Chapter 10,11,12,18

A young couple just ended their relationship after a 9-month engagement. One of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing? A) Safety loss B) Loss of security and sense of belonging C) Loss of self-esteem D) Loss related to self-actualization

B

A client approaches the nurse and loudly states, "I'm not putting up with this anymore!" The most appropriate response by the nurse would be which of the following? A) "I can see you are angry. Tell me what's going on." B) "You are not allowed to make threats. Please keep your voice down." C) "Why do you say that?" D) "You are here voluntarily. You can leave if you want."

a

A client with dependent personality disorder has a goal to increase her problem-solving skills. Which client behavior would indicate progress toward meeting that goal? A) Asking questions B) Being polite C) Controlling emotional outbursts D) Requesting assistance appropriately

a

A nurse is working with a client who has a history of repeated abusive intimate relationships. The nurse has difficulty understanding why a woman would repeatedly enter into relationships with abusive partners. When working with this client, the nurse can best maintain a therapeutic relationship through which of the following approaches? A) Keeping focused on the client's feelings about her life situation B) Honestly asking the client why she repeats the cycles of victimization C) Convincing the client to develop a self-rescue plan D) Not prying into the details of the client's private life

a

A nurse is working with a client who has frequent angry outbursts. Which of the following statements is most helpful when working with this client? A) "Anger is a normal feeling, and you can use it to solve problems." B) "You need to learn to suppress your angry feelings." C) "You can reduce your anger by hitting a punching bag." D) "You need to learn how to be less assertive in your communications."

a

A school nurse is educating a group of adolescent girls about rape and sexual assault. The nurse evaluates the students' understanding when they report which of the following as a high-risk factor regarding the incidence of rape? A) The highest incidence of rape occurs in adolescents and young adult women. B) Most rapes are committed by strangers. C) Most rapes are random acts of violence. D) A victim is at highest risk in unfamiliar neighborhoods.

a

A woman has just presented at the emergency department after being raped. The initial nursing action would be to... A) provide emotional support. B) refer her to a rape crisis hotline. C) encourage her to file charges immediately. D) perform a nursing history and physical as quickly as possible.

a

A young woman telephones the emergency department and loudly tells the nurse, "I've been raped! Please help me!" Which of the following is the priority for the nurse to determine? A) If the client was in a safe place, her condition, and if transportation is available B) If the client knew her assailant, knew her location, and had notified the police C) If the client has insurance, if she could get to the hospital by herself, and if pregnancy is a possibility D) If the client had bathed, douched, or changed clothes

a

An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. The most appropriate action by the nurse would be which of the following? A) Call for an emergency response from trained personnel. B) Approach the client and firmly say, "Stop, put it down." C) Calmly call the client by name and encourage verbal expression of anger. D) Assist the client to use problem-solving techniques instead of aggression.

a

Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively? A) "Why did he have to die so young?" B) "He shouldn't have been driving so recklessly." C) "If we had only stayed longer, he would not have been on that road." D) "It took the ambulance too long to get there."

a

One of the first steps that a nurse should take to deal effectively with aggressive clients is which of the following? A) Reflect on abilities to handle own feelings of anger B) Learn professional skills of anger management C) Become proficient using reflective communication techniques D) Understand how to activate crisis response teams

a

The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next? A) Ask the client when and how the bruises occurred B) Call the nursing supervisor immediately C) Follow the facility's policy and procedures for reporting abuse D) Notify the physician that abuse is suspected

a

The nurse is caring for a 16-year-old boy with a history of sexual abuse. What might the nurse expect to assess with this client? A) The client will experience long-term emotional trauma. B) The client will have no ill effects due to his age. C) The client will have high self-esteem. D) The client will easily share his concerns with the nurse.

a

The nurse is establishing outcomes for a grieving client. Which of the following is an appropriate outcome? A) The client will develop a plan for coping with the loss. B) The client will demonstrate self-reliance during the grief process. C) The client will suppress emotions related to the loss. D) The client will verbalize that loss will not adversely affect the quality of life.

a

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is which of the following? A) Neglect B) Physical abuse C) Sexual abuse D) Emotional abuse

a

The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action on him. Which is the best rationale for this intervention? A) It will assist the client to start basing decisions and actions on reality. B) It will help the client understand the origins of his or her paranoid thinking. C) It will help the client learn to trust other people. D) It will teach the client to differentiate when his or her suspicions are true.

a

The nurse is teaching a client with schizoid personality to function more comfortably with others in the community. Which nursing intervention would be effective to improve the client's social skills? A) Teach the client to make necessary requests in writing or over the phone. B) Accompany the client during initial interactions in the community. C) Suppress the display of any unusual behaviors in public. D) Assist in developing an explanation for bizarre behaviors to offer to others in the community.

a

The nurse is working with a client who lost her youngest child two months ago. When the nurse approaches, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases her response to the client on the understanding of which of the following? A) Hostility is a common behavioral response to grief. B) It is too soon after the loss to empathize with the client. C) Personality traits such as aggressiveness are exaggerated during the grief process. D) The nurse may have nonverbally indicated a judgmental attitude toward the client.

a

Upon admission, a client with a personality disorder identified as areas of concern for which the client would like help. The nurse is aware of which of the following will most likely be addressed by the health care team? A) Psychological distress B) Self-care C) Sexual expression D) Budgeting

a

When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success? A) collaborating with the client when establishing treatment goals B) educating the client to the importance of complying with treatment interventions C) evaluating the client's understanding of the etiology of the prescribed medications D) conducting regular assessments so the treatment can be changed when necessary

a

When interacting with a client in the day room, the nurse determines that a violent outburst is imminent. Which of the following should the nurse do first? A) Call for assistance. B) Give the client choices. C) Remove the other clients. D) Talk to the client calmly.

a

Which client should be assessed as demonstrating aggression? A) a client who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from another client standing at the pool table B) a client who bursts into tears, leaves the community meeting, and sits on the bed hugging a pillow and sobbing C) a client who tells the primary nurse, "When you told me that I could not have a pass, I felt angry." D) a client who tells the medication nurse, "I am not going to take that, or any other, medication."

a

Which disorder is characterized by pervasive mistrust and suspiciousness of others? A) Paranoid personality disorder B) Schizoid personality disorder C) Histrionic personality disorder D) Dependent personality disorder

a

The bereaved client has worked through many processes of grief with the nurse. Which of the following are eventual outcomes of the emotional dimension of grieving? Select all that apply. A) The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B) The survivor begins to gain independence and confidence. C) The survivor develops new ways of managing life and new relationships. D) The survivor's life returns to the same state as it was before the loss. E) The survivor forgets about the loss.

a b c

The client is talking to staff members individually and attempting to manipulate them. Which of the following are important in the limit-setting technique to deal with manipulative behavior? Select all that apply. A) Stating the behavioral limit B) Identifying the consequences if the limit is exceeded C) Identifying the expected or desired behavior D) Providing choices E) Allowing flexibility

a b c

Which of the following are typical characteristics of the perpetrator of intimate partner abuse? Select all that apply. A) The perpetrator often believes that the partner is his own property. B) The perpetrator is often irrationally jealous, even of his own children. C) The perpetrator is emotionally immature and needy. D) The perpetrator respects his partner. E) The perpetrator is intimidated by his partner.

a b c

Which of the following interventions is most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply. A) Planning group activities such as playing games B) Scheduling one-to-one interactions with the client C) Providing structure and consistency in the unit D) Avoiding discussions among clients on the unit E) Discouraging clients from negotiating solutions

a b c

Which of the following are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply. A) Abuse of power and control B) Alcohol and other drug abuse C) Intergenerational transmission D) Social isolation E) Victim instigates

a b c d

Which of the following are common behavioral and emotional responses to abuse? Select all that apply. A) One third of abusive men are likely to have come from violent homes. B) Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. C) Dependency on the abuser is a common trait found in victims of domestic violence. D) The victim caused the abuse. E) It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

a b c e

The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply. A) Paranoid B) Antisocial C) Schizotypal D) Narcissistic E) Avoidant

a b d

The nurse should assess clients' risks for anger or aggression in the care of clients with which of the following psychiatric diagnoses? Select all that apply. A) Alzheimer's dementia B) Schizophrenia C) Anorexia nervosa D) Acute alcohol intoxication E) Generalized anxiety disorder

a b d

Which of the following are common reasons why abused women remain with the abusive partner? Select all that apply. A) The abused person is personally and financially dependent on the abuser. B) The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work. C) The abused person uses alcohol or illegal drugs in the home. D) The abused person believes that she is unable to function without her husband. E) The abused person is afraid that the abuser will kill her if she tries to leave.

a b d e

The client often uses attention seeking behaviors. Which of the following nursing interventions are most important in a plan of care for a client with histrionic personality disorder? Select all that apply. A) Teach social skills. B) Assist the client to eliminate passive behavior. C) Provide factual feedback about behavior. D) Try to meet the client's needs for attention. E) Acceptance of the behavior.

a c

Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? Select all that apply. A) Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings. B) Considering the client to be a personal friend. C) Employ ongoing communication with team members to remain firm and consistent about expectations for clients. D) Solving the problems of the client. E) Understanding that behavior changes in clients with personality disorders can occur quickly.

a c

Of the following personality disorders, which are most likely related to lack of caring about others? Select all that apply. A) Schizotypal personality disorder B) Borderline personality disorder C) Antisocial personality disorder D) Narcissistic personality disorder E) Obsessive-compulsive personality disorder

a c d

Which of the following persons are most likely experiencing complicated grieving? Select all that apply. A) The spouse of a person who died 7 years ago and visits the grave several times a day. B) The grandchild of a soldier killed in war who visits the grave once a year on Memorial Day. C) A driver whose spouse and children all died as a result of his driving drunk. D) An adult who insisted for many years that she hated her deceased parent. E) The parent of a child who died after the having left the child in a car on a hot day.

a c d e

The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family's cultural preferences? Select all that apply. A) Dealing with the shock of losing a loved one B) Burial plans after death had occurred C) Efforts to stay connected to the client after death D) Use of support from family and friends E) Anger at the loss of a loved one

a c e

Which of the following statements about anger, hostility, and aggression are accurate? Select all that apply. A) Anger is an emotional response to a real or perceived provocation. B) Hostility stimulates the sympathetic nervous system. C) Physical aggression involves harming other persons or property. D) Anger, hostility, and physical aggression are normal human emotions. E) Hostility is also referred to as verbal aggression. F) Physical aggression often progresses to hostility.

a c e

While the nurse is observing the grieving client, which of the following are critical components in assessment of a person's grief? Select all that apply. A) Adequate perception regarding the loss B) Adequate time to experience the loss C) Adequate support while grieving for the loss D) Adequate opportunities to say goodbye to the person E) Adequate coping behaviors during the process

a c e

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply. A) The client has few friends. B) The client holds a dominant role in the family. C) The client is in charge of the family finances. D) There is a large amount of alcohol use in the home. E) The client reports that the father was abusive during childhood.

a d e

Which of the following are important issues for nurses to be aware of when working with angry, hostile, or aggressive clients? Select all that apply. A) Nurses must be aware of their own feelings about anger and their use of assertive communication and conflict resolution. B) Nurses must not allow themselves to become angry under any circumstances. C) Nurses must know that a client's anger or aggressive behavior is preventable by a skilled nurse. D) Nurses must discuss situations or the care of potentially aggressive clients with experienced nurses. E) Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior.

a d e

A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on... A) the client's plans for reconstructive surgery. B) the meaning of the mastectomy to the client. C) whether the client truly understands the surgery. D) why the client seems depressed.

b

A client states to a nurse, "They found a lump in my neck, and now they tell me I have an incurable disease." The client is young and appears to find this information hard to believe. The client's statement shows the pattern of response called... A) restitution. B) shock and disbelief. C) physiologic grieving. D) recovery.

b

A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse? A) "I'm glad you feel comfortable with me." B) "I'm here to help you just as all the staff members are." C) "You feel others don't understand you?" D) "I cannot be your friend. We need to be clear on that."

b

A female client with borderline personality was formerly cooperative with the treatment regimen. Suddenly, the client believes the staff is working against her and is refusing all interaction and participation in treatment. The nurse feels very frustrated by this client's behavior. What is the best action for the nurse to take regarding personal frustration with this client? A) Discuss the feelings of frustration with the client in a one-to-one interaction. B) Discuss the frustration with a colleague or supervisor in a private setting. C) Set aside the frustration and focus on reassessing the client's needs. D) Research the client's diagnosis further to better understand the client's behaviors.

b

A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder? A) perceives personal behavior to be embarrassing B) believes he or she is incapable of functioning independently C) tends to exaggerate the potential dangers of ordinary situations D) demands excessive attention from others whenever in a group situation

b

A person with temperament traits of high harm avoidance would most likely suffer from which personality disorder? A) Schizoid B) Avoidant C) Narcissistic D) Antisocial

b

A staff development coordinator is planning to teach the use of physical management techniques when clients become physically aggressive. The coordinator should stress the importance of which technique? A) spontaneity and surprise B) practice and teamwork C) caution and superior size D) diversion and physical outlets

b

A woman is in treatment for an anxiety disorder. Her history reveals that she was sexually abused repeatedly by her husband. Which of the following interventions would be appropriate in relation to this piece of data? A) Avoid discussing the abuse so as not to upset her. B) Encourage her to talk about feelings related to the abuse. C) Request an anxiolytic to reduce her anxiety levels. D) Help her explore her role in perpetuating the abuse.

b

After the death of a client's wife, a man tells the nurse "I can never live without my wife. My wife was my whole life." Which is the most therapeutic response from the nurse? A) "Remember, your wife is no longer suffering." B) "Your wife's death is a terrible loss for you." C) "Each day will get a little better." D) "Your friends will help you cope with this."

b

An elderly client with dementia lives with her daughter. During the day the client attends a Day Center. The nurse notices the client is unkempt and smells of urine. Upon examining the client, the nurse notes bruising on her arms and back. From the nurse's observations, which of the following is the type of abuse suspected? A) psychological abuse B) physical abuse C) financial abuse D) sexual abuse

b

As the nurse is performing an assessment on the client, the client's son is yelling and is hitting his hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client's son is exhibiting? A) Triggering B) Escalation C) Crisis D) Recovery

b

In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression? A) Getting as far away from him or her as possible B) Engaging the hostile person in dialogue C) Yelling at the client to settle down now D) Ensuring that the client gets his or her way

b

The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? A) Give the client a physical outlet to express anger. B) Give the client permission to be angry. C) Point out the senselessness of anger. D) Tell the client not to be angry all the time.

b

The client is being assessed for anger attacks. Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression? A) Delusions B) Depression C) Dementia D) Delirium

b

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following? A) Client's mood B) Client's safety C) Court order D) Physician's order

b

The nurse gathers information to formulate a plan of care for the client with aggressive issues. Which of the following is most likely to be the subject of an aggressive attack from a client with mental illness? A) Other people B) The client C) Animals D) Objects

b

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history? A) Hair loss B) Insomnia C) Compulsive behaviors D) Vomiting

b

The nurse is having an initial meeting with a client who has just spontaneously lost her unborn child. After establishing rapport, the priority nursing intervention should focus on which of the following? A) Assessing the client's support system B) Exploring what this loss means for the client C) Discussing helpful ways to cope with the loss D) Assessing what knowledge the client desires about the situation

b

The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid? A) Anticipating that a loss of control is possible and planning accordingly B) Explaining the consequences the client will face if control is lost C) Interviewing the client with another staff member present D) Responding to verbal threats by terminating the interview and obtaining assistance

b

The nurse is teaching a client to recognize early signs of anger and aggression. The nurse explores ways that the client can recognize which of the following? A) Decreased problem-solving ability B) Restlessness and irritability C) Remorse D) Severe muscle tension

b

Which behavior is considered inconsistent with the clinical picture of a client who is becoming increasingly aggressive? A) pacing B) sobbing inconsolably C) rigid posture with a clenched jaw D) staring with narrowed eyes into the eyes of another

b

Which client on the mental health unit should be assessed as being at highest risk for directing violent behavior toward others? A) a client who has obsessive-compulsive disorder and performs many rituals B) a client who has paranoid delusions and believes is being followed by members of the mafia C) a client who has severe depression with delusions of worthlessness D) a client who has completed alcohol withdrawal and is beginning a rehabilitation program

b

Which of the following interventions would assist the client with the appropriate expression of anger? A) Encourage catharsis B) Encourage verbalization C) Improve self-esteem D) Isolate the client from others

b

Which of the following is the best explanation for why family violence tends to occur over multiple generations of families? A) A tendency toward violence is hereditary. B) Family violence may be perpetuated between generations of families by role modeling and social learning. C) All persons who have become victims of family violence will grow up to perpetrate family violence. D) Family violence does not tend to have an intergenerational transmission process.

b

young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. Which of the following should be a consideration in providing care for this client? A) Most views regarding domestic violence are universal across cultures. B) She may fear deportation if she seeks public assistance. C) Immigrants have expedited access to public legal services. D) The nurse should ignore the details and focus on treatment.

b

The nurse is assessing the new grieving widow. Which of the following are critical components to assess in a grieving person? Select all that apply. A) Genetic risk B) Perception of the loss C) Support system D) Coping behaviors E) Religion

b c d e

Which challenges are posed when working with clients with personality disorders? Select all that apply. A) Clients with personality disorders are obviously unable to function more effectively. B) It can take a long time to change their behaviors, attitudes, or coping skills. C) The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. D) Clients with personality disorders challenge the ability of therapeutic staff to work as a team. E) Team members may have differing opinions about individual clients.

b c d e

Which of the following losses are likely to result in disenfranchised grief? Select all that apply. A) A young adult whose spouse has just died suddenly B) A family whose long-time pet snake has just died C) A nurse who has just witnessed the death of a patient D) A couple who has just experienced pregnancy loss E) The gay lover of a man who just died from AIDS F) The mother and sister of a soldier who was killed in war

b c d e

A client comes to the physician's office for an annual checkup. During the interview, the nurse learns that the client's husband died unexpectedly of a heart attack two months ago. The most appropriate response by the nurse would be... A) "At least you and your husband enjoyed life right until the end." B) "It's better to go quickly like your husband did instead of suffering." C) "The loss of your husband must be very painful for you." D) "You'll feel better after you get over the shock of your husband's death."

c

A client has just been informed of a diagnosis of terminal cancer. The client states, "God has to have mercy on me because my children need me. He knows I'll change if he gets me through this." The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief? A) Denial B) Anger C) Bargaining D) Depression

c

A client has not been to work in three days. When she returns to work, she is wearing dark glasses. Facial and body bruises are visible. Her supervisor takes her to the occupational nurse. Which assessment is the priority for the nurse? A) coping mechanisms B) emotional distress C) physical injuries D) psychological trauma

c

A client is clenching his fists and yelling at another client on the unit. He appears to be close to losing control of his anger. Which of the following actions by the nurse is appropriate at this time? A) Clear others out of the immediate area. B) Prepare a PRN sedative. C) Tell the client to stop and take a time-out. D) Alert the security department of an impending aggressive outburst.

c

A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately in a calm manner to prevent the client from moving to which phase of the aggression cycle? A) Triggering B) Escalation C) Crisis D) Recovery

c

A client is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the client by name and say which response? A) "Please quiet down." B) "Hey, what's up?" C) "You seem upset. Tell me about it." D) "You need to go to your room until you can control yourself."

c

A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. Which would be the best approach for the nurse to use? A) Have a sense of humor to show a lack of fear. B) Provide close contact to increase the client's sense of safety. C) Use brief statements and questions to obtain information. D) Use open-ended questions, so the client can elaborate.

c

A client with antisocial personality disorder is begging to use the phone to call his wife, even though it is against the unit rules. The client begs, "It is just this once, and she will be so hurt if I don't call her." Which would be the most appropriate response by the nurse? A) "Only to help your wife, you can call this time." B) "I will get in trouble with my supervisor if I let you call." C) "You may not use the phone to call your wife." D) "You cannot call because you need to focus on your recovery while you are here, not your wife."

c

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? A) "How would you feel if someone yelled at you like that?" B) "What's the matter with you? Don't you know any better?" C) "Yelling at others is unacceptable. You need to let staff know you're upset." D) "You're still having problems controlling your anger."

c

A community health nurse visits a home and finds a child who stayed home from school to care for a younger sibling. The nurse observes that the house is cluttered and dirty. When asked about the parents, the child states he does not think his father likes him because he calls him "stupid." The nurse suspects which type of abuse? A) physical abuse B) sexual abuse C) emotional abuse D) economic abuse

c

A married man expresses to the nurse that his wife's frequent nagging angers him. The nurse role-plays assertive communication techniques with the husband. Which of the following indicates the husband understands how to use assertive techniques effectively? A) "I really wish you would stop nagging me." B) "You are not perfect either." C) "I feel unappreciated when you criticize me." D) "Are you telling me you want me to change?"

c

A nurse cared for a terminally ill client over a period of a month. The nurse found that spending time with the client was a pleasure. When the client died, the nurse experienced feelings of sadness, sleeping poorly, lacking energy, and feeling mildly depressed. Eventually the nurse explained the feelings to the nurse supervisor. The nurse supervisor is aware of which of the following? A) The nurse needs to use stress reduction strategies. B) The nurse needs to seek therapy for dysfunctional grief. C) The nurse is experiencing disenfranchised grief. D) The nurse needs to consider taking a leave of absence to pursue healing.

c

A nurse is teaching a client with borderline personality disorder to reshape thinking patterns. Which is an example of a cognitive restructuring technique that would be helpful for this client? A) When negative thoughts begin, tell yourself "stop." B) Learn to look at situations realistically rather than assuming the worst. C) Recognize negative thoughts and replace them with positive ones. D) Express needs using "I" statements.

c

A young client tells the nurse that her husband died 3 months ago, and she is feeling alone and vulnerable. Which of the client would indicate that her coping skills are adequate? A) I can't understand why this happened to me. B) I'm mentally healthy. I can solve my own problems. C) I will find a support group. D) What can I do? My husband abandoned me.

c

After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which of the following is the most helpful response to the client at this time? A) "We will have to talk about this later." B) "You really scared me. I'm glad you are okay." C) "What happened that got you so upset?" D) "What can you do differently next time you get angry?"

c

An elderly woman who lives alone is beginning to have difficulty maintaining her household and performing daily tasks. The nurse asks her to identify someone who can help her. The woman replies, "I don't need help. I've been managing for years." Which of the following responses helps the client shift from denial to consciously coping with her situation? A) "You don't think you need any help? But your family is worried about you." B) "It must be hard to lose your independence. I'll ask a social worker to see what can be arranged." C) "If you were to need help with your house, who might you ask for help?" D) "If you don't ask for some help, then the only option is to move to an assisted living facility."

c

Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage five of Kubler-Ross's stages of grieving? A) Denial B) Bargaining C) Acceptance D) Anger

c

The client is talking to the nurse about her intimate relationships. Which one of the following statements regarding intimate partner violence is true? A) Males are never the victim in intimate partner violence. B) It is common for abusers to use one type of abuse only. C) Intimate partner violence can exist with former partners. D) Psychological abuse is not as harmful as physical abuse.

c

The client says to the nurse, "I really want to see my first grandchild born before I die. Is that too much to ask?" The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Acceptance B) Anger C) Bargaining D) Depression

c

The client states that decisions that are made by him are superior to everyone else's. Which of the following would the nurse expect to assess in a client with narcissistic personality disorder? A) Genuine concern for others B) Mistrust of others C) Grandiose and superior self-concept D) Dependence on others for decision making

c

The client tells the nurse that her husband abuses her often with he drinks, just as his father had beaten him and his mother. He always apologizes and is remorseful after the event. Which stage is this in the cycle of violence? A) tension building stage B) acute battering stage C) honeymoon stage D) recovery stage

c

The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as which of the following? A) controlling B) manipulation C) progress D) regression

c

The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following? A) Understand the practices associated with a client's culture. B) Suggest developing a new ritual to make mourning meaningful. C) Ask the client which rituals are personally meaningful. D) Contact a spiritual leader from the client's culture to become involved.

c

The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is... A) "I'm sorry you are sad. Is there anything I can do to help you feel better?" B) "Please don't cry. It will get better." C) "You look very sad. What is happening?" D) "What is bothering you?"

c

The nurse at a university health services clinic has been asked to meet with a freshman class of women about warning signs of relationship violence. The nurse points out which of the following danger signs the students should be alert for in a date? A) Dislikes your fiends B) Acts indifferent to your life choices C) Is excessively jealous D) Views you as superior to himself

c

The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior? A) Triggering B) Escalation C) Crisis D) Postcrisis

c

The nurse is assessing the client who states he is a spiritual healer. Which term describes the extent to which a person considers himself to be an integral part of the universe? A) Cooperativeness B) Self-directedness C) Self-transcendence D) Character

c

The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. Which of the following statements made by the expectant mother would be of greatest concern to the nurse? A) "I am going to rely on my sisters for a lot of help raising my baby." B) "I was raised with very strict discipline." C) "My child will love me, unlike my parents ever did." D) "I am not sure how I am going to pay for all the things my child will need."

c

The nurse visits with a client who was recently in a motor vehicle accident. Which of the following is most likely to prevent the client from experiencing complicated grief? A) Tendency to suppress emotions B) History of depression C) Places trust in others who are familiar D) Social isolation

c

The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which of the following data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse? A) The parents appear overprotective of the child B) Bruises over the child's bony prominences C) The injury occurring several days before the parents sought treatment D) Both parents reporting the exact same details pertaining to the injurious event

c

What a culture considers acceptable strongly influences the expression of anger. Which culture-bound syndrome is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects? A) Hwa-Byung B) Hwabyeong C) Amok D) Bouffée delirante

c

When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care? A) risk for self-mutilation B) disturbed personal identity C) ineffective coping D) social isolation

c

When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do? A) Aggressively confront the client about boundary violations. B) Limit interactions to 10 minutes at a time. C) Respect the client's boundaries at all times. D) Tell the client the relationship will last as long as the client wishes.

c

Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim of intimate partner violence? A) Encourages the partner to have a life outside the intimate relationship B) An inflated sense of self-esteem C) Needy and possessive of the partner D) An ability to feel remorse for the abuse

c

Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder? A) Client talks about three failed marriages. B) Client cries loudly whenever requests are denied. C) Client fears criticism from others, including staff. D) Client shows no remorse when accidentally breaking another client's bracelet.

c

Which of the following behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child? A) The child has a preference for associating with peers, rather than adults. B) The child has learning problems and shyness. C) The child tells sexually explicit stories to peers. D) The child wears dirty and threadbare clothing.

c

Which of the following is a psychosocial explanation for the development of personality disorders? A) Highly self-directed people reflect uncooperativeness and intolerance. B) Cooperative people become increasingly helpless over time. C) Failure to complete a developmental task jeopardizes future personality development. D) Self-transcendence contributes to self-consciousness and materialism.

c

Which of the following terms is used to describe the process by which a person experiences the grief? A) Anticipatory grieving B) Disenfranchised grief C) Bereavement D) Mourning

c

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? A) Insisting that others follow the rules of the unit B) Wondering why others are being friendly to her C) Having a tantrum if not getting enough attention D) Getting others to make decisions for her

c

. A nurse is caring for a client who is mourning the loss of a loved one. Which factor would the nurse expect to make the mourning process more difficult for the client? A) The client was relatively independent of the deceased. B) The client had few unresolved conflicts in the relationship with the deceased. C) The client has a good support system with meaningful relationships evident. D) The client has experienced a number of previous losses.

d

A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss

d

A client grieving her husband's sudden death tells the bereavement nurse, "I am not feeling very well. Yesterday, I was sitting in my kitchen and a saw my husband walk through the door and stop and smile at me. Then he just faded away. I think I must be going crazy." The most appropriate action for the nurse to take is to... A) assess for recent substance use. B) suggest a referral to the mental health clinic. C) arrange for a prescription for risperidone. D) counsel that visualizations are a normal part of grieving.

d

A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints by the nursing team. Which statement should the nurse make to explain the use of restraints to the client? A) "The length of time you'll be in restraints is undetermined." B) "The staff will monitor your behavior closely." C) "This is what happens when you lose control." D) "This is a means of keeping you and others safe."

d

A client suddenly jumps up from the chair and begins yelling and cursing at the nurse. Which would be the best response by the nurse? A) "I can see that you need attention; you should calmly ask for what you want." B) "I don't want to hear that kind of language; don't ever do that again." C) "I will limit your smoking privileges if you can't control yourself." D) "You seem angry. Tell me more about how you're feeling."

d

A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, "The best part of my day is when I am back at work. Is that wrong?" The nurse states to the client that work and other daily activities serve which purpose? A) "You cannot work effectively this soon. You should finish grieving first." B) "Working reminds you of your loss. It may be too early to go back." C) "Working is your way of avoiding grief, which will make it harder for you to move on." D) "Working is letting you take an emotional break from grieving. There's nothing wrong with that."

d

A client with terminal cancer has been told he has 3 or 4 months to live. Which of the following would indicate to the nurse that further interventions are needed? A) The client says he wants to live life to the fullest. B) The client hopes for a peaceful and dignified death. C) The client is reviewing his life and talking about death. D) The client says he is well and is making future plans.

d

A coherent elderly woman has been financially and emotionally abused by her adult children for the past several years, but has failed to report the abuse to anyone. Which is the most likely reason that the woman neglects to report the abuse? A) She cannot claim abuse if there is no evidence of physical harm. B) Laws do not provide protection against abuse when the suspect(s) is/are family members. C) She has no financial resources to hire legal representation against her children. D) She is emotionally close to her children and does not want to bring them harm.

d

A couple came to the emergency department with their 5-month-old son. He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to do which of the following? A) postpone notification of the extended family B) delay the grieving process until they are ready to cope C) minimize their discussion of the death with others D) plan funeral arrangements for their son

d

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." Which of the following is most likely true of the situation? A) The student is overreacting. B) This is a situation requiring a restraining order. C) The student's boyfriend is simply insecure and needs reassurance. D) This is characteristic of the tension-building phase of the violence cycle.

d

A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that she and the client were having an illicit affair. Which of the following is the best action by the nurse after learning of this relationship? A) Give the name of a clergy to the visitor and suggest she contact him for support B) Encourage the visitor to ask for support from the friends who are present C) Ignore the information about the affair and tend to the family D) Privately offer support to the visitor who was having the affair with the client

d

A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder? A) These clients are generally experiencing chronic depression and are severely impaired socially. B) A high stimulus environment will cause the client to exhibit exacerbated behaviors that are loud and attention seeking. C) The client is easily intimidated and may become so withdrawn that the assessment will be difficult if not impossible to complete. D) This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened.

d

A woman has just been served divorce papers from her husband. She has no financial resources and little social support. She states, "He's not really leaving. He'll be back." The most appropriate response by the nurse would be which of the following? A) "Has he done this before?" B) "I'll call social services and get you signed up for financial assistance." C) "You have to face reality. Here are the papers." D) "How is this affecting you right now?"

d

A woman has just delivered a stillborn baby boy. Which of the following would be the most appropriate nursing response? A) "Can I do anything for you?" B) "If something was wrong, it's better this way." C) "Your son is in heaven with God now." D) "Would you like to hold your son?"

d

A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience? A) Anticipatory grief B) Absence of grief C) Complicated grief D) Disenfranchised grief

d

After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive? A) "You still need to work on your problem-solving skills." B) "I will not allow you to get that angry again." C) "You should not have let your anger buildup like you did." D) "What could you have done when you first started to feel angry?"

d

After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Anger B) Bargaining C) Denial D) Depression

d

The community health nurse meets with the family members of an elderly client. The nurse includes which of the following in the plan of care as a preventive measure to guard against elder abuse? A) Reassure the primary caregiver that he or she in the best position to provide care to the elder B) Teach the primary caregiver skills to meet all of the elder's needs C) Assist in the transfer of legal authority for elder care to the primary caregiver D) Provide the primary caregiver with additional resources to meet the elder's needs

d

The nurse explains to the client that therapy will be a long process. Which of the following is a realistic outcome for the care of a person with a personality disorder? A) Outcomes that focus on satisfaction with daily life B) Outcomes that focus on the client's perception of others C) Outcomes that focus on increased client insight D) Outcomes that focus on change in behavior

d

The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful? A) "Being a loner really limits your employment opportunities." B) "Maybe your friend could see if there is a night position available at the convenience store." C) "Perhaps working part-time at a fast-food restaurant would be something you could do." D) "There is a job posting at the hospital for a file clerk in medical records."

d

The nurse is working in the emergency department with a woman who was raped one hour ago. Which of the following is most important for the nurse to remember when planning care? A) The client should set aside any angry feelings until physical care is completed. B) Evidence collection according to procedures is not as important as treating the client's injuries. C) The nurse will need to make decisions for this client. D) The woman may feel threatened by some of the procedures.

d

The nurse is working with a client at the battered women's shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, "What do you think about that?" Which is the best response by the nurse? A) "Batterers never change, so it would be best for you to leave." B) "If you don't leave, he'll think you're going to continue to endure his abuse." C) "If you leave, maybe he'll see that he has to change his behavior." D) "You may be in more physical danger after you leave him."

d

The nurse is working with a woman who lost her partner nearly 3 weeks ago. The woman has recently become less emotional and expressed an interest in possibly returning to work. Which response by the nurse is most appropriate at this time? A) "I am concerned. You are starting to show signs of ineffective grieving." B) "You must feel some anger. It is all right to let that out." C) "Let's look at the things in your life that you still enjoy." D) "You are just starting to accept that this loss is real."

d

The nurse observes two clients in the day room arguing. One client runs into the corner and huddles while the other follows and continues with verbal abuse. Which is the best action by the nurse? A) Take an authoritatively step between the two clients. B) Comfort the client huddled in the corner. C) Directly address both clients and ask what is going on. D) Engage the attention of the client who is still yelling and ask what is happening.

d

The nurse teaches an antisocial client to take a time-out in his room when challenged by another person instigating an argument. What is the main reason for the time-out? A) It allows time for the instigator to leave the area. B) It allows adequate space between the client and the instigating individual. C) It prevents the client from experiencing negative consequences of behavior. D) It allows an opportunity for the client to regain control of emotions.

d

The staff nurse that has a student assigned to her unit today notices that the nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then displays negativity. The nursing student may be showing signs of which of the following personality disorder or behavior? A) Paranoid B) Borderline C) Narcissistic D) Passive-aggressive behavior

d

Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality? A) The team needs to consider updating treatment recommendations as the client improves. B) Rotating team members need to be apprised of the care planned for the client. C) Staff frustrations in caring for the client need to be processed. D) Team consistency is important to prevent manipulation by the client.

d

Which of the following is most important to maintain therapeutic boundaries when working with aggressive clients? A) Encourage clients to express how the nurse can avoid causing emotional irritation. B) Discuss difficult patient care situations with a supervisor. C) Reflect on your actions that may have instigated the client's anger. D) Do not personalize a client's anger

d

Which of the following statements about the crisis phase of aggression when the client becomes physically aggressive is true? A) All staff should act to take charge of the situation. B) The client must be restrained or sedated at once. C) Staff should avoid communicating with the client. D) Four to six trained staff members are needed to restrain.

d

Which one of the following statements about anger is most accurate? A) Anger is an abnormal human emotion that is always negative. B) It is best to express anger by whatever means possible to minimize its consequences. C) Most men are socialized to suppress anger. D) Anger awareness and expression are necessary for women's growth and development.

d

Which referral would a nurse make for a client who was badly beaten by a spouse, has no place to go, and no financial means? A) community food bank B) vocational counseling C) law enforcement D) a women's shelter

d

Which thought process would cause a client with antisocial personality disorder to want to do everything for himself? A) Belief in his own self-worth B) Inability to delay gratification C) Rewards for competitive behavior D) Sense of mistrust of others

d

While observing the client the nurse notices the client's mood changes rapidly and erratically. When planning care for a client with passive-aggressive personality disorder, the nurse will need to include interventions for which behavior? A) Avoidance of anxiety-provoking situations B) Compulsive needs for perfection and praise C) Dependence on others for decisions D) Procrastination and intentional inefficiency

d