Mental Health Final Exam

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings should the nurse expect to note? Select all that apply. A. Dental decay B. Moist, oily skin C. Loss of tooth enamel D. Electrolyte imbalances E. Body weight well below ideal range

A. Dental decay C. Loss of tooth enamel D. Electrolyte imbalances Clients with bulimia nervosa initially may not appear to be physically or emotionally ill. They are often at or slightly below ideal body weight. On further inspection, a client exhibits dental decay and loss of tooth enamel if the client has been inducing vomiting. Electrolyte imbalances are present. Dry, scaly skin (rather than moist, oily skin) is present.

The client says to the nurse, "I wonder what's playing at the movies tonight." Which response by the nurse would be most therapeutic? A. "Are you telling me you would like to go to the movies?" B. "Why don't you look in the newspaper." C. "There's nothing worth watching." D. "We may have some DVDs available."

A. "Are you telling me you would like to go to the movies?" This nurse is restating or verbalizing the implied, which involves voicing what the client has hinted at or suggested. The nurse should apply this technique to confirm the implications of the client's statement before suggesting solutions to the presumed meaning.

The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the most appropriate nursing response? A. "I cannot discuss any client situation with you" B. "If you want to know about Carol, you need to ask her yourself" C. Only because you're worried about a friend, I'll tell you that she is improving" D. Being her friend, you know she is having a difficult time and deserves her privacy"

A. "I cannot discuss any client situation with you" The nurse is required to maintain confidentiality regarding the client and the client's care. Confidentiality is a basic to the therapeutic relationship and is a client's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain client confidentiality

The nurse determines that the wife of an alcoholic client is benefiting from attending an Al-Anon group if the nurse hears the wife make which statement? A. "I no longer feel that I deserve the beatings my husband inflicts on me" B. "My attendance at the meetings has helped me see that I provoke my husband's violence" C. "I enjoy attending the meetings because they get me out of the house and away from my husband" D. "I can tolerate my husband's destructive behaviors now that I know they are common among alcoholics"

A. "I no longer feel that I deserve the beatings my husband inflicts on me" Al-Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain excellent pointers about successful behavioral changes. The correct option is the healthiest response because it exemplifies an understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control. Option B is incorrect because the nonalcoholic partner should not feel responsible when the spouse loses control. Option C indicates that the group is viewed as an escape, not as a place to work on issues. Option D indicates that the wife remains codependent.

A 10-year-old child with Tourette's disorder is receiving haloperidol as part of his treatment plan. When assessing the child at a follow up visit, which statement by the child would lead the nurse to suspect that he is experiencing a side effect of the drug? A. "Sometimes I feel like I'm so sleepy." B. "I'm eating about the same amount as before." C. "My muscles seem pretty flexible lately." D. "I think I'm much more alert with this drug."

A. "Sometimes I feel like I'm so sleepy." The most frequently encountered side effects associated with medication therapy such as haloperidol include drowsiness, dulled thinking, muscle stiffness, akathisia, increased appetite and weight gain, and acute dystonic reactions.

Disulfiram should not be administered until a client has abstained from alcohol for at least how long? A. 12 hours B. 4 hours C. 8 hours D. 16 hours

A. 12 hours Warnings related to disulfiram include never administering the drug to an intoxicated client or without the client's knowledge, and not administering the drug until the client has abstained from alcohol for at least 12 hours.

Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization? A. A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL B. A 32-year-old with a temperature of 98°F and a pulse rate of 54 C. A 16-year-old with serum potassium of 3.8 mEq/L and a BP of 98/66 mmHg D. A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt

A. A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL Criteria for hospitalization include: acute weight loss, <85% below ideal; heart rate near 40 beats/min; temperature <36.1°C; blood pressure, <80/50 mm Hg; hypokalemia; hypophosphatemia; hypomagnesemia. The client with a weight 70% of ideal and magnesium level of 1.2 mg/dL (low) fits the criteria.

Which of the following behavioral patterns noted in clients diagnosed with borderline personality disorder (BPD) is associated with learned helplessness? A. Active passivity B. Emotional vulnerability C. Self-invalidation D. Apparent competence

A. Active passivity Active passivity occurs when a person fails to engage actively in solving his or her own life problems, but actively seeks problem solving from others in the environment; it is learned helplessness and hopelessness. Emotional vulnerability occurs when a person has difficulty regulating negative emotions. Self-invalidation occurs when a person fails to recognize his or her own emotional responses, thoughts, beliefs, and behaviors and sets unrealistically high standards and expectations for him- or herself. Apparent competence is the tendency of an individual to appear deceptively more competent than he or she actually is.

A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program? A. Admitting to having a problem B. Substituting other activities for gambling C. Stating that the gambling will be stopped D. Discontinuing relationships with people who gamble

A. Admitting to having a problem The first step in the 12-step program is to admit that a problem exists. Substituting other activities for gambling may be a strategy, but it is not the first step. The remaining options are not realistic strategies for the initial step of a 12-step program.

The nurse caring for clients with antisocial personality disorder (ASPD) has determined patterns that challenge her capacity to establish a therapeutic relationship with clients with ASPD. Which are challenges to the therapeutic relationship? Select all that apply. A. An initial bond that is only superficial B. Identification of future-oriented goals C. The use of self-challenge strategies by the client D. A loss of trust when client is challenged by the nurse E. A commitment to therapeutic work between sessions

A. An initial bond that is only superficial D. A loss of trust when client is challenged by the nurse In early encounters, the individual with ASPD can establish warm and engaging relationships. In the therapeutic nurse-client relationship, these relationships can break down when the client is challenged to adhere to a policy or when the person is challenged to improve their health or lifestyle patterns. It is not typical for the person with ASPD to offer future-oriented plans. Neither do clients have the level of insight and self-motivation to initiate self-change interventions. Even in helping sessions, ASPD clients have a tendency to offer superficial engagement in therapy, yet fail to follow through with interventions.

A hospitalized client with a history of alcohol misuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take? A. Call the nursing supervisor B. Call security to block all exits C. Restrain the client until the provider can be reached D. Tell the client that the client cannot return to this hospital again if the client leaves now

A. Call the nursing supervisor Most healthcare facilities have documents that the client is asked to sign relating to the client's responsibilities when the client leaves against medical advice. The client should be asked to wait to speak to the provider before leaving and to sign the "against medical advice" document before leaving. If the client refuses to do so, the nurse cannot hold the client against the client's will. Therefore, in this situation, the nurse should call the nursing supervisor. The nurse can be charged with false imprisonment if a client is made to believe wrongfully that she or he cannot leave the hospital. Restraining the client and calling security to block exits constitutes false imprisonment. All clients have a right to healthcare and cannot be told otherwise.

A client admitted voluntarily for treatment of an anxiety demands to be released from the hospital. Which action should the nurse take initially? A. Call the provider B. Call the client's family to arrange for transportation C. Attempt to persuade the client to stay "for only a few more days" D. Tell the client that leaving would likely result in an involuntary commitment

A. Call the provider Voluntary clients have the right to demand and obtain release, unless they pose an immediate danger to themselves or others, in which case the admission could become involuntary depending on the circumstances and regulations in that area and facility. The initial nursing action is to contact the provider, who has the authority to discuss discharge with the client. While arranging for safe transportation is appropriate, it is premature and should not be done without the client's permission. While it is appropriate to discuss why the client feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the client to stay for only a few more days has little value and will not likely be successful.A

The nurse is providing care to a client with somatic symptom disorder (SSD). Which would the nurse expect to be included in the client's plan of care? A. Cognitive behavior therapy B. Multiple provider evaluations C. Mood stabilizers to manage the symptoms D. Electroconvulsive therapy

A. Cognitive behavior therapy The cornerstone of management is trust and believing. Ideally, the client should see only one health care provider at regularly scheduled visits. During each primary care visit, the provider should conduct a partial physical examination of the organ system in which the client has complaints. Physical symptoms are treated conservatively using the least intrusive approach. In the mental health setting, the use of cognitive behavior therapy is effective. Medications may be used, such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors, but not mood stabilizers. Electroconvulsive therapy is not typically used.

The nurse asks a client to list the days of the week in reverse order. The nurse is assessing what? A. Concentration B. Memory C. Orientation D. Abstract thinking

A. Concentration The nurse assesses the client's ability to concentrate by asking the client to perform certain tasks such as repeating the days of the week backward. The nurse directly assesses memory, both recent and remote, by asking questions with verifiable answers. Orientation refers to the client's recognition of person, place, and time. Abstract thinking is making associations or interpretations about a situation or comment.

The nurse is caring for a child receiving a psychostimulant medication for treatment of attention deficit hyperactivity disorder (ADHD).The nurse understands that this type of medication achieves its effectiveness by targeting which neurotransmitter in the brain? Select all that apply. A. Dopamine B. Epinephrine C. Acetylcholine D. Serotonin E. Norepinephrine

A. Dopamine E. Norepinephrine Psychostimulants are the most commonly used medications for the treatment of ADHD. These medications enhance dopamine and norepinephrine activity and thereby improve attention and focus, increase inhibition of impulsive actions, and quiet the "noise" associated with distractibility and shifting attention. Serotonin, acetylcholine, and epinephrine are not enhanced by psychostimulants.

When describing the dementia associated with Huntington disease, a nurse understands that the problems involving behavior and attention arise from a disruption in which lobe of the brain? A. Frontal B. Temporal C. Parietal D. Occipital

A. Frontal The dementia syndrome of Huntington disease is characterized by insidious changes in behavior and personality. Typically, the dementia is frontal, which means that the person demonstrates prominent behavioral problems and disruption of attention.

Which occurs when an individual intentionally produces illness symptoms to avoid work? A. Malingering B. Alexithymia C. Conversion disorder D. Illness anxiety disorder

A. Malingering Malingering occurs when an individual intentionally produces illness symptoms, motivated by another specific self-serving goal, such as being classified as disabled or avoiding work. Individuals with alexithymia have difficulty identifying and expressing their emotions. They have a preoccupation with external events and are described as concrete, externally oriented thinkers. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. Illness anxiety disorder occurs when an individual is fearful of developing a serious illness based on a misinterpretation of body sensations.

A client is participating in a therapy group and focuses on viewing all team members as equally important in helping the clients to meet their goals. The nurse is implementing which therapeutic approach? A. Milieu therapy B. Interpersonal therapy C. Behavior modification D. Support group therapy

A. Milieu therapy All treatment team members are viewed as significant and valuable to the client's successful treatment outcomes in milieu therapy. Interpersonal therapy is based on a one-to-one or group therapy approach in which the therapist-client relationship is often used as a way for the client to examine other relationships in her or his life. Behavior modification is based on rewards and punishment. Support groups are based on the premise that individuals who have experienced and are insightful concerning a problem are able to help others who have a similar problem

When reviewing the admission assessment, the nurse notes that a client was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this client? A. Monitor closely for harm to self or others B. Assist in completing an application for admission C. Supply the client with written information about her or his mental health problem D. Provide an opportunity for the family to discuss why they felt the admission was needed

A. Monitor closely for harm to self or others Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the client's willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the client's mental health problem is likely premature initially. The family may have had no role to play in the client's admission

Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply. A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically D. Provide stimulation in the environment E. Provide reality orientation as appropriate F. Maintain NPO status

A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically E. Provide reality orientation as appropriate When the client is experiencing withdrawal from alcohol, the priority for care is to prevent the client from harming self or others. The nurse would monitor vital signs closely and report abnormal findings. The nurse would provide a low-stimulation environment to maintain the client in as calm a state as possible. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake need to be maintained.

A client diagnosed with a personality disorder exhibits a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Which personality disorder would the nurse identify as being characterized by this behavior? A. Narcissistic B. Histrionic C. Dependent D. Obsessive-compulsive

A. Narcissistic People with narcissistic personality disorder are grandiose, have an inexhaustible need for admiration, and lack empathy. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control.

The nurse working with clients who have borderline personality disorder (BPD) understands that they need help to both recognize genuine respect from others as well as reciprocate that respect for others. How can the nurse model self-respect? Select all that apply. A. Observe personal limits. B. Let the client make all the decisions. C. Be assertive. D. Clearly communicate expectations. E. Independently make all decisions.

A. Observe personal limits. C. Be assertive. D. Clearly communicate expectations. The nurse in the therapeutic relationship models self-respect by observing personal limits, being assertive, and clearly communicating expectations.

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model? A. Orientation phase B. Identification phase C. Exploitation phase D. Termination phase

A. Orientation phase According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end.

Which zone is a distance that is comfortable between family and friends who are talking? A. Personal B. Intimate C. Social D. Public

A. Personal The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.

The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client? Select all that apply. A. Restating B. Active listening C. Asking the client "Why?" D. Maintaining neutral responses E. Providing acknowledgment and feedback F. Giving advice and approval or disapproval

A. Restating B. Active listening D. Maintaining neutral responses E. Providing acknowledgment and feedback Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing. Asking "Why" is often interpreted as being accusatory by the client and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication

A client has been diagnosed with conversion disorder. Which medication classification has been shown to be effective in some cases of somatoform disorders? A. SSRIs B. Antimanics C. Antipsychotics D. Antibiotics

A. SSRIs SSRIs have been shown to be effective in some cases of somatoform disorders.

When assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply. A. Set clear limits with consequences B. Provide extensive explanations C. Keep to regular routines D. Maintain a calm environment E. Let him work on several things at once

A. Set clear limits with consequences C. Keep to regular routines D. Maintain a calm environment Interventions that can help the parents of a child with ADHD include: setting clear limits with clear consequences, using few words and simplifying instructions; establishing and maintaining a predictable environment with clear rules and regular routines for eating, sleeping, and playing; promoting attention by maintaining a calm environment with few stimuli; establishing eye contact before giving directions and asking the child to repeat what was heard; encouraging the child to do homework in a quiet place outside of a traffic pattern; and assisting the child to work on one assignment at a time (reward with a break after each completion).

The nurse should plan which goals of the termination stage of group development? Select all that apply. A. The group evaluates the experience B. The real work of the group is accomplished C. Group interaction involves superficial conversation D. Group members become acquainted with one another E. Some structuring of group norms, role, and responsibilities takes place F. The group explores members' feelings about the group and the impending separation

A. The group evaluates the experience F. The group explores members' feelings about the group and the impending separation The stages of group development include the initial stage, the working stage, and the termination stage. During the initial stage, the group members become acquainted with one another, and some structuring of group norms, roles, and responsibilities takes place. During the initial stage, group interaction involves superficial conversation. During the working stage, the real work of the group is accomplished. During the termination stage, the group evaluates the experience and explores members' feelings about the group and impending separation

The nurse states,"I feel anxious most of the time." Which defense mechanism(s) are unhealthy ways for the nurse use to decrease anxiety? Select all that apply. A. The nurse gets angry with the manager and tries to leave early before the manager comes in for work. B. The nurse works a double shift to promote continuity of care. C. The nurse waits until all reports are finished in the morning to leave. D. After failing to get a promotion to manager, the nurse tells co-workers that manager was not what was wanted all along. E. The nurse holds a position on the nursing advisory board of the local LPN school.

A. The nurse gets angry with the manager and tries to leave early before the manager comes in for work. D. After failing to get a promotion to manager, the nurse tells co-workers that manager was not what was wanted all along. Defense mechanisms are psychological mechanisms (acting out, compensation, denial, displacement, fantasy, identification, intellectualization, introjection, projection, rationalization, reaction formation, regression, repression, sublimation, and undoing) that help an individual respond to and cope with anxiety or difficult situations, emotional conflicts, and external stressors. Examples of healthier ways of coping are: the nurse holds a position on the nursing advisory board of the local LPN school, the nurse waits until all reports are finished in the morning to leave and the nurse works a double shift to promote continuity of care.

A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? A. Using open-ended questions and silence B. Sharing personal preference regarding food choices C. Documenting reasons why the client does not want to eat D. Offering opinions about the necessity of adequate nutrition

A. Using open-ended questions and silence Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing person food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify reasons for the behavior

An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is: A. inappropriate; room restriction is not treatment in the least restrictive environment B. inappropriate; the adolescent should be offered a sedative before room restriction C. appropriate; room restriction is an effective behavior modification technique D. appropriate; the adolescent should not have conflicts with others

A. inappropriate; room restriction is not treatment in the least restrictive environment Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. It means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary. Verbal and behavioral techniques should be instituted before physical measures such as sedation, restraint, or seclusion.

A nurse leading group therapy identifies an individual's participation of self-disclosure with personal problems that are inconsistent with the purpose of the group. Which action by the nurse would be most appropriate? A. limit repeated episodes and redirect discussion. B. ask the individual to leave the group. C. tell the client that this behavior is unacceptable. D. explore the individual's thoughts and feelings with the group.

A. limit repeated episodes and redirect discussion. If the group's purpose is inconsistent with self-disclosure of personal problems, the nurse should acknowledge the individual members' distress yet set limits while maintaining the group focus. In this instance, the nurse would limit repeated episodes of self-disclosure from that member or others and redirect discussion to the group task.

The nurse has been asked to explain electroconvulsive therapy to a client and his family. Which of the following statements made by the nurse would be correct? A. "You will need to receive treatment twice a week for the rest of your life." B. "A tapering schedule may be used to end your treatments to try to prevent rehospitalization." C. "If you show improvement after the treatment, your previous symptoms will not return." D. "The entire procedure typically lasts about 5 hours."

B. "A tapering schedule may be used to end your treatments to try to prevent rehospitalization." Typically ECT is given twice weekly on nonconsecutive days; treatments may range from a few to 15 sessions, depending on a client's response. The entire procedure lasts less than 1 hour, although each client's recovery time varies. When repeated episodes of depression or serious other life-threatening symptoms occur after a series of treatments with ECT, the physician may opt to taper ECT over several weeks to months. Typically, a tapering schedule is once a week for 1 month, once every 2 weeks for 2 months, once every 3 weeks for 2 months, and once every month for 2 to 4 months. This kind of tapering may help prevent rehospitalization. Occasionally, clients relapse and have to return for maintenance treatment.

The client says to the nurse, "I have special powers because I am the mother of God. I can heal everyone in the hospital." The nurse's best response would be: A. "That sounds interesting. But how can that be true?" B. "It would be unusual for anyone to have that kind of power." C. "You could not heal everyone. No one has that much power." D. "Well, you can certainly try."

B. "It would be unusual for anyone to have that kind of power." When the nurse states, "It would be unusual for anyone to have that kind of power," the nurse is voicing doubt or expressing uncertainty about the reality of the client's perceptions in an indirect way that maintains rapport. The other choices have demeaning connotations toward the client and should not be used because they harm the therapeutic relationship and limit communication.

The adult child of a client with dementia asks the nurse if the client will ever be able to live independently again. Which would be the most appropriate response by the nurse? A. "You sound like you aren't ready for the client to be dependent on caregivers." B. "Symptoms of dementia gradually get worse. Unfortunately, the client will not be independent again." C. "The client's confusion is a temporary complication of the physical illness and should subside when the illness gets better." D. "With early treatment, mild dementia can be reversed. It may be possible."

B. "Symptoms of dementia gradually get worse. Unfortunately, the client will not be independent again." The prognosis for dementia involves progressive deterioration of physical and mental abilities until death. Typically, in the later stages, clients have minimal cognitive and motor function, are totally dependent on caregivers, and are unaware of their surroundings or people in the environment. Delirium secondary to physical illness will subside with physical recovery. Saying "You sound like you aren't ready for her to be dependent on caregivers" does not address the daughter's specific question.

A nurse is leading a medication education group for clients with depression. A client states he has read that herbal treatments are just as effective as prescription medications. The best response is A. "When studies are published they can be trusted to be accurate." B. "We need to look at the research very closely to see how reliable the studies are." C. "Your prescribed medication is the best for your condition, so you should not read those studies." D. "Switching medications will alter the course of your illness. It is not advised."

B. "We need to look at the research very closely to see how reliable the studies are." Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their families to understand. The nurse must ensure that clients and families are well informed about progress in these areas and must also help them to distinguish between facts and hypotheses. The nurse can explain if, or how, new research may affect a client's treatment or prognosis. The nurse is a good resource for providing information and answering questions.

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I should get out of this bad situation." What is the most helpful response by the nurse? A. "Why don't you tell your wife about this?" B. "What do you find difficult about this situation?" C. "This is not the best time to make that decision." D. "I agree with you. You should get out of this situation."

B. "What do you find difficult about this situation?" The most helpful response is one that encourages the client to solve problems. Giving advice implies that the nurse knows what is best and can foster dependency. The nurse should not agree with the client, and the nurse should not request that the client provide explanations.

An individual with which body mass index (BMI) would be classified as having mild anorexia nervosa? A. 20 kg/m2 B. 17.4 kg/m2 C. 16.2 kg/m2 D. 15.4 kg/m2

B. 17.4 kg/m2 The severity of anorexia nervosa is classified as follows: mild: BMI ≥ 17 kg/m2; moderate: BMI 16-16.99 kg/m2; and severe: BMI 15-15.99 kg/m2. A BMI of 20 kg/m2 is considered normal.

A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a 2-bed room. A newly admitted client will be assigned to this client's room. Which client would be the best choice as a roommate for the client with anorexia nervosa? A. A client with pneumonia B. A client undergoing diagnostic tests C. A client who thrives on managing others D. A client who could benefit from the client's assistance at mealtime

B. A client undergoing diagnostic tests The client undergoing diagnostic tests is an acceptable roommate. The client with anorexia nervosa is most likely experiencing hematological complications, such as leukopenia. Having a roommate with pneumonia would place the client with anorexia nervosa at risk for infection. The client with anorexia nervosa should not be placed in a situation in which the client can focus on the nutritional needs of others or be managed by others, because this may contribute to sublimation and suppression of hunger

A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process? A. Assure the client that evidence-based care will be provided at all times during the admission B. Ask the client about any advance care directives that that the client has established C. Assure the client that Medicare and Medicaid reimbursement will be pursued at all times D. Inform the client that no information will be provided to his or her insurer without explicit permission

B. Ask the client about any advance care directives that that the client has established The PSDA specifies the need to recognize the presence of any advance care directives that the client may have established. Evidence-based care, confidentiality and advocacy are all aspects of high-quality care, but none is an explicit provision of the PSDA.

The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate discharge? A. Ask the client why he started taking illegal drugs B. Ask the client about the amount of drug use and its effect C. Ask the client how long he thought that he could take drugs without someone finding out D. Do not ask any questions for fear that the client is in denial and will throw the nurse out of the home

B. Ask the client about the amount of drug use and its effect Whenever the nurse carries out an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. Option A is incorrect because it is judgmental and off-focus, and reflects the nurse's bias. Option C is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. Option D is incorrect because it indicates passivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention.

A client with antisocial personality disorder uses manipulation to try leaving the unit with another client's family members after visiting hours. Which of the following interventions is best to deal with the manipulative behavior? A. Allow the client's nurse to determine how to deal with the client since the client has never attempted to escape before. B. Assist the client to identify patterns of behavior and consequences as determined by the team plan. C. Remind the client that he could be discharged for inappropriate behavior. D. Restrict the client from all unit activities to provide time for reflection on his behavior.

B. Assist the client to identify patterns of behavior and consequences as determined by the team plan. Following the team plan ensures consistency of response to the client's manipulative behavior. Learning the relationship between behavior and consequences is a positive outcome for the client. Answers A, C, and D are not appropriate interventions for the client exhibiting manipulative behavior.

The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. A. Libel B. Battery C. Assault D. Slander E. False Imprisonment

B. Battery C. Assault E. False Imprisonment False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a client from leaving the hospital if the client has been admitted voluntarily and if no agency or legal policies exist for detaining the client. Assault and battery are related to the act of restraining the client in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statements about the client.

Safe alcohol withdrawal usually is accomplished with the administration of which medication classification? A. Antipsychotics B. Benzodiazepines C. Anticonvulsants D. Antidepressants

B. Benzodiazepines Benzodiazepines are used for safe withdrawal of alcohol.

In planning care for clients with a somatic symptom disorder, an appropriate long-term outcome for treatment would be that the client will ... A. Assume responsibility for self-care activities B. Develop alternative coping mechanisms C. Learn new diversional recreation patterns D. Resume home maintenance activities

B. Develop alternative coping mechanisms The development of alternative coping mechanisms is the outcome that will decrease the client's somatic way of coping.

A client with anorexia nervosa is a member of a pre-discharge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior? A. Normal behavior B. Evidence of the client's disturbed body image C. Regression as the client is moving toward the community D. Indicative of the client's ambivalence about hospital discharge

B. Evidence of the client's disturbed body image Disturbed body image is a concern with clients with anorexia nervosa. Although the client may struggle with ambivalence and show regressed behavior, the client's coping pattern relates to the basic issue of disturbed body image. The nurse should address this need in the support group.

Which is the most commonly seen adverse side effect of typical antipsychotics? A. Accidental overdosage as a result of the narrow therapeutic range B. Extrapyramidal symptoms and tardive dyskinesia C. Serotonin syndrome D. Auditory and visual hallucinations

B. Extrapyramidal symptoms and tardive dyskinesia The greatest hazard of typical antipsychotics involves adverse effects, such as extrapyramidal symptoms (EPSs) and tardive dyskinesia. Risk of EPSs and other movement disorders is highest for clients who use older, high-potency neuroleptics, such as haloperidol or perphenazine, for long periods.

Which of the following characteristics differentiates functional neurologic symptom disorder from malingering disorder? A. Functional neurologic symptom disorder is normally permanent, while malingering disorder is transient in response to stress. B. Functional neurologic symptom disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms. C. Functional neurologic symptom disorder produces reward, while malingering disorder normally results in punishment or difficulty. D. Functional neurologic symptom disorder has no pathophysiological cause, while malingering disorder has a neurological or endocrine basis

B. Functional neurologic symptom disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms. In functional neurologic symptom disorder, anxiety-provoking impulses are converted unconsciously into functional symptoms. Malingering disorder is characterized by the voluntary or intentional production of false or grossly exaggerated physical or psychological symptoms. Both produce rewards, and neither has any pathophysiological cause. Neither disorder is considered a permanent or untreatable condition.

A client is brought to the emergency department following a car accident. The client's blood alcohol level (BAL) is 0.10%. Which of the following would the client likely exhibit? A. Giddiness B. Impaired coordination C. Ataxia D. Emotional lability

B. Impaired coordination With a blood alcohol level (BAL) of 0.10%, the person would most likely demonstrate difficulty driving and coordinating movement. Giddiness would be noted with a BAL of 0.05%. Ataxia and emotional lability would be noted with a BAL of 0.20%.

The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? A. Interrupt the client and weigh her immediately B. Interrupt the client and offer to take her for a walk C. Allow the client to complete her exercise program D. Tell the client that she is not allowed to exercise rigorously

B. Interrupt the client and offer to take her for a walk Clients with anorexia nervosa frequently are preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide appropriate exercise and place limits on rigorous activities. The correct option stops the harmful behavior yet provides the client with an activity to reduce anxiety that is not harmful. Weighing the client immediately reinforces the client's preoccupation with weight. Allowing the client to complete the exercise program can be harmful to the client. Telling the client that she is not allowed to complete the exercise program will increase the patient's anxiety

Fluoxetine includes a black box warning concerning which of the following? A. Myocardial infarction B. Suicidality in children and adolescents C. Renal failure D. Stroke

B. Suicidality in children and adolescents Fluoxetine includes a black box warning of suicidality in children and adolescents. It should be avoided during pregnancy and while breast-feeding. It should be used with caution in clients with impaired hepatic or renal function and diabetes. Possible toxicity may occur if taken with tricyclic antidepressants. Fluoxetine does not have a black box warning for myocardial infarction, renal failure, or stroke.

A nurse is teaching parents of a child with a disruptive behavior disorder how to use "time-out." The nurse determines the education was successful when the parents identify which as the first step? A. Giving the child a warning B. Labeling the behavior C. Identifying the consequence of the unacceptable behavior D. Instituting the time out

B. Labeling the behavior The first step is to label the behavior, that is, identify the behavior that the child is expected to perform or cease. The aim of this statement is to make clear what is required of the child. It typically takes the form of a simple declarative sentence: "Threatening is not acceptable." The next step is the warning. In this step, the child is informed that if he or she does not perform the expected behavior or stop the unacceptable behavior, he or she will be given a "time-out." "This is a warning: if you continue threatening to hit people, you'll have a time-out." The last step is the actual time-out. If the child does not heed the warning, he or she is told to take a time-out in simple straightforward terms: "Take a time-out."

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply. A. Looking down to the floor B. Leaning toward the client C. Mirroring the client's facial expression D. Maintaining eye contact with the client E. Sitting with closed arms and crossed legs

B. Leaning toward the client D. Maintaining eye contact with the client The nonverbal cues that convey that the nurse is paying attention are leaning toward the client and maintaining eye contact while speaking to the client. If the nurse looks down toward the floor when the client is trying to talk, this indicates that the nurse is disinterested. Having a sad facial expression does not indicate attentiveness. Sitting with closed arms and crossed legs indicates that the nurse is not willing to listen to the client.

A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include? A. Unlike heroin, methadone is nonaddicting. B. Methadone will meet the physical need for opiates without producing cravings for more. C. Methadone will produce a high similar to heroin. D. People taking methadone run the same risks associated with intravenous drug use as those taking heroin.

B. Methadone will meet the physical need for opiates without producing cravings for more. Methadone, a potent synthetic opiate, is used as a substitute for heroin in some maintenance programs. The client takes one daily dose of methadone, which meets the physical need for opiates but does not produce cravings for more. Methadone does not produce the high associated with heroin. The client has essentially substituted his or her addiction to heroin for an addiction to methadone; however, methadone is safer because it is legal, controlled by a physician, and available in tablet form. The client avoids the risks of intravenous drug use, the high cost of heroin (which often leads to criminal acts), and the questionable content of street drugs.

An 8-year-old boy has been diagnosed with ADHD. His mother is shocked that he will be prescribed a psychostimulant, stating, "His whole problem is that he's too stimulated, not understimulated!" Which of the following facts should underlie the nurse's response to the mother? A. Controlled, medication-induced stimulation helps children become more comfortable and functional during times of high stimulation. B. Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. C. Brain stimulation is inversely proportionate to motor stimulation. D. Psychostimulants are a form of aversion therapy in which the child becomes uncomfortable with overstimulation.

B. Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior, with the resulting effect of improved self-control.

During a group session, a nurse leader observes a member look down at the floor and change position in the chair, each time the topic of anger and violence comes up. The nurse leader says to the member, "I've noticed that any time the discussion involves anger and violence you look away and change your position. Is something going on?" The nurse leader is using which technique? A. Reflecting feelings B. Reflecting behavior C. Clarification D. Summarizing

B. Reflecting behavior The statement is an example of reflecting behavior; that is, the statement identifies behaviors that are occurring. This technique gives the member an opportunity to see how their behavior appears to others and toe evaluate its consequences. Reflecting feelings is a technique that orients members to the feelings that may lie behind what is being said or done. Clarification is a technique that checks on the meanings of the interaction and communication. Summarizing brings to focus still unresolved issues, themes, and patterns of interactions.

Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? Select all that apply. A. Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods. B. Remember to focus on the client's strengths and assets, as well as their problems. C. Transient conduct disorders are common in all children. D. Avoid a "blaming" attitude toward clients and/or families. E. Focus on positive actions to improve situations and/or behaviors.

B. Remember to focus on the client's strengths and assets, as well as their problems. D. Avoid a "blaming" attitude toward clients and/or families. E. Focus on positive actions to improve situations and/or behaviors. Points to consider when working with clients with disruptive behavior disorders and their families include remembering to focus on the client's strengths and assets, as well as their problems and avoiding a blaming attitude toward clients and/or families. The nurse should focus on positive actions to improve situations and/or behaviors. There is a familial tendency for behavior disorders, but that is not the only cause for behavior disorders and the nurse cannot assume that the client's parents also had a conduct disorder. Conduct disorders are not common in all children, but it can be difficult to distinguish normal child behavior from conduct disorders at times.

Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client? A. Leaning slightly forward to the client B. Sitting behind a desk C. Facing the client at eye level D. Keeping arms and legs uncrossed

B. Sitting behind a desk Therapeutic nonverbal communication uses positive body language, such as sitting at the same eye level as the client with a relaxed posture that projects interest and attention. Leaning slightly forward helps engage the patient. Generally, the nurse should not cross his or her arms or legs during therapeutic communication because such postures erect barriers to interaction. Uncrossed arms and legs project openness and a willingness to engage in conversation

The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority? A. The client will be able to accept a job promotion. B. The client will experience increased self-esteem. C. The client will engage in less risk-taking behavior D. The client will form a romantic relationship.

B. The client will experience increased self-esteem. People with avoidant personality disorder have a pattern of social discomfort, timidity, and fear of negative evaluation. They are preoccupied with what they perceive as their own shortcomings and will form relationships with others only if they believe acceptance is guaranteed. People with this disorder often view themselves as unattractive and inferior to others and are often socially inept. The priority goal should address increasing the client's self-esteem.

The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that the friend's relationship with the client was codependent and enabling. Which is an example of codependent behavior? A. The friend called Alcoholics Anonymous when the client expressed a need to stop drinking. B. The friend called the client every night to make sure the client got home safely and went looking for the client if not at home. C. The friend confronted the client on the effect of the client's drinking on their relationship. D. The friend refused to go out drinking with the client to celebrate the client's birthday.

B. The friend called the client every night to make sure the client got home safely and went looking for the client if not at home. Codependent behavior appears helpful on the surface but actually prolongs the drinking behavior. Watching out for the client's safety may appear helpful but it facilitates the client's behavior because it releases the client from being responsible. Calling Alcoholics Anonymous, confronting the client and refusing to participate are actions that show personal support for the client while not enabling or accepting his or her harmful behaviors.

Benzodiazepines work by the following mechanism of action: A. They act directly on dopaminergic neurons in the medulla. B. They act directly on GABA receptors and are thought to increase the amount of GABA available. C. They act indirectly through a second messenger to affect levels of circulating GABA. D. The mechanism of action of this category of drugs is unknown at this time.

B. They act directly on GABA receptors and are thought to increase the amount of GABA available. Benzodiazepines act directly on GABA receptors and are thought to increase GABA available to dampen neural overstimulation.

Wernick-Korsakoff syndrome is a neurologic condition that can result from heavy drinking. Which of the following medications is used to prevent Wernicke-Korsakoff syndrome? A. Folic acid (Folate) B. Thiamine (vitamin B1) C. Cyanocabalamin (vitamin B12) D. Lorazepam (Ativan)

B. Thiamine (vitamin B1) Thiamine is used to prevent Wernicke-Korsakoff syndrome. Folic acid, vitamin B12, and lorazepam are not used for this disease process.

The nurse is caring for a client that is confused. The nurse, while giving the client a bed bath leaves the room to get supplies. The nurse returns to find the client on the floor with the bed in high position, and side rails down. What law has been broken? A. non-maleficence B. negligence C. beneficence D. assault

B. negligence Negligence is an unintentional tort that is a breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries. Assault, beneficence, and non-maleficence do not demonstrate the law that has been broken. Assault is a threat of imminent harmful or offensive contact with a person. Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. Non-maleficence, beneficence, and assault have not been breached.

The nurse encourages an older adult client to write a letter to an old friend. What therapy is the nurse utilizing as an intervention? A. behavior therapy B. reminiscence C. bibiliotherapy D. cultural brokering

B. reminiscence The nurse is practicing the intervention of reminiscence with the client who can benefit from this as a way to stimulate thinking or review their life and remember past times to help maintain self-esteem. Behavior therapy involves modification of behavior to keep desired ones and eliminate those that are undesirable. Cultural brokering involves bridging between two cultures to help with understanding cultural beliefs and values. Bibliotherapy uses written materials to help with expression of feelings or gaining insight but this would involve the client reading, not writing.

The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller? A. "Hold one minute while I get the client for you" B. "The person you are asking for is not a client here" C. "I cannot confirm or deny the existence of any client here" D. "You will need to be placed on the client's contact list before I can discuss any information with you"

C. "I cannot confirm or deny the existence of any client here" The protection and privacy of personal health information is regulated by the federal government through the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Protected health information is any individually identifiable health information in oral, written, or electronic form. Mental health and substance abuse records have additional special protection under the privacy rules. Requesting placement on the contact list or getting the client verifies the client's presence to the caller. Denying the client's presence affirms the client's existence whether present or not, which violates client privacy and confidentiality.

The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is ... A. "I am sure there are other people in your life who are your friends; besides, we just met." B. "It makes me feel good that you trust me so much; it is important for the work we are doing together." C. "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." D. "We are not friends. This is strictly professional."

C. "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." The nurse's response must let the client know in clear terms that the relationship is professional while not demeaning or ridiculing the client. Choices A, B, and D would not be appropriate replies in this situation.

Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child? A. "I too have been disappointed by important people in my life." B. "What do you think motivated your father to do that." C. "That must have been terribly hurtful experience for you." D. "You will find that one of the constants in life is that people will often let you down."

C. "That must have been terribly hurtful experience for you." Empathy is important, yet challenging, to communicate. A genuine, open-ended, and nonjudgmental response can often convey empathy to a client. Claiming the same experience, turning the statement into a "lesson," or exploring before acknowledging are communication techniques that can impair communication.

A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? A. "Have you shared your feelings with your family?" B. "I think we should talk more about your anger with your family" C. "You're feeling angry that your family continues to hope for you to be cured?" D. "You are probably very depressed, which is understandable with such a diagnosis"

C. "You're feeling angry that your family continues to hope for you to be cured?" Restating is a therapeutic communication technique in which the nurse repeats what the client says to show understanding and to review what was said. Although it is appropriate for the nurse to attempt to assess the client's ability to discuss feelings openly with family members, it does not help the client discuss the feelings causing the anger. The nurse's direct attempt to expect the client to talk more about the anger is premature. The nurse would never make a judgment regarding the reason for the client's feeling; this is nontherapeutic in the one-to-one relationship

The nurse visits an a client at home. The client states, "I haven't slept at all the last couple nights." Which response by the nurse demonstrates therapeutic communication? A. "I see" B. Really?" C. "You're having difficulty sleeping?" D. "Sometimes I have difficulty sleeping too"

C. "You're having difficulty sleeping?" The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the client's major theme, which assists the nurse to obtain a more specific perception of the problem from this client. The remaining options are nontherapeutic responses because none of them encourages the client to expand on the problem. Offering person experiences moves the focus away from the client and onto the nurse

A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? A. 5 to 10 years old B. 10 to 14 years old C. 18 to 22 years old D. 25 to 35 years old

C. 18 to 22 years old The onset of bulimia nervosa commonly occurs in late adolescence or early adulthood. Bulimia nervosa is more prevalent than anorexia nervosa. Research suggests that bulimia occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and in which an abundance of food is available.

Which of the following terms describes an inability to recognize or name objects despite intact sensory abilities? A. Apraxia B. Aphasia C. Agnosia D. Executive functioning disturbance

C. Agnosia Agnosia is the inability to recognize the name of objects. Apraxia is the impaired ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function. Executive functioning is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.

Which of the following substances is abused most often in the United States? A. Marijuana B. Nicotine C. Alcohol D. Benzodiazepines

C. Alcohol Alcohol is abused most often in the United States.

The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss? A. Bulimia nervosa, purging type B. Anorexia nervosa, restricting type C. Anorexia nervosa, purging type D. Binge eating disorder

C. Anorexia nervosa, purging type The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests anorexia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.

A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans? A. Attempt to discuss placing the client into an assisted living environment B. Ask the parents how they have coped with the client's behaviors over the years C. Ask the parents to keep a written schedule of activities for each day for the client D. Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home

C. Ask the parents to keep a written schedule of activities for each day for the client When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder.

A psychiatric-mental health nurse has been leading a symptom management group for several weeks. The nurse and the participants express satisfaction with the group's activities and the nurse has identified that an indirect leadership style will be appropriate. How should the nurse apply this leadership style? A. Loosen the requirements around consistent attendance and punctuality B. Transition the group from being closed to being open C. Avoid intervening during a meeting unless absolutely necessary D. Have each member of the group take turns leading when the nurse is unable to attend

C. Avoid intervening during a meeting unless absolutely necessary Indirect leadership entails giving little guidance or direction to the group. However, this does not mean that attendance and punctuality become unimportant or that the group must become open. Indirect leadership does not mean that the nurse delegates leadership to participants.

A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment? A. Heat intolerance B. Complaints of heartburn C. Bradycardia D. Hypertension

C. Bradycardia Associated physical exam findings include cold intolerance, complaints of constipation and abdominal pain, hypotension, and bradycardia.

An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status? A. Depression related to declining health B. Dementia related to advancing age C. Delirium related to underlying medical problem D. Transient ischemic attacks related to vascular disease and diabetes

C. Delirium related to underlying medical problem Any disturbance in any organ or system that affects the brain can disrupt metabolism and neurotransmission, leading to a decline in cognition and function. Infections, fluid and electrolyte imbalances, and drugs are the most frequent causes of delirium. Older adults are especially susceptible to delirium disorders because the aging neurologic system is particularly vulnerable to insults caused by underlying systemic conditions. Indeed, delirium often predicts or accompanies physical illness in older adults.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder? A. Administer prescribed pharmacotherapy B. Ensure adherence to counseling C. Develop a sound, positive nurse-client relationship D. Assist in developing a daily routine

C. Develop a sound, positive nurse-client relationship Although administering prescribed pharmacotherapy, counseling, and assisting in developing a daily routine are important, the most crucial part of the plan of care is developing a sound, positive nurse-client relationship. Without the relationship, the nurse is just one more provider who fails to meet the client's expectations.

Brain images of people with ADHD have suggested decreased metabolism in which of the following cerebral lobes? A. Parietal B. Temporal C. Frontal D. Occipital

C. Frontal Brain images of people with ADHD have suggested decreased metabolism in the frontal lobes, which are essential for attention, impulse control, organization, and sustained goal-directed activity.

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include? A. In somatic symptom disorder, clients consciously seek attention. B. In factitious disorders, clients are unaware that their symptoms are not real. C. In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. D. Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder.

C. In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. Clients with somatic symptom disorder do not intentionally cause, and have no conscious or voluntary control over, their symptoms. Lack of voluntary control is in contrast to factitious disorder and malingering. In factitious disorder, clients deliberately make up or inflict symptoms.

During which type of leadership does the group leader offer little guidance to the group? A. Co-leadership B. Direct C. Indirect D. Autocratic

C. Indirect When using indirect leadership, the leader primarily reflects the group members' discussion and offers little guidance or information to the group. Direct leadership behavior enable the leader to control the interaction by giving direction and information and allowing little discussion. Co-leadership occurs when two people share responsibility for leading the group. Autocratic leadership occurs when one people make all the decisions for the group.

A nurse is conducting a presentation about autism spectrum disorder for a group of parents. When describing this condition, the nurse would identify that approximately 50% of those with this condition also experience which of the following? A. Seizure disorder B. Hypertension C. Intellectual disability D. Motor decline

C. Intellectual disability About half of children with autism spectrum disorder have intellectual disability, and about 25% have seizure disorders. Hypertension and motor decline are not associated with autism.

A client with a long history of alcohol abuse has presented to the emergency department with hallucinations and an incoherent story about being followed by the police. The client is likely experiencing which physiologic effect of alcohol use? A. cardiac myopathy B. flushing C. Korsakoff's psychosis D. leukopenia

C. Korsakoff's psychosis Korsakoff's psychosis is a physiologic effect of long-term alcohol use and manifests with hallucinations and making up or confabulating stories to mask the fact that there is significant memory loss. Cardiac myopathy is the weakening and thinning of the heart muscle effecting the ejection potential. Peripheral blood flow is disrupted. This problem is associate with long-term heavy alcohol use. Flushing refers to the reddening of the face and neck as a result of increased blood flow and has been linked to variants of gene enzymes involved in alcohol metabolism. Chronic alcohol consumption can have a variety of hematological effects including leukopenia. This is thought to be related to dysfunction of the liver. This problem would not manifest in the signs the client is presenting with, although bloodwork should be included in the client's medical investigations.

The nurse provides a therapy group on skills to a support group of clients with dependent personality disorder. The group identifies the need to addresses the nursing diagnosis of 'Impaired Home Maintenance.' What area does the nurse choose to focus on for these clients to address this nursing diagnosis? Select all that apply. A. Building a fence B. Avoiding conflict C. Managing finances D. Planning a weekly menu E. Simple meal preparation

C. Managing finances D. Planning a weekly menu E. Simple meal preparation The lack of skills to manage autonomously in the home is a typical challenge for an individual with dependent personality disorder. The nurse can focus on strengthening abilities in the areas of financial planning and management, preparing simple meals, and planning meals in advance. A task such as building a fence would be too complex and exceeds the scope of managing the home. Individuals with dependent personality disorder have a tendency to avoid interpersonal conflict, so incorporating this as an intervention to support improved functioning in the home is not warranted.

What examination is used to determine whether a client is experiencing abnormalities in thinking and reasoning ability, feelings, or behavior? A. Psychosocial examination B. Health examination C. Mental status examination D. Psychoses examination

C. Mental status examination The mental status examination (MSE) helps identify whether clients are experiencing abnormalities in thinking and reasoning, feelings, or behavior. It is part of the "tool kit" for gathering objective and observational data.

After educating a group of nursing students on somatic symptom disorder, the instructor determines that the education was successful when the group identifies which of the following as the most common problem? A. Nausea B. Paresthesias in the extremities C. Pain D. Muscle weakness

C. Pain Pain is the most common problem in people with somatic symptom disorder. Because pain is usually related to symptoms of all the major body systems, it is unlikely that somatic intervention (such as an analgesic) will be effective on a long-term basis. Nausea, muscle weakness, and paresthesias in the extremities are not the most common problems associated with somatic symptom disorder.

A older adult client develops delirium secondary to an infection. Which would be the most likely cause? A. Appendicitis B. Cellulitis C. Pneumonia D. Low platelet count

C. Pneumonia Delirium in the older adult is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia. Infections of the respiratory tract such as pneumonia or urinary tract are the most common. Appendicitis and cellulitis are not commonly associated with the development of delirium. Although low platelet count would render the older adult vulnerable to bleeding and easy bruising, it does not increase the risk of delirium.

Which of the following statements about somatic symptom disorder is most accurate? A. The disorder is usually diagnosed during middle age. B. The disorder is rare among most populations. C. The disorder manifests differently in different populations. D. Symptoms of the disorder in children usually involve joint pain

C. The disorder manifests differently in different populations. Somatic symptom disorder is found in most populations and cultures, even though its expression may vary from population to population. In cultures that highly stigmatize mental illness, somatic symptoms are more likely to occur. The disorder is usually diagnosed during adolescence. The most common symptoms in children are frequent abdominal pain, headache, fatigue, and nausea.

The client is brought to the hospital in a coma. The nurse understands that when a person is incapacitated, the document used to dictate the patient's written instructions for health care is called: A. patient rights B. durable power of attorney C. advance directive D. informed consent

C. advance directive Advance care directives are written instructions for health care when individuals are incapacitated. Informed consent, durable power of attorney, and patient rights are not instructions for health care when individuals are incapacitated. A durable power of attorney means that the advance care directives stays in effect if you become incapacitated and unable to handle matters on your own. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them.

After being arrested for prostitution, an adolescent client has been referred to a mental health clinic by a juvenile officer. The client has a history of truancy and being physically abusive to siblings. From the history gathered during assessment, the nurse might anticipate which diagnosis? A. intermittent explosive disorder B. oppositional disorder C. conduct disorder D. childhood depressive disorder

C. conduct disorder Conduct disorder is characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others. These clients have significantly impaired abilities to function in social, academic, or occupational areas. Symptoms are clustered in four areas: aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules. This is an example of moderate conduct. Moderate: The number of conduct problems increases as does the amount of harm to others. Examples include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. Many children can experience depression with social isolation but in this case it is a symptom not a diagnosis.

The most important tool of psychiatric nursing is the: A. physician. B. nurse. C. self. D. environment.

C. self. The most important tool of psychiatric nursing is the self.

The adult child of a client with dementia has been the primary caregiver for 5 months. The adult child expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most helpful response by the nurse? A. "Are you saying you don't want to care for your parent anymore?" B. "I know it is really hard. It takes a lot of work and you are doing such a good job." C. "Your parent really appreciates what you do. You are the best one to care for your parent." D. "Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?"

D. "Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?" Caregivers need outlets for dealing with their own feelings. Support groups can help them to express frustration, sadness, anger, guilt, or ambivalence; all these feelings are common. The nurse should not conclude that the daughter does not want to care for her mother or induce additional guilt. Affirming the daughter can be beneficial, but this does not offer solutions to the daughter's crisis.

A client with a dependent personality disorder is receiving treatment on a medical unit. The client asks the nurse for assistance to open the tube of toothpaste so they can brush their teeth. Which is the best response by the nurse? A. "Let me open that for you" B. "Tell me why you feel you can't do it yourself" C. "I feel you can get your family to help you with this when they come in" D. "I'll stay here and you can show me what you've tried to do to get the top off"

D. "I'll stay here and you can show me what you've tried to do to get the top off" A client with dependent personality disorder may look to others including the nurse to make everyday decisions and to assist with tasks both simple and complex. A helpful response by the nurse can integrate the typical challenges these clients face. The statement that validates the struggle, supports the client's individual efforts and supports the client by being present is the strongest response. Interventions that support dependency such as doing the task for the client or having someone else do it are not helpful. Offering a question using 'why' can contribute to defensiveness and a challenge to self-esteem.

The nurse best assesses a client's memory by asking which question? A. "Do you have any problems with memory?" B. "What did you have for lunch yesterday?" C. "Do you know why you are here?" D. "Who is the current president?"

D. "Who is the current president?" The nurse directly assesses memory, both recent and remote, by asking questions with verifiable answers such as "What is the name of the current president?" The nurse may not be able to verify the accuracy of the client's responses to questions such as "Do you have any memory problems?" or "What did you do yesterday?" Orientation refers to the client's recognition of person, place, and time. Asking the client why he or she is here assesses perception and insight.

A client is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa? A. 15.5 kg/m2 B. 16.1 kg/m2 C. 16.75 kg/m2 D. 17.3 kg/m2

D. 17.3 kg/m2 A BMI greater than or equal to 17 kg/m2 would characterize mild anorexia. Moderate anorexia is characterize by a BMI between 16 and 16.99 kg/m2. Severe anorexia would be characterized by a BMI between 15.0 to 15.99 kg/m2.

On review of the client's record, the nurse notes that the mental health admission was voluntary. Based on this information, the nurse anticipates which client behavior? A. Fearfulness regarding treatment measures. B. Anger and aggressiveness directed toward others. C. An understanding of the pathology and symptoms of the diagnosis. D. A willingness to participate in the planning of the care and treatment plan.

D. A willingness to participate in the planning of the care and treatment plan. If a client seeks voluntary admission, the most likely expectation is that the client will participate in the treatment program since he or she is actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee that a client understand their mental health problem, only the client's desire for help

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? A. Unable to identify a water pitcher B. Unable to transfer to sitting position C. Difficulty with verbal expression D. Disoriented to person

D. Disoriented to person Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. Dementia symptoms include aphasia (deterioration of language function), apraxia (impaired ability to execute motor functions despite intact motor abilities), and agnosia (inability to recognize or name objects despite intact sensory abilities).

A client meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this client would most likely be diagnosed with which of following? A. Anorexia nervosa B. Bulimia nervosa C. Binge eating disorder D. Eating disorder not otherwise specified

D. Eating disorder not otherwise specified Subclinical cases, also called partial syndromes, are usually diagnosed as Eating Disorder Not Otherwise Specified (EDNOS). These individuals still need treatment despite not meeting criteria for anorexia nervosa or bulimia nervosa.

A client is showing no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which term when documenting the client's affect? A. Absent affect B. Restricted affect C. Broad affect D. Flat affect

D. Flat affect Common terms used in assessing affect include blunted affect: showing little or a slow-to-respond facial expression; broad affect: displaying a full range of emotional expressions; flat affect: showing no facial expression; inappropriate affect: displaying a facial expression that is incongruent with mood or situation, often silly or giddy regardless of circumstances; restricted affect: displaying one type of expression, usually serious or somber. A flat affect is not synonymous with having an "absent" affect.

During a physical assessment, the nurse would recognize that there is the potential for medication-induced weight loss in a client who is being treated with which medication? A. Olanzapine B. Ziprasidone C. Risperidone D. Fluoxetine

D. Fluoxetine Atypical antipsychotics are often associated with weight gain, while some antidepressants such as fluoxetine tend to induce weight loss.

When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? A. Providing a supportive environment B. Examining intrapsychic conflicts and past issues C. Emphasizing social interaction with clients who withdraw D. Helping the client to examine dysfunctional thoughts and beliefs

D. Helping the client to examine dysfunctional thoughts and beliefs Cognitive behavioral therapy is used to help the client identify and examine dysfunctional thoughts and to identify and examine beliefs that maintain these thoughts. The remaining options, while therapeutic in certain situations, are not the focus of cognitive behavioral therapy

The nurse is assessing a client who was admitted 24 hours ago for a fractured humerus. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? A. Hypotension, ataxia, hunger B. Stupor, lethargy, muscular rigidity C. Hypotension, coarse hand tremors, lethargy D. Hypertension, changes in level of consciousness, hallucinations

D. Hypertension, changes in level of consciousness, hallucinations Symptoms associated with alcohol withdrawal delirium typically include anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, changes in LOC, agitation, fever, and delusions.

A client has a blood alcohol level of 0.05%. The nurse would expect which behavior to occur? A. Difficulty driving B. Stupor C. Coma D. Impaired judgment

D. Impaired judgment A blood alcohol level of 0.05% (1-2 drinks) would produce impaired judgment, giddiness, and mood changes. Difficulty driving occurs at a level of 0.10%. Stupor and coma occur at levels of 0.30% and 0.40%, respectively.

A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the client while respecting the client's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client? A. In the client's room when the client's roommate is present and 3 feet away B. In the client's room when the client's roommate is present and 3 feet away C. In an interview room in a remote section of the unit with the nurse 1 foot away from the client D. In a quiet corner of the dayroom at least 4 feet away from others

D. In a quiet corner of the dayroom at least 4 feet away from others A quiet corner of the dayroom at least 4 feet away from others would allow the patient privacy while being to deter any inappropriate activity would be the most appropriate setting. Being in the patient's room when the patient's roommate is present and 3 feet away or at the nurse's station when other patients and visitors are less than 4 feet away would not allow for the patient's privacy and may facilitate more inappropriate statements. An interview room in a remote section of the unit would not be a good choice as the area is too isolated and could exacerbate the problem. Additionally, the nurse should maintain a distance of more than 1.5 feet away from the patient as closer distances are within the intimate zone.

A child with attention deficit hyperactivity disorder is taking methylphenidate in divided doses. If the child takes the first dose at 8 a.m., which behavior might the school nurse expect to see at noon? A. Sleepiness or drowsiness B. Social isolation from peers C. Lack of appetite for lunch D. Increased impulsivity or hyperactive behavior

D. Increased impulsivity or hyperactive behavior Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. The child's symptoms may worsen four hours after a dose. Giving stimulants during daytime hours usually effectively combats insomnia. Social isolation is likely to be an ongoing, long term problem that is unrelated to the precise timing of doses. A loss of appetite is more likely when serum levels of the drug are higher.

The nurse is working with a client, who, despite making a heroic effort, was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship? A. Exploring the client's ability to function B. Exploring the client's potential for self-harm C. Inquiring about the client's perception or appraisal of why the rescue was unsuccessful D. Inquiring about and examining the client's feeling for any that may block adaptive coping

D. Inquiring about and examining the client's feeling for any that may block adaptive coping The client must first deal with feelings and negative responses before the client can work through the meaning of the crisis. The correct option pertains directly to the client's feelings and is client-focused. The remaining options do not directly focus on or address the client's feelings

A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client? A. Check the client's belongings for additional drugs. B. Pad the side rails of the bed because seizures are likely. C. Prepare a dose of ipecac, an emetic. D. Monitor respiratory function.

D. Monitor respiratory function. Barbiturates are potent central nervous system depressants and can greatly decrease respiratory functioning. Respiratory depression would be a more likely and life-threatening complication than seizures, and would consequently be prioritized. Locating additional drugs does nothing to address life-threatening complications. Inducing vomiting would not remove drugs that the client has already metabolized, so would be of little benefit.

A client with a somatic symptom illness asks what is causing the physical symptoms. Which would be the appropriate explanation for the nurse to offer? A. Physical symptoms can be attributed to an organic cause. B. Physical symptoms are deliberately expressed in order to benefit in some way. C. Physical symptoms are independent of the amount of the client's psychic distress. D. Physical symptoms are an involuntary way of dealing with psychic conflict.

D. Physical symptoms are an involuntary way of dealing with psychic conflict. The three central features of somatic symptom are as follows: physical complaints suggest major medical illness, but have no demonstrable organic basis; psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms; and symptoms or magnified health concerns are not under the client's conscious control. The severity of symptoms corresponds to the severity of psychic conflict

The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment? A. Assign peer-led exercise activities on a daily basis. B. Provide a buffet-style menu with many food choices. C. Open the windows and doors to allow fresh air to circulate through the environment. D. Plan for the same caregivers to provide care to individuals as much as possible.

D. Plan for the same caregivers to provide care to individuals as much as possible. Providing the same caregiver establishes familiarity and routine and can provide reassurance to clients with dementia. Open doors pose a safety risk of wandering away. Buffet-style meals require the client to make too many choices, thus adding to frustration. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission? A. Suicidal assessment B. Working on self-esteem C. Impulse control D. Protection from self-mutilation

D. Protection from self-mutilation Clients with borderline personality disorder become intensely and inappropriately angry if they believe others are ignoring them and consequently may impulsively try to harm or mutilate themselves.

A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? A. Guided imagery B. Distraction C. Music therapy D. Self-monitoring

D. Self-monitoring Self-monitoring is a type of behavioral therapy. It is designed to help the client with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.

The nurse receives a report that a 75-year-old client is recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse the name of the client's daughter. The nurse interprets this behavior as what? A. Normal for the first postoperative day B. Normal, given the client's age C. Signs of early Alzheimer's disease D. Signs of delirium

D. Signs of delirium Delirium is a syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. Growing rates of delirium mirror the increasing older adult population and are expected to continue to rise. Delirium is the most common psychiatric syndrome in general hospitals, occurring in up to 50% of elderly inpatients. It is associated with significantly increased morbidity and mortality both during and after hospitalization.

The nurse is beginning a group counseling session with an open group system. The nurse should explain to the group members that one advantage of an open group system is that ... A. it can offer the best treatment outcomes. B. the topics for the group can be controlled. C. relationships are more easily established in the group. D. new members can join the group at any time.

D. new members can join the group at any time. One advantage of an open group system is that new members can join the group at any time and stay in the group as long as needed.

What is the most appropriate nursing action to manage a manic client who is monopolizing a group therapy session? A. Ask the client to leave the group for this session only. B. Refer the client to another group that includes manic clients C. Tell the client to stop monopolizing in a firm but compassionate manner D. Thank the client for the input, but inform the client that others now need a chance to contribute

D. Thank the client for the input, but inform the client that others now need a chance to contribute If a client is monopolizing the group, the nurse must be direct and decisive. The best action to thank the client and suggest that the client stop talking and try listening to others. Although telling the client to stop monopolizing in a firm but compassionate manner may be a direct response, the correct option is more specific and provides direction for the client. The remaining options are inappropriate because they are not directed toward helping the client in a therapeutic manner

In providing post-op care for the client who has just undergone ECT, which of the following findings would indicate that ECT has been effective and the client is displaying normal sequelae of this procedure? A. The client's heart rate is 120 and a slight arrhythmia is detected. B. The client has a seizure in the recovery room. C. The client is highly agitated and trying to get out of the bed. D. The client cannot remember to which inpatient unit he or she is returning.

D. The client cannot remember to which inpatient unit he or she is returning. Short-term memory loss is a common side effect of the ECT procedure. Arrhythmias, tachycardia, seizures, and agitation are not expected following ECT; they should be thoroughly assessed.

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? A. The client has revitalized the relationship with the client's sister. B. The nurse has designated a specific time each day to interact with the client. C. The client expresses a desire to be mothered and pampered. D. The client recognizes feelings of anger and expresses them appropriately.

D. The client recognizes feelings of anger and expresses them appropriately. When the client can begin to recognize feelings and talk about them, the relationship has moved into a working phase.

A 22-year-old client has voluntarily sought treatment for an eating disorder at a rural residential facility. Despite a promising start, the client has been involved in recent conflicts with staff members and insists that the client wants to leave the facility. Staff members have refused to facilitate the client's transportation from the facility and have stated that they will not return the client's money and identification that were held when the client was admitted. Staff at the treatment facility may be guilty of false imprisonment due to what? A. The client's diagnosis is not terminal B. The facility is in an inaccessible location C. The client's diagnosis is not psychiatric in etiology D. The client voluntarily admitted for treatment

D. The client voluntarily admitted for treatment Clients who voluntarily admit themselves for psychiatric treatment have the right to leave whenever they choose

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as ... A. Confrontation B. Countertransference C. Incongruence D. Transference

D. Transference Transference is the shifting of an emotion from one person to another. Confrontation is a technique used to highlight the incongruence between a person's verbalizations and actual behavior. Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. Incongruence occurs when the communication content and process disagree.

A client has contacted the care provider because of concerns for the client's 55-year-old spouse, who suddenly became very forgetful in recent days. Most recently, the spouse became lost while driving to the spouse's home of 30 years and temporarily forgot the client's adult child's name. The client also had a temporary slurring of speech lasting about a minute. Diagnostic testing has ruled out delirium and the spouse had been previously healthy. Which would the nurse most likely suspect? A. Alzheimer's Disease B. Neurocognitive disorder with Lewy Bodies C. Frontotemporal neurocognitive disorder D. Vascular neurocognitive disorder

D. Vascular neurocognitive disorder The behavior changes that result from vascular neurocognitive disorder are similar to those found in Alzheimer's disease, such as memory loss, depression, emotional lability or emotional incontinence (including inappropriate laughing or crying), wandering or getting lost in familiar places, bladder or bowel incontinence, difficulty following instructions, gait changes such as small shuffling steps, and problems handling daily activities (e.g., money management). However, these symptoms usually begin more suddenly rather than developing slowly, as is the case in Alzheimer's disease. The onset of Alzheimer's disease is most likely after the age of 65. Neurocognitive disorder with Lewy bodies is associated with progressive cognitive decline with visual hallucination, rapid eye movement sleep disorder, and spontaneous Parkinsonism. Frontotemporal neurocognitive disorder is associated with progressive development of behavioral and personality change and/or language impairment.

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? A. "You have everything to live for" B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed" D. "You've been feeling like a failure for a while?"

D. You've been feeling like a failure for a while? Responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the client's experience and do not facilitate exploration of the client's expressed feelings. In addition, use of the word why is nontherapeutic because clients frequently interpret why questions accusations; why questions can cause resentment, insecurity, and mistrust