Mental health

12. Which of the following nursing statements or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.) 1. "Tell me what happened." 2. "What coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened." 4. "Let's focus on the current problem." 5. "I'll assist you in selecting functional coping strategies."

1, 2, 3 Page: 203 Feedback 1. This is an appropriate statement to encourage the client to communicate. 2. This statement enables the client to evaluate current coping strategies for effectiveness. 3. This is an appropriate statement to encourage the client to communicate. 4. Focusing on the current problem would not occur until after a complete assessment. 5. Selecting functional coping strategies would not occur until after a complete assessment.

8. Which is the priority focus of recovery models? 1. Empowerment of the health-care team to bring their expertise to decision-making 2. Empowerment of the client to make decisions related to individual health care 3. Empowerment of the family system to provide supportive care 4. Empowerment of the physician to provide appropriate treatments

2 Page: 216 Feedback 1 Empowerment of the health-care team is not the priority focus of the recovery model. 2 The basic concept of a recovery model is empowerment of the client. The recovery model is designed to allow clients primary control over decisions about their own care. 3 Empowerment of the family system is not the priority focus of the recovery model. 4 Empowerment of the physician is not the priority focus of the recovery model.

4. A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to SAMHSA, which dimension of recovery is supporting this client? 1. Health 2. Home 3. Purpose 4. Community

2 Page: 216 Feedback 1 The dimension of health is not supporting this client. 2 SAMHSA describes the dimension of home as a stable and safe place to live. 3 The dimension of purpose is not supporting this client. 4 The dimension of community is not supporting this client.

3. A nursing instructor is teaching about the guiding principles of the recovery model, as described by SAMHSA. Which student statement indicates that further teaching is needed? 1. "Recovery occurs via many pathways." 2. "Recovery emerges from strong religious affiliations." 3. "Recovery is supported by peers and allies." 4. "Recovery is culturally based and influenced."

2 Page: 217 Feedback 1 The statement indicates understanding of the recovery model. 2 Recovery emerges from hope but affiliation with any particular religion would have little bearing on the recovery process. 3 This statement indicates that the student has adequate understanding of the recovery model. 4 This statement is accurate regarding the recovery model.

3. A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. What should be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while monitoring suicidal ideations 4. Encouraging client to express feelings related to suicide

3 Page: 236 Feedback 1 Seclusion may be excessive for this client. 2 Checks every 15 minutes would be inadequate for this client. 3 The nurse's priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation. 4 The client's physical safety is the priority.

14. A new nursing graduate asks the psychiatric nurse manager how to best classify suicide. Which is the nurse manager's best reply? 1. "Suicide is a DSM-5 diagnosis." 2. "Suicide is a mental disorder." 3. "Suicide is a behavior." 4. "Suicide is an antisocial affliction."

3 Page: 236 Feedback 1 Suicide is not a diagnosis. 2 Suicide is not a disorder. 3 Suicide is a behavior. 4 Suicide is not an affliction.

21. Which client data indicates that a suicidal client is participating in a plan for safety? 1. Compliance with antidepressant therapy 2. A mood rating of 9/10 3. Disclosing a plan for suicide to staff 4. Expressing feelings of hopelessness to nurse

3 Page: 238-239 Feedback 1 Compliance with antidepressant therapy does not indicate the client participating in a plan for safety. 2 A mood rating of 9/10 does not indicate the client participating in a plan for safety. 3 A degree of the responsibility for the suicidal client's safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide. 4 Expressing feelings of hopelessness do not indicate the client participating in a plan for safety.

12. A nurse says to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? 1. The therapeutic technique of giving advice 2. The therapeutic technique of defending 3. The nontherapeutic technique of presenting reality 4. The nontherapeutic technique of giving reassurance

4 Page: 139 Feedback 1 The nurse's statement does not give advice to the client. 2 This is not an example of the therapeutic technique of defending. 3 This statement does not present reality to the client. 4 The nurse's statement, "Things will look better tomorrow after a good night's sleep," is an example of the nontherapeutic communication technique of giving reassurance. Giving reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

6. A nurse maintains a client's confidentiality, addressed the client appropriately, and does not discriminate based on gender, age, race, or religion. Which guiding principle of recovery has this nurse employed? 1. Recovery is culturally based and influenced. 2. Recovery is based on respect. 3. Recovery involves individual, family, and community strengths and responsibility. 4. Recovery is person-driven.

2 Page: 218 Feedback 1 SAMHSA lists the following as guiding principles for the recovery model: Recovery is culturally based and influenced. 2 SAMHSA lists the following as guiding principles for the recovery model: Recovery is based on respect. 3 SAMHSA lists the following as guiding principles for the recovery model: Recovery involves individual, family, and community strengths and responsibility. 4 SAMHSA lists the following as guiding principles for the recovery model: Recovery is person-driven.

4. Group therapy is strongly encouraged, but not mandatory, in an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve? 1. Justice 2. Autonomy 3. Veracity 4. Beneficence

2 Page: 42 Feedback 1 The principle of justice requires individuals to be treated fairly. 2 The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that health-care workers must respect these decisions. 3 Veracity refers to one's duty to always be truthful. 4 Beneficence refers to the duty to promote the good of others.

22. A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.) 1. The staff nurse is frequently absent from work. 2. The staff nurse experiences mood swings. 3. The staff nurse makes elaborate excuses for behavior. 4. The staff nurse frequently uses the restroom. 5. The staff nurse has a flushed face.

2, 3, 4, 5 Page: 322-323 Feedback 1. There may be high absenteeism if the person's source is outside the work area. 2. Mood swings can be a sign of substance abuse. 3. The impaired nurse may make elaborate excuses for behavior. 4. The impaired nurse will frequently use the restroom. 5. A flushed face is a sign of drug use.

21. After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

2; Page: 408-410 Feedback 1 Tyramine is only an issue when MAOI medications are prescribed. 2 Imipramine is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect. 3 Alcohol potentiates the effects of antidepressants. 4 Concomitant use of St. John's wort and SSRIs, not tricyclics, increases, not decreases the effects of the drug.

10. Which therapeutic communication technique is being used in the following nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" 1. Reflecting 2. Making observations 3. Formulating a plan of action 4. Giving recognition

3 Page: 137-138 Feedback 1 Reflecting does not explore behavior alternatives. 2 Making observations does not explore behavior alternatives. 3 The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking. The use of this technique may serve to prevent anger or anxiety from escalating. 4 Giving recognition does not explore behavior alternatives.

8. The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? 1. Address only serious suicide threats to avoid the possibility of secondary gain. 2. Promote trust by verbalizing a promise to keep suicide attempt information within the family. 3. Offer a private environment to provide needed time alone at least once a day. 4. Be available to actively listen, support, and accept feelings.

4 Page: 236 Feedback 1 Addressing only serious suicide threats would not be helpful to the client. 2 Keeping suicide attempts a secret in the family does not help the client. 3 Providing alone time does not help the client. 4 Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

15. A nursing student is developing a plan of care for a suicidal client. Which documented intervention should the student implement first? 1. Communicate therapeutically. 2. Observe the client. 3. Provide a hazard-free environment. 4. Assess suicide risk.

4 Page: 236 Feedback 1 After assessing suicide risk, the nurse can communicate therapeutically. 2 After assessing suicide risk, the nurse can observe the client. 3 After assessing suicide risk, the nurse can provide a hazard-free environment. 4 Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment should always be the first step taken when working with depressed or suicidal patients.

7. The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision? 1. No previous admissions for major depressive disorder 2. Vital signs stable; no psychosis noted 3. Able to comply with medication regimen; able to problem-solve life issues 4. Able to participate in a plan for safety; family agrees to constant observation

4 Page: 236 Feedback 1 History of admissions does not focus on suicide prevention. 2 Assessment of vital signs does not focus on suicide prevention. 3 Compliance with medication regimen does not focus on suicide prevention. 4 Participation in a plan of safety and constant family observation will decrease the risk for self-harm.

6. During a one-to-one session with a client, the client states, "Nothing will ever get better," and "Nobody can help me." Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time? 1. Powerlessness R/T altered mood AEB client statements 2. Risk for injury R/T altered mood AEB client statements 3. Risk for suicide R/T altered mood AEB client statements 4. Hopelessness R/T altered mood AEB client statements

4 Page: 236 Feedback 1 The client is experiencing hopelessness. This diagnosis would be inappropriate. 2 Risk for injury has not been identified. 3 Risk for suicide has not been identified. 4 The client's statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the client's suicidal ideations and intent would be necessary.

13. A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply? 1. "Why don't you consider doing volunteer work in a homeless shelter?" 2. "Let's discuss the negative aspects of your life." 3. "Things will look better in the morning." 4. "It sounds like you are feeling pretty hopeless."

4 Page: 236 Feedback 1 This question does not help the client open up about feelings. 2 This statement does not help the client discuss feelings. 3 This statement may be degrading to the client's feelings. 4 This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.

11. When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!"

4 Page: 7 Feedback 1 This behavior does not indicate denial. 2 Yelling at family members does not indicate denial. 3 Burning dinner on purpose is not an action that indicates denial. 4 The client's statement "I don't drink too much!" alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.

6. A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior? 1. That families are male-dominated, with clear male-female role distinctions 2. That religious tenets support the use of violence in a marital context 3. That the nuclear family is female-dominated and the mother has ultimate authority 4. That marriage dynamics are controlled by dominant females in the family

1 Page: 102-103 Feedback 1 The nurse should associate the cultural belief that families are male-dominated, with clear male-female role distinctions with the client's abusive behavior. The father in the Latin American family usually has the ultimate authority. 2 Religious tenets do not support the use of violence. 3 The Latin American family is male-dominated. 4 This statement is untrue, because Latin American families are male-dominated.

4. Which client action should a nurse expect during the working phase of the nurse-client relationship? 1. The client gains insight and incorporates alternative behaviors. 2. The client establishes rapport with the nurse and mutually develops treatment goals. 3. The client explores feelings related to reentering the community. 4. The client explores personal strengths and weaknesses that impact behavioral choices.

1 Page: 129 Feedback 1 The nurse should expect that the client will gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. 2 Establishing rapport with the nurse and mutually developing treatment goals occurs before the working phase. 3 Exploring feelings related to reentering the community does not occur during the working phase. 4 Exploring personal strengths and weaknesses that impact behavioral choices does not occur during the working phase.

9. Which therapeutic communication technique is being used in the following nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." 1. Restatement 2. Offering general leads 3. Focusing 4. Accepting

1 Page: 137-138 Feedback 1 The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. It allows the client to know whether the statement has been understood and provides an opportunity to continue. 2 Offering general leads does not involve summarizing the client's statement. 3 Offering focusing does not involve summarizing the client's statement. 4 Offering accepting does not involve summarizing the client's statement.

1. A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? 1. "Medications only address biological factors. Environmental and interpersonal factors must also be considered." 2. "Because biological factors are the sole cause of depression, medications will improve your mood." 3. "Environmental factors have been shown to exert the most influence in the development of depression." 4. "Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."

1 Page: 15-19 Feedback 1 The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression. 2 The statement is false because biological factors are not the sole cause of depression. 3 It is false that environmental factors have been shown to exert the most influence in the development of depression. 4 Researchers have demonstrated a link between nature and nurture.

9. The following outcome was developed for a client: "Client will list five personal strengths by the end of day one." Which correctly written nursing diagnostic statement most likely generated the development of this outcome? 1. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements 2. Self-care deficit R/T altered thought process 3. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 4. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

1 Page: 159 Feedback 1 The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day one. 2 The self-care deficit nursing diagnoses is incorrectly written. 3 Disturbed body image would generate specific outcomes in accordance with specific needs and goals. 4 The risk for disturbed self-concept nursing diagnoses is incorrectly written.

3. A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing response? 1. "The purpose of group therapy is to learn and practice new coping skills." 2. "Group therapy is mandatory. All clients must attend." 3. "Group therapy is optional. You can go if you find the topic helpful and interesting." 4. "Group therapy is an economical way of providing therapy to many clients concurrently."

1 Page: 172 Feedback 1 The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. 2 The client owns his or her environment and can make decisions to attend group or not. 3 Group therapy is encouraged so that the client can learn new coping skills. 4 Group therapy is important because it teaches clients how to interact with others and problem solve.

5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration? 1. Encourage clients to request their medications at the appropriate times. 2. Refuse to administer medications unless clients request them at the appropriate times. 3. Allow the clients to determine appropriate medication times. 4. Take medications to the clients' bedside at the appropriate times.

1 Page: 175 Feedback 1 The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units, but nurses must work with clients to encourage self-reliance and responsibility, which may result in independent decision-making, leading to medication adherence. 2 Refusing to administer medication does not promote self-reliance. 3 Allowing clients to choose medication times does not promote self-reliance. 4 Taking medications to the bedside does not promote self-reliance.

10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

2 Page: 21 Feedback 1 Serotonin plays a role in sleep, libido, and appetite. 2 The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability. 3 GABA prevents postsynaptic excitation. 4 Histamine mediates allergic and inflammatory reactions.

6. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? 1. "I found a Web site explaining the different types of brain tumors and their treatment." 2. "My brother also had a brain tumor and now is completely cured." 3. "I understand your fear and will be by your side during this time." 4. "My mother was also diagnosed with cancer of the brain."

1 Page: 185 Feedback 1 Yalom's curative group factor of imparting information involves group members sharing knowledge gained through formal instruction, as well as advice and suggestions. 2 Stating, "My brother also had a brain tumor and now is completely cured," is not an example of imparting information. 3 Stating, "I understand your fear and will be by your side during this time," is not an example of imparting information. 4 Stating, "My mother was also diagnosed with cancer of the brain," is not an example of imparting information.

8. During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to a nurse leader that the client is assuming which group role? 1. The group role of aggressor 2. The group role of initiator 3. The group role of gatekeeper 4. The group role of blocker

1 Page: 188 Feedback 1 The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others. 2 The initiator outlines tasks at hands and proposes methods for solution. 3 The gatekeeper encourages acceptance of and participation by all members. 4 The blocker resists group efforts.

5. After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? 1. "Are you currently thinking about harming yourself?" 2. "Why do you want to harm yourself?" 3. "Have you thought about the consequences of your actions?" 4. "Who is your emergency contact person?"

1 Page: 203 Feedback 1 The nurse should first assess the client for current harmful or suicidal thoughts to minimize risk of harm to the client and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team's priority is to assess client safety. 2 This question is important after the immediate risk of harm has been ruled out. 3 This question should be addressed after the client is safe. 4 The client's safety should be assessed prior to asking this question.

17. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Body dysmorphic disorder 4. Parkinson's disease

1 Page: 21, 24 Feedback 1 The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia spectrum disorder. Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania. 2 Increased dopamine activity is not associated with major depressive disorder. 3 Increased dopamine activity is not associated with body dysmorphic disorder. 4 Increased dopamine activity is not associated with Parkinson's disease.

5. A client diagnosed with obsessive-compulsive disorder states, "I really think my future will improve because of my successful treatment choices. I'm going to make my life better." Which guiding principle of recovery has assisted this client? 1. Recovery emerges from hope. 2. Recovery is person-driven. 3. Recovery occurs via many pathways. 4. Recovery is holistic.

1 Page: 216 Feedback 1 SAMHSA lists the following as guiding principles for the recovery model: Recovery emerges from hope. 2 SAMHSA lists the following as guiding principles for the recovery model: Recovery is person-driven. 3 SAMHSA lists the following as guiding principles for the recovery model: Recovery occurs via many pathways. 4 SAMHSA lists the following as guiding principles for the recovery model: Recovery is holistic.

1. A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed? 1. "The goal of recovery is improved health and wellness." 2. "The goal of recovery is expedient, comprehensive behavioral change." 3. "The goal of recovery is the ability to live a self-directed life." 4. "The goal of recovery is the ability to reach full potential."

1 Page: 216 Feedback 1 The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental health disorders and substance use disorders as a process of change through which individuals improve their health and wellness. 2 Change in recovery is not an expedient process. It occurs incrementally over time. 3 SAMHSA defines recovery from mental health disorders and substance use disorders as a process of change through which individuals live a self-directed life. 4 SAMHSA defines recovery from mental health disorders and substance use disorders as a process of change through which individuals strive to reach their full potential.

11. A client states, "My illness is so devastating, I feel like my life is on hold." The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates? 1. Moratorium 2. Awareness 3. Preparation 4. Rebuilding

1 Page: 222 Feedback 1 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 1: Moratorium. 2 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 2: Awareness. 3 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 3: Preparation. 4 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 4: Rebuilding.

20. A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response? 1. "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended." 2. "You must have misunderstood. An MAOI like Emsam always has dietary restrictions." 3. "Only oral MAOIs require dietary restrictions." 4. "All transdermal MAOIs do not require dietary modifications."

1 Page: 408-410 Feedback 1 Dietary restrictions at this dose are not recommended. 2 Dietary modifications are recommended, however, at the 9 mg/24 hr and 12 mg/24 hr dosages. 3 All forms of Emsam require dietary modification at dosages of 9 mg/24 hr and 12 mg/24 hr. 4 This statement is inaccurate regarding transdermal MAOIs.

13. A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to find when assessing this client? 1. A client feeling confident about achieving goals in life. 2. A client who is aware of the need to set goals in life. 3. A client who has mobilized personal and external resources. 4. A client who begins to actively take control of his or her life.

1 Page: 224 Feedback 1 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. In the growth stage, the individual feels a sense of optimism and hope of a rewarding future. Skills that have been nurtured in the previous stages are applied with confidence, and the individual strives for higher levels of well-being. 2 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 2: Awareness. 3 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 3: Preparation. 4 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 4: Rebuilding.

12. A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? 1. The more specific the plan is, the more likely the client will attempt suicide. 2. Clients who talk about suicide never actually commit it. 3. Clients who threaten suicide should be observed every 15 minutes. 4. After a brief assessment, the nurse should avoid the topic of suicide.

1 Page: 236 Feedback 1 Clients who have specific plans are at greater risk for suicide. 2 Clients who talk about suicide should be taken seriously. 3 One-to-one supervision should be provided for any client who threatens suicide. 4 The nurse should be direct and upfront when discussing suicide with clients and their families.

23. A client has been brought to the emergency department for signs and symptoms of chronic obstructive pulmonary disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? 1. Assessing the client's pulse oximetry and vital signs 2. Developing a plan for safety for the client 3. Assessing the client for suicidal ideations 4. Establishing a trusting nurse-client relationship

1 Page: 237 Feedback 1 It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslow's hierarchy of needs. This client's problems with oxygenation will take priority over assessing for current suicidal ideations as they can lead to death more quickly if not reversed. 2 Developing a plan for safety can occur after physical needs have been met. 3 Assessing for suicidal ideation can occur after physical needs have been met. 4 Establishing a nurse-client relationship can occur after physical needs have been met.

19. Which nursing intervention strategy is most important to implement initially with a suicidal client? 1. Ask a direct question such as, "Do you ever think about killing yourself?" 2. Ask client, "Please rate your mood on a scale from 1 to 10." 3. Establish a trusting nurse-client relationship. 4. Apply the nursing process to the planning of client care.

1 Page: 237 Feedback 1 The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan. 2 Asking the client to rate mood does not help assess suicide risk. 3 Establishing a nurse-client relationship does not help assess suicide risk. 4 Applying the nursing process to planning does not help assess suicide risk.

6. A client diagnosed recently with AD is prescribed donepezil (Aricept). The client's spouse inquires, "How does this work? Will this cure him?" Which is the appropriate nursing response? 1. "This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." 2. "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease." 3. "This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." 4. "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

1 Page: 269-270 Feedback 1 The most appropriate response by the nurse is to explain that donepezil delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD. Some side effects include dizziness, headache, gastrointestinal upset, and elevated transaminase. 2 The statement is inaccurate for donepezil (Aricept). 3 This statement provides the client with inaccurate information about donepezil (Aricept). 4 This statement regarding donepezil (Aricept) is false.

1. What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1 Page: 284 Feedback 1 The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia. 2 Disturbed thought processes R/T tactile hallucinations is important, but is not the priority nursing diagnosis. 3 Ineffective coping R/T powerlessness over alcohol use is important, but is not the priority nursing diagnosis. 4 Ineffective denial R/T continued alcohol use despite negative consequences is important, but is not the priority nursing diagnosis.

20. A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

1 Page: 289 Feedback 1. The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing. The treatment of hepatic encephalopathy requires abstention from alcohol and temporary elimination of protein from the diet. 2. This statement indicates that teaching has been effective. 3. This statement indicates that no further education is required. 4. The instructor should interpret this statement as accurate.

15. A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands a psychiatrist to prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics are expensive and have numerous side effects. 3. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

1 Page: 291 Feedback 1 The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction. 2 These drugs do not have numerous side effects. 3 The drugs do not interfere with REM sleep. 4 These drugs are effective for inducing sleep.

5. A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation? 1. Psychological addiction 2. Codependence 3. Substance induced disorder 4. Social induced disorder

1 Page: 294 Feedback 1 The nurse should use the term psychological addiction to best describe the client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure or avoid discomfort. 2 Codependence describes depending on others for decision-making. 3 Substance induced disorders are induced by the use of a drug or substance. 4 Social induced disorders describe using a drug or substance in the presence of others, or socially.

7. A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching? 1. After discharge, the client will immediately attend 90 AA meetings in 90 days. 2. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. 3. After discharge, the client will incorporate family in AA attendance. 4. After discharge, the client will seek appropriate deterrent medications through AA.

1 Page: 307, 312, 314-316 Feedback 1 The most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcohol addiction. It accepts alcohol addiction as an illness and promotes total abstinence as the only cure. 2 Relying on a sponsor does not hold the client accountable. 3 Encouraging family attendance at AA meetings does not hold the client accountable. 4 Seeking further deterrent medications does not hold the client accountable.

17. A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

1 Page: 330-331 Feedback 1 There is a correlation between pathological gambling and abnormalities in the serotonergic, noradrenergic, and dopaminergic neurotransmitter systems. This is not the case with non-pathological gambling. 2 Pathological gambling occurs more commonly among men not women and generally runs a chronic, not acute course. 3 This statement is inaccurate regarding the pathological gambler. 4 For a pathological gambler, the preoccupation with and impulse to gamble intensifies when the individual is under stress.

4. Which client should the nurse anticipate to be most receptive to psychiatric treatment? 1. A Jewish, female social worker. 2. A Baptist, homeless male. 3. A Catholic, black male. 4. A Protestant, Swedish business executive.

1 Page: 4 Feedback 1 The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important to physical health. 2 The homeless client may have difficulty accessing health care and may not place a high emphasis on mental health treatment. 3 Women are more likely to seek treatment for mental health problems than men. 4 This client is not typically as receptive to psychiatric treatment as the client of Jewish culture.

4. Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client? 1. On his or her side, to prevent aspiration 2. In high Fowler's position, to prevent increased intracranial pressure 3. In Trendelenburg's position, to promote blood flow to vital organs 4. In prone position, to prevent airway blockage

1 Page: 405-406 Feedback 1 The nurse should place a client who has received ECT on his or her side to prevent aspiration. 2 High Fowler's does not prevent aspiration. 3 Trendelenburg does not prevent aspiration. 4 Prone position does not prevent aspiration.

3. Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of retaliation. What is the ethical interpretation of the coworker's lack of involvement? 1. Taking no action is still considered an unethical action by the coworker. 2. Taking no action releases the coworker from ethical responsibility. 3. Taking no action is advised when potential adverse consequences are foreseen. 4. Taking no action is acceptable, because the coworker is only a bystander.

1 Page: 42 Feedback 1 The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any observed unethical actions. 2 The coworker is not released from responsibilities by taking no action. 3 Taking no action is never advised when harm could come to the client. 4 The coworker has a responsibility to report any observed unethical actions.

15. A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home-health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? 1. Allow the client to decline the medication and document the decision. 2. Tell the client that if the medication is refused, hospitalization will occur. 3. Arrange with a relative to add the medication to the client's morning orange juice. 4. Call for help to hold the client down while the injection is administered.

1 Page: 44 Feedback 1 It is ethically appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The client's right to refuse treatment should be upheld, unless the refusal puts the client or others in harm's way. 2 It would be unethical for the nurse to force hospitalization. 3 It would be unethical for the nurse to trick the client into taking the medication. 4 It would be unethical for the nurse to force the client to take the medication.

2. Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)? 1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to "normal" daily events. 3. Depressive symptoms occur in PTSD and not in AD. 4. Depressive symptoms occur in AD and not in PTSD.

1 Page: 476-477 Feedback 1 PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events, such as divorce, failure, or rejection. 2 PTSD results from exposure to an extreme traumatic event. 3 Depressive symptoms can also occur in AD. 4 Depressive symptoms can also occur in PTSD.

10. A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? 1. The nurse refuses to give any information to the caller, citing rules of confidentiality. 2. The nurse hangs up on the caller. 3. The nurse confirms that the person has been at the facility but adds no additional information. 4. The nurse suggests that the caller speak to the client's therapist.

1 Page: 48 Feedback 1 The most appropriate action by the nurse is to refuse to give any information to the caller. 2 This would be an inappropriate and unprofessional action by the nurse. 3 Admission to the facility would be considered protected health information and should not be disclosed by the nurse without prior client consent. 4 Giving this information would violate the client's right to privacy.

11. A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

1 Page: 50 Feedback 1 The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or representative would be asked to give consent. 2 The principle of beneficence refers to one's duty to promote the good of others. 3 Nonmaleficence means to do no harm. 4 Justice refers to the right of individuals to be treated fairly.

12. An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client? 1. Electroconvulsive therapy (ECT) 2. Neuroleptic therapy 3. An antiparkinsonian agent 4. An anxiolytic agent

1 Page: 678 Feedback 1 The nurse should anticipate that ECT will be ordered to treat this client's symptoms of depression. ECT remains one of the safest and most effective treatments for major depression in older adults. The response to ECT may be slower in older clients, and the effects may be of limited duration. 2 Neuroleptic therapy is not a therapeutic intervention for the client with major depressive disorder. 3 An antiparkinsonian agent is not a therapeutic intervention for the client with major depressive disorder. 4 An anxiolytic agent is not a therapeutic intervention for the client with major depressive disorder.

5. A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

1 Page: 7 Feedback 1 The nurse should determine that defense mechanisms can be appropriate during times of stress. 2 Defense mechanisms are not maladaptive attempts of the ego to manage anxiety. 3 Defense mechanisms are a normal part of coping with stress. They are not used by individuals with weak ego integrity. They should not be discouraged and eliminated. 4 Defense mechanisms are normal and are used by all individuals in some way during times of stress; they do not cause disintegration of the ego.

1. A geriatric nurse is teaching the client's family about the possible cause of delirium. Which statement by the nurse is most accurate? 1. "Taking multiple medications may lead to adverse interactions or toxicity." 2. "Age-related cognitive changes may lead to alterations in mental status." 3. "Lack of rigorous exercise may lead to decreased cerebral blood flow." 4. "Decreased social interaction may lead to profound isolation and psychosis."

1; Page: 249 Feedback 1 The nurse should identify that taking multiple medications that may lead to adverse reactions or toxicity is a risk factor for the development of delirium in older adults. 2 Age-related cognitive changes do not lead to delirium. 3 Lack of vigorous exercise does not lead to delirium. 4 Decreased social interaction does not lead to delirium.

3. A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents? 1. Reactions to stress are relative rather than absolute; individual responses to stress vary. 2. It is abnormal for identical twins to react differently to similar stressors. 3. Identical twins should share the same temperament and respond similarly to stress. 4. Environmental influences to stress weigh more heavily than genetic influences.

1 Page: 7 Feedback 1 The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress. 2 It is considered normal for twins to react differently to stress. 3 Identical twins do not necessarily respond similarly to stress, due to differences in temperament and personality. 4 Environmental influences and temperament can affect stress reactions.

11. In the treatment of anxiety disorders, benzodiazepines (such as Ativan and Xanax) are indicated for___ use and have __ abuse potential. 1. short-term; high 2. long-term; high 3. short-term; low 4. long-term; low

1 Page: 71 Feedback 1 Because tolerance to these medications occurs, there is high risk for abuse. Therefore, they should be used as a short-term intervention for anxiety. 2 Benzodiazepines should not be used for long-term treatment of anxiety. 3 Benzodiazepines have high abuse potential. 4 Benzodiazepines should not be used for long-term treatment of anxiety, as they have high abuse potential.

17. A psychiatrist prescribes a MAOI for a client. When teaching the client about the effects of tyramine, which foods will the nurse caution the client to avoid? 1. Pepperoni pizza and red wine 2. Bagels with cream cheese and tea 3. Apple pie and coffee 4. Potato chips and Diet Coke

1 Page: 71 Feedback 1 Both these foods are high in tyramine. 2 Bagels with cream cheese and tea are not high in tyramine. 3 Apple pie and coffee are not high in tyramine. 4 Potato chips and Diet Coke are not high in tyramine.

14. A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which potentially fatal side effect will the nurse teach the client about? 1. Agranulocytosis 2. Akathisia 3. Dystonia 4. Akinesia

1 Page: 81 Feedback 1 Agranulocytosis is a potentially fatal disorder in which the client's white blood cell count drops to extremely low levels, placing the client at great risk for infections. 2 The client is not at risk for akathisia. 3 The client is not at risk for dystonia. 4 The client is not at risk for akinesia.

19. Which information suggests that caution is necessary in prescribing a benzodiazepine to an anxious client? 1. The client has a history of alcohol dependence. 2. The client has a history of diabetes mellitus. 3. The client has a history of schizophrenia. 4. The client has a history of hypertension.

1 Page: 81 Feedback 1 Tolerance and psychological dependence are common problems with the long-term use of benzodiazepines. They should be used cautiously with clients who have a history of substance abuse. 2 Clients with a history of diabetes mellitus can still take benzodiazepines. 3 Clients with a history of schizophrenia can still take benzodiazepines. 4 Clients with a history of hypertension can still take benzodiazepines.

8. A client with depression and substance abuse has an interrupted sleep pattern. She demands that her psychiatrist prescribe her a sedative. What teaching would the nurse provide about the rationale for the use of nonpharmacological interventions instead? 1. "Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them." 2. "Sedative-hypnotics work best in combination with other techniques." 3. "Sedative-hypnotics are not permitted for use in patients with substance abuse disorders." 4. "Sedative-hypnotics are not as effective as the antidepressant medications for treating sleep disturbances."

1 Page: 85 Feedback 1 Sedative-hypnotics are potentially addictive and should be used with caution by clients with a history of substance abuse. Tolerance can easily develop. 2 This statement is not accurate regarding sedative-hypnotics. 3 Sedative-hypnotics can become habit forming. 4 This statement is misleading to the client.

22. Joey, age 8 years, takes methylphenidate (Ritalin) for attention deficit/hyperactivity disorder. His mother complains to the nurse that Joey has a very poor appetite, and she struggles to help him gain weight. What teaching will the nurse provide? 1. Administer Joey's medication immediately after meals. 2. Administer Joey's medication at bedtime. 3. Skip a dose of the medication when Joey does not eat anything. 4. Assure Joey's mother that Joey will eat when he is hungry.

1 Page: 89 Feedback 1 To reduce the anorexia associated with methylphenidate (Ritalin), the medication should be given after meals. 2 Administering Joey's medication at bedtime could keep him awake at night. 3 Joey will likely have a decrease in appetite. The medication should be given after breakfast. 4 Assuring Joey's mother that he will eat when hungry does not help improve Joey's appetite.

24. After a teenager reveals that he is gay, his father responds by beating him. The next morning, the teenager is found hanging in his closet. Which paternal grief responses should a nurse anticipate? Select all that apply. 1. "I can't believe this is happening." 2. "If only I had been more understanding." 3. "How dare he do this to me!" 4. "I'm just going to have to accept that he was gay." 5. "Well, that was a selfish thing to do."

1, 2, 3 Page: 239-240 Feedback 1. Suicide of a family member can induce a whole gamut of feelings in the survivors, including shock. 2. Suicide of a family member can induce a whole gamut of feelings in the survivors, including guilt. 3. Suicide of a family member can induce a whole gamut of feelings in the survivors, including anger. 4. Stating, "I'm just going to have to accept that he was gay," reflects acceptance and understanding. 5. Stating, "Well, that was a selfish thing to do," reflects acceptance and understanding.

16. Which of the following conditions have been known to precipitate delirium in some individuals? (Select all that apply.) 1. Febrile illness 2. Seizures 3. Migraine headaches 4. Herniated brain stem 5. Temporomandibular joint syndrome

1, 2, 3 Page: 249-250 Feedback 1. Delirium most commonly occurs in individuals with serious medical, surgical, or neurological conditions. Some examples of conditions that have been known to precipitate delirium in some individuals include the following: febrile illness. 2. Delirium most commonly occurs in individuals with serious medical, surgical, or neurological conditions. Some examples of conditions that have been known to precipitate delirium in some individuals include the following: seizures. 3. Delirium most commonly occurs in individuals with serious medical, surgical, or neurological conditions. Some examples of conditions that have been known to precipitate delirium in some individuals include the following: migraine headaches. 4. A herniated brain stem would most likely result in death, not delirium. 5. Temporomandibular joint syndrome is marked by limited movement of the joint during chewing, not delirium.

21. Which of the following individuals are communicating a message? (Select all that apply.) 1. A mother spanking her son for playing with matches 2. A teenage boy isolating himself and playing loud music 3. A biker sporting an eagle tattoo on his biceps 4. A teenage girl writing, "No one understands me" 5. A father checking for new email on a regular basis

1, 2, 3, 4 Page: 134 Feedback 1. The nurse should determine that a mother spanking her son for playing with matches is a way in which people communicate messages to others. 2. The nurse should determine that a teenage boy isolating himself and playing loud music is a way in which people communicate messages to others. 3. The nurse should determine that a biker sporting an eagle tattoo on his biceps is a way in which people communicate messages to others. 4. The nurse should determine that writing is a way in which people communicate messages to others. 5. Checking for new emails is not an example of communicating a message.

26. The nurse is preparing to assess a client before the physician prescribes a regimen of psychopharmacological therapy. Which components will the nurse assess? (Select all that apply.) 1. Medical history 2. Physical examination findings 3. Ethnocultural characteristics 4. Current medication

1, 2, 3, 4 Page: 64-67 Feedback 1. The nurse should assess medical history. 2. The nurse should assess physical examination findings. 3. The nurse should assess ethnocultural characteristics. 4. The nurse should assess current medications.

14. Which of the following has SAMHSA described as major dimensions of support for a life of recovery? (Select all that apply) 1. Health 2. Community 3. Home 4. Religious affiliation 5. Purpose

1, 2, 3, 5 Page: 216 Feedback 1. SAMHSA suggests that a life in recovery is supported by four major dimensions, which include health, home, purpose, and community. 2. SAMHSA suggests that a life in recovery is supported by four major dimensions, which include health, home, purpose, and community. 3. SAMHSA suggests that a life in recovery is supported by four major dimensions, which include health, home, purpose, and community. 4. Religious affiliation is not included in the listed dimensions. 5. SAMHSA suggests that a life in recovery is supported by four major dimensions, which include health, home, purpose, and community.

13. Which of the following interventions should a nurse use when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.) 1. Maintain a calm demeanor. 2. Clearly delineate the consequences of the behavior. 3. Use therapeutic touch to convey empathy. 4. Set limits on the behavior. 5. Teach the client to avoid "I" statements related to expression of feelings.

1, 2, 4 Page: 200-202 Feedback 1. The nurse should determine that, when working with an inpatient client with difficulty expressing anger appropriately, it is important to maintain a calm demeanor. 2. The nurse should determine that, when working with an inpatient client with difficulty expressing anger appropriately, it is important to clearly define the consequences. 3. The use of therapeutic touch may not be appropriate and could increase the client's anger. 4. The nurse should determine that, when working with an inpatient client with difficulty expressing anger appropriately, it is important to set limits on the behavior. 5. Teaching would not be appropriate when a client is agitated.

15. A nurse uses the commitments of the Tidal Model of Recovery in psychiatric nursing practice. Which of the following nursing actions reflect the use of the Develop Genuine Curiosity commitment? (Select all that apply.) 1. The nurse expresses interest in the client's story. 2. The nurse asks for clarification of certain points. 3. The nurse encourages the client to speak his own words in his own unique way. 4. The nurse assists the client to unfold the story at his or her own rate. 5. The nurse provides the clients with copies of all documents relevant to care.

1, 2, 4 Page: 219 Feedback 1. Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include: Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. 2. Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include: Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. 3. Encouraging the client to speak his own words in his own unique way is not included in the Tidal Model. 4. Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include: Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. 5. Providing the clients with copies of all documents relevant to care is not included in the Tidal Model.

When used in combination with anxiolytic medication, alcohol leads to ___ effects, and caffeine leads to ___ effects. 1.increased; increased 2. increased; decreased 3. decreased; decreased 4. decreased; increased

2 Page: 67 Feedback 1 Alcohol leads to increased effects and caffeine leads to decreased effects. 2 Anxiolytic medications work through depression of certain central nervous system (CNS) functions. Alcohol, which is a CNS depressant, would increase/potentiate their effects. Caffeine, which is a CNS stimulant, would decrease/inhibit their effects. 3 Alcohol leads to increased effects and caffeine leads to decreased effects 4 Alcohol leads to increased effects and caffeine leads to decreased effects.

19. Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

1, 2, 4 Page: 312 Feedback 1. The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. 2. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients diagnosed with this problem. 3. This statement does not exemplify the cognitive process that must be completed by a nurse prior to client care. 4. Determining the need to set boundaries is an example of a cognitive process that must be completed by a nurse prior to client care. 5. This statement does not exemplify the cognitive process that must be completed by a nurse prior to client care.

16. A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span

1, 2, 4 Page: 7 Feedback 1. This symptom is a sign of anxiety. 2. This is a symptom that the nurse would expect in a client experiencing anxiety. 3. The nurse would not expect the client to have palpitations. 4. This option indicates anxiety. 5. Limited attention span does not indicate anxiety.

21. A clinic nurse is about to meet with a client diagnosed with a gambling disorder. Which of the following symptoms and/or behaviors is the nurse likely to assess? (Select all that apply.) 1. Stressful situations precipitate gambling behaviors. 2. Anxiety and restlessness can only be relieved by placing a bet. 3. Winning brings about feelings of sexual satisfaction. 4. Gambling is used as a coping strategy. 5. Losing at gambling meets the client's need for self-punishment.

1, 2, 4, 5 Page: 330-331 Feedback 1. In gambling disorder, the preoccupation with and impulse to gamble intensifies when the individual is under stress. 2. Many impulsive gamblers describe a physical sensation of restlessness and anticipation that can only be relieved by placing a bet. 3. Winning brings feelings of special status, power, and omnipotence, not sexual satisfaction. 4. Gambling is used as a coping strategy for dealing with stress and disappointments. 5. The gambler increasingly depends on this activity to cope with disappointments, problems, and negative emotional states.

18. Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) 1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. 2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. 3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is a possible correlation between increased levels of prolactin and anorexia nervosa. 5. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

1, 3 Page: 29 Feedback 1. The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones. 2. There is no correlation between anorexia nervosa and antidiuretic hormone levels. 3. Research shows that there is possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is no correlation between anorexia nervosa and increased prolactin levels. 5. There is no correlation between anorexia nervosa and altered levels of oxytocin.

23. A nursing supervisor is offering an impaired staff member information regarding employee assistance programs. Which of the following facts should the supervisor include? (Select all that apply.) 1. A hotline number will be available in order to call for peer assistance. 2. A verbal contract detailing the method of treatment will be initiated prior to the program. 3. Peer support is provided through regular contact with the impaired nurse. 4. Contact to provide peer support will last for one year. 5. One of the program goals is to intervene early in order to reduce hazards to clients.

1, 3, 5 Page: 322-323 Feedback 1. Most states provide either a hotline number that the impaired nurse may call or phone numbers of peer assistance committee members, which are made available for the same purpose. 2. Typically, a written, not verbal, contract is drawn up, detailing the method of treatment, which may be obtained from various sources, such as employee assistance programs, Alcoholics Anonymous, Narcotics Anonymous, private counseling, or outpatient clinics. 3. Peer support is provided through regular contact with the impaired nurse. 4. Peer support is usually for a period of two years, not one year. 5. The peer assistance programs strive to intervene early, to reduce hazards to clients, and increase prospects for the nurse's recovery.

24. A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply.) 1. The client has a long history of focusing thoughts and behaviors on other people. 2. The client, as a child, experienced overindulgent and overprotective parents. 3. The client is a people pleaser and does almost anything to gain approval. 4. The client exhibits helpless behaviors but actually feels very competent. 5. The client can achieve a sense of control only through fulfilling the needs of others.

1, 3, 5 Page: 323-324 Feedback 1. The codependent person has a long history of focusing thoughts and behavior on other people and is able to achieve a sense of control only through fulfilling the needs of others. 2. They usually have experienced abuse or emotional neglect as a child. 3. Codependent clients are "people pleasers" and will do almost anything to get the approval of others. 4. They outwardly appear very competent, but actually feel quite needy, helpless, or perhaps nothing at all. 5. Codependent clients achieve a sense of control when they are fulfilling the needs of others.

4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? 1. Peer pressure 2. Structured programming 3. Visitor restrictions 4. Mandated activities

2 Page: 173 Feedback 1 The milieu does not provide peer pressure. 2 The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. Time is also devoted to personal problems and focus groups. 3 The milieu does not provide visitor restrictions. 4 The milieu does not provide mandated activities.

17. A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis? (Select all that apply.) 1. "Have you taken any new medications recently?" 2. "Have you recently traveled away from home?" 3. "Have you recently experienced any traumatic event?" 4. "Have you ever felt detached from your environment?" 5. "Have you had any history of memory problems?"

1, 3, 5 Page: 518-520 Feedback 1. The nurse should assess the client for possible causes of amnesia, which may include side effects of new medications. 2. This question would not help confirm the diagnosis. 3. The nurse should assess the client for possible causes of amnesia, which may include experiencing a traumatic event. 4. This question would not be beneficial in helping the nurse confirm the diagnosis. 5. The nurse should assess the client for possible causes of amnesia, which may include having a history of memory problems.

13. Which of the following types of care should the interdisciplinary team of hospice provide? (Select all that apply.) 1. Physical care available on a 24/7 basis 2. Counseling on the addictive properties of pain-management medications 3. Discussions related to death and dying 4. Explorations of new aggressive treatments 5. Assistance with obtaining spiritual support and guidance

1, 3, 5 Page: 770 Feedback 1. The nurse should identify that the interdisciplinary team of hospice provides physical care available on a 24/7 basis. 2. The interdisciplinary team of hospice does not provide counseling on the addictive properties of pain-management medications. 3. The nurse should identify that the interdisciplinary team of hospice provides discussions related to death and dying. 4. The interdisciplinary team of hospice does not provide explorations of new aggressive treatments. 5. The nurse should identify that the interdisciplinary team of hospice provides assistance with obtaining spiritual support and guidance.

19. After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department. The client threatens suicide. Which of the following criteria would enable a physician to consider involuntary commitment? (Select all that apply.) 1. Being dangerous to others 2. Being homeless 3. Being disruptive to the community 4. Being gravely disabled and unable to meet basic needs 5. Being suicidal

1, 4, 5 Page: 44-45 Feedback 1. The physician could consider involuntary commitment when a client is dangerous to others. 2. Being homeless is not enough for involuntary commitment. 3. Being disruptive to the community is not enough for involuntary commitment. 4. The physician could consider involuntary commitment when a client is gravely disabled. 5. The physician could consider involuntary commitment when a client is suicidal.

17. Which of the following medications that have been known to precipitate delirium? (Select all that apply.) 1. Antineoplastic agents 2. H2-receptor antagonists 3. Antihypertensives 4. Corticosteroids 5. Lipid-lowering agents

1234; Page: 250 Feedback 1. Medications that have been known to precipitate delirium include antineoplastic agents. 2. Medications that have been known to precipitate delirium include H2-receptor antagonists (e.g., cimetidine). 3. Medications that have been known to precipitate delirium include antihypertensives. 4. Medications that have been known to precipitate delirium include corticosteroids. 5. There have been no reports of delirium ascribed to the use of lipid-lowering agents.

24. A client is prescribed phenelzine (Nardil). Which of the following statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food and medication labels." 4. "I'm going to miss my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

1235; Page: 408, 410 Feedback 1. The client needs to tell other physicians about taking MAOIs, because of the risk of drug interactions. 2. The nurse should evaluate that teaching has been successful when the client states that phenelzine should not be taken in conjunction with the use of alcohol. 3. The nurse should evaluate that teaching has been successful when the client states that phenelzine should not be taken in conjunction with foods high in tyramine. 4. The client will not have to give up caffeinated coffee with this medication. 5. This medication should not be stopped abruptly.

14. Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply.) 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. Restrict sodium content. 5. Restrict fluids to 1,500 mL per day.

123; Page: 434, 439-440 Feedback 1. The nurse should instruct the client taking lithium to avoid excessive use of caffeine. 2. The nurse should instruct the client taking lithium to maintain a consistent sodium intake. 3. The nurse should instruct the client taking lithium to consume at least 2,500 to 3,000 mL of fluid per day. 4. Fluid restriction can impact lithium levels. 5. Sodium restriction can impact lithium levels.

19. Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.) 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

12; Page: 28 Feedback 1. The nurse should associate depression with decreased levels of TSH. 2. The nurse should associate fatigue with decreased levels of TSH. 3. Decreased libido is associated with decreased levels of TSH. 4. Mania is not associated with decreased levels of TSH. 5. Hyperexcitability is not associated with decreased levels of TSH.

1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? 1. Clarify personal attitudes, values, and beliefs. 2. Obtain thorough assessment data. 3. Determine the client's length of stay. 4. Establish personal goals for the interaction.

1; Page: 126 Feedback 1 The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness. 2 Obtaining thorough assessment data is not the most important task. 3 Determining the client's length of stay is not the most important task. 4 Establishing personal goals for the interaction is not the most important task.

9. A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? 1. Thyroid-stimulating hormone (TSH) level of 25 U/mL 2. Potassium (K+) level of 4.2 mEq/L 3. Sodium (Na+) level of 140 mEq/L 4. Calcium (Ca2+) level of 9.5 mg/dL

1; Page: 380 Feedback 1 A diagnosis of major depressive episode may be ruled out if the client's lab results reveal a TSH level of 25 U/mL. Normal levels of TSH range from 2 to 10 U/mL. High levels of TSH indicate low thyroid function. The client's high TSH value may indicate hypothyroidism, which can lead to depressive symptoms. The DSM-5 criteria for the diagnosis of major depressive episode states that this diagnosis must not be attributable to the direct physiological effects of another medical condition. 2 Potassium levels do not lead to depression. 3 Sodium levels do not lead to depression. 4 Calcium levels do not lead to depression.

5. Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

1; Page: 455-456 Feedback 1 A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions. 2 Clients with OCD experience obsessions and compulsions. Clients with obsessive-compulsive personality disorder do not. 3 The nurse would not recognize these symptoms as differentiating the disorders. 4 This statement is inaccurate regarding these disorders.

14. A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

1; Page: 470 Feedback 1 The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. This intervention is used when taking lithium (Eskalith) for the treatment of bipolar disorder. 2 The client should not be stopped abruptly. 3 The drug should not be taken in conjunction with alcohol. 4 The client should understand that taking extra doses of a benzodiazepine may result in addiction.

18. A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? 1. History of alcohol use disorder 2. History of personality disorder 3. History of schizophrenia 4. History of hypertension

1; Page: 471 Feedback 1 The nurse should question a prescription of alprazolam for acute anxiety if the client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance use disorder may be more likely to abuse other addictive substances. 2 History of personality disorder would not cause the nurse to question the order. 3 History of schizophrenia would not cause the nurse to question the order. 4 History of hypertension would not cause the nurse to question the order.

3. A nurse discharges a female client to home after delivering a stillborn infant. The client finds that neighbors have dismantled the nursery that she and her husband planned. According to Worden, how could this intervention affect the woman's grieving task completion? 1. This intervention may hamper the woman from continuing a relationship with her infant. 2. This intervention would help the woman forget the sorrow and move on with life. 3. This intervention communicates full support from her neighbors. 4. This intervention would motivate the woman to look to the future and not the past.

1; Page: 760 Feedback 1 The nurse should anticipate that this intervention could hinder the woman from continuing a relationship with her infant. The first task in Worden's grief process is to accept the reality of the loss. It is common for individuals to refuse to believe that the loss has occurred. 2 This intervention could complicate the grieving process. 3 The intervention could isolate the women from others. 4 This intervention could prevent the women from grieving the loss and moving forward.

8. To effectively plan care for Asian American clients, a nurse should be aware of which cultural factor? 1. Obesity and alcoholism are common problems. 2. Older people maintain positions of authority within the culture. 3. "Tai" and "chi" are the fundamental concepts of Asian health practices. 4. Asian Americans are likely to seek psychiatric help.

2 Page: 101-102 Feedback 1 Obesity and alcoholism are low among Asian Americans. 2 To effectively care for Asian American clients, the nurse should be aware that older people in this culture maintain positions of authority. 3 The balance of yin and yang is the fundamental concept of Asian health practices. 4 Psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families.

7. When an individual is "two-faced," which characteristic—essential to the development of a therapeutic relationship—should a nurse identify as missing? 1. Respect 2. Genuineness 3. Sympathy 4. Rapport

2 Page: 127 Feedback 1 Respect is not the characteristic missing when an individual is "two-faced." 2 When an individual is "two-faced," which means double-dealing or deceitful, the nurse should identify that genuineness is missing in the relationship. Genuineness refers to the nurse's ability to be open and honest and maintain congruence between what is felt and what is communicated. When a nurse fails to bring genuineness to the relationship, trust cannot be established. 3 Sympathy is not the characteristic missing when an individual is "two-faced." 4 Rapport is not the characteristic missing when an individual is "two-faced."

3. What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? 1. Acknowledge the client's actions, and generate alternative behaviors. 2. Establish rapport and develop treatment goals. 3. Attempt to find alternative placement. 4. Explore how thoughts and feelings about this client may adversely impact nursing care.

2 Page: 129 Feedback 1 Acknowledging the client's actions and generating alternative behaviors can occur after rapport has been established. 2 The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client, based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship. 3 Attempting to find alternative placement can occur after rapport has been established. 4 Exploring how thoughts and feelings about this client may adversely impact nursing care can occur after rapport has been established.

14. A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? 1. S 2. O 3. L 4. E 5. R

2 Page: 136 Feedback 1 The acronym SOLER includes: sitting squarely facing the client (S). 2 The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. 3 The acronym SOLER includes: leaning forward toward the client (L). 4 The acronym SOLER includes: establishing eye contact (E). 5 The acronym SOLER includes: relaxing (R).

13. A client diagnosed with posttraumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of "broad openings"? 1. "What occurred prior to the rape, and when did you go to the emergency department?" 2. "What would you like to talk about?" 3. "I notice you seem uncomfortable discussing this." 4. "How can we help you feel safe during your stay here?"

2 Page: 137 Feedback 1 This question asks specific information about the rape. 2 The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of a broad opening. Using broad openings allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction. 3 This question is not an example of a broad opening. 4 While this question is important, it is not an example of a broad opening.

18. A mother rescues two of her four children from a house fire. In an emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? 1. "The smoke was too thick. You couldn't have gone back in." 2. "You're experiencing feelings of guilt, because you weren't able to save your children." 3. "Focus on the fact that you could have lost all four of your children." 4. "It's best if you try not to think about what happened. Try to move on."

2 Page: 137-138 Feedback 1 Stating, "The smoke was too thick. You couldn't have gone back in," is not therapeutic and would not benefit the mother. 2 The best response by the nurse is, "You're experiencing feelings of guilt, because you weren't able to save your children." This response uses the therapeutic communication technique of restating what the client has said. This lets the client know whether an expressed statement has been understood or if clarification is necessary. 3 Stating, "Focus on the fact that you could have lost all four of your children," is not therapeutic and would not benefit the mother. 4 Stating, "It's best if you try not to think about what happened. Try to move on," is not therapeutic and would not benefit the mother.

1. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? 1. Medical history is of little significance and can be eliminated from the nursing assessment. 2. Assessment provides a holistic view of the client, including biopsychosocial aspects. 3. Comprehensive assessments can be performed only by advanced practice nurses. 4. Psychosocial evaluations are gained by subjective reports rather than objective observations.

2 Page: 148 Feedback 1 Medical history is significant and should not be eliminated from the nursing assessment. 2 The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. 3 Assessments can be completed by a variety of health-care providers. 4 The nurse should gather subject and objective information.

7. What is the purpose of a nurse gathering client information? 1. It enables the nurse to modify behaviors related to personality disorders. 2. It enables the nurse to make sound clinical judgments and plan appropriate care. 3. It enables the nurse to prescribe the appropriate medications. 4. It enables the nurse to assign the appropriate Axis I diagnosis.

2 Page: 156 Feedback 1 Modifying behaviors can occur after the nurse completes a thorough assessment. 2 The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client, including information collected from the client, significant others, and health-care providers. 3 After completing a thorough assessment, the nurse can prescribe the appropriate medications. 4 After completing a thorough assessment, the nurse can assign the appropriate Axis I diagnosis.

10. How should a nurse prioritize nursing diagnoses? 1. By the established goal of care 2. By the life-threatening potential 3. By the physician's priority of care 4. By the client's preference

2 Page: 159 Feedback 1 Client care goals can be met after safety has been established. 2 The nurse should prioritize nursing diagnoses related to their life-threatening potential. Safety is always the nurse's first priority. 3 The physician's priority of care can be met after safety has been established. 4 The client can choose a goal as a priority after safety has been established.

14. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis, which was recently removed from the NANDA-I list, still accurately reflects this client's problem? 1. Disturbed thought processes 2. Disturbed sensory perception 3. Anxiety 4. Chronic confusion

2 Page: 161 Feedback 1 The nursing diagnosis, disturbed thought processes, does not accurately reflect the client's problem. 2 The nursing diagnosis disturbed sensory perception accurately reflects the client's symptoms of hearing things that others do not. The nursing diagnosis describes the client's condition and facilitates the prescription of interventions. 3 The nursing diagnosis, anxiety, does not accurately reflect the client's problem. 4 The nursing diagnosis, chronic confusion, does not accurately reflect the client's problem.

7. What is the best rationale for including family in the client's therapy within the inpatient milieu? 1. To structure a program of social and work-related activities 2. To facilitate discharge from hospitalization 3. To provide a concrete demonstration of caring 4. To encourage the family to model positive behaviors

2 Page: 179 Feedback 1 The family is not expected to structure a program of social and work-related activities 2 The nurse should include the client's family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment. 3 The family is not included to provide a concrete demonstration of caring. 4 The family is not included to model positive behaviors.

5. A client diagnosed with alcohol use disorder experiences a first relapse. During an Alcoholics Anonymous (AA) meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? 1. Imparting of information 2. Instillation of hope 3. Catharsis 4. Universality

2 Page: 185 Feedback 1 Imparting of information consists of giving and receiving information through formal instruction. 2 This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that their personal problems can also be resolved. 3 Catharsis is the expression of both positive and negative feelings in the group setting. 4 Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing.

9. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? 1. "It's hard for me to tell my story when I'm not sure about the reactions of others." 2. "I think Joe's Antabuse suggestion is a good one and might work for me." 3. "My situation is very complex, and I need professional, not peer, advice." 4. "I am really upset that you expect me to solve my own problems."

2 Page: 186 Feedback 1 Stating, "It's hard for me to tell my story when I'm not sure about the reactions of others," does not demonstrate that the group has progressed to the working phase. 2 The nurse should recognize that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and use it constructively to create change. 3 Stating, "My situation is very complex, and I need professional, not peer, advice," does not demonstrate that the group has progressed to the working phase. 4 Stating, "I am really upset that you expect me to solve my own problems," does not demonstrate that the group has progressed to the working phase.

13. Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

2 Page: 19 Feedback 1 The cerebellum is concerned with involuntary movement, posture, and equilibrium. 2 The limbic system is often referred to as the "emotional brain." The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior. 3 The cortex is identified by numerous folds called gyri and sulci. 4 The left temporal lobe is concerned with auditory functions.

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? 1. Maturational/developmental crisis 2. Psychiatric emergency crisis 3. Anticipated life transition crisis 4. Traumatic stress crisis

2 Page: 197 Feedback 1 The client is not experiencing a maturational/developmental crisis. 2 The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility. 3 The client is not experiencing an anticipated life transition crisis. 4 The client is not experiencing a traumatic stress crisis.

9. An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert a nurse to escalating anger and aggression? 1. The client requests prn medications. 2. The client has a tense facial expression and body language. 3. The client refuses to eat lunch. 4. The client sits in group with back to peers.

2 Page: 198 Feedback 1 Requesting prn medications is not an indication that anger is escalating. 2 The nurse should assess that tense facial expressions and body language may indicate that a client's anger is escalating. 3 Refusing lunch does not indicate that anger is escalating. 4 Sitting with peers does not indicate that anger is escalating.

8. A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing response is most appropriate? 1. "I'm confident you know what's best for you." 2. "This may not be the best time for you to make such an important decision." 3. "Your children will be terribly disappointed." 4. "Tell me why you want to make this change."

2 Page: 205 Feedback 1 This statement does not help the client in solving the problem. 2 During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse should help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed. 3 This statement is not therapeutic to the client. 4 The nurse should also assist the client in determining whether any changes are realistic.

8. An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? 1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission

2 Page: 21 Feedback 1 Regeneration is incorrect wording to describe this process. 2 The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse. 3 Recycling is incorrect wording to describe this process. 4 Retransmission is incorrect wording to describe this process.

10. A nursing instructor is teaching about components present in the recovery process as described by Andresen and associates that led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed? 1. "A client has a better chance of recovery if he or she truly believes that recovery can occur." 2. "If a client is willing to give the responsibility of treatment to the health-care team, they are likely to recover." 3. "A client who has a positive sense of self and a positive identity is likely to recover." 4. "A client has a better chance of recovery if he or she has purpose and meaning in life."

2 Page: 220 Feedback 1 This statement is true regarding recovery. 2 In examining a number of studies, Andresen and associates identified four components that were consistently evident in the recovery process. These components are hope, responsibility, self and identity, and meaning and purpose. Under responsibility, this model tasks the client, not the health-care team, with taking responsibility for his or her life and well-being. 3 This statement indicates that teaching has been effective. 4 This statement indicates that no further teaching is necessary.

12. A client states, "I have come to the conclusion that this disease has not paralyzed me." The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andresen and associates? 1. Moratorium 2. Awareness 3. Preparation 4. Rebuilding

2 Page: 222 Feedback 1 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 1: Moratorium. 2 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 2: Awareness. 3 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 3: Preparation. 4 Andresen and associates have conceptualized a five-stage model of recovery called the Psychological Recovery Model. The stages include: Stage 4: Rebuilding.

11. A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include? 1. Elderly people use less lethal means to commit suicide. 2. Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3. Suicide is the second leading cause of death among the elderly. 4. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

2 Page: 234 Feedback 1 The elderly do not necessarily use less lethal means of committing suicide. 2 Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides. 3 Suicide is not the second leading cause of death among the elderly. 4 An expressed desire to die is not normal in any age group.

10. After years of dialysis, an 84-year-old states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care? 1. "Have there been any changes in appetite or sleep?" 2. "How often is your spouse left alone?" 3. "Has your spouse been following a diet and exercise program consistently?" 4. "How would you characterize your relationship with your spouse?"

2 Page: 237 Feedback 1 Changes in appetite or sleep do not accurately indicate risk for suicide. 2 This client has many risk factors for suicide. The client should have increased supervision to decrease likelihood of self-harm. 3 Asking about diet and exercise do not assess risk for suicide. 4 Asking about the client's relationship with his spouse does not accurately assess the risk for suicide.

5. A nurse admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this client's safety upon discharge? 1. Provide a 6-month supply of Elavil to ensure long-term compliance. 2. Provide a 3-day supply of Elavil with refills contingent on follow-up appointments. 3. Provide a pill dispenser as a memory aid. 4. Provide education regarding the avoidance of foods containing tyramine.

2 Page: 237 Feedback 1 This amount of medication may be enough for the client to overdose. 2 The health-care provider should provide no more than a 3-day supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the client's safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential. In addition, clients may gain energy to carry out a suicide once they begin to have more energy from taking the antidepressants. 3 This option would not prevent the client from committing suicide. 4 This option does not prevent suicide.

16. Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self? 1. The client will not physically harm self. 2. The client will express three positive self-attributes by day four. 3. The client will reveal a suicide plan. 4. The client will establish a trusting relationship.

2 Page: 237 Feedback 1 This outcome may take time for the client to commit to. 2 Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low self-esteem. Outcomes should be client-centered, specific, realistic, and measurable and contain a time frame. 3 This outcome may be a big step for the client. 4 This outcome may not be realistic right away for the client.

9. A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? 1. "Your grieving will subside within 1 year; until then I recommend antidepressants." 2. "Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area." 3. "The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them." 4. "Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

2 Page: 240 Feedback 1 This statement is not therapeutic for the family or helpful. 2 Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work. 3 This statement provides inaccurate information to the family. 4 This statement is inaccurate and not therapeutic to the family.

11. A client with a history of cerebrovascular accident is brought to an emergency department experiencing memory problems, confusion, and disorientation. Based on this client's assessment data, which diagnosis would the nurse expect the physician to assign? 1. Delirium due to adverse effects of cardiac medications 2. Vascular neurocognitive disorder 3. Altered thought processes 4. Alzheimer's disease

2 Page: 250, 252-253 Feedback 1 It is not known whether or not the client is taking cardiac medications. 2 The nurse should expect that the client will be diagnosed with vascular NCD, which is caused by significant cerebrovascular disease. Vascular NCD often has an abrupt onset. Progression of this disease often occurs in a fluctuating pattern. 3 Based on symptoms and progression of the disease, the physician would not diagnose altered thought process. 4 The physician would not likely diagnose Alzheimer's disease.

15. Which statement accurately differentiates NCD from pseudodementia (depression)? 1. NCD has a rapid onset, whereas pseudodementia does not. 2. NCD symptoms include disorientation to time and place, and pseudodementia does not. 3. NCD symptoms improve as the day progresses, but symptoms of pseudodementia worsen. 4. NCD causes decreased appetite, whereas pseudodementia does not.

2 Page: 259 Feedback 1 NCD has a slow progression of symptoms, whereas pseudodementia has a rapid progression of symptoms. 2 NCD symptoms include disorientation to time and place, and pseudodementia does not. 3 NCD symptoms' severity worsens as the day progresses, whereas in pseudodementia, symptoms improve as the day progresses. 4 In NCD the appetite remains unchanged, whereas in pseudodementia, the appetite diminishes.

10. A client diagnosed with major NCD is exhibiting behavioral problems on a daily basis. At change of shift, the client's behavior escalates from pacing to screaming and flailing. Which action should be a nursing priority? 1. Consult the psychologist regarding behavior-modification techniques. 2. Medicate the client with prn antianxiety medications. 3. Assess environmental triggers and potential unmet needs. 4. Anticipate the behavior and restrain when pacing begins.

2 Page: 265 Feedback 1 Consulting the psychologist is not the priority, because it does not keep the client safe. 2 The priority nursing action is to first medicate the client to avoid injury to self or others. 3 It is important to assess environmental triggers and potential unmet needs in order to address these problems in the future, but interventions to ensure safety must take priority. Because of the cognitive decline experienced in clients diagnosed with this disorder, communication skills and orientation may limit assessment and teaching interventions. 4 Restraining the client may make behavioral problems worse.

18. A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed? 1. "The state board of nursing must be notified with factual documentation of impairment." 2. "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice." 3. "Many state boards of nursing require an impaired nurse to successfully complete counseling treatment programs prior to a return to work." 4. "After a return to practice, a recovering nurse may be closely monitored for several years."

2 Page: 283-284 Feedback 1 This is an accurate statement regarding impaired nurses. 2 Several state boards of nursing have passed diversionary laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment program(s); evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period. 3 This statement does not indicate that further education is required. 4 This statement indicates that teaching has been effective.

2. A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance addiction? 1. Narcotic pain medication is contraindicated for all clients with active substance use disorders. 2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control. 3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance. 4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

2 Page: 287 Feedback 1 Narcotic pain medication should never be held because a client has a substance abuse disorder. 2 The nurse should assess the client for substance addiction, because clients who are addicted to alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug. 3 The client should be assessed for a substance abuse disorder as needed, so that proper follow up can be arranged for the client. 4 In this scenario, the client is not exhibiting signs of substance abuse withdrawal.

8. A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse's first priority? 1. Hearing and visual impairment 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 on numeric scale 4. Dehydration

2 Page: 291 Feedback 1 Hearing and visual impairment are not life threatening and do not indicate alcohol withdrawal. 2 The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal syndrome and should promptly report this finding to the physician. Complications associated with alcohol withdrawal syndrome may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol use. 3 A mood rating of 2/10 on numeric scale is not life threatening and does not indicate alcohol withdrawal. 4 Dehydration is not life threatening and does not indicate alcohol withdrawal.

14. A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

2 Page: 291 Feedback 1 Intoxication would not occur at this blood alcohol level. 2 The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. 3 Blood alcohol would have to be higher for intoxication to occur. 4 While the client would be intoxicated, this is not the minimum level at which intoxication would occur.

14. According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? 1. A client rudely complaining about limited visiting hours 2. A client exhibiting aggressive behavior toward another client 3. A client stating that no one cares 4. A client verbalizing feelings of failure

2 Page: 3 Feedback 1 Clients who complain are struggling with higher-level needs, such as the need for love and belonging or the need for self-esteem. 2 The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslow's hierarchy of needs and must be fulfilled before other higher-level needs can be met. 3 Clients who state that no one cares are struggling with higher-level needs such as the need for love and belonging or the need for self-esteem. 4 Clients who have feelings of failure are struggling with higher-level needs, such as the need for love and belonging or the need for self-esteem.

2. At what point should the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection.

2 Page: 3 Feedback 1 The client with a mental illness would have symptoms that reflect the DSM-5. 2 The nurse should determine that the client is at risk for mental illness when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental illness, daily functioning must be significantly impaired. 3 The client's ability to communicate distress would be considered a positive attribute. 4 The use of defense mechanisms does not indicate that the client is at risk for mental illness.

6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? 1. Neuroendocrinology 2. Psychoneuroimmunology 3. Diagnostic technology 4. Neurophysiology

2 Page: 31 Feedback 1 Neuroendocrinology is the study of the interaction between the nervous system and the endocrine system. 2 Psychoneuroimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli. 3 Diagnostic testing assists in diagnosing. 4 Neurophysiology is the physiology of the nervous system.

5. A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder? 1. Altered communication R/T feelings of worthlessness AEB anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

2 Page: 380 Feedback 1 Altered communication R/T feelings of worthlessness AEB anhedonia does not address a behavioral symptom of this disorder. 2 A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive episode. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, curled-up position, and no attention to personal hygiene and grooming. 3 Altered thought processes R/T hopelessness AEB persecutory delusions does not address a behavioral symptom of this disorder. 4 Altered nutrition: less than body requirements R/T high anxiety AEB anorexia does not address a behavioral symptom of this disorder.

11. What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems.

2 Page: 382 Feedback 1 The assessment does not decrease social isolation. 2 The nurse should determine that a client with a diagnosis of major depressive episode needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders. 3 Physical health complications are not likely to arise from antidepressant therapy. 4 Not all depressed clients avoid addressing health and medical problems.

1. In response to a student's question regarding choosing a psychiatric specialty, a charge nurse states, "Mentally ill clients need special care. If I were in that position, I'd want a caring nurse also." From which ethical framework is the charge nurse operating? 1. Kantianism 2. Christian ethics 3. Ethical egoism 4. Utilitarianism

2 Page: 42 Feedback 1 Kantianism states that decisions should be made based on moral law and that actions are bound by a sense of moral duty. 2 The charge nurse is operating from a Christian ethics framework. The imperative demand of Christian ethics is that all decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated. 3 Ethical egoism promotes the idea that what is right is good for the individual. 4 Utilitarianism holds that decisions should be made focusing on the end result being happiness.

2. During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework? 1. "I would want to be treated in a caring manner if I were mentally ill." 2. "This job will pay the bills, and the workload is light enough for me." 3. "I will be happy caring for the mentally ill. Working in med/surg kills my back." 4. "It is my duty in life to be a psychiatric nurse. It is the right thing to do."

2 Page: 42 Feedback 1 This statement reflects Christian ethics. 2 The applicant's comment reflects the ethical egoism framework. This framework promotes the idea that decisions are made based on what is good for the individual and may not take the needs of others into account. 3 This statement does not accurately reflect the ethical egoism framework. 4 This statement reflects Kantianism.

9. Which statement about the tricyclic group of antidepressant medications is accurate? 1. Strong or aged cheese should not be eaten while taking them. 2. Their full therapeutic potential may not be reached until 4 weeks. 3. They may cause hypomania or recent memory impairment. 4. They should not be given with antianxiety agents.

2 Page: 67 Feedback 1 This statement is misleading to the client. 2 It may take several weeks for tricyclic medications to reach their full therapeutic effect. 3 These medications do not cause hypomania or recent memory impairment. 4 These medications can be administered with antianxiety agents.

5. Which is an example of an intentional tort? 1. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome. 2. A nurse physically places an irritating client in four-point restraints. 3. A nurse makes a medication error and does not report the incident. 4. A nurse gives patient information to an unauthorized person.

2 Page: 47 Feedback 1 Failing to assess a client is an example of an unintentional tort. 2 A tort, which can be intentional or unintentional, is a violation of civil law in which an individual has been wronged. A nurse who intentionally physically places an irritating client in restraints has touched the client without consent and has committed an intentional tort. 3 Failing to report a medical error is an example of an unintentional tort. 4 Giving patient information to an unauthorized person is a violation of the Health Insurance Portability and Accountability Act (HIPAA).

11. After a teaching session about grief, a client says to the nurse, "I seem to be stuck in the anger stage of grieving over the loss of my son." How would the nurse assess this statement, and in what phase of the nursing process would this occur? 1. Assessment phase; nursing actions have been successful in achieving the objectives of care. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

2 Page: 481, 484 Feedback 1 This statement is assessed in the evaluation phase, not the assessment phase. 2 In the evaluation phase of the nursing process, reassessment is conducted to determine if the nursing actions have been successful in achieving the objectives of care. The implementation of client teaching has enabled the client to verbalize an understanding of the grief process and his or her position in the process. Therefore, the nurse's actions can be evaluated as successful. Without the evaluation phase, it would be difficult for the nurse to determine if actions have been successful. 3 This statement is assessed in the evaluation phase, not the implementation phase. 4 This statement is assessed in the evaluation phase, not the diagnosis phase.

6. A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client's concerns. 4. Encourage attending a grief therapy group.

2 Page: 485-486 Feedback 1 After the nurse has assessed the stage of grief, the client can be encouraged to journal feelings. 2 Prior to implementing all other nursing interventions presented, the nurse must assess the stage of grief in which the client is fixed. Appropriate nursing interventions are always based on accurate assessments. 3 After the nurse has assessed the stage of grief, the client can be given community resources. 4 After the nurse has assessed the stage of grief, the client can be encouraged to attend a grief therapy group.

10. Which situation is an example of selective amnesia? 1. A client cannot relate any lifetime memories. 2. A client can describe driving to Ohio but cannot remember the car accident that occurred. 3. A client often wanders aimlessly after sunset. 4. A client cannot provide personal demographic information during admission assessment.

2 Page: 510 Feedback 1 In the generalized type, the individual has amnesia for his or her identity and total life history. 2 In selective amnesia, the individual can recall only certain incidents associated with a stressful event for a specific period after the event. 3 Wandering aimlessly is not an example of selective amnesia. 4 This is not an example of selective amnesia.

8. Which potential client should a nurse identify as a candidate for involuntarily commitment? 1. The client living under a bridge in a cardboard box 2. The client threatening to commit suicide 3. The client who never bathes and wears a wool hat in the summer 4. The client who eats waste out of a garbage can

2 Page: 52 Feedback 1 This client's personal safety is not in jeopardy. 2 The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatments is in danger and needs emergency treatment. 3 This client seems capable of making decisions regarding personal safety. 4 This client does not meet the requirements for involuntary commitment.

16. Which situation exemplifies both assault and battery? 1. The nurse becomes angry, calls the client offensive names, and withholds treatment. 2. The nurse threatens to "tie down" the client and then does so, against the client's wishes. 3. The nurse hides the client's clothes and medicates the client to prevent elopement. 4. The nurse restrains the client without just cause and communicates this to family.

2 Page: 55 Feedback 1 This action is unethical. 2 The nurse in this situation has committed both the acts of assault and battery. Assault refers to an action that results in fear and apprehension that the person will be touched without consent. Battery is the touching of another person without consent. 3 This action is unethical by the nurse, but is not considered assault and battery. 4 This action would be considered battery because the nurse touched the client, but it is not considered assault.

10. Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality.

2 Page: 6 Feedback 1 The client with psychosis is unaware that his or her behavior is maladaptive. 2 The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. 3 The client with psychosis is unaware he or she has a psychological problem. 4 The client experiencing psychosis has a lack of awareness of reality.

17. A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

2 Page: 637 Feedback 1 The Ritalin dosage should not be doubled. 2 The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development. 3 Ritalin can cause weight loss and should be given after breakfast. 4 Ritalin increases ability to concentrate and learn.

2. A client was recently admitted to the inpatient unit after a suicide attempt. He has been placed on a tricyclic antidepressant. In terms of medication, what steps should be taken to maintain the client's safety when he is discharged? 1. Provide a 6-month supply to ensure long-term compliance. 2. Provide a 1-week supply of medication, with refills authorized only after he visits his provider. 3. Encourage him to increase fluid intake to counteract the common side effect of diarrhea. 4. Educate him not to eat foods that contain tyramine.

2 Page: 69 Feedback 1 A limited supply should be given to reduce the risk for suicide. 2 To prevent suicide through overdose on antidepressant medication, a limited supply should be given at discharge. Clients with a history of depression who have a lifting of mood may have an increased risk for suicide. Giving the client a larger supply of antidepressant medication increases the chances of overdose. 3 Although increasing fluid intake is generally a way to promote health, it will not decrease the client's risk for suicide. 4 Avoiding foods with tyramine will not decrease the chances of suicide.

3. A nursing instructor is teaching about case management. What student statement indicates that learning has occurred? 1. "Case management is a method used to achieve independent client care." 2. "Case management provides coordination of services required to meet client needs." 3. "Case management exists mainly to facilitate client admission to needed inpatient services." 4. "Case management is a method to facilitate physician reimbursement."

2 Page: 739 Feedback 1 This statement indicates that further education is needed. 2 The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames. 3 This statement indicates that learning has not occurred. 4 This statement indicates that further teaching is required.

1. A client is diagnosed with terminal cancer. Which situation represents Kübler-Ross's grief stage of "anger"? 1. The client registers for an Ironman marathon to be held in 9 months. 2. The client is a devout Catholic but refuses to attend church and states that his faith has failed him. 3. The client promises God to give up smoking if allowed to live long enough to witness a grandchild's birth. 4. The client gathers family in order to plan a funeral and make last wishes known.

2 Page: 759 Feedback 1 This is stage one, or denial. 2 The nurse should assess that the client is in the "anger" stage of grieving when the client refuses to attend church and states that his faith has failed him. Anger is the second stage of Kübler-Ross's grief process, in which the reality of the situation is realized, and the individual has feelings of sadness, guilt, shame, helplessness, and hopelessness. 3 This is the bargaining stage. 4 This is stage five, or acceptance.

2. A nurse is caring for an Irish client who has recently lost his wife. The client tells the nurse that he is planning an elaborate wake and funeral. According to George Engel, what purpose would these rituals serve? 1. To delay the recovery process initiated by the loss of the client's wife 2. To facilitate the acceptance of the loss of the client's wife 3. To avoid dealing with grief associated with the loss of the client's wife 4. To eliminate emotional pain related to the loss of the client's wife

2 Page: 760 Feedback 1 These rituals do not serve to delay the recovery process initiated by the loss of the client's wife. 2 The nurse should anticipate that the purpose of these rituals is to facilitate the acceptance of the loss of the client's wife. Resolution of the loss is the fourth stage in Engel's grief process, in which the bereaved experiences a preoccupation with the loss, which gradually decreases over time. 3 These rituals do not serve to avoid dealing with grief associated with the loss of the client's wife. 4 These rituals do not serve to eliminate emotional pain related to the loss of the client's wife.

24. A physician prescribes an additional medication for a client taking an antipsychotic agent. The medication is to be administered "prn for EPS." When will the nurse plan to give this medication? 1. When the client's white blood cell count falls below 3,000/mm3 2. When the client exhibits tremors and a shuffling gait 3. When the client complains of dry mouth 4. When the client experiences a seizure

2 Page: 81 Feedback 1 White blood cell count is not an example of an EPS. 2 Tremors and a shuffling gait are examples of EPS. 3 Dry mouth is not an extrapyramidal side effect. 4 Seizure is not an extrapyramidal side effect.

9. Which nursing statement about the concept of neurosis is most accurate? 1. An individual experiencing neurosis is unaware that he or she is experiencing distress. 2. An individual experiencing neurosis feels helpless to change his or her situation. 3. An individual experiencing neurosis is aware of the psychological causes of his or her behavior. 4. An individual experiencing neurosis has a loss of contact with reality.

2 Page: 9 Feedback 1 The client is aware that he or she is experiencing distress. 2 The client feels helpless to change his or her situation. 3 The client is unaware of the psychological causes of the distress. 4 The client experiences no loss of contact with reality.

17. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.) 1. Encourage members to provide feedback to each other about individual progress. 2. Ensure that group rules do not interfere with goal fulfillment. 3. Work with group members to establish rules that will govern the group. 4. Emphasize the need for and importance of confidentiality within the group. 5. Help the leader to resolve conflicts and foster cohesiveness within the group.

2, 3, 4 Page: 186 Feedback 1. Individuals should not be providing feedback to each other on progress. 2. The leader should ensure that group rules do not interfere with goal fulfillment. 3. During the orientation phase of group development, the nurse leader should work together with members to establish rules that will govern the group. 4. The leader should establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion in order to move into the working phase. 5. During the orientation phase it would not be appropriate to implement feedback or resolve conflict.

8. On which task should a nurse place priority during the working phase of relationship development? 1. Establishing a contract for intervention 2. Examining feelings about working with a particular client 3. Establishing a plan for continuing aftercare 4. Promoting the client's insight and perception of reality

4 Page: 129 Feedback 1 Establishing a contract for intervention would occur in the orientation phase. 2 Examining feelings about working with a client should occur in the preinteraction phase. 3 Establishing a plan for aftercare would occur in the termination phase. 4 The nurse should place priority on promoting the client's insight and perception of reality during the working phase of relationship development.

10. A nurse attends an interdisciplinary team meeting regarding a newly admitted client. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.) 1. Respiratory therapist and psychiatrist 2. Occupational therapist and psychologist 3. Recreational therapist and art therapist 4. Social worker and hospital volunteer 5. Mental health technician and chaplain

2, 3, 5 Page: 176-177 Feedback 1. The respiratory therapist and psychiatrist are not typical members of the interdisciplinary treatment team in psychiatry. 2. The occupational therapist and psychologist participate in the interdisciplinary treatment team. 3. The recreational therapist and art therapist participate in the interdisciplinary treatment team. 4. The social worker and hospital volunteer do not participate in the interdisciplinary treatment team. 5. Mental health technician and chaplain participate in the interdisciplinary treatment team.

13. Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.) 1. An acutely suicidal teenager 2. A chronically mentally ill woman who has a history of medication nonadherence 3. A socially isolated older individual 4. A depressed individual who is able to contract for safety 5. A client who is hearing voices that tell the client to harm s

2, 4 Page: 740-741 Feedback 1. A suicidal teenager is not an appropriate candidate for a structured day program. 2. The nurse should recommend a structured day program for a chronically mental ill woman who has a history of medication nonadherence. 3. A socially isolated older adult is not an appropriate candidate for a structured day program. 4. The nurse should recommend a structured day program for a depressed individual who is able to contract for safety. 5. A client hearing voices is not an appropriate candidate for a structured day program.

11. Which of the following conditions promote a therapeutic community? (Select all that apply.) 1. The unit schedule includes unlimited free time for personal reflection. 2. Unit responsibilities are assigned according to client capabilities. 3. A flexible schedule is determined by client needs. 4. The individual is the sole focus of therapy. 5. A democratic form of government exists.

2, 5 Page: 179 Feedback 1. Unlimited free time does not promote a therapeutic community. 2. A therapeutic community is promoted when unit responsibilities are assigned according to client capability. 3. Flexible schedules do not promote a therapeutic community. 4. Sole focus of one individual during therapy does not promote a therapeutic community. 5. A therapeutic community is promoted when a democratic form of government exists.

20. Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.) 1. Meeting the psychological needs of the nurse and the client 2. Ensuring therapeutic termination 3. Promoting client insight into problematic behavior 4. Collaborating to set appropriate goals 5. Meeting both the physical and psychological needs of the client

2345; Page: 125 Feedback 1. Meeting the nurse's psychological needs should never be addressed within the nurse-client relationship. 2. The nurse-client therapeutic relationship should include ensuring therapeutic termination. 3. The nurse-client therapeutic relationship should include promoting client insight into problematic behavior. 4. The nurse-client therapeutic relationship should include collaborating to set appropriate goals. 5. The nurse-client therapeutic relationship should include meeting both the physical and psychological needs of the client.

14. When interviewing a client of a different culture, which of the following questions should a nurse consider? (Select all that apply.) 1. Would using perfume products be acceptable? 2. Who may be expected to be present during the client interview? 3. Should communication patterns be modified to accommodate this client? 4. How much eye contact should be made with the client? 5. Would hand shaking be acceptable?

2345; Page: 96-97 Feedback 1. Use of perfume products should be avoided in case of allergies. 2. When interviewing a client from a different culture, the nurse should consider who might be with the client during the interview 3. When interviewing a client from a different culture, the nurse should consider whether communication patterns should be adjusted to accommodate the client's culture. 4. When interviewing a client from a different culture, the nurse should consider the amount of eye contact. 5. When interviewing a client from a different culture, the nurse should consider the acceptability of hand-shaking.

12. Which mental illness should a nurse identify as being associated with an increase in prolactin hormone level? 1. Major depressive episode 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

2; Page: 29 Feedback 1 There is no known correlation between increased levels of prolactin and major depressive disorder. 2 Although the exact mechanism is unknown, there may be some correlation between increased levels of the hormone prolactin and schizophrenia. 3 There is no known correlation between increased levels of prolactin and anorexia nervosa. 4 There is no known correlation between increased levels of prolactin and Alzheimer's disease.

14. A nurse is working with a client who has just been prescribed buproprion (Wellbutrin). Which statement by the client indicates that further education is necessary? 1. "I will begin using sunblock when outdoors." 2. "If I miss a dose, I will just take two pills the next day to catch up." 3. "I will only discontinue the medication under the guidance of my physician." 4. "I will use caution when driving and using dangerous machinery."

2; Page: 405-407 Feedback 1 The client should use sunblock or protective clothing as skin sensitivity may occur. 2 Clients should never double up on a dose if they miss a day, as this could increase the risk of seizures or other adverse reactions. 3 Clients should only discontinue any medication under the guidance of their physician. 4 Clients should use caution when driving or operating dangerous machinery, as drowsiness and dizziness can occur.

16. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response? 1. "This combination of drugs can lead to delirium tremens." 2. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." 3. "That's a good idea. There have been good results with the combination of these two drugs." 4. "The only disadvantage would be the exorbitant cost of the MAOI."

2; Page: 408 Feedback 1 The combination would not lead to delirium tremens. 2 The nurse should explain to the client that combining an MAOI and fluvoxamine, an SSRI, can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches, with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread." 3 This statement by the nurse would be inappropriate, and potentially life threatening. 4 This statement by the nurse is not accurate.

12. A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1. Increase the dosage of fluoxetine. 2. Discontinue the fluoxetine and rethink the client's diagnosis. 3. Order benztropine (Cogentin) to address extrapyramidal symptoms. 4. Order olanzapine (Zyprexa) to address altered thoughts.

2; Page: 424-425 Feedback 1 Increasing the dosage would not help this client. 2 A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis. It would be inappropriate to increase the dosage of fluoxetine. 3 The client is not having extrapyramidal symptoms. 4 The client is not having altered thoughts.

13. A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

2; Page: 455-456 Feedback 1 This may not be realistic for the client. 2 An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. 3 Participating in three activities on the first day may not be realistic for this client. 4 The nurse should plan realistic outcomes for the client.

4. A client was recently admitted to the inpatient unit after a suicide attempt and has not responded to SSRIs or tricyclic antidepressants. The client asks the nurse, "I heard about monoamine oxidase inhibitors (MAOIs). Why can't they be added to what I am on now? Wouldn't adding one help?" Which is the appropriate nursing response? 1. "Electroconvulsive therapy is your best option at this point." 2. "Combined use can lead to a life-threatening condition called hypertensive crisis." 3. "There is no reason why an MAOI couldn't be added to your therapy." 4. "They can't be used together because their mechanisms of action are very different."

2; Page: 70 Feedback 1 This statement does not provide accurate information to the client. 2 If MAOIs are taken with other antidepressants, a hypertensive crisis could result. 3 The statement is false; use of an MAOI with an SSRI could cause harm to the client. 4 This statement is not therapeutic or accurate.

15. A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which signs and symptoms of a potentially fatal side effect will the nurse teach the client about? 1. Blurring vision and muscular weakness 2. Sore throat, fever, and malaise 3. Tremor, shuffling gait, and rigidity 4. Fine tremor, tinnitus, and nausea

2; Page: 81 Feedback 1 Blurred vision and muscular weakness are not side effects of clozapine (Clozaril). 2 These are symptoms of agranulocytosis, which is a potentially fatal disorder in which the client's white blood cell count drops to extremely low levels. This places the client at great risk for infections. 3 Tremor, shuffling gait, and rigidity are not side effects of clozapine (Clozaril). 4 Fine tremor, tinnitus, and nausea are not side effects of clozapine (Clozaril).

7. When working with clients of a particular culture, which action should a nurse avoid? 1. Making direct eye contact 2. Assuming that all individuals who share a culture or ethnic group are similar 3. Supporting the client in participating in cultural and spiritual rituals 4. Using an interpreter to clarify communication

2; Page: 95 Feedback 1 Avoiding eye contact is not necessary in all cultures. 2 The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. 3 The nurse should always strive to support the client in cultural and spiritual rituals. 4 The nurse should assess whether or not an interpreter is needed.

12. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so mad that the children and I had to put up with him as long as we did." 3. "Yes, it was a difficult relationship, but I think I have learned from the experience." 4. "I still don't have any appetite and continue to lose weight."

3 Page: 10 Feedback 1 This statement indicates denial. 2 This statement indicates anger. 3 The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life. 4 This statement indicates prolonged grieving.

5. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to affect this client's decision? 1. Future orientation causes the client to devalue assertiveness skills. 2. Decreased emotional expression makes it difficult to be assertive. 3. Assertiveness techniques may not be aligned with the client's definition of the female role. 4. Religious prohibitions prevent the client's participation in assertiveness training.

3 Page: 102-103 Feedback 1 It is not likely that the Latin American woman devalues assertiveness skills. 2 It is not likely that the Latin American woman has decreased emotional expression. 3 The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be affected by the Latin American cultural definition of the female role. Latin Americans place a high value on the family, which is male dominated. The father usually possesses the ultimate authority. 4 It is not likely that the Latin American woman has religious prohibitions.

11. The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a "general lead"? 1. "Do you know why you are here?" 2. "Are you feeling depressed or anxious?" 3. "Yes, I see. Go on." 4. "Can you order the specific events that led to your admission?"

3 Page: 137 Feedback 1 This is a specific question, not a general lead. 2 This is a closed ended question; it does not encourage the client to elaborate. 3 The nurse's statement, "Yes, I see. Go on," is an example of a general lead. Offering general leads encourages the client to continue sharing information. 4 This question does not encourage the client to give more information.

15. An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? 1. "Why did you use the client's name on your clinical worksheet?" 2. "You were very careless to refer to your client by name on your clinical worksheet." 3. "Surely you didn't do this deliberately, but you breeched confidentiality by using names." 4. "It is disappointing that after being told you're still using client names on your worksheet."

3 Page: 138 Feedback 1 Asking questions does not give feedback to the student. 2 Feedback should impart information to the student. 3 The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using names," is an example of effective feedback. Feedback is method of communication for helping others consider a modification of behavior. 4 Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice.

5. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? 1. CIWA scale 2. GGT 3. MMSE 4. CAPS scale

3 Page: 147 Feedback 1 The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdrawal from substances such as alcohol. 2 The GGT test is a blood test used to assess gamma-glutamyl transferase levels, which may be an indication of alcoholism. 3 The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. 4 The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD.

13. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the student's question? 1. "You can use NIC, a standardized reference for nursing outcomes." 2. "Look at your client's problems and set a realistic, achievable goal." 3. "With client collaboration, outcomes should be based on client problems." 4. "Copy your standard outcomes from a nursing care plan textbook."

3 Page: 155 Feedback 1 Using NIC does not help develop outcomes specific for the client. 2 This option is helpful, but the most attainable goals are set with collaboration. 3 Client outcomes are most realistic and achievable when there is collaboration among the interdisciplinary team members, the client, and significant others. 4 Goals should be personalized for each client.

6. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? 1. Mood 2. Perception 3. Orientation 4. Affect

3 Page: 155 Feedback 1 These questions do not assess mood. 2 These questions do not assess perception. 3 The nurse should ask the client to identify name, date, residential address, and situation to assess the client's orientation. Assessment of the client's orientation to reality is part of a mental status evaluation. 4 These questions do not assess affect.

8. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? 1. Health teacher 2. Case manager 3. Milieu manager 4. Psychotherapist

3 Page: 156 Feedback 1 Health teaching involves promoting health in a safe environment. 2 Case management is used to organize client care so that outcomes are achieved. 3 The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. 4 Psychotherapy involves conducting individual, couples, group, and family counseling.

2. Which statement regarding nursing interventions should a nurse identify as accurate? 1. Nursing interventions are independent from the treatment team's goals. 2. Nursing interventions are solely directed by written physician orders. 3. Nursing interventions occur independently but in concert with overall treatment team goals. 4. Nursing interventions are standardized by policies and procedures.

3 Page: 156 Feedback 1 Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the client's care. 2 Nursing interventions are not solely directed by written physician orders. 3 The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. 4 Nursing interventions are created in conjunction with standardized by policies and procedures.

9. A client is to undergo psychological testing. Which member of the interdisciplinary team should a nurse consult for this purpose? 1. The psychiatrist 2. The psychiatric social worker 3. The clinical psychologist 4. The clinical nurse specialist

3 Page: 176-177 Feedback 1 Consulting the psychiatrist would be inappropriate in this scenario. 2 Consulting the psychiatric social worker would be inappropriate in this scenario. 3 The nurse should consult with the clinical psychologist to obtain psychological testing for the client. Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic process. 4 Consulting the clinical nurse specialist would be inappropriate in this scenario.

12. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? 1. Open-ended membership; circle of chairs; group size of 5 to 10 members 2. Open-ended membership; chairs around a table; group size of 10 to 15 members 3. Closed membership; circle of chairs; group size of 5 to 10 members 4. Closed membership; chairs around a table; group size of 10 to 15 members

3 Page: 184 Feedback 1 Membership should be closed and focused on relations within the group. 2 Closed membership helps keeps the focus on members within the group. 3 The nurse should identify that the most optimal conditions for a therapeutic group is one in which the membership is closed and the group size is between 5 and 10 members, who are arranged in a circle of chairs. These criteria create a more favorable working environment for clients, as they are able to become more comfortable with each other. The focus of therapeutic groups is directed to relations within the group and the interactions among group members. 4 This configuration is not the most optimal.

16. What is a nurse's purpose for providing appropriate feedback? 1. To give the client good advice 2. To advise the client on appropriate behaviors 3. To evaluate the client's behavior 4. To give the client critical information

4 Page: 138 Feedback 1 Feedback should not be used to give advice. 2 Feedback should not be used to give advice on behaviors. 3 Feedback should not be used to evaluate behaviors. 4 The purpose of providing appropriate feedback is to give the client critical information.

7. Prayer group members at a local Baptist church are meeting with a poor, homeless family whom they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? 1. "Social services might be able to help you find a job." 2. "The last time we helped a family, they got back on their feet and prospered." 3. "I can give you all of my baby clothes for your little one." 4. "I can appreciate your situation. I had to declare bankruptcy last year."

3 Page: 185 Feedback 1 The statement, "Social services might be able to help you find a job," is not an example of the curative group factor of altruism. 2 The statement, "The last time we helped a family, they got back on their feet and prospered," is not an example of the curative group factor of altruism. 3 Yalom's curative group factor of altruism occurs when group members provide assistance and support to each other that creates a positive self-image and promotes self-growth. Individuals gain self-esteem through mutual caring and concern. 4 The statement, "I can appreciate your situation. I had to declare bankruptcy last year," is not an example of the curative group factor of altruism.

4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client? 1. Ineffective coping R/T situational crisis AEB powerlessness 2. Anxiety R/T fear of failure 3. Risk for self-directed violence R/T hopelessness 4. Risk for low self-esteem R/T loss events AEB suicidal ideations

3 Page: 201-202 Feedback 1 Ineffective coping R/T situational crisis AEB powerlessness is inappropriate because safety is a priority. 2 Anxiety R/T fear of failure is inappropriate because safety is a priority. 3 The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes based on potential safety risk to the client or others. 4 Risk for low self-esteem R/T loss events AEB suicidal ideations is inappropriate because safety is a priority.

11. A nursing instructor is teaching about the Roberts' Seven-stage Crisis Intervention Model. Which nursing action should be identified with Stage IV? 1. Collaboratively implement an action plan. 2. Help the client identify the major problems or crisis precipitants. 3. Help the client deal with feelings and emotions. 4. Collaboratively generate and explore alternatives.

3 Page: 203 Feedback 1 Stage VI: Implement an Action Plan 2 Stage III: Identify the Major Problems or Crisis Precipitants 3 Stage IV: Deal with Feelings and Emotions 4 Stage V: Generate and Explore Alternatives

7. A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites 2. Axons 3. Neurotransmitters 4. Synapses

3 Page: 21 Feedback 1 Dendrites are processes that transmit impulses toward the cell body. 2 Axons transmit impulses away from the cell body. A junction between two neurons is a synapse. 3 The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications. 4 A junction between two neurons is a synapse.

3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

3 Page: 21 Feedback 1 The peripheral nervous system does not play a major role during stressful situations. 2 The somatic nervous system is part of the peripheral nervous system. 3 The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. 4 The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

7. A nurse on an inpatient unit helps a client understand the significance of treatments, and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the "Tidal Model of Recovery?" 1. Know that Change Is Constant 2. Reveal Personal Wisdom 3. Be Transparent 4. Give the Gift of Time

3 Page: 218 Feedback 1 Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments upon which the Tidal Model is based. They include: Know That Change Is Constant. 2 Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments upon which the Tidal Model is based. They include: Reveal Personal Wisdom. 3 Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments upon which the Tidal Model is based. They include: Be Transparent. 4 Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments upon which the Tidal Model is based. They include: Give the Gift of Time.

18. A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client's belief system, the nurse should conclude which client would potentially be at highest risk for suicide? 1. Roman Catholic 2. Protestant 3. Atheist 4. Muslim

3 Page: 231 Feedback 1 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts because religions teach that suicide is a sin. 2 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts because religions teach that suicide is a sin. 3 An atheist does not believe in punishment for suicide by a higher power. 4 Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts because religions teach that suicide is a sin.

22. A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide? 1. Family history of depression 2. The client's orientation to reality 3. The client's history of suicide attempts 4. Family support systems

3 Page: 232 Feedback 1 Family history of depression is not critical to determining risk for suicide. 2 Client's orientation to reality not critical to determining risk for suicide. 3 A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the client's risk. Of those who commit suicide, 50-80 percent had a previous attempt. 4 Family support systems are not critical to determining risk for suicide.

20. A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide? 1. Encouraging participation in the milieu to promote hope 2. Developing a strong personal relationship with the client 3. Observing the client at intervals determined by assessed data 4. Encouraging and redirecting the client to concentrate on happier times

3 Page: 238-239 Feedback 1 Encouraging participation does not best lower the client's risk for suicide. 2 Developing a personal relationship with the client does not best lower the client's risk for suicide. 3 The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors. 4 Encouraging and redirecting the client does not best lower the client's risk for suicide.

13. A client diagnosed with NCD is disoriented, ataxic and wanders. Which is the priority nursing diagnosis? 1. Disturbed thought processes 2. Self-care deficit 3. Risk for trauma 4. Altered health-care maintenance

3 Page: 251 Feedback 1 Disturbed thought process is an important diagnosis, but safety is the priority. 2 Self-care deficit is an important diagnosis, but safety is the priority. 3 The priority nursing diagnosis for this client is risk for injury. The client who is ataxic suffers from motor coordination deficits and is at an increased risk for falls. Clients that wander are at a higher risk for injury. 4 Altered health-care maintenance is an important diagnosis, but safety is the priority.

14. Which statement accurately differentiates mild NCD from major NCD? 1. Major NCD involves disorientation that develops suddenly, whereas mild NCD develops more slowly. 2. Major NCD involves impairment of abstract thinking and judgment, whereas mild NCD does not. 3. Major NCD criteria requires substantial cognitive decline from a previous level of performance, and mild NCD requires modest decline. 4. Major NCD criteria requires decline from a previous level of performance in three of the listed domains, and mild NCD requires only one.

3 Page: 251 Feedback 1 The progression of the disorder is not a criterion for determining the severity of an NCD. 2 Abstract thinking and judgment can be affected in both mild NCD and major NCD. 3 Major NCD criteria requires substantial cognitive decline, and mild NCD requires modest decline. 4 Both major and mild NCD classifications require decline from a previous level of performance in only one of the listed domains.

4. A client is diagnosed in stage 7 of AD. To address the client's symptoms, which nursing intervention should take priority? 1. Improve cognitive status by encouraging involvement in social activities. 2. Decrease social isolation by providing group therapies. 3. Promote dignity by providing comfort, safety, and self-care measures. 4. Facilitate communication by providing assistive devices.

3 Page: 253 Feedback 1 Encouraging involvement in social activities does not address the client's symptoms. 2 Decreasing social isolation does not address the client's symptoms. 3 The most appropriate intervention in the seventh stage of AD is to promote the client's dignity by providing comfort, safety, and self-care measures. Stage 7 is characterized by severe cognitive decline in which the client is unable to recognize family members and is most commonly bedfast and aphasic. 4 Facilitating communication does not address the client's symptoms.

8. After one week of continuous mental confusion, an older African American client is admitted with a preliminary diagnosis of AD. What should cause the nurse to question this diagnosis? 1. AD does not typically occur in African American clients. 2. The symptoms presented are more indicative of Parkinsonism. 3. AD does not develop suddenly. 4. There has been no T3- or T4-level evaluation ordered.

3 Page: 259 Feedback 1 This option does not accurately reflect AD. 2 Presentation mirroring Parkinson's disease does not accurately reflect AD. 3 The nurse should recognize that AD does not develop suddenly and should question this diagnosis. The onset of AD symptoms is slow and insidious. The disease is generally progressive and deteriorating. 4 This option would not cause the nurse to question the diagnosis.

7. A client diagnosed with AD exhibits progressive memory loss, diminished cognitive functioning, and verbal aggression upon experiencing frustration. Which nursing intervention is most appropriate? 1. Organize a group activity to present reality. 2. Minimize environmental lighting. 3. Schedule structured daily routines. 4. Explain the consequences for aggressive behaviors.

3 Page: 266 Feedback 1 Organizing a group activity to present reality is not likely to reduce verbal aggression. 2 Minimizing environmental lighting will not likely reduce verbal aggression. 3 The most appropriate nursing intervention for this client is to schedule structured daily routines. A structured routine will reduce frustration and thereby reduce verbal aggression. 4 Explaining the consequences for aggressive behaviors will not likely reduce verbal aggression.

3. On the first day of a client's alcohol detoxification, which nursing intervention should take priority? 1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. 4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

3 Page: 284 Feedback 1 Encouraging AA meetings is important, but the administration of medication to prevent alcohol withdrawal takes priority due to client safety. 2 Education is important, but the administration of medication to prevent alcohol withdrawal takes priority due to client safety. 3 The priority nursing intervention for this client should be to administer ordered chlordiazepoxide in a dosage according to protocol. Chlordiazepoxide is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal to reduce life-threatening complications. 4 Vitamin B1 administration is important, but the administration of medication to prevent alcohol withdrawal takes priority due to client safety.

4. Which client statement reflects an understanding of circadian rhythms in psychopathology? 1. "When I dream about my mother's horrible train accident, I become hysterical." 2. "I get really irritable during my menstrual cycle." 3. "I'm a morning person. I get my best work done before noon." 4. "Every February, I tend to experience periods of sadness."

3 Page: 29-30 Feedback 1 This statement does not indicate understanding of circadian rhythms. 2 The menstrual cycle is not affected by the circadian rhythm. 3 By stating, "I am a morning person," the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness. 4 Experiencing periods of sadness is not indicative of the circadian rhythm.

13. A nurse is performing a mental health assessment on an adult client. According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? 1. Maintaining a long-term, faithful, intimate relationship 2. Achieving a sense of self-confidence 3. Possessing a feeling of self-fulfillment and realizing full potential 4. Developing a sense of purpose and the ability to direct activities

3 Page: 3 Feedback 1 This option is not the highest level on Maslow's hierarchy of needs. 2 While this option is important, it is not the highest level on Maslow's hierarchy of needs. 3 The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslow's hierarchy of needs. 4 This option is important for the development of the client, but is not the most important on Maslow's hierarchy of needs.

11. A client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." A nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? 1. Knowledge deficit 2. Fluid volume excess 3. Imbalanced nutrition: less than body requirements 4. Ineffective individual coping

3 Page: 312 Feedback 1 Knowledge deficit is incorrect because it does not address the client's statement regarding lack of nutritional intake for three days. 2 Fluid volume excess is incorrect because it does not address the client's statement regarding lack of nutritional intake for three days. 3 The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition, as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods. 4 Ineffective individual coping is incorrect because it does not address the client's statement regarding lack of nutritional intake for three days.

12. A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

3 Page: 323-324 Feedback 1 Stating, "Why do you assume responsibility for his behaviors?" may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse. 2 Stating, "I think you should start to confront his behavior." may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse. 3 The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Codependency is a typical behavior of spouses of alcoholics. Partners of clients with substance addiction must come to realize that the only behavior they can control is their own. 4 Stating, "Do you understand what the term enabler means?" may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse.

15. How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in ..." which of the following? 1. Psychosocial, biological, or developmental process underlying mental functioning 2. Psychological, cognitive, or developmental process underlying mental functioning 3. Psychological, biological, or developmental process underlying mental functioning 4. Psychological, biological, or psychosocial process underlying mental functioning

3 Page: 4 Feedback 1 This option in not part of the DSM-5 definition of a mental disorder. 2 This option does not define the DSM-5's mental disorder definition. 3 The new DSM-5 definition of a mental disorder is "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in the psychological, biological, or developmental process underlying mental functioning." 4 This option is incorrect, because it does not meet the definition set by the DSM-5 for mental health disorders.

3. A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

3 Page: 405-406 Feedback 1 Oxygen is not administered to prevent increased intracranial pressure. 2 Oxygen is not administered to prevent diminished vital signs. 3 The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. 4 Oxygen is not administered to prevent a blocked airway.

8. A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I may experience drowsiness or dizziness while taking this medication." 3. "I do not need to quit smoking." 4. "I will stop drinking alcohol now that I am taking this medication."

3 Page: 405-407 Feedback 1 Clients should continue to take the medication even if symptoms have not subsided. 2 Clients may experience drowsiness and dizziness while taking this medication, therefore care should be used when driving or operating dangerous machinery. 3 Clients should not smoke when taking this medication, as smoking increases the metabolism of tricyclic antidepressants. 4 The client should avoid alcohol while taking this medication.

7. A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

3 Page: 427 Feedback 1 Weight loss is not typical with this drug. 2 Clients gain weight regardless of diet with Lithium therapy. 3 The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication adherence and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication. 4 Weight gain is a common side effect with this medication.

13. Which situation reflects violation of the ethical principle of veracity? 1. A nurse discusses with a client another client's impending discharge. 2. A nurse refuses to give information to a physician who is not responsible for the client's care. 3. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. 4. A nurse does not treat all of the clients equally, regardless of illness severity.

3 Page: 43 Feedback 1 Discussing a client's personal information with another client is a HIPAA violation. 2 Discussing another client's personal information with uninvolved health-care providers is a HIPAA violation. 3 The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients. 4 Not treating all clients equally violates the principle of justice.

9. A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? 1. A client makes inappropriate sexual innuendos to a staff member. 2. A client constantly demands attention from the nurse by begging, "Help me get better." 3. A client physically attacks another client after being confronted in group therapy. 4. A client refuses to bathe or perform hygienic activities.

3 Page: 44 Feedback 1 Making inappropriate sexual innuendos does not give the nurse reason to medicate the client against wishes. 2 Demanding attention does not give the nurse reason to medicate the client against wishes. 3 The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making informed choices. The client's refusal to accept treatment can be challenged, because the client is endangering the safety of others. 4 Refusing to bathe does not give the nurse reason to medicate the client against wishes.

19. During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? 1. Complicated grieving 2. Altered family processes 3. Ineffective coping 4. Body image disturbance

3 Page: 461 Feedback 1 The child is not suffering from complicated grieving. 2 The child is not suffering from altered family process. 3 Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a diagnosis of hair-pulling disorder, or trichotillomania, may be assigned. 4 The client is not suffering from body image disturbance.

18. A brother calls to speak to his sister, who has been admitted to a psychiatric unit. The nurse connects him to the community phone, and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken? 1. The National Alliance for the Mentally Ill Act 2. The Tarasoff Ruling 3. The Health Insurance Portability and Accountability Act 4. The Good Samaritan Law

3 Page: 48 Feedback 1 This act does not require consent to discuss private medical information. 2 This is incorrect wording for the protection of private health information. 3 The nurse has violated HIPAA by revealing that the client had been admitted to the psychiatric unit. The nurse should not have provided any information without proper consent from the client. 4 This law protects individuals who help others in a time of need.

19. A mother questions the decreased effectiveness of methylphenidate (Ritalin) prescribed for her child's ADHD. Which nursing response best addresses the mother's concern? 1. "The physician will probably switch from Ritalin to a central nervous system stimulant." 2. "The physician may prescribe an antihistamine with the Ritalin to improve effectiveness." 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." 4. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

3 Page: 637-638 Feedback 1 Ritalin is a nervous system stimulant, this statement provides false information. 2 Antihistamines would not improve the effectiveness of Ritalin; this statement provides false information. 3 The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur. 4 These are not signs of an allergic reaction to Ritalin.

11. An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime? 1. Altered cortical and intellectual functioning 2. Altered respiratory and gastrointestinal functioning 3. Altered liver and kidney functioning 4. Altered endocrine and immune system functioning

3 Page: 674 Feedback 1 The nurse would not need to consider altered cortical and intellectual functioning. 2 The nurse would not need to consider altered respiratory and gastrointestinal functioning. 3 The nurse should question the use of antidepressant medication in a client with altered liver and kidney function. Antidepressant medication should be administered with consideration for age-related physiological changes in absorption, distribution, elimination, and brain receptor sensitivity. Because of these changes, medications can reach high levels despite moderate oral dosage. 4 The nurse would not need to consider altered endocrine and immune system functioning.

7. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? 1. The employee assertively confronts the boss. 2. The employee leaves the staff meeting to work out in the gym. 3. The employee criticizes a coworker. 4. The employee takes the boss out to lunch.

3 Page: 7 Feedback 1 Confronting others is not a behavior consistent with displacement. 2 Leaving the staff meeting is not a behavior consistent with displacement. 3 The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss. 4 Taking the boss out to lunch is not a behavior consistent with displacement.

5. A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago and asks why he has gained 12 lbs. since then. Which is the appropriate nursing response? 1. "I'm surprised you have gained; weight loss is the typical pattern when taking lithium." 2. "Your weight gain is more likely related to food intake than medication." 3. "Weight gain is a common, but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." 4. "There's not much you can do about the weight gain. It's better than being emotionally unstable, though."

3 Page: 74 Feedback 1 Weight gain is typical with lithium treatment. 2 While a healthy diet is helpful at reducing weight gain, this side effect is common with lithium treatment. 3 Weight gain is a common side effect of lithium therapy. To ensure compliance the nurse should help the client develop strategies to prevent excessive weight gain. 4 This statement is not therapeutic to the client.

6. The nurse is assessing a client who has a diagnosis of schizophrenia and takes an antipsychotic agent daily. Which finding requires further nursing assessment? 1. Respirations of 22 beats/minute 2. Weight gain of 8 lbs. in 2 months 3. Temperature of 101oF 4. Excess salivation

3 Page: 80-81 Feedback 1 This finding is considered normal. 2 Slow weight gain is not concerning. 3 A fever could be one of the first signs of an infection caused by reduced immunity from agranulocytosis secondary to antipsychotic medication. 4 This symptom is not life-threatening.

7. An aging client with chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol) for hypertension and an antipsychotic. Given the combined side effects of these drugs, what teaching should the nurse provide? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3 Page: 80-81 Feedback 1 This will not prevent the client from having a syncopal episode. 2 While watching diet is important, it will not prevent the client from suffering from propranolol side effects. 3 The antipsychotic medication can cause orthostatic hypotension that could be magnified by the propranolol. 4 Wearing sunscreen will not prevent syncopal episodes.

20. Which medication is most likely to be prescribed for the extrapyramidal side effects of antipsychotic medications? 1. Diazepam (Valium) 2. Amitriptyline (Elavil) 3. Benztropine (Cogentin) 4. Methylphenidate (Ritalin)

3 Page: 83 Feedback 1 Diazepam (Valium) would not be prescribed for the extrapyramidal side effects of antipsychotic medications. 2 Amitriptyline (Elavil) would not be prescribed for the extrapyramidal side effects of antipsychotic medications. 3 Benztropine (Cogentin) is one of the most commonly used medications for extrapyramidal side effects. 4 Methylphenidate (Ritalin) would not be prescribed for the extrapyramidal side effects of antipsychotic medications.

25. A client is diagnosed with anxiety disorder. Which medication is prescribed for anxiety? 1. Chlorpromazine (Thorazine) 2. Clozapine (Clozaril) 3. Diazepam (Valium) 4. Methylphenidate (Ritalin)

3 Page: 85 Feedback 1 Chlorpromazine (Thorazine) is not an antianxiety agent. 2 Clozapine (Clozaril) is not an antianxiety agent. 3 Diazepam (Valium) is an antianxiety agent. 4 Methylphenidate (Ritalin) is not an antianxiety agent.

6. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It is just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section."

3 Page: 9 Feedback 1 This statement is not therapeutic to the client. 2 This statement is not therapeutic and may anger the client further. 3 The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. 4 It is not appropriate to skip physiological and psychosocial questions, as this would lead to an inaccurate assessment.

15. Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) 1. Client outcomes are specifically formulated by nurses. 2. Client outcomes are not restricted by time frames. 3. Client outcomes are specific and measurable. 4. Client outcomes are realistically based on client capability. 5. Client outcomes are formally approved by the psychiatrist.

3, 4 Page: 155 Feedback 1. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, the client, and significant others. 2. Outcomes should be given a time frame. 3. The nurse should identify that client outcomes should be specific and measurable. 4. The nurse should identify that client outcomes should be based on client capability. 4. 5. Outcomes do not need to be approved by a psychiatrist.

1. An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? 1. Conflict should be avoided at all costs on inpatient psychiatric units. 2. Conflict should be resolved by the nursing staff. 3. On inpatient units, every interaction is an opportunity for therapeutic intervention. 4. Conflict resolution should only be addressed during group therapy.

3; Page: 172 Feedback 1 Conflict is often hard to avoid, and at times is resolved between clients or other staff members. 2 Conflict should be resolved between clients or other staff members. 3 The nurse's response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention. 4 Conflict resolution should be addressed as soon as it is therapeutic to the individuals involved.

4. A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase frequency of client observation. 4. Request that the psychiatrist reevaluate the current medication protocol.

3; Page: 236 Feedback 1 The client should not be given off-unit privileges, as this could be unsafe. 2 Group involvement is important, but client safety must take priority. 3 The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication. 4 Medication can be reevaluated after client safety has been established.

1. A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? 1. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note 2. Establishing room restrictions, because the client's threat is an attempt to manipulate the staff 3. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide 4. Calling an emergency treatment team meeting, because the client's threat must be addressed

3; Page: 236 Feedback 1 This action would not be appropriate and could be considered a restraint. 2 Establishing room restrictions does not keep the client safe in the immediate situation. 3 The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide. 4 The client's immediate safety is a priority.

14. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? 1. Acute mania 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

3; Page: 31 Feedback 1 There is no correlation between abnormal levels of growth hormone and acute mania. 2 There is no correlation between abnormal levels of growth hormone and schizophrenia. 3 The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life. 4 There is no correlation between abnormal levels of growth hormone and Alzheimer's Disease.

16. A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the client's physician to treat this disorder. The nurse would give the client information on which medications? 1. Escitalopram (Lexapro) and clozapine (Clozaril) 2. Citalopram (Celexa) and olanzapine (Zyprexa) 3. Lithium carbonate (Lithobid) and sertraline (Zoloft) 4. Naltrexone (ReVia) and ziprasidone (Geodon)

3; Page: 332 Feedback 1 Escitalopram (Lexapro) and clozapine (Clozaril) would not effectively treat this client. 2 Citalopram (Celexa) and olanzapine (Zyprexa) are not treatments of choice for this disorder. 3 Lithium carbonate (Lithobid) and sertraline (Zoloft) have been used successfully in the treatment of pathological gambling as a form of obsessive-compulsive disorder. 4 Naltrexone (ReVia) and ziprasidone (Geodon) would not appropriately treat this client.

4. Which treatment should the nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

3; Page: 470 Feedback 1 Long-term treatment with diazepam (Valium) is not appropriate treatment for clients diagnosed with generalized anxiety disorder. 2 Acute symptom control with citalopram (Celexa) is not appropriate treatment for clients diagnosed with generalized anxiety disorder. 3 The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics. 4 Acute symptom control with ziprasidone (Geodon) is not appropriate treatment for clients diagnosed with generalized anxiety disorder.

14. A client who will be receiving ECT must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent? 1. The client is paranoid. 2. The client is 87 years old. 3. The client incorrectly reports his or her spouse's name, date, and time of day. 4. The client relies on his or her spouse to interpret the information.

3; Page: 50 Feedback 1 This would not lead the nurse to believe that the client is incompetent to make informed choices. 2 If the client is oriented, then informed consent can be obtained. 3 The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that this client is disoriented and may not be competent to make informed choices. 4 The use of an interpreter does not make the informed consent invalid.

15. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? 1. The client experiences unwanted, intrusive, and persistent thoughts. 2. The client experiences unwanted, repetitive behavior patterns. 3. The client experiences inflexibility and lack of spontaneity when dealing with others. 4. The client experiences obsessive thoughts that are externally imposed.

3; Page: 599-600 Feedback 1 Experiencing unwanted and intrusive thoughts is not consistent with the diagnosis of obsessive-compulsive personality disorder. 2 Unwanted, repetitive behaviors is not consistent with a diagnosis of obsessive-compulsive personality disorder. 3 The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules. 4 Externally imposed obsessive thoughts are not consistent with a diagnosis of obsessive-compulsive personality disorder.

2. A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? 1. "The occipital lobe governs perceptions, judging them as positive or negative." 2. "The parietal lobe has been linked to depression." 3. "The medulla regulates key biological and psychological activities." 4. "The limbic system is largely responsible for one's emotional state."

4 Page: 16 Feedback 1 The occipital lobes are the area of visual reception and interpretation. 2 Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. 3 The medulla contains vital centers that regulate heart rate and reflexes. 4 The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system is often called the "emotional brain" and is associated with feelings, sexuality, and social behavior.

2. A client on an inpatient unit angrily says to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? 1. "I'll talk to Peter and present your concerns." 2. "Why are you overreacting to this issue?" 3. "You should bring this to the attention of your treatment team." 4. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

4 Page: 173 Feedback 1 It would be inappropriate for the nurse to solve the problem for the client. 2 It would be inappropriate for the nurse to ignore the conflict. 3 The nurse should not pass the conflict off to other members of the treatment team, but should assist the client in handling it immediately. 4 The most appropriate nursing response involves restating the client's feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction is an opportunity for therapeutic intervention to improve communication and relationship-development skills.

11. A nursing instructor is teaching students about self-help groups like AA. Which student statement indicates that learning has occurred? 1. "There is little research to support AA's effectiveness." 2. "Self-help groups used to be the treatment of choice, but their popularity is waning." 3. "These groups have no external regulation, so clients need to be cautious." 4. "Members themselves run the group, with leadership usually rotating among the members."

4 Page: 184 Feedback 1 These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences. 2 Self-help groups are very popular and very effective. 3 The groups are run by members, with leadership rotating. 4 The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups.

4. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? 1. Imparting of information 2. Instillation of hope 3. Altruism 4. Universality

4 Page: 185 Feedback 1 Imparting of information consists of giving and receiving information through formal instruction. 2 Installation of hope gives members hope that their problems can be resolved. 3 Altruism is assimilated through mutual sharing and concern. 4 The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others.

13. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? 1. The leader should referee the debate. 2. The leader should adamantly oppose physical disciplining measures. 3. The leader should redirect the group to a less controversial topic. 4. The leader should positively reinforce the behavior of collective problem solving.

4 Page: 186 Feedback 1 Members are encouraged to solve issues that relate to the group cooperatively. 2 The leader should not take sides in the debate. 3 A democratic leadership style supports members in their participation and problem-solving. 4 The role of the group leader is to encourage the group to solve the problem collectively.

10. Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development? 1. The group leader establishes the rules that will govern the group after discharge. 2. The group leader encourages members to rely on each other for problem solving. 3. The group leader presents and discusses the concept of group termination. 4. The group leader helps the members to process feelings of loss.

4 Page: 186 Feedback 1 This option is not appropriate after the group has ended. 2 Group members should have gained independence while in the group. 3 This option does not have the group members move through the termination phase. 4 The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss as they are losing the support of their group as it disbands. The leader should encourage members to review goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress.

3. A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client's crisis? 1. The client will change his type-A personality traits to more adaptive ones by one week. 2. The client will list five positive self-attributes. 3. The client will examine how childhood events led to his overachieving orientation. 4. The client will return to previous adaptive levels of functioning by week six.

4 Page: 197 Feedback 1 Changing his type-A personality traits to more adaptive ones by one week may be unrealistic for this client. 2 Listing five positive self-attributes may not be realistic for this client. 3 Examining childhood events may not be realistic for this client. 4 The nurse should identify that a realistic long-term outcome for this client is to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect immediacy of the situation.

10. What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place in an inpatient unit? 1. Reinforce unit rules with the client population. 2. Create protocols for the future release of tensions associated with anger. 3. Process client feelings and alleviate fears of undeserved seclusion and restraint. 4. Discuss the situation that led to inappropriate expressions of anger.

4 Page: 199 Feedback 1 Reinforcing unit rules is important but does not help process feelings about the situation. 2 Creating protocols does not help process feelings about the situation. 3 Processing feelings related to seclusion and restraint does not help clients through the take-down intervention. 4 The nurse should determine that the purpose for holding a debriefing session with clients and staff after a take-down intervention is to discuss the situation that led to inappropriate behavior. It is important to determine the factors leading to the inappropriate behavior in order to develop future intervention strategies. It is also important to help clients and staff process feelings about the situation.

7. A college student, who was nearly raped while jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? 1. "You've really been helpful. Can I count on you for continued support?" 2. "I work out in the college gym rather than jogging outdoors." 3. "I'm really glad I didn't go home. It would have been hard to come back." 4. "I carry mace when I jog. It makes me feel safe and secure."

4 Page: 205 Feedback 1 Asking for continued support does not indicate the development of adaptive coping strategies. 2 This statement may indicate fear. 3 This statement indicates that the client has not developed coping strategies. 4 The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. The final phase of crisis intervention involves evaluating the outcome of the crisis intervention and anticipatory planning.

6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior? 1. Initiate forced medication protocol. 2. Help the client to explore the source of anger. 3. Ignore the act to avoid reinforcing the behavior. 4. With staff support and a show of solidarity, set firm limits on the behavior.

4 Page: 205 Feedback 1 Pushing food onto the floor should not warrant forced medication. This intervention may be too restrictive, considering the behavior. 2 Exploring the source of anger may be more appropriate once the client has resolved the current emotion or in a therapeutic group setting. 3 Ignoring the act may further upset the client and is not a method of teaching appropriate behavior. 4 The most appropriate nursing intervention is to set firm limits on the behavior.

9. A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine

4 Page: 21 Feedback 1 Acetylcholine functions include pain, arousal, and pain perception. 2 Dopamine functions include regulation of movement and coordination. 3 Serotonin plays a role in sleep, libido, and appetite. 4 The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

2. Which situation presents an example of the basic concept of a recovery model? 1. The client's family is encouraged to make decisions in order to facilitate discharge. 2. A social worker, discovering the client's income, changes the client's discharge placement. 3. A psychiatrist prescribes an antipsychotic drug based on observed symptoms. 4. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.

4 Page: 216 Feedback 1 The client's family making decisions for the client does not show empowerment of the consumer. 2 The social worker making decisions for the client does not show empowerment of the consumer. 3 The psychiatrist prescribing medication is not an example of empowerment by the consumer. 4 The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care.

9. A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model should be employed, and what action reflects this step? 1. Step 3: Triggers that cause distress or discomfort are listed. 2. Step 4: Signs indicating relapse are identified and plans for responding are developed. 3. Step 5: A specific plan to help with symptoms is formulated. 4. Step 6: Following client-designed plan, caregivers now become decision-makers.

4 Page: 221 Feedback 1 The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include: Step 3. Triggers. 2 The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include: Step 4. Early Warning Signs. 3 The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include: Step 5. Things Are Breaking Down or Getting Worse. 4 The WRAP recovery model is a step-wise process through which an individual is able to monitor and manage distressing symptoms that occur in daily life. The six steps include: In step 6 (Crisis Planning), clients can no longer care for themselves, make independent decisions, or keep themselves safe. Caregivers take an active role in this step on behalf of the client and implement the plan that the client has previously developed.

17. A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? 1. "Suicidal threats and gestures should be considered manipulative and/or attention-seeking." 2. "Suicide is the act of a psychotic person." 3. "All suicidal individuals are mentally ill." 4. "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

4 Page: 230-232 Feedback 1 This statement is inaccurate regarding suicide. 2 This statement is untrue regarding suicide. 3 This statement is a myth about suicide. 4 It is a fact that between 50 and 80 percent of all people who kill themselves have a history with a previous attempt.

5. Which is the reason for the proliferation of the diagnosis of NCDs? 1. Increased numbers of neurotransmitters have been implicated in the proliferation of NCD. 2. Similar symptoms of NCD and depression lead to misdiagnoses, increasing numbers of NCD. 3. Societal stress contributes to the increase in this diagnosis. 4. More people now survive into the high-risk period for neurocognitive disorders.

4 Page: 250 Feedback 1 The increased number of neurotransmitters is not the reason for the proliferation of the diagnosis of NCDs 2 Similar symptoms of NCD and depression does not lead to increasing numbers of NCD. 3 Societal stress does not contribute to the increase in this diagnosis. 4 The proliferation of NCD has occurred because more people now survive into the high-risk period for neurocognitive disorder, which is middle age and beyond. Previously, many more people died in their 50s, 60s, and early 70s.

3. A client diagnosed with Alzheimer's disease (AD) can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent verbalizations. The nurse recognizes these symptoms as indicative of which stage of the illness? 1. Stage 4: Mild-to-Moderate Cognitive Decline 2. Stage 5: Moderate Cognitive Decline 3. Stage 6: Moderate-to-Severe Cognitive Decline 4. Stage 7: Severe Cognitive Decline

4 Page: 252-253 Feedback 1 The client's symptoms do not indicate stage 4 of the illness. 2 The client's symptoms do not indicate stage 5 of the illness. 3 The client's symptoms do not indicate stage 6 of the illness. 4 The nurse should recognize that a client exhibiting these symptoms is in the severe cognitive decline, seventh stage, of AD.

9. A client diagnosed with AD has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority? 1. Present evidence of objective reality to improve cognition. 2. Design a bulletin board to represent the current season. 3. Label the client's room with name and number. 4. Assist with bathing and toileting.

4 Page: 266 Feedback 1 Presenting evidence of objective reality to improve cognition is incorrect because it is not an activity of daily living. 2 Designing a bulletin board to represent the current season is incorrect because it is not an activity of daily living. 3 Labeling the client's room with name and number is not an activity of daily living. 4 The priority nursing intervention for this client is to assist with bathing and toileting. A client who is incapable of performing activities of daily living requires assistance in these areas to ensure health and safety.

2. A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client's safety? 1. His wife works from home in telecommunication. 2. The client has worked the nightshift his entire career. 3. His wife has minimal family support. 4. The client smokes one pack of cigarettes per day.

4 Page: 267 Feedback 1 Working from home does not suggest that the client could be injured. 2 Working the night shift does not suggest that the client could be injured. 3 Minimal family support does not suggest that the client could be injured. 4 The nurse should question the client's safety at home if the client smokes cigarettes. Patients with this disorder become confused and are at risk for injury.

12. An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication should the nurse expect the physician to prescribe? 1. Haloperidol (Haldol) 2. Donepezil (Aricept) 3. Diazepam (Valium) 4. Sertraline (Zoloft)

4 Page: 272-273 Feedback 1 The client would most benefit from an antidepressant; haloperidol (Haldol) is not an antidepressant. 2 The client would most benefit from an antidepressant; donepezil (Aricept) is not an antidepressant. 3 The client would most benefit from an antidepressant; diazepam (Valium) is not an antidepressant. 4 The nurse should expect the physician to prescribe sertraline to improve the client's social functioning and concentration levels. Sertraline is a selective serotonin reuptake inhibitor antidepressant. Depression is the most common mental illness in older adults and is often misdiagnosed as a neurocognitive disorder.

6. Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy

4 Page: 291 Feedback 1 Antagonist therapy does not accurately describe this CNS depressant medication. 2 Deterrent therapy does not accurately describe this CNS depressant medication. 3 Codependency therapy does not accurately describe this CNS depressant medication. 4 Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called substitution therapy and may be required to reduce the life-threatening effects of alcohol withdrawal.

4. Which client statement indicates a knowledge deficit related to a substance use disorder? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously." 4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

4 Page: 307 Feedback 1 Cannabis is the second most widely abused drug in the United States. 2 This statement does not indicate a knowledge deficit. 3 This statement is true regarding LSD. 4 The nurse should determine that the client has a knowledge deficit related to substance use disorders when the client compares marijuana to smoking cigarettes and claims it to be harmless.

15. A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of dopamine 3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine

4 Page: 31 Feedback 1 Abnormal levels of serotonin do not cause memory deficits and decreased motor functions. 2 Abnormal levels of dopamine do not cause memory deficits and decreased motor functions. 3 Abnormal levels of norepinephrine do not cause memory deficits and decreased motor functions. 4 The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major chemical effector of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.

11. A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist is using an interpersonal approach. 2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest. 4. The client is susceptible to illness because of effects of stress on the immune system.

4 Page: 31 Feedback 1 This approach is not proven by evidence-based research. 2 This rationale is not proven by evidence-based research. 3 Reminding clients about nutrition, exercise and rest is routine but is not proven by evidence-based research. 4 The therapist's recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoneuroimmunology.

10. A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? 1. To assess for emotional strength 2. To assess for Wernicke-Korsakoff syndrome 3. To assess for tachycardia 4. To assess for fine tremors

4 Page: 315 Feedback 1 The nurse is not checking for emotional strength by holding the client's hand. 2 The nurse is not assessing for Wernicke-Korsakoff syndrome. 3 The nurse is not assessing for tachycardia. 4 The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, and coarse tremors.

9. Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "I will faithfully attend Narcotic Anonymous when I can't control my cravings." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

4 Page: 316-317 Feedback 1 This statement does not demonstrate positive progress in recovery. 2 Attending meetings infrequently puts the client at risk for relapse. 3 This statement does not indicate reflection and understanding on the impact of substance abuse. 4 A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of a 12-step program.

2. When planning care for a depressed client, which correctly written outcome should be a nurse's first priority? 1. The client will promise not to physically harm self. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during hospital stay.

4 Page: 393 Feedback 1 The outcome should be specific. 2 The outcome should be realistic. 3 The outcome should have a time frame. 4 The nurse's first priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's first priority.

12. An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which ethical principle should a nurse determine has been violated based on these actions? 1. Autonomy 2. Beneficence 3. Nonmaleficence 4. Justice

4 Page: 43 Feedback 1 Autonomy refers to an individual's right to make informed decisions. 2 Beneficence refers to one's duty to promote the good of others. 3 Nonmaleficence means to do no harm. 4 The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally, regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.

17. A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? 1. The client is placed in seclusion. 2. The client is placed in a geriatric chair with tray. 3. The client is placed in soft Posey restraints. 4. The client is monitored by an ankle bracelet.

4 Page: 44-46 Feedback 1 The client does not pose a direct dangerous threat to self or others, so seclusion would not be justified. 2 This is not the least restrictive option. 3 The client does not pose a direct dangerous threat to self or others, so physical restraints would not be justified. 4 The least-restrictive alternative for this client would be monitoring by an ankle bracelet.

6. An involuntarily committed client is verbally abusive to the staff, repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? 1. Verbally redirect the client, and then refuse one-on-one interaction. 2. Involve the hospital's security division as soon as possible. 3. Notify the client that documenting personal staff information is against hospital policy. 4. Continue professional attempts to establish a positive working relationship with the client.

4 Page: 55 Feedback 1 The involuntarily committed client should be respected and has the right to assert grievances if rights are infringed. 2 This option is likely important, but it is not the most appropriate action for decreasing the possibility of a lawsuit. 3 This option is not therapeutic for the client. 4 The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client.

12. A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? 1. "You really don't have to go by that schedule. I'd just stay home sick." 2. "There has got to be a hidden agenda behind this schedule change." 3. "Who do you think you are? I expect to interact with the same nurse every Saturday." 4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

4 Page: 599-600 Feedback 1 The statement, "You really don't have to go by that schedule. I'd just stay home sick," is not typical of the client with obsessive-compulsive disorder 2 The statement, "There has got to be a hidden agenda behind this schedule change," is not typical of the client with obsessive-compulsive disorder 3 The statement, "Who do you think you are? I expect to interact with the same nurse every Saturday," is not typical of the client with obsessive-compulsive disorder. 4 The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

10. A client was admitted with major depression that was a single episode and moderate. During her stay, she was started on Prozac (fluoxetine) at 40 mg orally every day. The nurse's discharge teaching should include all of the following except: 1. Continue taking Prozac as prescribed. You will continue to see improvement over the next few weeks. 2. Make sure that you follow up with outpatient psychotherapy as you and the social worker have arranged. 3. You may be able to discontinue the medication within 6 months to 1 year, but only under a doctor's supervision. However, there is a chance of recurring episodes. 4. You should avoid foods with tyramine, including beer, beans, processed meats, and red wine.

4 Page: 71 Feedback 1 The client should see improvement over the next few weeks. 2 The client should follow up as scheduled. 3 The client should only discontinue the medication under a doctor's supervision. 4 This is true regarding MAOIs, not an SSRI antidepressant, such as fluoxetine.

18. A client has been diagnosed with major depression and is prescribed imipramine (Tofranil). What information specifically related to this class of antidepressants will the nurse plan to include in client and family education? 1. The medication may cause dry mouth. 2. The medication may cause nausea. 3. The medication should not be discontinued abruptly. 4. The medication may cause photosensitivity.

4 Page: 71 Feedback 1 This medication does not cause dry mouth. 2 This medication does not cause nausea. 3 This medication can be discontinued under a doctor's supervision. 4 Tricyclic antidepressants cause photosensitivity.

4. A teenager has recently lost a parent. Which grieving behavior should a school nurse expect when assessing this client? 1. Denial of personal mortality 2. Preoccupation with the loss 3. Clinging behaviors and personal insecurity 4. Acting-out behaviors, exhibited in aggression and defiance

4 Page: 764-765 Feedback 1 The nurse would not expect denial of personal mortality. 2 The nurse would not expect preoccupation with the loss. 3 The nurse would not expect clinging behaviors and personal insecurity. 4 The school nurse should anticipate that the teenager will exhibit aggression and acting out. Adolescents have the ability to understand death on an adult level yet have difficulty tolerating the intense feelings associated with the death of a loved one. It is often easier for adolescents to talk with peers about feelings than with other adults.

12. Which medication does not require periodic blood-level monitoring? 1. Eskalith (lithium carbonate) 2. Depakote (valproic acid) 3. Clozaril (clozapine) 4. Paxil (paroxetine)

4 Page: 77 Feedback 1 Blood level monitoring is required for Eskalith (lithium carbonate) 2 Blood level monitoring is required for Depakote (valproic acid) 3 Blood level monitoring is required for Clozaril (clozapine). 4 Blood level monitoring is usually not done for Paxil (paroxetine).

13. As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include? 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. All of the above

4 Page: 77 Feedback 1 The client should avoid excessive use of beverages containing caffeine. 2 The client should maintain a consistent sodium intake. 3 The client should consume at least 2,500 to 3,000 mL of fluid per day. 4 Caffeine, a stimulant, should be limited in clients with mania. Adequate sodium and fluid intake is necessary to prevent lithium toxicity.

16. A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which blood cell counts would reveal a potentially fatal side effect of this medication? 1. WBCs, >3,000/mm3; granulocytes, >2,000/mm3 2. WBCs, <3,000/mm3; granulocytes, >2,000/mm3 3. WBCs, >3,000/mm3; granulocytes, <2,000/mm3 4. WBCs, <3,000/mm3; granulocytes, <2,000/mm3

4 Page: 81 Feedback 1 The following results do not indicate agranulocytosis: WBCs, >3,000/mm3; granulocytes, >2,000/mm3. 2 The following results do not indicate agranulocytosis: WBCs, <3,000/mm3; granulocytes, >2,000/mm3. 3 The following results do not indicate agranulocytosis: WBCs, >3,000/mm3; granulocytes, <2,000/mm3. 4 These blood test results are indicative of agranulocytosis, a potentially fatal disorder in which the client's white blood cell count drops to extremely low levels.

1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

4 Page: 9 Feedback 1 The client's behaviors are to be expected in a time of grief. 2 The client's behaviors are not presented as being extensive. 3 The client's behaviors are to be expected after a loss. 4 The nurse should assess that the client's daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations.

6. A mother who is notified that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy? 1. "This situation is very sad, but time is a great healer." 2. "You are sad, but you must be strong for your other children." 3. "Once you cry it all out, things will seem so much better." 4. "It must be horrible to lose a child, and I'll stay with you until your husband arrives."

4; Page: 127-128 Feedback 1 Stating, "This situation is very sad, but time is a great healer," does not convey empathy and would not be therapeutic to the mother. 2 Stating, "You are sad, but you must be strong for your other children," does not convey empathy and would not be therapeutic to the mother. 3 Stating, "Once you cry it all out, things will seem so much better," does not convey empathy and would not be therapeutic to the mother. 4 The nurse's response, "It must be horrible to lose a child, and I'll stay with you until your husband arrives," conveys empathy to the client. Empathy is the ability to see the situation from the client's point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.

2. If a client demonstrates transference toward a nurse, how should the nurse respond? 1. Promote safety and immediately terminate the relationship with the client. 2. Encourage the client to ignore these thoughts and feelings. 3. Immediately reassign the client to another staff member. 4. Help the client to clarify the meaning of the relationship, based on the present situation.

4; Page: 129 Feedback 1 This action would not be therapeutic to the client. 2 The nurse should assist the client in separating the past from the present. 3 This option would not be therapeutic to the client, who may continue to displace feelings onto others. 4 The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship based on the present situation. Transference occurs when the client unconsciously displaces feelings about a person from the past toward the nurse.

19. A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? 1. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." 2. "It is important for you to discontinue these ritualistic behaviors." 3. "Why are you asking for help, if you won't participate in unit therapy?" 4. "Let's figure out a way for you to attend unit activities and still wash your hands."

4; Page: 137-138 Feedback 1 Stating, "Everyone diagnosed with OCD needs to control their ritualistic behaviors," is not therapeutic to the client and may damage rapport. 2 Stating, "It is important for you to discontinue these ritualistic behaviors," is not therapeutic to the client and may damage rapport. 3 Stating, "Why are you asking for help, if you won't participate in unit therapy?" is not therapeutic to the client and may damage rapport. 4 The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship.

16. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? 1. Bipolar disorder: mania 2. Schizophrenia spectrum disorder 3. Generalized anxiety disorder 4. Major depressive episode

4; Page: 21 Feedback 1 A decrease in norepinephrine would not lead to mania. 2 A decrease in norepinephrine would not lead to schizophrenia. 3 A decrease in norepinephrine would not lead to generalized anxiety disorder. 4 The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

2. During the planning of care for a suicidal client, which correctly written outcome should be a nurse's first priority? 1. The client will not physically harm self. 2. The client will express hope for the future by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during the hospital stay.

4; Page: 236 Feedback 1 This answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, realistic, and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated. 2 This option may take longer to achieve. 3 This option is important, but safety must be established first. 4 The nurse's priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's priority.

13. Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine-withdrawal delirium? 1. Haloperidol (Haldol) and fluoxetine (Prozac) 2. Carbamazepine (Tegretol) and donepezil (Aricept) 3. Disulfiram (Antabuse) and lorazepan (Ativan) 4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

4; Page: 291 Feedback 1 Haloperidol (Haldol) and fluoxetine (Prozac) would not effectively treat the client and are not appropriate. 2 Carbamazepine (Tegretol) and donepezil (Aricept) would not effectively treat the client and are not appropriate. 3 Disulfiram (Antabuse) and lorazepan (Ativan) would not effectively treat the client and are not appropriate. 4 The nurse should anticipate that a physician would order chlordiazepoxide and phenytoin for a client who has a history of benzodiazepine-withdrawal delirium. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy.

12. A nurse is planning care for a 13-year-old client who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

4; Page: 390 Feedback 1 Paroxetine (Paxil) is not approved to treat depression in adolescents. 2 Sertraline (Zoloft) is not approved to treat depression in adolescents. 3 Citalopram (Celexa) is not approved to treat depression in adolescents. 4 Fluoxetine (Prozac) has been approved by the FDA to treat depression in children and adolescents, and escitalopram was approved in 2009 for treatment of depression in adolescents aged 12 to 17 years. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

15. An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

4; Page: 408 Feedback 1 The client would have serotonin syndrome. 2 The nurse would not anticipate this to be the cause. 3 The nurse would not expect ingestion of an SSRI and MAOI. 4 The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

8. A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

4; Page: 434, 439 Feedback 1 These symptoms do not indicate consumption of foods high in tyramine. 2 These symptoms do not indicate lithium carbonate discontinuation syndrome. 3 These symptoms do not indicate development of lithium carbonate tolerance. 4 The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure proper dosage.

16. A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

4; Page: 463 Feedback 1 Attempting to distract the client is not an appropriate intervention, because it does not help the client gain insight. 2 Seeking medication increase is not an appropriate intervention, because it does not help the client gain insight. 3 Locking the client's room is not an appropriate intervention, because it does not help the client gain insight. 4 The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to control interrupting anxiety, he or she must first learn to recognize precipitating factors.

7. Which statement should a nurse identify as correct regarding a client's right to refuse treatment? 1. Clients can refuse pharmacological but not psychological treatment. 2. Clients can refuse any treatment at any time. 3. Clients can refuse only electroconvulsive therapy (ECT). 4. Professionals can override treatment refusal by an actively suicidal or homicidal client.

4; Page: 50 Feedback 1 Clients can refuse both pharmacological and psychological treatment. 2 Clients may not be able to refuse emergency treatment. 3 Clients can refuse pharmacological and psychological treatment in a nonemergent situation. 4 The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be in danger or a danger to others. This situation should be treated as an emergency, and treatment may be performed without informed consent.

3. A client was recently admitted to the inpatient unit after a suicide attempt and is prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse teaches the client about serotonin syndrome. Which of the following is a symptom of serotonin syndrome? 1. Change in mental status 2. Myoclonus 3. Blood pressure lability 4. Priapism

4; Page: 69 Feedback 1 Change in mental status is not a symptom of serotonin syndrome. 2 Myoclonus is not a symptom of serotonin syndrome. 3 Blood pressure lability is not a symptom of serotonin syndrome. 4 Impotence may be a side effect of an SSRI antidepressant.

21. A client takes a maintenance dosage of lithium carbonate for a bipolar disorder. She has come to the community health clinic, stating that she "has had the flu for over a week." She describes her symptoms as coughing, runny nose, chest congestion, fever, and gastrointestinal upset. Her temperature is 100.9°F. What situation does the nurse anticipate? 1. She has consumed some foods high in tyramine. 2. She has stopped taking her lithium carbonate. 3. She has probably developed a tolerance to the lithium carbonate. 4. The lithium carbonate may be producing symptoms of toxicity.

4; Page: 77 Feedback 1 The nurse would not anticipate the cause to be foods high in tyramine. 2 Discontinuation of lithium carbonate is not likely. 3 The development of tolerance to lithium carbonate is not likely. 4 Blurred vision, gastrointestinal upset, and tinnitus are symptoms of lithium toxicity.

23. A client is experiencing a psychotic episode. He is in good physical health but has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Which antipsychotic medication would be contraindicated for the client? 1. Haloperidol, because it is used only in elderly patients 2. Clozapine, because it is incompatible with desipramine 3. Risperidone, because it exacerbates symptoms of depression 4. Thioridazine, because of cross-sensitivity among phenothiazines

4; Page: 78 Feedback 1 Haloperidol would not be contraindicated because of cross sensitivities. 2 Clozapine would not be contraindicated because of cross sensitivities. 3 Risperidone would not be contraindicated because of cross sensitivities. 4 There may be cross-sensitivity among phenothiazines. Both prochlorperazine (Compazine) and thioridazine (Mellaril) are phenothiazines. Since the client has a known allergy to one phenothiazine, he should not be given another phenothiazine.