EAQ Psych - Mental Health Disorders

A student is anxious about an upcoming examination but is able to study intently and does not become distracted by a roommate's talking and loud music. What level of anxiety is demonstrated by the student's ability to shut out the distractions? 1 Mild 2 Panic 3 Severe 4 Moderate

1 A person with mild anxiety has a broad perceptual field and increased problem-solving abilities. Panic is characterized by a completely disruptive perceptual field. With severe anxiety, the perceptual field is reduced, as is the ability to focus on details. A moderately anxious person shuts out peripheral events and focuses on central concerns but has a decreased ability to problem solve.

7. A nurse is caring for an angry, hostile client with the diagnosis of borderline personality disorder. What is probably an issue for this client? 1 Low self-esteem 2 Inability to test reality 3 Disturbed energy field 4 Ineffective verbal communication

1 The client is demonstrating a reaction to low self-esteem with hostile behavior. People with borderline personality disorder often have identity disturbances. There is no evidence of an inability to test reality, a disturbed energy field, or impaired verbal communication.

Despite repeated nursing interventions to improve reality orientation, a client insists that he is the commander of an alien spaceship. What is the client experiencing? 1 Illusion 2 Delusion 3 Confabulation 4 Hallucination

2 A delusion is a fixed false belief. An illusion is a false sense interpretation of an external stimulus. Confabulation is the client's attempt to fill gaps in memory with imaginary events. A hallucination is a false sensory perception with no external stimulus.

When taking a health history from a client who has a moderate level of cognitive impairment as a result of dementia, what does the nurse expect to find? 1 Hypervigilance 2 Increased inhibition 3 Enhanced intelligence 4 Accentuated premorbid traits

4 A moderate level of cognitive impairment because of dementia is characterized by increasing dependence on environmental and social structure and by increasing psychological rigidity with accentuated previous traits and behaviors. Although paranoid attitudes, which are associated with hypervigilance, may be exhibited, the disorientation, loss of memory, and decrease in cognition usually do not lead to hypervigilance. With the decrease in impulse control that is associated with dementia, decreased, not increased, inhibition occurs. Enhancement of intelligence does not occur with dementia, but initially intellectual deterioration is subtle.

A couple arrives at the mental health clinic for counseling because the husband consistently believes that his wife is having multiple affairs. After several sessions a delusional disorder is diagnosed. What specific subtype of the delusion does the nurse identify? 1 Jealousy 2 Somatic 3 Grandiose 4 Persecutory

1 A client who is convinced that a mate is unfaithful exhibits delusional jealousy. Somatic delusions concern preoccupation with the body, including complaints of disfigurement, nonfunctioning body parts, insect infestation, and presence of a serious illness. In a grandiose delusion, the client seeks a position of power by expressing an exaggerated belief in his or her importance or identity. Clients with persecutory delusions believe that they are being conspired against, spied on, drugged, or poisoned.

Within a few hours of alcohol withdrawal the nurse should assess the client for the presence of what symptoms? 1 Irritability and tremors 2 Yawning and convulsions 3 Disorientation and paranoia 4 Fever and profuse diaphoresis

1 Alcohol is a central nervous system depressant; irritability and tremors are the body's neurological adaptation to the withdrawal of alcohol. Tachycardia, irritability, and tremors are the early signs of withdrawal and will appear 24 to 48 hours after the last ingestion of alcohol. Yawning occurs with heroin withdrawal. Convulsions (delirium tremens, or DTs) are a later sign of severe withdrawal that occurs with alcohol withdrawal delirium. Delirium (paranoia and disorientation) is not an early sign of alcohol withdrawal and occurs 48 to 72 hours after abstinence. Fever and diaphoresis may occur during prolonged periods of delirium and are a result of autonomic overactivity.

Clients addicted to alcohol often use the defense mechanism of denial. What is the reason that this defense is so often used? 1 It reduces their feelings of guilt. 2 It creates the appearance of independence. 3 It helps them live up to others' expectations. 4 It makes them look better in the eyes of others.

1 Alcoholic clients often use denial as a defense against feelings of guilt; this reduces anxiety and protects the self. Denial may make a client seem more stable to others, not independent. Denial deals more with a client's own expectations. Looking better in the eyes of others may be part of the reason, but the bigger motivating factor is to ease guilt feelings

While caring for an older adult client, what symptom requires an immediate reassessment of the client's needs and plan of care? 1 Memory loss or confusion 2 Neglect of self-care 3 Increased daily fatigue 4 Withdrawal from usual activities

1 All are common signs of depression due to the aging process, however, memory loss or confusion may require immediate intervention. The development of confusion indicates that the client's ability to maintain equilibrium has not been achieved and that further disequilibrium is occurring, setting the client up for safety issues. Confusion may also be related to more serious physical conditions that can occur which require medical intervention.

What should the nurse teach parents about childhood depression? 1 May appear as acting-out behavior 2 Looks almost identical to adult depression 3 Does not respond to conventional treatment 4 Is short in duration and has an early resolution

1 Children have difficulty verbally expressing their feelings; acting-out behaviors, such as temper tantrums, may indicate an underlying depression. Many conventional therapies for adults with depression, including medication, are effective for children with depression. Adult and childhood depression may be manifested in different ways. Childhood depression is not necessarily short and requires treatment.

For which clinical indication should a nurse observe a child in whom autism is suspected? 1 Lack of eye contact 2 Crying for attention 3 Catatonia-like rigidity 4 Engaging in parallel play

1 Children with autism usually have a pervasive impairment of reciprocal social interaction. Lack of eye contact is a typical behavior associated with autism. Crying for attention, rigidity, and parallel play are not indicative of autism.

When working with a client who is in an alcohol detoxification program, what nursing action is most important? 1 Address the client's holistic needs. 2 Support the client's need for nurture. 3 Discuss with the client the negative effects of alcohol. 4 Promote the client's compliance with the program through gentle prodding.

1 Clients who abuse alcohol characteristically have multiple nursing care needs, among them physiological, psychological, social, and occupational. Although nurture is important, this client must learn self-reliance. Discussing with the client the negative effects of alcohol is probably an old story to this client and will have a minimal positive effect. Promoting the client's compliance with the program through gentle prodding will not provide an atmosphere that can help the client withstand the stress of the detoxification program.

When planning for a client's care during the detoxification phase of acute alcohol withdrawal, what need should the nurse anticipate? 1 Checking on the client frequently 2 Keeping the client's room lights dim 3 Addressing the client in a loud, clear voice 4 Restraining the client during periods of agitation

1 During detoxification frequent checks help ensure safety and prevent suicide, which is a real threat. Bright light is preferable to dim light because it minimizes shadows that may contribute to misinterpretation of environmental stimuli (illusions). The client who is going through the detoxification phase of acute alcohol withdrawal usually does not lose his sense of hearing, so there is no need to shout. Restraints may upset the client further; they should be used only if the client is a danger to himself or others.

What are the "four As" for which nurses should assess clients with suspected Alzheimer disease? 1 Amnesia, apraxia, agnosia, aphasia 2 Avoidance, aloofness, asocial, asexual 3 Autism, loose association, apathy, affect 4 Aggressive, amoral, ambivalent, attractive

1 Neurofibrillary tangles in the hippocampus cause recent memory loss (amnesia); temporoparietal deterioration causes cognitive deficiencies in speech (aphasia), purposeful movements (apraxia), and comprehension of visual, auditory, and other sensations (agnosia). Avoidance, aloofness, asocial, and asexual are characteristics of the schizoid personality. Autism, loose association, apathy, and affect are characteristics of schizophrenia. Aggressive, amoral, ambivalent, and attractive are characteristics of an antisocial personality.

A female client with obsessive-compulsive disorder has become immobilized by her elaborate handwashing and walking rituals. Which feelings does the nurse recall are often the basis of obsessive-compulsive disorder? 1 Anxiety and guilt 2 Anger and hostility 3 Embarrassment and shame 4 Hopelessness and powerlessness

1 Ritualistic behavior seen in this disorder is aimed at controlling feelings of anxiety and guilt by maintaining an absolute set pattern of action. Although the person with an obsessive-compulsive disorder may be angry and hostile, the feelings of anger and hostility do not precipitate the rituals. Although the person with an obsessive-compulsive disorder may be embarrassed and ashamed by the ritual or feel hopeless and powerless to the ritual, the basic feelings precipitating the rituals are usually anxiety and guilt

When the nurse is managing the care of an acutely depressed client, which of these demonstrates that the nurse recognizes the client's fundamental mental health need? 1 Role modeling a hopeful attitude regarding life and the future 2 Sharing that life has presented depressing situations for all of us at times 3 Devoting time with the client and trying to focus on happy, positive memories 4 Identifying the client's personal weaknesses and designing interventions to strengthen them

1 Role modeling has been shown to be an excellent tool in molding adaptive behavior. Depression affects the individual's ability to see hope in the future and role modeling will help provide adaptation to similar feelings. Affirming that everyone has depressive situations in their lives does not foster a positive response in the depressed client. Reminiscing about happier times and events is likely to highlight the client's current loss of happiness rather than foster positive feelings. The depressed client generally has low self-esteem and is often too tired to engage in physical activities. When a client is depressed, the nurse should identify the client's personal strengths, not weaknesses, and focus on interventions to reinforce those strengths. Focusing on a client's weaknesses when the client is already depressed may initiate a deeper depression.

What is a primary consideration for the nurse caring for a client with a history of substance abuse? 1 Setting firm, consistent limits and not varying from them 2 Using the same type of communication pattern that the client uses 3 Avoiding upsetting the client by calling attention to the drug abuse problem 4 Realizing that the client will probably need less pain medication than a nonabuser would

1 Setting limits gives structure and balance and demonstrates a caring attitude. The nurse serves as a role model and should use a caring, professional approach with the client. The client must be helped to recognize that a problem with drugs exists. Many substance abusers use multiple drugs, including central nervous system depressants such as alcohol, barbiturates, and antianxiety agents. Opioid abuse is very common. All these drugs lead to cross-tolerance, and the client may need more analgesia than a nonabuser would.

A nurse who plans to care for a client with an obsessive-compulsive disorder should understand that the client's personality can usually be characterized in what way? 1 Marked emotional maturity 2 Rapid, frequent mood swings 3 Elaborate delusional systems 4 Doubts, fears, and indecisiveness

1 This disorder is characterized by anxiety and minor distortions of reality. The anxiety results in an inability to reach a decision because all alternatives are threatening. Part of emotional maturity is the ability to relate to people, and these clients have difficulty in this area. Elaborate delusions are indicative of severe emotional illness, not an anxiety disorder. Rapid mood swings are indicative of a mood disorder.

A nurse is assessing an older adult with the diagnosis of dementia. Which manifestations are expected in this client? Select all that apply. 1 Resistance to change 2 Inability to recognize familiar objects 3 Preoccupation with personal appearance 4 Inability to concentrate on new activities or interests 5 Tendency to dwell on the past and ignore the present

1, 2, 4, 5 Resistance to change is a clinical finding associated with dementia; these clients need structure and routines [1] [2] [3]. An inability to recognize familiar objects (agnosia) is a typical cognitive dysfunction associated with dementia. A short attention span and little or no interest in new activities are typical of dementia. The past, rather than the threatening present, is where these clients feel comfortable. Clients with delirium, dementia, and other cognitive disorders rarely express any concern about personal appearance. The staff must meet most of these clients' personal needs.

A client is brought to the emergency department by friends because of increasingly bizarre behavior. Which signs does the nurse identify that indicate that the client was using cocaine? Select all that apply. 1 Euphoria 2 Agitation 3 Panic attacks 4 Slurred speech 5 Hypervigilance 6 Impaired judgment

1, 2, 5, 6

A delirious client sees a design on the wallpaper and perceives it as an animal. How should a nurse communicate in the change-of-shift report what the client perceived? 1 A delusion 2 An illusion 3 A hallucination 4 An idea of reference

2 An illusion is a misperception or misinterpretation of an actual external stimulus. A delusion is a false belief that cannot be changed even by evidence; it is associated with psychosis. A hallucination results from an imaginary, not real, stimulus. An idea of reference is a belief that others are talking about the person.

When caring for a client with bulimia nervosa, the nurse remembers that bulimia nervosa follows a cyclical pattern. What does the nurse identify as the first pattern in this cycle? 1 Hunger resulting from food deprivation and stress 2 Dieting in an attempt to maintain control of one's life 3 Binge eating to numb physical and emotional discomforts 4 Purging in another attempt to regain control and alleviate guilt

2 Dieting may be one area of control the person has in her life, and she elects to exercise control over it. The body does experience hunger, and binge eating serves as emotional comfort when the person ingests large amounts of calories. Purging is the final phase in this cycle; individuals are unaware often that purging rids fewer than 50% of the calories ingested.

A nurse is caring for a hyperactive, manic client who exhibits flight of ideas and is not eating. What may be the reason why the client is not eating? 1 Feeling undeserving of the food 2 Too busy to take the time to eat 3 Wishes to avoid others in the dining room 4 Believes that there is no need for food at this time

2 Hyperactive clients frequently will not take the time to eat because they are overinvolved with everything in their environment. Feeling undeserving of the food is characteristic of a depressive episode. The client is unable to sit long enough with the other clients to eat a meal; this is not conscious avoidance. The client probably gives no thought to food because of overinvolvement with the activities in the environment.

A client with schizophrenia repeatedly says to the nurse, "No moley, jandu!" What does the nurse determine that the client is exhibiting? 1 Echolalia 2 Neologism 3 Concretism 4 Perseveration

2 Neologisms are words that are invented and understood only by the person using them. Echolalia is the verbal repeating of exactly what is heard. Concretism is a pattern of speech characterized by the absence of abstractions or generalizations. Perseveration is a disturbed system of thinking manifested by repetitive verbalizations or motions or by persistent repetition of the same idea in response to different questions.

What defense mechanism should the nurse anticipate that a client with the diagnosis of schizophrenia, undifferentiated type, will most often exhibit? 1 Projection 2 Regression 3 Repression 4 Rationalization

2 Regression is the defense mechanism that is commonly used by clients with schizophrenia, undifferentiated type, to reduce anxiety by returning to earlier behavior. Projection is an organized defense used by clients with schizophrenia, paranoid type, in which the delusional system is well systematized. Repression, or unconscious forgetting, is not a major defense used by clients with schizophrenia; if it were, they would not need to break with reality. Rationalization, in which the individual blames others for problems and attempts to justify actions, is seldom used by clients with schizophrenia.

A client with a history of atrial fibrillation has a stroke, and vascular dementia (multiinfarct dementia) is diagnosed. In a comparison of assessment findings in clients with vascular dementia and dementia of the Alzheimer type, which factor is unique to vascular dementia? 1 Memory impairment 2 Abrupt onset of symptoms 3 Difficulty making decisions 4 Inability to use words to communicate

2 The signs and symptoms associated with vascular dementia have an abrupt onset (days to weeks) because of the occlusion of small arteries or arterioles in the cortex of the brain. Dementia of the Alzheimer type is associated with a gradual (years), progressive loss of function. Both vascular dementia and dementia of the Alzheimer type are associated with this deficit in function. Memory impairment may or may not be a symptom of vascular dementia, it depends on which part of the brain is affected. Alzheimer disease usually results in memory impairment, but the client does not have abrupt onset of symptoms. Difficulty making decisions is a major part of Alzheimer disease, but may not be manifested with vascular dementia, depending on which part of the brain is affected. Inability to use words to communicate is a typical symptom of Alzheimer disease, but with vascular dementia, the client may have trouble speaking or understanding speech.

During a one-on-one interaction with a client with paranoid-type schizophrenia, the client says to the nurse, "I've figured out how foreign agents have infiltrated the news media. They want to shut me up before I spill the beans." How should the nurse describe this statement when documenting this client's response? 1 Nihilistic delusion 2 Delusions of persecution 3 Delusions of control 4 Delusions of grandeur

2 Thoughts of being pursued by powerful agents because of one's special attributes or powers are fixed false beliefs and are referred to as delusions of persecution. There is no evidence to indicate that there are nihilistic delusions of total or partial nonexistence. There is also no evidence to support that external forces are controlling the client (delusions of control) or that the client has false beliefs of being a famous figure (delusions of grandeur).

A nurse in an outpatient mental health setting has been assigned to care for a new client who has been found to have an antisocial personality disorder. What does the nurse expect to observe in the client during the assessment? 1 Pays great attention to detail and demonstrates a high level of anxiety 2 Has scars from self-mutilation and a history of many negative relationships 3 Displays charm, has an above-average intelligence, and tends to manipulate others 4 Demonstrates suspiciousness, avoids eye contact, and engages in limited conversation

3 A client with an antisocial personality disorder is charming on first contact, but this charm is a manipulative ploy. These clients usually are bright and use their intelligence for self-gain. Paying great attention to detail and demonstrating a high level of anxiety are traits of an individual with an obsessive-compulsive personality disorder. The client with a borderline personality disorder self-mutilates when under stress; there is a fear of abandonment so that any relationship is better than no relationship. Demonstrating suspiciousness, avoiding eye contact, and engaging in limited conversation resembles the behavior of an individual with a paranoid personality, which includes suspiciousness and lack of trust.

A 65-year-old man is admitted to a mental health facility with a diagnosis of substance-induced persisting dementia resulting from chronic alcoholism. When conducting the admitting interview, the nurse determines that the client is using confabulation. What does the nurse recall precipitates the client's use of confabulation? 1 Ideas of grandeur 2 Need for attention 3 Marked memory loss 4 Difficulty in accepting the diagnosis

3 A client with this disorder has a loss of memory and adapts by filling in areas that cannot be remembered with made-up information. Ideas of grandeur do not occur with this type of dementia. The use of confabulation is not attention-seeking behavior; the individual is attempting to mask memory loss. This person is not coping with the diagnosis; when confabulating, the individual is attempting to mask memory loss.

When having a discussion with a home health nurse, a client states that drinking is a problem. What is the nurse's initial response when the client asks for help? 1 Arranging for the client to be admitted to the hospital detoxification unit 2 Scheduling an appointment for the client at the alcohol rehabilitation center 3 Having the client call Alcoholics Anonymous to find out the schedule of local meetings 4 Recommending that the client discuss the problem with family members before seeking help

3 Alcoholics Anonymous is community based and is the most effective intervention for drinking problems. There are no data to indicate that the client requires detoxification. Scheduling an appointment for the client at the alcohol rehabilitation center may come later if further intervention is needed. Recommending that the client discuss the problem with family members before seeking help is not a priority; the client must take the first step toward recovery.

A nurse is counseling clients who are attending an alcohol rehabilitation program. Which substance poses the greatest risk of addiction for these clients? 1 Heroin 2 Cocaine 3 Nicotine 4 Marijuana

3 Although polysubstance abuse is common, clients undergoing rehabilitation from alcohol dependence are more likely to use or develop a dependence on nicotine, another legal substance, than on an illegal substance such as heroin, cocaine, or marijuana.

A mental health nurse is admitting a client with anorexia nervosa. When obtaining the history and physical assessment, the nurse expects the client's condition to reveal which symptom? 1 Edema 2 Diarrhea 3 Amenorrhea 4 Hypertension

3 Amenorrhea results from endocrine imbalances that occur when fat stores are depleted. The client is dehydrated; edema is not expected. Constipation, not diarrhea, may occur because of lack of fiber in the diet. Hypotension, not hypertension, may occur because of dehydration.

A nurse is caring for a client with a diagnosis of catatonic schizophrenia. What clinical finding does the nurse expect the client to exhibit? 1 Crying 2 Self-mutilation 3 Immobile posturing 4 Repetitive activities

3 Clients with catatonia exhibit rigidity and posturing behaviors. Most clients with catatonic schizophrenia are unable to express feelings. Self-mutilation is associated with depression. Repetitive activities are associated with obsessive-compulsive disorders.

A client is admitted to the mental health hospital with the diagnosis of major depression. What is a common problem that clients experience with this diagnosis? 1 Loss of faith in God 2 Visual hallucinations 3 Decreased social interaction 4 Feelings about the future are absent

3 Depressed clients demonstrate decreased social interaction because of a lack of psychic or physical energy. They tend to withdraw, speak in monosyllables, and avoid contact with others. Loss of faith and visual hallucinations are not commonly associated with the diagnosis of major depression. Hallucinations are associated with schizophrenic disorders. Depressed clients are commonly negative and pessimistic, especially regarding their future

n older adult client is talking to the nurse about his Vietnam experiences and shares that he still has flashbacks. While assessing him the nurse notes that he is jumpy and exhibits startle reactions and poor concentration. With which mental health disorder does the nurse associate these symptoms? 1 Delusions 2 Hallucinations 3 Posttraumatic stress disorder (PTSD) 4 Obsessive-compulsive disorder (OCD)

3 PTSD is a syndrome characterized by the development of symptoms after an extremely traumatic event. Symptoms include helplessness, flashbacks, intrusive thoughts, memories, images, emotional numbing, loss of interest, avoidance of any place that reminds the affected person of the traumatic event, poor concentration, irritability, startle reactions, jumpiness, and hypervigilance. Delusions are beliefs that guide one's interpretation of events and help make sense of disorder. Common delusions among older adults involve being poisoned, having their assets taken by their children, being held prisoner, and being deceived by a spouse or lover. Hallucinations are visual or auditory perceptions of nonexistent objects and sounds. Older adults with hearing and vision deficits may hear voices or see people who are not actually present. OCD is characterized by recurrent and persistent thoughts, impulses, and urges of ritualistic behaviors that improve the affected person's comfort level.

For what most common characteristic of autism should a nurse assess a child in whom the disorder is suspected? 1 Responds to any stimulus 2 Responds to physical contact 3 Unresponsiveness to the environment 4 Interacts with children rather than adults

3 Poor interpersonal relationships, inappropriate behavior, and learning disabilities prevent autistic children from emotionally adapting or responding to the environment even when the intelligence level is high. It is the lack of response to stimuli that is the clue that the child may have autism. Children with autism have an aversion to physical contact; they also have impaired interpersonal relationships regardless of the age of the other person.

A client with a long history of alcohol abuse who has been hospitalized for 1 week tells the nurse, "I feel much better and probably won't need any more treatment." What does the nurse conclude when evaluating the client's progress? 1 The client has accepted the illness and now must use willpower to resist alcohol. 2 The client will probably not use alcohol again as long as the client's family remains supportive. 3 The client's lack of insight into the emotional aspects of the illness indicates the need for continued supervision. 4 The client's statement should be communicated to the practitioner so aversion therapy can be started before the client's discharge.

3 The client's statement indicates denial. The basic problem that led to the alcoholism has not been resolved, and therefore continued supervision is required. It is not true that the client has accepted the illness and now must use willpower to resist alcohol; the client is still denying the illness, and willpower alone will not keep the client away from alcohol. It may be true that the client probably will not use alcohol again as long as the client's family remains supportive, but it does not ensure compliance or successful rehabilitation. Aversion therapy will not be helpful unless the client understands the basic problem and how to resolve it.

A client with a history of gambling is experiencing legal difficulties for embezzling money and has been required to obtain counseling. During an intake interview the client says, "I never would have done this if I'd been paid what I am worth." What factor will create the greatest difficulty in helping this client develop insight? 1 Feelings of boredom and emptiness 2 Grandiosity related to personal abilities 3 Projection of reasons for difficulties onto others 4 Anger toward those who are in authority positions

3 The development of insight is impeded by the client's unwillingness or inability to face his own contribution to a problem. Feelings of boredom and emptiness will not impede the development of insight. Such feelings are common in clients with borderline personality disorders. Grandiosity will not impede the development of insight. It is often a cover for feelings of inadequacy, which are threatening to the client; these feelings usually disappear with insight. Anger will not impede the development of insight. It is not the anger itself but instead how the anger contributes to interpersonal difficulty that the client must recognize.

A parent of a 17-year-old girl who has been hospitalized for extremely disturbed acting-out behavior leaves a gift for the daughter but says, "I'm too busy to visit today." The daughter becomes upset and tearful after being given the message and opening the package. What does the nurse conclude that the parent's actions represent? 1 Parental rejection 2 Projective behavior 3 Double-bind message 4 Obsessive-compulsive behavior

3 The parent's behavior sends two conflicting messages: One says, "I care," and the other says, "I don't care." This behavior often is demonstrated by people with personality disorders. If the parent were rejecting the daughter, the parent would not have brought a gift. No evidence of projection of feelings is evident in the information presented. Obsessive-compulsive behavior is ritualistic behavior in which the person repeats actions over and over again to decrease anxiety. This is not occurring in this situation.

What does the nurse recall is the major defense mechanism used by an individual with a phobic disorder? 1 Splitting 2 Regression 3 Avoidance 4 Conversion

3 The person transfers anxieties to activities or objects, usually inanimate objects, which are then avoided to decrease anxiety. Splitting is the compartmentalization of opposite affective states and the inability to integrate the positive and negative aspects of others or self. Regression, the return to an earlier, more comfortable level of development, is not the defense mechanism used by someone with a phobia. Conversion, the transfer of a mental conflict to a physical symptom, is not the defense mechanism used by someone with a phobia.

A client with a history of drug abuse begins group therapy. After attending the first meeting the client says to the nurse, "It helps to know that I'm not the only one with this type of problem." What concept does this statement reflect? 1 Altruism 2 Catharsis 3 Universality 4 Transference

3 Universality is the sense that one is not alone in any situation; one purpose of group therapy is to share feelings and gain support from others with similar thoughts and feelings. Altruism in group therapy is giving support, insight, and reassurance to others, which eventually promotes self-knowledge and growth. Catharsis involves group members relating to one another through the verbal expression of negative and positive feelings. Transference occurs when a client unconsciously assigns to the therapist feelings and attitudes originally associated with another important person in the client's life

A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply. 1 Lability of affect 2 Specific food cravings 3 Neglect of personal hygiene 4 "I don't know" answers to questions 5 Apathetic response to the environment

3, 4, 5 Clients with depression are uninterested in their appearance because of low self-esteem. "I don't know" answers to questions require little thought or decision making, typical of depression. These clients' sense of futility leads to a lack of response to the environment. With depression there is little or no emotional involvement and therefore little alteration in affect. Clients with depression are uninterested in food of any kind.

A 3-year-old child is found to have autism. Which behaviors should the nurse expect when assessing this child? Select all that apply. 1 Imitates others 2 Seeks physical contact 3 Avoids eye-to-eye contact 4 Engages in cooperative play 5 Performs repetitive activities 6 Displays interest in children rather than adults

3, 5 Impairment of social interaction manifests as a lack of eye contact, a lack of facial responses, and a lack of responsiveness to and interest in others. Children with autism display obsessive ritualistic behaviors such as rocking, spinning, dipping, swaying, toe-walking, head-banging, and hand-biting because of their self-absorption and need to stimulate themselves. The impairments in communication and imaginative activity result in a failure to imitate others. Children with autism are indifferent to or have an aversion to affection and physical contact. Impairments in social interaction and imaginative activity manifest as failure to engage in cooperative or imaginative play with others. They are unable to establish meaningful relationships with adults or children because of their lack of responsiveness to others.

A client who has been admitted to the hospital for an elective prostatectomy is extremely anxious and has hand tremors. The client's partner informs the nurse that the client has been drinking heavily for the last 5 years. While the client is unpacking the nurse sees him hiding a bottle of whiskey in the rear of a drawer. How should the nurse respond initially to this behavior? 1 Trying to catch the client drinking the alcohol 2 Confiscating the alcohol when the client is not looking 3 Waiting for the client to bring up the subject of drinking 4 Asking the client how much alcohol he consumes in a week

4 Asking the client how much alcohol he consumes in a week will reveal the client's level of alcohol abuse through direct questioning. Trying to catch the client drinking the alcohol is a judgmental approach that involves manipulation and will decrease the client's self-esteem. Confiscating the alcohol when the client is not looking is not straightforward and will decrease trust. The client probably will not bring up the subject, because denial is often used to cope with alcohol abuse.

A man is admitted to the psychiatric unit after attempting suicide. The client's history reveals that his first child died of sudden infant death syndrome 2 years ago, that he has been unable to work since the death of the child, and that he has attempted suicide before. When talking with the nurse he says, "I hear my son telling me to come over to the other side." What should the nurse conclude that the client is experiencing? 1 Fixed delusion 2 Magical thought 3 Pathological regression 4 Command hallucination

4 Command hallucinations are auditory hallucinations that give verbal messages to do harm either to the self or others; giving an identity to the hallucinated voice increases the risk of compliance. A delusion is a false belief held to be true even with evidence to the contrary. In magical thinking, the individual believes that thinking about something can make it happen. Magical thinking is common in young children. The data do not indicate that the client has regressed to a prior level of development.

An older adult is admitted for evaluation of anemia and unsteady gait. While obtaining a health history, the nurse notes that the client seems to make up stories to fill in for memory lapses. How should the nurse document what the client is doing? 1 Lying 2 Denying 3 Fantasizing 4 Confabulating

4 Confabulation is the filling in of memory gaps as a protective mechanism. Lying is false or dishonest behavior that is conscious and deliberate and is used in an attempt to deceive or mislead; there is no evidence of this behavior. Denying is a refusal to believe or accept reality and is used as a protective defense mechanism; there is no evidence of this behavior. Fantasizing is a more-or-less connected series of mental images, such as those that occur in daydreams, that usually involve some unfulfilled desire; there is no evidence of this behavior.

A 70-year-old retired man has difficulty remembering his daily schedule and finding the right words to express himself. He is found to have dementia of the Alzheimer type. What does the nurse know about symptoms of this disorder? 1 Occur fairly rapidly 2 Have periods of remission 3 Begin after a loss of self-esteem 4 Demonstrate a progression of disintegration

4 Dementias, such as that of the Alzheimer type, result from pathological changes of central nervous system cells, producing deterioration that is long-term and progressive. These changes involve cognitive, functional, and behavioral changes that reflect predictable stages (stage 1, mild; stage 2, moderate; stage 3, severe). The duration of Alzheimer disease [1] [2] [3] is 3 to 20 years, with an average of 10 years. Symptoms of delirium, not dementia, develop rapidly as a result of derangements of cerebral metabolism and neurotransmission. Once neurons are destroyed, remissions are uncommon. Interpersonal events do not precipitate dementias.

A woman with bipolar disorder, manic episode, has been spending thousands of dollars on clothing and makeup. She has been partying in bars every night and rarely sleeps or eats. The nurse in the outpatient clinic knows that this client rarely eats. What does the nurse recognize as the most likely cause of her eating problems? 1 Feelings of guilt 2 Need to control others 3 Desire for punishment 4 Excessive physical activity

4 During a manic episode hyperactivity and the inability to sit still long enough to eat are the causes of eating difficulties. Feelings of guilt do not precipitate eating difficulties in clients with the diagnosis of bipolar disorder, manic episode. Clients in a manic episode of bipolar disorder have a need to avoid and therefore control anxiety associated with depression; they do not have a need to control others; nor do they have a desire for punishment.

A nurse is assessing a client with major depression. Which clinical manifestation reflects a disturbance in affect related to depression? 1 Echolalia 2 Delusions 3 Confusion 4 Hopelessness

4 Feelings of hopelessness are symptomatic of depression; the individual feels unable to find any solution to problems and therefore feels overwhelmed. Echolalia, the pathological meaningless repetition of another's words or phrases, is associated with schizophrenia, not with depression. Delusions are associated with psychotic disorders such as schizophrenia, not depression. Confusion is not common because these individuals are in contact with reality.

A client with schizophrenia is admitted to an acute care psychiatric unit. Which clinical findings indicate positive signs and symptoms of schizophrenia? 1 Withdrawal, poverty of speech, inattentiveness 2 Flat affect, decreased spontaneity, asocial behavior 3 Hypomania, labile mood swings, episodes of euphoria 4 Hyperactivity, auditory hallucinations, loose associations

4 Hyperactivity, auditory hallucinations, and loose associations are positive symptoms of schizophrenia; positive symptoms reflect a distortion or excess of normal function. Hypomania, labile mood swings, and episodes of euphoria are associated with bipolar disorder, manic episode. Withdrawal, poverty of speech, inattentiveness, flat affect, decreased spontaneity, and asocial behavior are all negative symptoms associated with schizophrenia; negative symptoms reflect a diminution or absence of normal function.

A client who has been experiencing excessive stress is hospitalized because of an inability to walk. After a physiologic cause for the problem is ruled out, a diagnosis of somatoform disorder, conversion type, is made. What does the nurse conclude is the cause of the client's paralysis? 1 Nondisabling illness 2 Way to get attention 3 Loss of contact with reality 4 Result of intrapsychic conflict

4 In situations in which a client may experience a high level of anxiety and psychic pain, a physical reason for not acting may unconsciously be used to limit negative feelings. Somatoform disorders are disabling; the client truly believes that the symptoms are real. These individuals do not enjoy their illness; their anxiety is relieved by it. These individuals are in contact with reality.

A 3-year-old child is found to have a pervasive developmental disorder not otherwise specified. What should the nurse consider most unusual for the child to demonstrate? 1 Interest in music 2 Ritualistic behavior 3 Attachment to odd objects 4 Responsiveness to the parents

4 One of the symptoms that an autistic child displays is lack of responsiveness to others; there is little or no extension to the external environment. Music is nonthreatening, comforting, and soothing. Repetitive behavior provides comfort. Repetitive visual stimuli, such as a spinning top, are nonthreatening and soothing.

What is a major recognizable difference between anorexia nervosa clients and bulimia nervosa clients? 1 Anorexia nervosa clients tend to be more extroverted than clients with bulimia. 2 Anorexia nervosa clients seek intimate relationships, whereas clients with bulimia avoid them. 3 Anorexia nervosa clients are at greater risk for fluid and electrolyte imbalances than are clients with bulimia. 4 Anorexia nervosa clients deny the problem, whereas clients with bulimia generally recognize that their eating pattern is abnormal.

4 The client with anorexia nervosa denies the illness; the client with bulimia nervosa hides the behavior because she recognizes that the behavior is a problem. Clients with anorexia nervosa are more introverted and tend to avoid relationships. Clients with bulimia are at a greater risk for fluid and electrolyte problems because of the purging; clients with anorexia nervosa are at greater risk for severe nutritional deficiencies.

A nurse is caring for a client with an obsessive-compulsive personality disorder that involves rituals. What should the nurse conclude about the ritual? 1 It has a purpose but is useless. 2 It is performed after long urging. 3 It appears to be performed willingly. 4 It seems illogical but is needed by the person.

4 The client's exact adherence to the compulsive ritual relieves anxiety, at least temporarily. Furthermore, it meets a need and is necessary to the client. The compulsive act is purposeless repetition and useful only in that it temporarily eases the client's anxiety. Urging has no effect getting the the client to start or stop the ritualistic behavior. The person cannot stop the activity; it is not under his voluntary control.

What characteristic uniquely associated with psychophysiologic disorders differentiates them from somatoform disorders? 1 Emotional cause 2 Feeling of illness 3 Restriction of activities 4 Underlying pathophysiology

4 The psychophysiologic response (e.g., hyperfunction or hypofunction) produces actual tissue change. Somatoform disorders are unrelated to organic changes. There is an emotional component in both instances. There is a feeling of illness in both instances. There may be a restriction of activities in both instances.

A nurse has been assigned to care for a client with the diagnosis of obsessive-compulsive disorder (OCD). Before providing care for this client, what should the nurse remember about clients with OCD? 1 Are unaware that the ritual serves no purpose 2 Can alter the ritual depending on the situation 3 Should be prevented from performing the ritual 4 Do not want to repeat the ritual but feel compelled to do so

4 The repeated thought or act defends the client against even higher, more severe levels of anxiety. Clients usually do recognize that the ritual serves little or no purpose. Rituals are usually followed rigidly; setting limits on or altering a ritual increases anxiety. Preventing the client from performing the ritual may precipitate a panic level of anxiety.

A school nurse is teaching a high school health class about inhalant abuse. What serious effect of using inhalants should the nurse discuss? 1 Esophageal varices 2 Acute electrolyte imbalances 3 Extrapyramidal tract symptoms 4 Death in one third of first-time users

4 Use of inhalants, called "huffing," is most often seen in preadolescent males in rural areas, and it can be lethal in overdose. Esophageal varices are associated with alcoholic cirrhosis. Acute electrolyte imbalances are associated with alcoholic cirrhosis and are related to malnutrition, dehydration, and ascites. Extrapyramidal tract symptoms are associated with typical antipsychotic medications.

What behavior by a client with a long history of alcohol abuse is an indication that the client may be ready for treatment? 1 Drinking only socially 2 Not drinking for a week 3 Hospitalization for detoxification 4 Verbalizing an honest desire for help

4 When clients with alcohol problems voice a desire for help, it usually signifies that they are ready for treatment, because they are admitting they have a problem. Adherence to an alcohol treatment program requires abstinence. A week is too short a time to signal readiness for treatment. Hospitalization alone is not an indication that the client is really ready for treatment, because many factors can influence admission.

A client arrives at the mental health clinic complaining about feelings of extreme terror when attempting to ride in an elevator and feelings of uneasiness in large crowds. He reports that these fears are interfering with his concentration at work. What does the nurse identify as the source of these symptoms? 1 Conflict with society, resulting in an obsession 2 Depression about life events, resulting in unreasonable fears 3 Generalized anxiety about conflicts, resulting in unreasonable fears 4 Repression of a terrifying incident in an elevator, resulting in a phobia

Phobias are specific fears that often serve as a means of coping with generalized anxiety. Conflicts with society do not result in phobias. Although depression is related to phobias, finding a direct connection to life events is difficult. Repression of a terrifying incident in an elevator does not result in a phobia. Repression is utilized as a coping mechanism to protect the client's conscious mind from thoughts or events that will cause them anxiety.