Psychosocial Integrity Quizzes

An adolescent gives birth to an infant with a severe cleft lip and palate who is immediately placed on the radiant warmer. After ensuring that there is an adequate airway, the nurse gives the newborn to the mother. Which response to the infant would the nurse anticipate? A. "I don't believe it. This can't be my baby!" B. "I'm so sad. Do you think I'm being punished?" C. "My parents will be so upset. What could have happened?" D. "I shouldn't have had this baby! Now my boyfriend won'

A Rationale: Denial or disbelief and shock are considered initial grieving responses. There is a feeling of guilt and inadequacy when an infant is born with a defect. It is unusual for a client to initially verbalize feelings of punishment or guilt so directly. A sense of shame and guilt is voiced later, after denial, disbelief, and shock have occurred. It is unusual for a client to use rationalization and voice it so obviously.

The nurse in a long-term healthcare setting will introduce a client who has a PhD to the other clients. The client tells the nurse, "I wish to be called Doctor." Which response by the nurse is correct? A. "Your wish will be respected." B. "Why do you want to be called Doctor?" C. "Residents here call one another by their first names." D. "Wouldn't it be better if the others do not know you are a doctor?"

A Rationale: The client has the right to make this decision, and the staff should accept the client's wishes. The client has a PhD, and the nurse's statement "Why do you want to be called Doctor?" attacks the client's self-concept. The informality of using first names is not encouraged unless it is the client's choice. The nurse can and should honor the client's request.

Which characteristic related to achieving autonomy would the nurse anticipate when providing care to a toddler? A. Ritualism B. Positivity C. Magical thinking D. Object permanence

A Rationale: The nurse expects the toddler to exhibit ritualism during this stage of development to achieve autonomy. The nurse also would expect the toddler to exhibit negativism, not positivity. Magical thinking is a characteristic the nurse anticipates for the preschool-age, not toddler-age, client. Object permanence is a characteristic that the nurse anticipates for the infant, not the toddler.

At 10:00 PM when the nurse enters the lounge, the client with a personality disorder requests a sleeping pill and the nurse says, "First go to bed and try to sleep." Which technique would the nurse be using? A. Setting limits B. Reality testing C. Routinizing care D. Conditioning behavior

A Rationale: The nurse is using the technique of setting limits. The expectation is communicated that before the medication is given the client must first try to sleep. No data are given to indicate that the client is out of touch with reality, nor is this a form of reality testing. No data are given to indicate that the nurse is enforcing a rule to preserve a routine by routinizing care. The nurse's response is not an attempt to condition behavior; it merely communicates an expectation.

Which behavior would the nurse observe when caring for a client with major neurocognitive disorder? A. Lability B. Independence C. Curiosity D. Being outgoing

A Rationale: The nurse would observe lability. Diffuse impairment of brain tissue function results in fluctuations in the extremes of emotions; lability of mood is common with major neurocognitive disorder. Clients with major neurocognitive disorder usually fluctuate between aggressive acting out and passive acceptance. Clients with major neurocognitive disorder are not independent; they usually need help with activities of daily living. These clients are not curious; intellectual deterioration associated with neurocognitive disorders decreases interest and curiosity in the environment. Clients with major neurocognitive disorders are not outgoing; they are withdrawn or moody.

Which defense mechanism would the nurse conclude a female client with obsessive-compulsive disorder who washes her hands more than 20 times a day is using to ease anxiety? A. Undoing B. Projection C. Introjection D. Displacement

A Rationale: Undoing is an act that partially negates a previous one; the client is using this defense mechanism to atone for unacceptable acts or wishes. The client is not attributing self-thoughts or impulses to another person or group, which is called projection. The client is not absorbing into the self a hated or loved object (introjection). Displacement is the transferring of feelings from one person, object, or experience onto another, less threatening person, object, or experience. The client is not using displacement when compulsively washing hands.

Which activities would the nurse recommend to a middle-age adult client to find a sense of fulfillment, according to Erikson? Select all that apply. A. Attending church functions B. Visiting adult children in their homes C. Becoming involved at a local hospital D. Volunteering to coach for a grandchild's soccer team E. Allowing independent decision-making when hospitalized

A, C, D Rationale: According to Erikson, middle-aged persons often find a sense of fulfillment by volunteering in a local school, hospital, or church; therefore, the nurse would recommend that the client attend church functions, become involved at a local hospital, and volunteer to coach a grandchild's soccer team. All of these suggestions would allow the client to find a sense of fulfillment. Visiting adult children in their homes and allowing independent decision-making when hospitalized are not recommendations that will allow the client to find a sense of fulfillment.

For a client with a bipolar mood disorder, manic episode, which factor would the nurse consider when planning care? A. Client is likely to feel embarrassed by the manic behavior B. Client is acutely aware of the environment and reality C. Client should be able to control the acting-out behavior D. Client is likely to engage in bingeing and purging behavior

B Rationale: Manic individuals are acutely aware of what is happening and react strongly to environmental stimuli. These clients are not out of contact with reality; in fact, they are continually reacting to it. These clients' symptoms are an attempt to avoid anxiety and do not cause embarrassment. They are unable to control acting-out behavior. Bingeing and purging behavior is a symptom of bulimia.

Which initial action would the nurse take for a nursing home resident with moderate Alzheimer's disease who begins to engage in numerous acting-out behaviors? A. Assess the client's level of consciousness B. Identify the stressors that precipitate the client's behavior C. Observe the client's performance of activities of daily living D. Monitor the side effects associated with the client's medications

B Rationale: The nurse would initially identify the stressors that precipitate the client's behavior. If the areas that cause stress can be identified, the client would be better able to control the acting-out behavior. These clients may be confused or disoriented, but they usually do not experience an altered level of consciousness; an altered level of consciousness is associated with delirium, not dementia. Although the client's performance of activities of daily living may be observed, this is only one area of function that should be assessed and it is not the initial action. The initial action would focus on the acting-out behaviors. Although monitoring the side effects associated with the client's medications is important, it is not the initial action.

A client with the diagnosis of borderline personality disorder has a history of suicidal behavior and self-mutilation. Which rationale best explains the self-mutilation? A. The client uses self-mutilation to control others. B. Self-mutilation is an expression of anger or frustration. C. The client is trying to convey feelings of autonomy. D. The behavior is used to manipulate family and friends.

B Rationale: Typically, recurrent self-mutilation is an expression of intense anger, helplessness, or guilt or is a form of self-punishment. Self-mutilation is used not to control others, but rather for self-validation; also, it is a means of blocking psychological pain by inducing physical pain. Expression of autonomy and manipulation are not the purposes of self-destructive behaviors.

The nurse is providing anticipatory guidance to the parents of a child who has a difficult temperament. What would the nurse include in teaching these parents regarding their child's temperament? SATA. A. "Your child will develop predictable habits." B. "YC will benefit from a bedtime routine." C. "YC is open to change and adapts easily." D. "YC is likely to adapt slowly to the new daycare setting." E. "YC will display intense emotions, including those associated with happiness."

B, D, E Rationale: Children who are classified as having a difficult temperament will benefit from a bedtime routine, will likely adapt slowly to a new daycare setting, and will display intense emotions, including those associated with happiness. The child who is classified as easy will develop predictable habits and will be open to change and adapt easily.

A client with generalized anxiety disorder presents with restlessness and fatigue. Which additional clinical manifestation would the nurse monitor for? A. Hoarding B. Panic attacks C. Excessive worry D. Fear of leaving the house

C Rationale: The nurse would monitor for excessive worry. Generalized anxiety disorder is the manifestation of both physical and cognitive symptoms of chronic or excessive anxiety/worry. Hoarding is a sign of hoarding disorder, not generalized anxiety disorder. Panic attacks occur in panic disorder, not generalized anxiety disorder. Fear of leaving the house is a symptom of agoraphobia, not generalized anxiety disorder.

A client with depression presents with feelings of sadness and is having difficulty sleeping. Which additional signs and symptoms would the nurse monitor for? Select all that apply. A. Rigidity with a narrowing of perception B. Alternating episodes of fatigue and high energy C. Diminished pleasure in activities D. Excessive socialization E. Alteration in appetite

C, E Rationale: Additional signs and symptoms include diminished pleasure in activities and alteration in appetite. Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite (either decreased or increased) is common in depressed clients. Although there is a narrowing of perception, rigidity is uncommon with depression. Fatigue is continually present and does not alternate with a high energy level. In depression there is a loss of interest in socialization, not excessive socialization.

A woman who is frequently physically abused says, "It's my fault that my husband beats me." Which response would the nurse use? A. "Maybe, but it's likely that your husband is also at fault." B. "I can't agree with that—no one should be beaten." C. "Tell me why you believe that you deserve to be beaten." D. "You say that it was your fault—help me understand that."

D Rationale: Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior. A closed declarative statement (husband is also at fault) limits dialogue. Nurse-focused statements (I can't agree) do not empower the client. "Why" questions are generally not therapeutic because most clients cannot respond to these questions with logical explanations.

In an effort to foster a healthy grief response to the birth of a stillborn child, which response would the nurse make to the mother's questions about the cause? A. "This often happens when something is wrong with the baby." B. "It's God's will; we have to have faith that it was for the best." C. "You're young, and you'll have other children—wait and see." D. "You may be wondering whether something you did caused this."

D Rationale: The nurse would say, "You may be wondering whether something you did caused this." The mother must be helped to identify her feelings to foster a healthy grief response. Many stillborn children are apparently free of any defects. Telling the woman that it was God's will and that we have to have faith that it was for the best is based on the nurse's religious beliefs; there is no indication that the client has the same beliefs, so this closes off communication. Telling her that she is young and will have other children is false reassurance; it does not encourage the client to explore her feelings.

Which school-age client would the nurse assess for symptoms related to burnout? A. 7 year old B. 8 year old C. 9 year old D. 10 year old

D Rationale: The school-age client between the ages of 10 to 12 years often becomes overinvolved with activities leading to burnout; therefore, the nurse would assess the 10-year-old client for clinical manifestations associated with burnout. The other school-age clients (7 years, 8 years, and 9 years) do not often become overinvolved in activities leading to burnout.