3554 Module 6 practice q's
What is the priority concern of the crisis intervention nurse regarding the client? The client's physical safety Setting up support contacts Helping the client brainstorm possible solutions Assisting the client to work through termination issues associated with therapy
A Client safety is always the priority concern in crisis intervention therapy. The disequilibrium of crisis predisposes the client to suicidal thinking.
A class of medications commonly prescribed for somatic disorders is mood stabilizers. antidepressants. anxiolytics. antipsychotics.
C Primary care providers prescribe anxiolytic agents for patients who seem highly anxious and concerned about their symptoms. Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety or to induce sleep
The risk of elder abuse in a home is best determined by conducting which assessment? The vulnerability of the elder and the stress of the caregiver The amount of disruption the elder causes in the home How much actual physical assistance the elder needs on a daily basis The financial contribution of the elder and the caregiver's early life experience with abuse
A Abuse occurs across all segments of society and is reinforced by the society and the culture. The actual occurrence of violence requires (1) a perpetrator, (2) someone who by age or situation is vulnerable (e.g., children, women, men, the elderly, mentally ill persons, and physically challenged persons), and (3) a crisis situation.
Which characteristics will the nurse assess in the client diagnosed with antisocial personality? Deceitfulness, impulsiveness, and lack of empathy Perfectionism, preoccupation with detail, and verbosity Avoidance of interpersonal contact and preoccupation with being criticized A need for others to assume responsibility for decision making and seeking nurture
A Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which of the client's classic characteristics? Mood shifts, impulsivity, and splitting Grief, anger, and social isolation Altered sensory perceptions and suspicion Perfectionism and preoccupation with detail
A Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.
Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of which psychiatric disorder? Posttraumatic stress disorder (PTSD) A maturational crisis A dissociative disorder Obsessive compulsive disorder (OCD)
A Most of those who have been raped are eventually able to resume their previous lives after supportive services and crisis counseling. However, many carry with them a constant emotional trauma: flashbacks, nightmares, fear, phobias, and other symptoms associated with posttraumatic stress disorder (PTSD).
Patients diagnosed with BPD exhibit negative effect, which includes rapidly moving from one emotional extreme to another. What term is used to describe this characteristic? Lability Impulsivity Splitting Denial
A One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Patients exhibiting this trait are often documented as being labile.
What is the typical response when a stressful event occurs and the individual is unable to resolve the situation by using their usual coping strategies? A state of emotional disorder results in trial-and-error problem solving. They will withdraw and act as though the problem does not exist. They develop severe personality disorganization. Their distress often causes them to resort to planning suicide.
A The description is that of the second stage of crisis, according to accepted crisis theory. In this stage the individual will adopt the trial-and-error method of problem solving since their usual strategies are no longer effective.
Which assumption serves as a foundation for the use of crisis intervention? The individual is mentally healthy but in a state of disequilibrium. Long-term dysfunctional adjustment can be addressed by crisis intervention. An anxious person is unlikely to be willing to try new problem-solving strategies. Crisis intervention nurses need to remain passive as the client deals with the crisis.
A The patient in a crisis situation is assumed to be mentally healthy, to have functioned well in the past, and to be presently in a state of disequilibrium.
During the immediate post-rape period what verbal nursing intervention would best lower client anxiety and increase feelings of well-being? "You are safe here. I will stay with you while you have your examination." "I know you feel confused. We will make all the necessary decisions for you." "Please tell me as much about the details of the rape as you can remember." "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."
A The presence of the nurse is reassuring, especially when the client is experiencing disorganization and the environment is confusing. Safety is the primary concern for both the client and the nurse. The nurse's presence conveys a sense of safety to the client.
Which statement would be an appropriate long-term outcome for a rape client? Integrate of the rape event and resumption of an optimal level of functioning. Identify and develop coping skills necessary to reduce level of anxiety. Appropriately blame the rapist rather than blaming herself for the situation. Repress feelings of shame, embarrassment, and self-blame.
A This is the ideal long-term result of treatment for rape trauma syndrome, that life will go on and the client will return to the usual pre-trauma level of functioning. Repressing is not a healthy coping mechanism.
Which of the following are myths surrounding rape? Select all that apply. Women are usually raped by a stranger. Women do not "ask" to be raped by their behavior or dress. Most rapes occur away from home areas such as alleys and behind buildings. Documented rape cases include women from 8 to 70 years old. Rape is an expression of aggression and anger. Rape is usually an impulsive, spur-of-the-moment decision by the rapist. Unless the assailant is armed, most women should be able to get away and avoid the rape.
A, C, D, F, G
To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control his/her anger, what is the most appropriate short-term goal for the parent? Demonstrating understanding of the impact of violence on the child within 2 days Beginning attending anger management training sessions within 2 weeks Stating a willingness to attend a support group for physical abusers within 1 week Showing remorse for their anger management issues within 2 days
B Perpetrators of violence need help learning how to manage anger. A structured group is an excellent way to provide this teaching. This option most directly addresses the issue of preventing the anger from escalating to physical abuse.
A newly admitted client has a diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be directed toward which classic client need? Set firm limits on behavior. Respect need for social isolation. Encourage expression of feelings. Involve in milieu and group activities.
B Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.
When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving which form of treatment? Primary prevention Secondary prevention Tertiary prevention Stop-gap therapy
B Secondary prevention involves early intervention in abusive situations to minimize their disabling or long-term effects. This scenario demonstrates actions only associated with secondary prevention.
The mother of a 4-year-old daughter states that the child has recently begun, "Touching her vagina and rubs herself down there all the time." The child drew a picture showing two people with one on top of the other and said they were "doing sex." Based on the assessment description, what conclusion should the nurse explore further? Educate the mother to normal developmental behavior in a 4-year-old child. There is a possibility that the child has been sexually abused. The mother should be enrolled in parenting classes to improve her parenting skills. The child's exposure to graphic sexual images on television should be monitored closely.
B Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children. It is not normal developmental behavior for a 4-year-old child. The other options may be true, but sexual abuse is more likely and must be investigated.
What type of crisis is a newly unemployed person most likely to experience? Reactive Situational Maturational Unexpected
B Situational crises arise from external sources. Examples are death of a loved one, divorce, marriage, or a change in health status.
Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder? 13-year-old male 23-year-old female 33-year-old male 43-year-old female
B The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals
When discussing somatic disorders from a cultural perspective, which statement is true? Somatic disorders are rarely observed in males. Somatic symptoms vary widely from culture to culture. Underdeveloped countries rarely tolerate somatic disorders. Secondary gain is seldom a factor in somatic disorders.
B The type and frequency of somatic symptoms vary across cultures
Which assessment data describes a client in phase IV of Caplan's phases of crisis? The client reports experiencing increased anxiety and feelings of extreme discomfort the day after the tornado. The client comes to the crisis clinic reporting depression and expresses that he does not want to go on living. The client reports experiencing a panic attack. The client reports experiencing anxiety symptoms the day after being fired.
B This describes that phase IV, which, if coping is ineffective, may lead to depression, confusion, violence, or suicidality. The other options describe phase II, phase III, and phase I in Caplan's phases of crisis.
What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? Steering conversation away from the client's feelings Conveying an interest in the client rather than in the symptoms Encouraging the client to use benzodiazepines liberally Encouraging the client to rely on the nurse to meet the client's needs
B When the nurse focuses on the client rather than on the symptoms, the client's self-worth and coping skills are enhanced. The discussion related to client feelings is a major focus of therapy.
Which statement would suggest to the crisis intervention nurse the need to arrange for hospitalization of a client? "I'm feeling overwhelmed by all that has happened, and I need help sorting it out." "I see no solution for this situation if nothing changes by tomorrow." "There are three possibilities that might help, but I can't decide what to do." "I feel a little calmer than yesterday at this time, but things are still very difficult."
B Whenever the client presents a danger to himself or herself or others, hospitalization must be considered. Such a danger may exist if the client expresses hopelessness as in the correct option.
Which behavior demonstrated by a woman attempting to escape a chronically abusive relationship presents the greatest personal risk? Relying on alcohol to escape the emotional pain of abuse Adapting an aggressive attitude toward her abuser Considering ways to commit suicide Threatening to call the police if she is abused again
C A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer. A suicide attempt may be the presenting symptom in the emergency department. At least 10% of abused women attempt suicide.
Which child is at lowest risk for abuse? A 3-month-old who has colic and teenaged parents A 4-year-old who has cerebral palsy and cognitively challenged parents A 2-year-old who has leukemia and two working parents A 5-year-old who has ADHD and a father who was abused as a child
C Although the child in option C has a serious physical disorder, she is at lower risk than the child in option A, whose inconsolable crying can be frustrating; the child in option B, who will not be as independent as other children his age and who has parents who may not understand his needs; or the child in option D, whose hyperactivity can be annoying, especially to a parent who himself has been abused
What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? Client will walk unassisted within 1 week. Client will return to a pre-illness level of functioning within 2 weeks. Client will be able to state two new effective coping skills within 2 weeks. Client will assume full self-care within 3 weeks.
C An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic.
A client comes to the crisis intervention clinic and tearfully tells the nurse, "It is so painful! I have thought about it, and I cannot see how I can go on without my partner." The nurse states, "You have resilience and will look back on this as a crisis you were able to manage." What is the evaluation of the nurse's response after analysis of this nurse-client interaction? demonstrates a good understanding of the effect of time on perception of a crisis. is offering a statement of positive outcome based on client coping ability. has failed to follow up on the client's verbal clues to suicidal thoughts. has introduced a concept associated with traditional psychotherapy.
C Nurses who are uncomfortable with the idea of suicide may fail to pick up on a client's clues. This client clearly was open to discussing her suicidal thoughts, or she would not have said, "I cannot see how I can go on."
Which statement best illustrates support in giving care to a patient who has just been sexually assaulted? "I'm so sorry for what you have been through." "Don't worry. It's hard now, but everything will be alright." "I am going to stay with you. We can talk as long as you want to." "Let's talk about new coping skills you can use."
C The most effective approach for counseling in the emergency department or crisis center is to provide nonjudgmental care and optimal emotional support. Sympathy is not a therapeutic response and does not focus on the patient. Telling the patient not to worry is false reassurance. It is too soon to try to learn new coping skills because the patient is in an acute stress phase.
A client is treated in the emergency department for injuries sustained while vacationing hundreds of miles away from home. How should the nurse best meet the client's emotional needs in order to minimize the risk of crisis? A. Arranging to hospitalize the client so all needs will be met. B. Referring the client for traditional psychotherapy for the expected development of posttraumatic stress disorder. C. Providing temporary support by arranging shelter for the client and contacting family or traveling companions. D. Suggesting that contacting a victim support group would be more appropriate than crisis intervention.
C When a client has no support system, the nurse may assume that role for a short time. In this situation, temporary shelter and contact with family/friends would be supportive.
When should the nurse expect the abuse of a victim to worsen? The perpetrator feels he is in complete control. The perpetrator is feeling remorseful for being abusive. The victim moves toward independence from the abuser. The victim submits to the domination of the perpetrator.
C When the abuser thinks they are losing control over the victim, the violence escalates.
Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? "A combination of antianxiety and antidepressant therapy is the most effective therapy." "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."
D CBT is the most consistently supported treatment for the full spectrum of somatic disorders.
An elderly client pays the bills because she fears that her family will make her live elsewhere if she doesn't "help out." The nurse assesses as the client may be at risk for what form of abuse? Neglect Physical violence Psychological Financial maltreatment
D Financial maltreatment occurs when the perpetrator takes financial advantage of the elderly person, often through the use of subtle threats of what unpleasant or frightening outcome will occur if the elder does not supply funds.
It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? Utilizing many different therapeutic strategies or modalities for enhanced coping Involving every member of the family as well as the patient in treatment Incorporating spirituality and religion into treatment Considering all dimensions of the patient, including biological, psychological, and sociocultural
D It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient.
Anticipatory teaching for a rape victim should include information addressing what common survivor problem? Denial of the event Headaches and fatigue Shock and numbness Intrusive thoughts
D Just as in posttraumatic stress disorder, intrusive thoughts haunt the rape victim in the weeks and months during which long-term reorganization is occurring. Knowing that this is a common occurrence is reassuring to the client, who often is frightened by the symptom.
What type of crises occur as an individual moves from one developmental level to another? Reactive Recurring Situational Maturational
D Maturational crises are normal states in growth and development in which specific new maturational tasks must be learned when old coping mechanisms are no longer effective.
What distinction can be made between abuse and neglect? Neglect occurs in the psychological domain; abuse occurs in the physical domain. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. Neglect is perpetrated against children; abuse victims can be children or adults. Neglect is a failure to provide; abuse is a failure to control aggression.
D Neglect is failure to provide necessary care, and abuse is physical maltreatment.
A sexual assault survivor tells the nurse, "I should have tried to fight him off! But I was so terrified that I could not move. I should have tried harder." Which response should the nurse make to reassure the client? "Try not to think about it. Put it out of your mind." "We each behave in characteristic ways in a crisis. That was your way." "Do you think others will think badly of you for not trying to fight?" "The way you behaved was the right thing to do at the time."
D The victim should always be told that staying alive was the priority and that whatever she did to that end was the right thing to do.
What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? "I feel less anxiety than before." "My memory is better than it was a month ago." "I take my medications just as the physician prescribed." "I don't think about my symptoms all the time as I used to."
D This statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome. Neither medication adherence nor memory loss is associated with this disorder. The client would not acknowledge generalized anxiety as a symptom of their disorder
Which statement is true regarding antisocial personality disorder (APD)? Select all that apply... A. It is the least studied of the personality disorders. B. It is characterized by rigidity and inflexible standards of self and others. C. Persons with APD display magical thinking. D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. F. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. G. Frontal lobe dysfunction is a brain change identified in APD.
D E G APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes STPD. People with APD usually present with depression because of the consequences of their behaviors, not because they care about the effects of their actions on others.
Which statement is true of pharmacological therapies associated with the treatment of personality disorders? A. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. B. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. C. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. D. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
A At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off-label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder? Antisocial personality disorder Borderline personality disorder Schizotypal personality disorder Narcissistic personality disorder
A Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.
To assess the client's perception of the event precipitating a crisis, the nurse would initially ask which question? "How does this situation affect your life?" "During difficult times in the past, what has helped you?" "Can you give me the name of someone you trust?" "Who is available to help you?"
A Individuals process information differently. An event may be minor to some while being extremely serious to others. The correct option is the only query that is directed at the client's perception of the precipitating event.
Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff should implement which personal intervention? Regularly discuss their feelings about the client during the unit's interprofessional care meetings. Attend in-services that focus on the various aspects of somatic disorders. Rotate care of the client among the entire nursing department staff to minimize the frustration. Provide a unified approach to the client's behavior so as to manage and lessen the barrier itself.
A It is helpful for health care workers, no matter the setting, to discuss responses to these patients in conferences with other health care members to allow for expression of feelings and, ultimately, to provide for consistent care
Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." "Our son is really a good little boy, but he needs to be disciplined both at home and in school." "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." "We have become active in the support group but still find the suggestions extremely difficult to put into practice."
A Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation.
A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A court date this week for drunk driving Was adopted at the age of 5 years A history of physical abuse by his stepfather A history of oppositional-defiant disorder Raised primarily in a single parent household
A Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations.
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." What response should the nurse provide to address the client's comment? "I will be continuing to follow the care plan for the patient." "I see you are trying to control that patient's therapy as well as your own." "Your eye for perfection extends even to my nursing interventions." "That patient's care is really of no concern to you or to other clients."
A Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.
Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present with which assessment characteristic? Vague physical complaints such as insomnia or pain Extreme anger and unpredictable behavior Family members described as supportive Psychosis and/or mania as a result of long-term abuse
A Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence. Presenting with extreme anger is possible but not as common as presenting with vague physical complaints. Having many family members there is unlikely as many victims keep their history of being battered a secret. It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint
Two 16-year-old students were both involved in serious car accident. Both students have spoken with a counselor about the incident. One student has been able to move forward with little dysfunction as a result of the accident while the other has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. The difference in the way the accident affected both boys may be explained primarily by what factor? Personal perception of the event. Individual personality. Existence of previous, unresolved emotion trauma. One student received ineffective counseling.
A People vary in the way they absorb, process, and use information from the environment. Some people may respond to a minor event as if it were life threatening. Conversely, others may experience a major event and look at it in a calmer fashion.
Which statement is descriptive of clients with a personality disorder? They are resistant to behavioral change. They have an ability to tolerate frustration and pain. They usually seek help to change maladaptive behaviors. They have little difficulty with cognitive functioning.
A Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.
Which situation has the potential for early crisis intervention to occur? Mrs. R tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist. Ms. T is hospitalized after an unsuccessful suicide attempt that she states, "was a mistake." Mr. W asks for reassurance that he will be welcome at the day hospital after his hospital discharge. Ms. G enters the emergency department with a strong smell of alcohol on his person, stating he is anxious and depressed.
A Phase I intervention is when a person confronted by a conflict or problem that threatens the self-concept responds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem-solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety.
How is the act of rape is best described? An act of violence using sex as the weapon Assault by a stranger on an unsuspecting victim Sexual desire satisfied inappropriately An act prompted by early childhood neglect
A Rape is a violent crime. Sex is only the medium for perpetrating the crime.
The emergency department nurse planning care for a rape survivor must realize that the emotional reaction displayed by many rape victims during the initial assessment and treatment is which emotion? Fear Eagerness Aggression Disinterest
A Rape is an act of violence, and sex is the weapon used by the perpetrator. Rape engulfs its victims in fear and anxiety, resulting in withdrawal for some and causing severe panic reactions in others. After being traumatized, the person who has been raped often carries an additional burden of shame, guilt, fear, anger, distrust, and embarrassment.
To provide discharge treatment and support, the nurse should realize that the most common outcome of acquaintance rape is which psychosocial dysfunction? Sexual distress Fear of men Depression Anxiety
A Women who have been raped by acquaintances frequently develop symptoms that prevent them from participating in normal sexual relations. Sexual distress is more common among women who have been sexually assaulted by intimates; fear and anxiety are more common in those assaulted by strangers. Depression occurs in both groups.
What is the expected outcome for an individual who has successful resolved all the maturational crises they have been presented with? Select all that apply. The development of basic human qualities The elimination of future maturational crises The development of new, effective coping mechanisms The elimination to specific barriers to psychosocial growth The ability to pass through subsequent developmental stages
A C E Successful resolution of these maturational tasks leads to development of basic human qualities. Erikson believed that the way these crises are resolved at one stage affects the person's ability to pass through subsequent stages. Each crisis provides the starting point for movement toward the next stage with the opportunity to learn new coping mechanisms and experience personal psychosocial growth. Each new stage of development results in a maturational crisis
A 24-year-old patient diagnosed with borderline personality disorder (BPD) is admitted to the inpatient psychiatric unit following a suicide attempt. Which client statements illustrate a primary coping style of persons with BPD? "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." "I will never again speak to any of my messed up family members. I know that this will help me to be more functional." "I promise I am not feeling suicidal. I won't hurt myself."
B A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person.
A 28-year-old married client who is seeking treatment after being raped tearfully asks the nurse, "What if I am pregnant?" The nurse's response should be guided by what knowledge? The risk of pregnancy after rape is high, up to 50%. About 5% of women who are raped become pregnant as a result. Reproductive functions shut down during a violent attack, and as a result pregnancy does not occur. The client may be worried about how her spouse will accept the baby.
B About 5% of women who are raped become pregnant as a result (Rape, Abuse & Incest National Network, 2008). Pregnancy prophylaxis can be offered in the emergency department after the results of the pregnancy test are available. The risk of pregnancy is not high after rape. Reproductive functions do not shut down during a violent attack. The patient may be worried about her spouse's reaction; however at this time most important consideration is to give the patient pertinent education regarding rape and pregnancy.
Which nursing intervention is best directed at the psychological needs of a physically abused client? Encourage the client to immediately leave the abuser. Affirm that the client did not deserve or cause the abuse. Provide a referral to social services for economic problems. Facilitate contact with law enforcement to take legal action.
B Abused clients often believe that they are deserving of the abuse and, in some way, prompt the abuser to attack. They need specific reassurance that they did not deserve to be abused and they did not cause the attack.
Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" "Your legs don't work because your brain is screwed up." "Your emotional distress is being expressed as a physical symptom." "You are making up your symptoms as a cry for help." "You are overly anxious about having a severe illness."
B Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control.
When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, what should the priority nursing intervention be? Advising her to enter counseling at the mental health center Assisting her in developing a plan to go to a shelter in case of a crisis Suggesting that she leave the abuser immediately and go to a trusted friend's home Teaching her to counter verbal abuse with assertive replies
B Every victim of abuse should have an escape plan, but one is particularly important when the nurse believes the client is in severe danger.
The primary difference between a factitious disorder and other somatic disorders is described in which statement? Factitious disorders respond well to confrontation as a primary therapeutic technique. Factitious disorders have a symptomatology that is actually controlled by the client. Factitious disorders have their origins in depression and anxiety. Factitious disorders are always self-directed.
B Factitious disorders, in contrast to other somatic disorders, are under conscious control.
Research has indicated that the antisocial personality may be characterized by what behavior? Social isolation Lack of remorse Learning difficulties Difficulty with reality testing
B Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others.
A 36 year old comes to the crisis clinic with reports of not sleeping, anxiety, and excessive crying. After a tornado devastated his hometown, the client was suddenly unemployed and homeless. Which of the following statements regarding crisis accurately describes the client's situation? He is experiencing low self-esteem from the job loss, as well as anger because of the loss of his home. He is experiencing a situational crisis that is associated with both a natural disaster and a personal event. He is experiencing ineffective coping and should be hospitalized for intensive therapy. He is experiencing a situational crisis with the added stress of financial burden.
B It is possible to experience more than one type of crisis situation simultaneously, and as expected, the presence of more than one crisis further taxes individual coping skills. The client lost his job (personal event) and also experienced the devastating effects of a tornado (natural disaster). The first option may be true but doesn't accurately describe the crisis criteria. There is nothing in the scenario suggesting he needs acute hospitalization at this time. He is experiencing not only a personal situational crisis but a natural disaster as well, which makes coping more difficult
A physician describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? a. Falsely claiming to have symptoms. b. Experiencing symptoms that cannot be explained medically. c. Experiencing symptoms that have a physiological basis. d. Seeking medication to ease pain of psychological origin.
B Malingering is a consciously motivated act to deceive based on the desire for material gain. The symptoms described are nonexisting and so none of the other options are correct statements of behavior
When there is reason to suspect that a child is being abused, the nurse must initially implement which intervention? Call the local police to report it. Follow agency policy for reporting. Confront the parent or parents. Question the child to obtain proof.
B Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse.
Playing one staff member against another is an example of what defense mechanism? Devaluation Splitting Impulsiveness Social ineptitude
B Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.
The nurse performing the assessment of a wheelchair-bound client suspects that his wife's explanation of how he sustained facial contusions and a broken nose may not be entirely truthful. The nurse should implement which assessment intervention? Confront the wife with the suspicion that her husband's injuries are the result of abuse. Have the wife wait in the waiting room so her husband can be interviewed in private. Report the husband's injuries to the police and ask for a confidential investigation. Document the suspicion and follow a policy of "wait and see" whether he returns again.
B Suspected victims of abuse should always be interviewed in private. If the perpetrator is in the room, the victim cannot speak freely. Confronting the wife would likely cause her to be uncooperative and increase tensions.
An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, what is the most appropriate nursing diagnosis? Hopelessness Fear Post-trauma syndrome Risk for self-directed violence
B The client is expressing fear based on a known threat.
Considering client function, what is the expected outcome at the conclusion of crisis intervention therapy? Function is higher level than before the crisis. Function is at the precrisis level. Function is only marginally below the precrisis level. Function is occurring without aid from identified support systems.
B The intent of crisis intervention is to return the individual to the precrisis level of functioning. While this goal is not always attainable, it remains the expected outcome of crisis intervention therapy.
A 12-year-old finds herself feeling anxious and overwhelmed and seeks out the school nurse to report that "Everything is changing; my body, the way the boys who were my friends are treating me, everything is so different." What term is used to describe what this child is experiencing? A personal identity disorder A maturational crisis Suicidal ideations Mild neurosis
B The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary.
A woman comes to the crisis intervention clinic and reports that her 16-year-old son uses drugs in the home and often assaults her. The nurse tells the client: "This is not an uncommon problem. Don't worry." "Together we will be able to work on this problem." "Now that you are asking for help, everything will be all right." "I have friends in law enforcement who can help us choose a solution."
B The nurse takes an active collaborative role in problem resolution beginning with telling the client that a solution will be found.
A sexual assault victim asks to be given "the morning-after pill" to prevent conception. The nurse does not believe in abortion. What action the nurse should take? Refer the woman for social services counseling. Report and document the request. Ask the supervising nurse to reassign the client. Ask the client to reevaluate her request after 24 hours.
B The nurse's ethical beliefs should never interfere with client rights. The nurse should report and document the client's request.
Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? Somatic disorder Factitious disorder Illness anxiety disorder Conversion disorder
C Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic.
A crisis is so acutely uncomfortable to the individual that it is likely to self-resolve in what time frame? 1 to 10 days. 1 to 3 weeks. 4 to 6 weeks. 3 to 4 months.
C At 4 to 6 weeks, the individual is making accommodations and adjustments to relieve anxiety, and the crisis is no longer a crisis.
The client, diagnosed with which personality disorder, will most likely require admission to a psychiatric unit? Paranoid personality disorder Narcissistic personality disorder Borderline personality disorder Dependent personality disorder
C Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.
Which statement made by a client would support the diagnosis of Illness anxiety disorder? "I feel confused and disoriented." "I feel as though I'm outside my body watching what is happening." "I know I have cancer, but the doctors just cannot find it." "I woke up one morning, and my left leg was paralyzed from the knee down."
C Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. People experience extreme worry and fear about the possibility of having a disease.
An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse recognizes that the client is describing which stage of the cycle of violence? Tension building Acute battering Honeymoon Escalation
C During the honeymoon stage, the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence. This stage is usually brief
Which statement, made by a female adult concerning her boyfriend, should cause the nurse to suspect that the client is at risk for being emotionally abused? "He has a good job and keeps control of all the finances but our electricity still got turned off last week." "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." "He has always had a fiery temper."
C Emotional abuse may be less obvious and more difficult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety. Controlling the finances and having the electricity turned off describes the possibility of economic abuse. Not wanting to add to the boyfriend's stress does not describe an abusive situation. Describing the boyfriend as having a temper would more likely hint at physical abuse rather than emotional.
A 4-year-old child tells the nurse, "I'm a bad boy. Daddy always says I'm not worth a second look." This situation can be an example of which form of abuse? Neglect Physical Emotional Tough love
C Emotional violence occurs when the child's self-esteem is attacked. It is as devastating to the child as physical abuse.
When interviewing an adult victim of abuse, what is the nurse's best approach when asking relevant questions? Confrontational and assertive Gentle but direct Direct and professional Sympathetic but detached
C Expressing strong emotion does not help the victim. A direct, honest, and professional manner of asking questions produces the best results.
Which statement reflects a fact about family violence? Ninety-five percent of abuse victims are women. The victim's behavior is often the cause of the violence. Violence occurs in families of all backgrounds. Alcohol and stress are the major causes of abuse.
C Family violence is a serious community health problem common among all backgrounds.
Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. Which nursing diagnosis best addresses this sort of interpersonal dysfunction? Spiritual distress Defensive coping Impaired social interaction Disturbed sensory perception
C For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.
Which nursing action directed toward a client in crisis demonstrates signs of a problematic nurse-client relationship? Offering to change the time of the counseling session for the second time in 3 weeks Experiencing frustration about the decisions the client is making Giving the client a personal number to call when they "need to talk" Suggesting that the client attend an extra counseling session each month
C Giving a client one's personal telephone number is a reaction to the nurse's need to be needed and undermines the client's sense of self-reliance.
A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of what process? Regression Depersonalization La belle indifference Dissociative amnesia
C La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety.
Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? Potential for violence Level of confusion Dependence on medication Personal identity disturbance
C Many clients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the client has taken, but also for amounts and length of time over which the drugs have been prescribed.
Which statement reflects a truth about rape? Some women want to be raped. Rapists are oversexed. Most rapes are planned. Most women are raped by strangers.
C Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated.
What characteristic behaviors will the nurse assess in the narcissistic client? Dramatic expression of emotion, being easily led Perfectionism and preoccupation with detail Grandiose, exploitive, and rage-filled behavior Angry, highly suspicious, aloof, withdrawn behavior
C Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.
What is the priority nursing intervention for a client diagnosed with borderline personality disorder? Protect other clients from manipulation. Respect the client's need for attention. Assess for suicidal and self-mutilating behaviors. Provide clear, consistent limits and boundaries.
C One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which behaviors? Frequent episodes of psychosis Constant involvement with the needs of significant others Inflexible and maladaptive responses to stress Abnormal ego functioning
C Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.
When the nurse finishes addressing a group of college women about rape, the following comments are heard during the discussion period. Which comment calls for additional teaching by the nurse? "It makes sense that rape is a crime of violence, not a crime of sex." "Who would have guessed that most rape victims know the rapist?" "So if you dress conservatively, your risk of being raped is small." "I always thought rapes happened at night, but now I know that isn't true."
C Rapes have little to do with whether the victim dresses seductively because rape is a crime of violence rather than a crime of sex.
Which nursing diagnosis should be investigated for clients with somatoform disorders? Deficient fluid volume Self-care deficit Ineffective coping Delayed growth and development
C Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms. This information supports that clients generally demonstrate ineffective coping of anxiety, loneliness, and risk of suicide.
Which mental health disorder is an example of a somatoform disorder? a. Depersonalization b. Dissociative fugue c. Conversion disorder d. Dissociative identity disorder
C Somatic disorders include conversion disorders that are functional neurological disorders.
Splitting is a process in which the client demonstrates what behavior? Unconsciously represses undesirable aspects of self Places responsibility for his or her behavior outside the self Sees things as divided into "all good" or "all bad" Evidences lack of personal boundaries
C Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.
It has been 6 months since a woman was raped. Which statement by the client would indicate that counseling has helped her to achieve an important long-term outcome? "I'm not having as many nightmares about the rape so I do get a little sleep at night." "My husband has been very supportive during this whole thing." "I am not going to let that rapist be in control of my life. I know things will keep getting better." "I am not pressing charges because I want this whole thing to be over with so I can move on."
C The correct option expresses empowerment and hope for the future. Long-term outcome includes the absence of any residual symptoms after the trauma and would be indicated by healing of physical injuries, relief of anger in nondestructive ways, comfort in relationships, and feelings of empowerment and expression of hope. While there has been an improvement, having nightmares and not sleeping well indicates that the patient is still going through acute stress related to the rape. The fact that the husband is supportive is a positive statement regarding her husband but doesn't express her own indicators of recovery. Not pressing charges may indicate that the patient may not be dealing with the event in a healthy way by avoiding the trauma.
Which of the following persons has the highest risk factors for physical abuse? Emma, a 7-month-old baby who has colic and doesn't sleep through the night Roland, a 53-year-old man with cardiovascular disease living with his son Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder Rose, a 77-year-old woman living with her daughter and son-in-law
D Older women dependent on family members for care are at higher risk for abuse.
Which of the following statements by a woman who was sexually assaulted a year ago would indicate that she has recovered from the trauma? "I don't walk home alone anymore because I am terrified it may happen again." "I am sleeping better but still only get about 5 hours of sleep at night because of bad dreams about the rape." "I realize that I was partly to blame for the rape because of walking in an unsafe neighborhood." "My husband and I are having sex again and I enjoy it."
D Sexual assault survivors are considered to be recovered if they are relatively free of any signs or symptoms of acute stress disorder and posttraumatic stress disorder. Signs of recovery include sleeping well with few instances of nightmares or dreams, being only mildly fearful, having positive self-regard, and returning to pre-rape sexual functioning and interest. The closer the survivor's lifestyle is to how it was before the rape, the more complete the recovery has been. Not walking home because of being terrified indicates a high level of fear. Only sleeping 5 hours at night indicates sleeping is still seriously disturbed. Stating that she is partly to blame indicates that the patient is placing the blame for the rape on herself instead of the perpetrator.
Which statement about somatoform disorders is true? An organic basis exists for each group of disorders. Nurses perceive clients with these disorders as easy to care for. No relation exists between these disorders and early childhood loss or trauma. Clients lack awareness of the relations among symptoms, anxiety, and conflicts.
D Somatization disorders are believed to be responses to psychosocial stress, although the patient often shows no insight into the potential stressors.
Studies have shown a correlation between mental disorders and which medical condition? Psoriasis Asthma Chronic renal failure Cardiovascular disease
D Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions such as cardiovascular disease and cancer.
What is the priority outcome for a toddler who has been sexually abused? The mother will learn coping techniques to support the child. The child will be able to verbalize exactly what happened to her. The child will no longer demonstrate inappropriate sexual behavior. The sexual abuse will cease immediately.
D The highest priority in this case is that the abuse stops so that the patient can be safe and undergo recovery. The question is asked about the priority outcome for the victim, not the mother. Verbalizing exactly what happened is not a priority. The victim will most likely stop the sexualized behavior when the abuse has stopped and recovery is supported by age-appropriate interventions.
A 37-year-old patient, referred to the mental health clinic with a suspected personality disorder, is withdrawn and suspicious and states, "I've always preferred to be alone" and then adds, "I can read your thoughts whenever I want to." This presentation supports which psychiatric diagnosis? Obsessive-compulsive personality disorder Narcissistic personality disorder Avoidant personality disorder Schizotypal personality disorder (STPD)
D The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious.
What is the highest nursing priority for a client experiencing a situational crisis? Reduction of expressed anxiety. Development of new coping skills. Prevention of boundary blurring. Promoting client safety.
D The nurse's initial task is to promote safety by assessing the patient's potential for suicide or homicide. The other options are all important components of the care plan, but safety of the patient takes the highest priority.
