serve a protective purpose. If they did not serve a protective purpose, they would be abandoned.

Which behaviors are observed in children with autism? Select all that apply. A. Imitates others B. Engages in cooperative play C. Avoids eye-to-eye contact D. Seeks physical contact E. Performs repetitive activities F. Prefers children rather than adults

C, E Rationale: Impairment of social interaction manifests as a lack of eye contact, a lack of facial responses, and a lack of responsiveness to and interest in others. Children with autism display obsessive ritualistic behaviors such as rocking, spinning, dipping, swaying, toe-walking, head-banging, and hand-biting because of their self-absorption and need to stimulate themselves. The impairments in communication and imaginative activity result in a failure to imitate others and failure to engage in cooperative or imaginative play with others. These children are indifferent to or have an aversion to affection and physical contact. They are unable to establish meaningful relationships with adults or children because of their lack of responsiveness to others.

Based on Maslow's hierarchy of needs, which client is demonstrating characteristics of self-actualization? A. Client is competent and is esteemed by others for accomplishing work goals B. Client maintains a stable, loving, same-sex partnership for several years C. Client learns to sublimate aggressive impulses using physical exercises D. Client has an accurate perception of reality and is accepting of self and others

D Rationale: According to Maslow, a self-actualized person has an accurate perception of reality and is accepting of self and others. This person is fair-minded, independent, spontaneous, and creative; he or she takes pleasure in being alone but is also socially active. Accomplishing work goals is meeting self-esteem needs. Being in a stable, loving relationship is evidence of having love and belonging needs met. Sublimating aggressive impulses demonstrates that safety needs are being met.

Which response will the nurse use to maintain the boundaries of a therapeutic relationship when a client asks, "Can we go out for coffee and a movie after I get discharged?" A. "I'm flattered, but that would be professionally irresponsible and unethical." B. "You feel connected to me now; that will change once you are discharged." C. "The attention I've been giving you isn't social; it's just part of the job." D. "As your nurse, let's talk about how you can form social friendships."

D Rationale: Clients often become socially interested in the nursing staff. When this occurs, the nurse would remind the client of the nursing role and take the opportunity to discuss the need for friendships and how to achieve them. The other responses do not emphasize the nurse's role or nursing responsibility in this therapeutic relationship.

Which information about the client with obsessive-compulsive disorder would best validate the client's improvement at work? A. States spending less time on ritualistic behaviors while at work B. Discusses techniques used to provide distraction from obsessive thoughts C. Reports spending an increased amount of time with friends in pleasurable activities D. Receives a letter from a supervisor at work stating job performance has improved

D Rationale: The information that best validates the client's improvement at work is a letter from the supervisor stating job performance has improved. The letter provides objective validation that the client's work performance has improved. Although spending less time at work on ritualistic behavior, coming up with techniques to lessen the need for obsessive thoughts, and spending more time with friends in pleasurable activities are all acceptable outcomes of therapy, they all represent subjective information reported by the client.

Which prognosis for a normal, productive life would be appropriate for a child with autism spectrum disorder? A. Dependent on an accurate diagnosis B. Often related to the child's overall temperament C. Ensured as long as the child attends a school tailored to meet needs D. Guarded because of interference with so many parameters of function

D Rationale: The prognosis is guarded. There are many factors that affect a normal productive life. Accurate diagnosis has not been shown to promote a normal, productive life; however, early, intensive intervention may help individuals maximize their abilities. Although temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Stating that success is ensured as long as the child attends a school tailored to meet needs is false reassurance and is not helpful.