Psychobiological disorders
A client is admitted to the psychiatric unit of the hospital with a diagnosis of conversion disorder. The client is unable to move either leg. Which finding should the nurse consider consistent with this diagnosis? 1. Feeling depressed 2. Appearing composed 3. Demonstrating free-floating anxiety 4. Exhibiting tension when discussing symptoms
2. Appearing composed
A middle-age female client who has lost 20 lb over the last 2 months cries easily, sleeps poorly, and refuses to participate in any family or social activities that she previously enjoyed. What is the most important nursing intervention? 1. Providing the client with a high-calorie, high-protein diet 2. Reducing the client's crying episodes by setting firm, consistent limits 3. Assuring the client that she will regain her usual function in a short time 4. Allowing the client to externalize her feelings, especially anger, in a safe manner
4. Allowing the client to externalize her feelings, especially anger, in a safe manner
A nurse is caring for a client with the diagnosis of alcohol withdrawal delirium. Which action is most appropriate for the nurse to implement? 1. Keeping the client calm by applying wrist restraints 2. Encouraging the client to relate the content of hallucinations 3. Assuring the client that the symptoms are part of the withdrawal syndrome 4. Dimming the client's room lights to counter the visual distortions being experienced
3. Assuring the client that the symptoms are part of the withdrawal syndrome
A nurse is caring for a client with the diagnosis of somatoform disorder, conversion type. What type of affect does the nurse expect this client to exhibit? (Select all that apply.) 1 . Calm 2 . Cheerful 3 . Depressed 4 . Frightened 5 . Matter-of-fact
1 . Calm 5 . Matter-of-fact
The parent of a child with a tentative diagnosis of attention deficit-hyperactivity disorder (ADHD) arrives at the pediatric clinic insisting on getting a prescription for medication that will control the child's behavior. What is best response by the nurse? 1. "It must be frustrating to deal with your child's behavior." 2. "Have you considered any alternatives to using medication?" 3. "Perhaps you're looking for an easy solution to the problem." 4. "Let me teach you about the side effects of medications used for ADHD."
1. "It must be frustrating to deal with your child's behavior." **Stating that it must be frustrating acknowledges the parent's distress and encourages verbalization of feelings.
A client with schizophrenia reports having ongoing auditory hallucinations that he describes as "voices telling me that I'm a bad person" to the nurse. What is the best response by the nurse? 1. "Try to ignore the voices." 2. "What are the voices saying to you?" 3. "Do you believe what the voices are saying?" 4. "They're only voices, so just try not to be afraid."
1. "Try to ignore the voices."
Encouragement and appropriate praise should be given to hyperactive clients to help them increase their feelings of self-esteem. When they have acted appropriately, what is the best statement for the nurse to make in an effort to let them know of their improvement? 1. "You behaved well today." 2. "I knew you could behave." 3. "Everyone likes you better when you behave like this." 4. "Your behavior today was much better than it was yesterday."
1. "You behaved well today."
An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider? (Select all that apply.) 1. Blurred vision 2. Suicidal ideation 3. Difficult urination 4. Tardive dyskinesia 5 . Transient hypoglycemia
1. Blurred vision 2. Suicidal ideation 3. Difficult urination
A nurse concludes that a client's withdrawn behavior may temporarily provide a: 1. Defense against anxiety 2. Basis for emotional growth 3. Time for internal problem-solving 4. Delay to organize personal resources
1. Defense against anxiety
A client arrives at the mental health clinic disheveled, agitated, and demanding that the nurse "do something to make these feeling stop." What clinical manifestation is evident? 1. Feelings of panic 2. Suicidal tendencies 3. Narcissistic ideation 4. Demanding personality
1. Feelings of panic
A client tells the nurse, "I used to believe that I was a princess, but now I know that that's not true." What is the best response by the nurse? 1. "You really believed that?" 2. "Many people have this delusion." 3. "That's is a sign that you're getting better." 4. "What caused you to think that you were a princess?"
3. "That's is a sign that you're getting better."
How can a nurse minimize agitation in a disturbed client? 1. By ensuring constant staff contact 2. By increasing environmental sensory stimulation 3. By limiting unnecessary interactions with the client 4. By discussing the reasons for the client's suspicions
3. By limiting unnecessary interactions with the client
A client with a diagnosis of dementia of the Alzheimer type has been taking donepezil (Aricept) 10 mg/day for 3 months. The client's partner calls the clinic and reports, "He's gotten more restless and agitated, and now he's nauseated." What should the nurse advise the partner to do? 1. Give the medication with food 2. Administer the medication to the partner at bedtime 3. Omit one dose today and start with a lower dose tomorrow 4. Bring the partner to the clinic for testing and a physical examination
4. Bring the partner to the clinic for testing and a physical examination
What should a nurse conclude that a client is doing when he makes up stories to fill in blank spaces of memory? 1. Lying 2. Denying 3. Rationalizing 4. Confabulating
4. Confabulating
A nurse is caring for a client with the diagnosis of dementia. What should the nurse ask the client to best ascertain orientation to place? 1. "Where are you?" 2. "Who brought you here?" 3. "Do you know where you are?" 4. "Do you know what day you arrived?"
1. "Where are you?"
What is the primary reason that the nurse encourages the family of an alcoholic to become involved in the treatment program? 1. Alcoholism involves the entire family. 2. Alcoholics try to hide their drinking from their families. 3. Family members provide insights into the dynamics behind the drinking. 4. Family members have been most successful in providing necessary support.
1. Alcoholism involves the entire family.
A client is found to have an adjustment disorder with mixed anxiety and depression. What should the nurse anticipate as the client's primary problem? 1. Low self-esteem 2. Deficient memory 3. Intolerance of activity 4. Disturbed personal identity
1. Low self-esteem
A client with dementia has been cared for by the spouse for 5 years. During the last month the client has become agitated and aggressive and is incontinent of urine and feces. What is the priority nursing care while this client is in an inpatient mental health facility? 1. Managing the behavior 2. Preventing further deterioration 3. Focusing on the needs of the spouse 4. Establishing an elimination retraining program
1. Managing the behavior
A constructive but lengthy method of confronting the stress of adolescence and preventing a negative and unhealthy developmental outcome is: 1. Role experimentation 2. Adherence to peer standards 3. Sublimation through schoolwork 4. Development of dependence on parents
1. Role experimentation
What childhood problem has legal as well as emotional aspects and cannot be ignored? 1. School phobia 2. Fear of animals 3. Fear of monsters 4. Sleep disturbances
1. School phobia **School phobia is a disorder that cannot legally be ignored for long because children must attend school.
What is the primary concern for a nurse caring for a client who is grossly impaired by stimulants? 1. Drowsiness 2. Seizure activity 3. Fluid imbalance 4. Suicidal ideation
2. Seizure activity
A daycare environment is recommended for a client with incapacitating behaviors resulting from an obsessive-compulsive personality disorder. The client's partner asks the nurse why this approach is necessary. What is the best response by the nurse? 1. "This environment limits time to carry out the rituals." 2. "A neutral atmosphere facilitates the working through of conflicts." 3. "A location that requires no decision-making will resolve feelings of anxiety." 4. "The daycare setting allows the staff to exert control over unacceptable behaviors."
2. "A neutral atmosphere facilitates the working through of conflicts."
What defense mechanism should the nurse anticipate that a client with the diagnosis of schizophrenia, undifferentiated type, will most often exhibit? 1. Projection 2. Regression 3. Repression 4. Rationalization
2. Regression
A client's history demonstrates a pervasive pattern of unstable and intense relationships, impulsiveness, inappropriate anger, manipulation, offensive behavior, and hostility. The admitting diagnosis is borderline personality disorder. What does the nurse anticipate that this client may attempt to do? 1. Act out to intimidate others 2. Cooperate with the staff to gain praise 3. Divide the staff into opposing factions to gain self-esteem 4. Remain removed from others to avoid interacting with them
3. Divide the staff into opposing factions to gain self-esteem
A client with a diagnosis of panic disorder who had a panic attack on the previous day says to the nurse, "That was a terrible feeling I had yesterday. I'm so afraid to talk about it." What is the most therapeutic response by the nurse? 1. "OK; we don't have to talk about it." 2. "Why don't you want to talk about it?" 3. "What were you doing yesterday when you first noticed the feeling?" 4. "I understand, but don't be concerned; that feeling probably won't come back."
3. "What were you doing yesterday when you first noticed the feeling?"
A client who is on the third day of detoxification therapy becomes agitated and restless. What are the signs and symptoms that indicate impending alcohol withdrawal delirium? (Select all that apply.) 1. Polydipsia 2. Drowsiness 3. Diaphoresis 4. Tachycardia 5. Hypertension
3. Diaphoresis 4. Tachycardia 5. Hypertension
What is the greatest difficulty for nurses caring for the severely depressed client? 1. Client's lack of energy 2. Negative cognitive processes 3. Contagious quality of depression 4. Client's psychomotor retardation
3. Contagious quality of depression **Depression is contagious; it affects the nurse as well as the client.
A nurse is assigned to care for a college student who has been talking to unseen people and refusing to get out of bed, go to class, or participate in daily grooming activities. What is the nurse's initial effort toward helping this client? 1. Providing frequent rest periods 2. Reducing environmental stimuli 3. Facilitating the client's social relationships with a peer group 4. Attempting to establish a meaningful relationship with the client
4. Attempting to establish a meaningful relationship with the client
A client with the diagnosis of schizophrenia refuses to eat meals. Which nursing action is most beneficial for this client? 1. Directing the client repeatedly to eat the food 2. Explaining to the client the importance of eating 3. Waiting and allowing the client to eat whenever the client is ready 4. Having a staff member sit with the client in a quiet area during mealtimes
4. Having a staff member sit with the client in a quiet area during mealtimes
A depressed client is admitted to the mental health unit. What factor should the nurse consider most important when evaluating the client's current risk for suicide? 1. History of suicide attempts 2. Lack of interest in appearance 3. How long the depression has existed 4. Impending anniversary of the loss of a loved one
4. Impending anniversary of the loss of a loved one
A nurse is caring for a client with an obsessive-compulsive personality disorder that involves rituals. What should the nurse conclude about the ritual? 1. It has a purpose but is useless. 2. It is performed after long urging. 3. It appears to be performed willingly. 4. It seems illogical but is needed by the person
4. It seems illogical but is needed by the person
A nurse is assisting with the administration of electroconvulsive therapy (ECT) to a severely depressed client. What side effect of the therapy should the nurse anticipate? 1. Loss of appetite 2. Postural hypotension 3. Complete temporary loss of memory 4. Confusion immediately after the treatment
4. Confusion immediately after the treatment
The parents of an overweight 12-year-old bring their child to the mental health clinic. One parent says, "You've got to do something to help us—just look how huge he is." The child tells the nurse, "I hate school. The other kids tease me about my weight. I'm always last when they pick teams in gym." What is the most therapeutic response by the nurse? 1. "That hurts a lot when you want to be liked." 2. "Not everybody's a great athlete; you have other strengths." 3. "You should try letting them know how that makes you feel" 4. "It will be great when you lose weight; then you can do better in gym"
1. "That hurts a lot when you want to be liked." **The response "That hurts a lot when you want to be liked" identifies the child's feelings and lets the child know that the nurse understands.
A 5-foot 5-inch 15-year-old girl who weighs 80 lb is admitted to a mental health facility with a diagnosis of anorexia nervosa. The nurse recognizes that her problem most likely is caused by: 1. A desire to control her life 2. The wish to be accepted by her peers 3. The media's emphasis on the beauty of thinness 4. A delusion in which she believes that she must be thin
1. A desire to control her life
A withdrawn client refuses to get out of bed and becomes upset when asked to do so. What nursing action is most therapeutic? 1. Requiring the client to get out of bed 2. Staying with the client until the client calms down 3. Giving the client the PRN antipsychotic that is prescribed 4. Leaving the client alone in bed for as long as the client wishes
2. Staying with the client until the client calms down
Which suicide method is the least lethal? 1. Hanging 2. Ingesting pills 3. Jumping from a tall bridge 4. Poisoning with carbon monoxide
2. Ingesting pills
Which activity is most appropriate for a nurse to introduce to a depressed client during the early part of hospitalization? 1. Board game 2. Project involving drawing 3. Small aerobic exercise group 4. Card game with three other clients
2. Project involving drawing
A client is responding within an hour of receiving naloxone to combat respiratory depression from an overdose of heroin. Why should a nurse continue to closely monitor this client's status? 1. The drug may cause peripheral neuropathy. 2. Naloxone and heroin when combined can cause cardiac depression. 3. Symptoms of the heroin overdose may return after the naloxone is metabolized. 4. Hyperexcitability and amnesia may cause the client to thrash about and become abusive.
3. Symptoms of the heroin overdose may return after the naloxone is metabolized.
A nurse is planning care for a depressed client. Which approach is most therapeutic? 1. Allowing the client time to complete activities 2. Helping the client focus on the family support system 3. Encouraging the client to perform repetitious menial tasks 4. Telling the client repeatedly that the staff views the client as worthwhile
1. Allowing the client time to complete activities
A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene because these behaviors eventually will cause the other clients to feel: 1. Angry 2. Dependent 3. Inadequate 4. Ambivalent
1. Angry **A person with a condescending, superior attitude frequently evokes feelings of anger in others and will increase their anxiety.
An adult client confides to a clinic nurse, "I fantasize about having sex with children, and I get the urge to do it, too." What is the most appropriate response by the nurse? 1. Asking the client, "Have you ever acted on these thoughts?" 2. Explaining that these thoughts are unacceptable and that intensive therapy is needed. 3. Asking the client, "Are you able to control your thoughts about sexual relations with children?" 4. Informing the appropriate child protective services about the client and the thoughts that the client has reported
1. Asking the client, "Have you ever acted on these thoughts?"
A client newly admitted to the psychiatric unit because of an acute psychotic episode is actively hallucinating. The admitting nurse has documented the content of the auditory hallucinations, which center on the theme of powerlessness. Later the primary nurse approaches the client, who appears to be listening to voices, and comments, "You seem to be listening to something. Tell me what you hear." The primary nurse requests feedback from the psychiatric clinical specialist regarding this nursing intervention. How should the clinical specialist respond? 1. By reminding the nurse that once the content is known, there is no need to focus on the hallucinations because doing so reinforces them 2. By giving positive feedback for the nurse's attempt to explore the content of the client's hallucinations and reinforcing the need to continue this approach 3. By recognizing this as a positive intervention and helping the nurse develop a plan of care that calls for a contract to refrain from acting on command hallucinations 4. By suggesting that the nurse use an open-ended approach and asking the nurse to discuss the correlation between positive behaviors observed and prescribed antipsychotics.
1. By reminding the nurse that once the content is known, there is no need to focus on the hallucinations because doing so reinforces them
The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the client's record and finds that this client did not have an interrupted sleep pattern disorder before transfer from a private room to a four-bed room 3 days ago. What factor should the nurse identify as most likely related to the client's sleeplessness? 1. Fear of the other clients 2. Concern about family at home 3. Watching for an opportunity to escape 4. Trying to work out emotional problems
1. Fear of the other clients **Because the client has paranoid feelings that other people are out to do harm, assignment to a four-bed room may be threatening.
A client with a history of schizophrenia attends the mental health clinic for a regularly scheduled group therapy session. The client arrives agitated and exhibits behaviors that indicates that she is hearing voices. When a nurse begins to walk toward her, the client pulls out a large knife. What is the best approach by the nurse? 1. Firm 2. Passive 3. Empathetic 4. Confrontational
1. Firm
What is the best nursing intervention to encourage a socially withdrawn client to talk? 1. Focusing on nonthreatening subjects 2. Trying to get the client to discuss feelings 3. Asking simple yes-or-no questions of the client 4. Sitting quietly while looking through magazines with the client
1. Focusing on nonthreatening subjects
A client in the mental health clinic has a phobia about closed spaces. Which desensitization method should the nurse expect to be used successfully with this client? 1. Imagery 2. Contracting 3. Role playing 4. Assertiveness training
1. Imagery **Imagery is a therapeutic approach that is used to facilitate positive self-talk; mental pictures under the control of and initiated by the client may correct faulty cognitions.
A 4-year-old child is found to have attention deficit-hyperactivity disorder (ADHD). What information about the child's behavior should the nurse expect when obtaining a health history from the parents? (Select all that apply.) 1. Impulsiveness 2. Excessive talking 3. Spitefulness and vindictiveness 4. Deliberate annoyance of others 5. Playing video games for hours on end 6. Failure to follow through or finish tasks
1. Impulsiveness 2. Excessive talking 5. Playing video games for hours on end 6. Failure to follow through or finish tasks
What should nurses consider when working with depressed young children? 1. It is important to include the family in the treatment plan. 2. The goal of therapy is for the child to gain insight into problems. 3. Depressed children are treated in much the same way as depressed adults. 4. Antidepressant medication is the treatment of choice for depressed children
1. It is important to include the family in the treatment plan.
An agitated, acting-out, delusional client is receiving large doses of haloperidol (Haldol), and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations should alert the nurse to stop the drug immediately? (Select all that apply.) 1. Jaundice 2. Dizziness 3. Tachycardia 4. Lethargic behavior 5. Extrapyramidal symptoms
1. Jaundice 3. Tachycardia
A client who attempted suicide by slashing her wrists is transferred from the emergency department to a mental health unit. What important nursing interventions must be implanted when the client arrives on the unit? (Select all that apply.) 1. Obtaining vital signs 2. Assessing for suicidal thoughts 3. Instituting continuous monitoring 4. Initiating a therapeutic relationship 5. Inspecting the bandages for bleeding
1. Obtaining vital signs 2. Assessing for suicidal thoughts 3. Instituting continuous monitoring 4. Initiating a therapeutic relationship 5. Inspecting the bandages for bleeding
A client in the early dementia stage of Alzheimer's disease is admitted to a long-term care facility. Which activities must the nurse initiate? (Select all that apply.) 1. Weighing the client once a week 2. Having specialized rehabilitation equipment available 3. Keeping the client in pajamas and robe most of the day 4. Establishing a schedule with periods of rest after activities 5. Reviewing the client's weekly budget and use of community resources 6. Setting up a plan for weekly entertainment through a senior citizens group
1. Weighing the client once a week 2. Having specialized rehabilitation equipment available 3. Keeping the client in pajamas and robe most of the day
A nurse is working in a clinic that provides services to clients who abuse drugs. What effect of cocaine should the nurse consider as the reason that it easily causes dependence? 1. Eases pain 2. Blurs reality 3. Clears the sensorium 4. Decreases motor activity
2. Blurs reality **The addict tries to avoid stress and reality.
A nurse is caring for a hyperactive, manic client who exhibits flight of ideas and is not eating. What may be the reason why the client is not eating? 1. Feels undeserving of the food 2. Is too busy to take the time to eat 3. Wishes to avoid others in the dining room 4. Believes that there is no need for food at this time
2. Is too busy to take the time to eat
At mealtime a client with schizophrenia moves to the counter to choose food but is unable to decide what to do next. The nurse, recognizing the client's ambivalence, assists by using: 1. Nonverbal communication 2. Simple declarative statements 3. Basic questions requiring simple choices 4. Rewards for each of the food items chosen
2. Simple declarative statements
A nurse considers the cultural factors that may influence the development of eating disorders. The nurse recalls that eating disorders exist more frequently in: 1. Affluent families 2. European countries 3. Industrialized societies 4. Men rather than women
3. Industrialized societies **Eating disorders are prevalent in industrialized societies that have an abundance of food; affected individuals likely equate food with pleasure, comfort, and love and may have been nurtured, punished, or rewarded with food.
A client tells a nurse, "I have been having trouble sleeping and feel wide awake as soon as I get into bed." Which strategies should the nurse teach the client that will promote sleep? (Select all that apply.) 1. Eating a heavy snack near bedtime 2. Reading in bed before shutting out the light 3. Leaving the bedroom when unable to sleep 4. Drinking a cup of warm tea with milk at bedtime 5. Exercising in the afternoon rather than in the evening 6 . Counting backward from 100 to 0 when his mind is racing
3. Leaving the bedroom when unable to sleep 5. Exercising in the afternoon rather than in the evening 6 . Counting backward from 100 to 0 when his mind is racing
A nurse is caring for an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? 1. Paranoid delusions and hypervigilance 2. Depression and psychomotor retardation 3. Loosened associations and hallucinations 4. Ritualistic behavior and obsessive thinking
3. Loosened associations and hallucinations
A client with the diagnosis of bipolar disorder, depressive episode, has been hospitalized on a psychiatric unit for 1 week. What is the most appropriate activity for this client? 1. Completing a jigsaw puzzle alone 2. Playing cards with several other clients 3. Talking with the nurse several times during the day 4. Engaging in a game of table tennis with another client
3. Talking with the nurse several times during the day
When talking with one of the day nurses, a client with the diagnosis of anorexia nervosa states that the day nurses give better care and are nicer than the night nurses. The client also asks a question that the day nurse knows was already answered by one of the night nurses. What conclusion should the nurse make about the client? 1. The client needs assistance in exploring and verbalizing feelings about the night nurses 2. The client is trying to develop a bond of trust with a staff member that should be supported 3. The client is trying to divide the staff, and the behavior should be reported to the other staff members 4. The client has negative feelings about the night nurses, and the nurses should be informed of these feelings
3. The client is trying to divide the staff, and the behavior should be reported to the other staff members
A depressed client is concerned about many fears that are upsetting and frightening and expresses a feeling of having committed the "unpardonable sin." What is the most therapeutic response by the nurse? 1. "Your family loves you very much." 2. "You do understand that you really aren't a bad person, right?" 3. "You know that these feelings are in your imagination and aren't true, right?" 4. "Your thoughts are just a part of your illness, and they'll change as you get better."
4. "Your thoughts are just a part of your illness, and they'll change as you get better."
What characteristic of the environment is most therapeutic for clients with the diagnosis of bulimia nervosa? 1. Controlling 2. Empathetic 3. Focused on food 4. Based on realistic limits
4. Based on realistic limits **Realistic guidelines reduce anxiety, increase feelings of security, and increase adherence to the therapeutic regimen.
What therapeutic nursing intervention may redirect a hyperactive, manic client? 1. Suggesting that the client write a short story 2. Having the client initiate group social activities on the unit 3. Asking the client to guide other clients as they clean their rooms 4. Encouraging the client to tear pictures out of magazines for a scrapbook
4. Encouraging the client to tear pictures out of magazines for a scrapbook
Hospitalization or day-treatment centers are often indicated for the treatment of a client with obsessive-compulsive disorder because these settings: 1. Prevent the client from completing rituals 2. Allow the staff to exert control over the client's activities 3. Resolve the client's anxiety because decision making is minimal 4. Provide the neutral environment the client needs to work through conflicts
4. Provide the neutral environment the client needs to work through conflicts
When reviewing the medications for a group of clients on a psychiatric unit, the nurse concludes that the pharmacotherapy for anxiety disorders is moving away from benzodiazepines and moving toward: 1. Anticholinergics 2. Lithium carbonate 3. Antipsychotic medications 4. Selective serotonin reuptake inhibitors
4. Selective serotonin reuptake inhibitors **Selective serotonin reuptake inhibitors have better safety profiles and do not carry the risk of substance abuse and tolerance.
What characteristic uniquely associated with psychophysiological disorders differentiates them from somatoform disorders? 1. Emotional cause 2. Feeling of illness 3. Restriction of activities 4. Underlying pathophysiology
4. Underlying pathophysiology **The psychophysiological response (e.g., hyperfunction or hypofunction) produces actual tissue change.
What is the prognosis for a normal productive life for a child with autism? 1. Dependent on an early diagnosis 2. Often related to the child's overall temperament 3. Ensured as long as the child attends a school tailored to meet needs 4. Unlikely because of interference with so many parameters of function
4. Unlikely because of interference with so many parameters of function
A nurse in a community therapeutic recreation program is working with a client with dysthymia. The treatment plan suggests group activities when possible for this client. What is the priority rationale for this intervention? 1. A group can offer increased support. 2. The client is comfortable in group settings. 3. Exposure to group events will dispel the dysthymia. 4. Increased stimulation from the group elevates the mood.
1. A group can offer increased support.
A client who was involved in a near-fatal automobile collision arrives at the mental health clinic with complaints of insomnia, anxiety, and flashbacks. The nurse determines that the client is experiencing symptoms of crisis. What is the nurse's initial intervention? 1. Focusing on the present 2. Identifying past stressors 3. Discussing a referral for psychotherapy 4. Exploring the client's history of mental health problems
1. Focusing on the present **Crisis intervention deals with the here and now; the past is not important except in building on client strengths.
A nurse is caring for several clients with the diagnosis of bulimia nervosa. What primary feeling does the nurse anticipate that these clients experience after an episode of bingeing? 1. Guilt 2. Paranoia 3. Euphoria 4. Satisfaction
1. Guilt **A sense of being out of control accompanies the consumption of large amounts of food, resulting in guilt, depression, and disgust with one's self.
A client with a diagnosis of bipolar disorder, manic episode, is admitted to the mental health unit. Because the environment is important, what should the nurse do? 1. Place the client in a private room to provide a quiet atmosphere 2. Assign the client to a room near the dayroom to provide access to activities 3. Schedule multiple activities with other clients to keep the client socially engaged 4. Ensure that there are colorful drapes in the client's room to provide a cheerful environment
1. Place the client in a private room to provide a quiet atmosphere
An older depressed person at an independent living facility constantly complains about her health problems to anyone who will listen. One day the client says, "I'm not going to any more activities. All these old crabby people do is talk about their problems." What defense mechanism does the nurse conclude that the client is using? 1. Projection 2. Introjection 3. Somatization 4. Rationalization
1. Projection **The client is assigning to others those feelings and emotions that are unacceptable to him- or herself. Introjection is treating something outside the self as if it is inside the self. Somatization is the unconscious transformation of anxiety into a physical symptom that has no organic cause. Rationalization is the use of a socially acceptable logical explanation to justify personally unacceptable material.
Unsatisfied needs create anxiety that motivates an individual to action. What should the nurse identify as the purpose for this action? 1. Reducing tension 2. Denying the situation 3. Minimizing physical discomfort 4. Problem-solving and focusing on the problem
1. Reducing tension
A client in the early dementia stage of Alzheimer's disease is admitted to a long-term care facility. Which activities must the nurse initiate? (Select all that apply.) 1. Weighing the client once a week 2. Having specialized rehabilitation equipment available 3. Keeping the client in pajamas and robe most of the day 4 . Establishing a schedule with periods of rest after activities 5 . Reviewing the client's weekly budget and use of community resources 6 . Setting up a plan for weekly entertainment through a senior citizens group
1. Weighing the client once a week 2. Having specialized rehabilitation equipment available 4 . Establishing a schedule with periods of rest after activities
An older adult, accompanied by family members, is admitted to a long-term care facility with symptoms of dementia. During the admission procedure the initial statement by the nurse most helpful to this client is: 1. "You're a little disoriented now, but don't worry. You'll be all right in a few days." 2. "Don't be afraid. I'm your nurse, and everyone here in the hospital is here to help you." 3. "I'm the nurse on duty today. You're in the hospital. Your family can stay with you for a while." 4. "Let me introduce you to the staff here first. In a little while I'll get you acquainted with our unit routine."
2. "Don't be afraid. I'm your nurse, and everyone here in the hospital is here to help you."
A nurse uses the CAGE screening test for alcoholism to determine an individual's potential for a drinking problem. What is one of the four questions included on this test? 1. "Do you feel that you are a normal drinker?" 2. "Have you ever felt bad or guilty about your drinking?" 3. "Are you always able to stop drinking when you want to?" 4. "How often did you have a drink containing alcohol in the past year?"
2. "Have you ever felt bad or guilty about your drinking?"
A client who is addicted to opioids undergoes emergency surgery. During the postoperative period the health care provider decreases the previously prescribed methadone dosage. For what clinical manifestations should the nurse monitor the client? 1. Constipation and lack of interest in surroundings 2. Agitation and attempts to escape from the hospital 3. Skin dryness and scratching under the incision dressing 4. Lethargy and refusal to participate in therapeutic exercises
2. Agitation and attempts to escape from the hospital
A nurse is caring for a newly admitted, extremely depressed client. The most appropriate initial goal for the client 1. Setting realistic life goals 2. Developing trust in others 3. Expressing hostile feelings 4. Getting involved in activities
2. Developing trust in others
The nurse is caring for a client with vascular dementia. What does the nurse identify as the cause of this problem? 1. A long history of inadequate nutrition 2. Disruptions in cerebral blood flow, resulting in thrombi or emboli 3. A delayed response to severe emotional trauma in early adulthood 4. Anatomical changes in the brain that produce acute, transient symptoms
2. Disruptions in cerebral blood flow, resulting in thrombi or emboli
A frail, depressed client who frequently paces the halls becomes physically tired from the activity. What action should the nurse take to help reduce this activity? 1. Restrain the client in a chair 2. Have the client perform simple, repetitive tasks 3. Ask the client's health care provider to prescribe a sedative 4. Place the client in a single room to limit pacing to a smaller area
2. Have the client perform simple, repetitive tasks
A disturbed male client, unprovoked, attacks another client. A short-term initial plan for this client should include: 1. Placing the client in restraints or secluding the client 2. Having the client sit with a staff member in whom he trusts 3. Keeping the client actively participating in activities and in contact with reality 4. Getting the client to apologize for the attack to the other client and to show remorse
2. Having the client sit with a staff member in whom he trusts
What should a nurse do when caring for a client whose behavior is characterized by pathological suspicion? 1. Protect the client from environmental stress 2. Help the client feel accepted by the staff on the unit 3. Ask the client to explain the reasons for the feelings 4. Help the client realize that the suspicions are unrealistic
2. Help the client feel accepted by the staff on the unit
A client who is to begin a physical therapy regimen after orthopedic surgery expresses anxiety about starting this new therapy. The nurse responds that some of this apprehension can be an asset because it will: 1. Slow physiological function 2. Increase alertness to the environment 3. Mobilize automatic behavioral responses 4. Promote the use of ego defense mechanisms
2. Increase alertness to the environment
A depressed client resists becoming involved in an activity, complains that he can't do anything well, and claims to be worthless. What is the best approach by the nurse? 1. Listening to the client and delaying activities till another time 2. Involving the client in an activity in which success can be ensured 3. Encouraging the client to select an activity in which there is some interest 4. Scheduling the client for activities that can be implemented independently
2. Involving the client in an activity in which success can be ensured
A client with a history of depression tells the nurse about planning to retire from work next year. What common dynamic about retirement should the nurse consider when interacting with this client? 1. It is damaging to self-esteem. 2. It is a developmental task of significance. 3. It is a negative event associated with the concept of aging. 4. It is a milestone that is eagerly anticipated by most older people.
2. It is a developmental task of significance.
A nurse is teaching the parents of a school-aged child with attention deficit-hyperactivity disorder (ADHD) about the prescribed medication methylphenidate (Ritalin). When should the daily dose be administered? 1. When the child arrives at school 2. Just after breakfast 3. Immediately before lunch 4. When the child arrives home from school
2. Just after breakfast **Methylphenidate (Ritalin) should be given just after breakfast to avoid appetite suppression.
A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? (Select all that apply.) 1. Dementia 2. Multiple losses 3. Declines in health 4. A milestone birthday 5. An injury requiring hospitalization
2. Multiple losses 3. Declines in health
The health care provider prescribes donepezil (Aricept) 5 mg by mouth once a day for a client exhibiting initial signs of dementia of the Alzheimer type. The client is already taking digoxin (Lanoxin) 0.125 mg in the morning and alprazolam (Xanax) 0.5 mg twice a day. What should the nurse teach the client's spouse to do? 1. Hang a list of medications with the times at which the spouse should take them 2. Prefill a weekly drug box with the medications for the spouse to self-administer 3. Remind the spouse in the morning which medications must be taken during the day 4. Provide the spouse with the medications at the appropriate times they should be taken
2. Prefill a weekly drug box with the medications for the spouse to self-administer
A male client with a diagnosis of antisocial personality disorder is admitted to the mental health hospital. What is the priority nursing intervention? 1. Encouraging interactions with others 2. Presenting a united, consistent staff approach 3. Assuming a nurturing, forgiving tone in disputes 4. Using seclusion when manipulative behaviors are exhibited
2. Presenting a united, consistent staff approach
A nurse is working with an adolescent client with conduct disorder. Which strategies should the nurse implement while working on the goal of increasing the client's ability to meet personal needs without manipulating others? (Select all that apply.) 1. Discuss how others can precipitate anxiety 2. Provide physical outlets for aggressive feelings 3. Establish a contract regarding manipulative behavior 4. Develop activities that provide opportunities for success 5. Encourage the client to verbalize negative feelings to others
2. Provide physical outlets for aggressive feelings 3. Establish a contract regarding manipulative behavior 4. Develop activities that provide opportunities for success
A 54-year-old client has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After being found walking down a street, disoriented and semi-naked, the client is admitted to the hospital, and a diagnosis of dementia of the Alzheimer type is made. The client expresses fear and anxiety. What is the best approach for the nurse to take? 1. Exploring the reasons for the client's concerns 2. Reassuring the client with the frequent presence of staff 3. Initiating the program of planned interaction and activity 4. Explaining the purpose of the unit and why admission was necessary
2. Reassuring the client with the frequent presence of staff
What characteristic of anxiety is associated with a diagnosis of conversion disorder? 1. Free-floating 2. Relieved by the symptom 3. Consciously felt by the client 4. Projected onto the environment
2. Relieved by the symptom
During the admission procedure a client appears to be responding to voices. The client cries out at intervals, "No, no! I didn't kill him! You know the truth — tell that police officer! Please help me!" What is the most appropriate response by the nurse? 1. Listening attentively and assuming an expression of disbelief 2. Saying, "I want to help you. I realize that you must be very frightened." 3. Sitting quietly and refraining from responding to the client's statements 4. Saying, "Don't be so upset. No one is talking to you; those voices are part of your illness."
2. Saying, "I want to help you. I realize that you must be very frightened."
A recovering alcoholic joins Alcoholics Anonymous (AA) to help maintain sobriety. What type of group is AA? 1. Social group 2. Self-help group 3. Resocialization group 4. Psychotherapeutic group
2. Self-help group
A mother of a 6-year-old boy with the diagnosis of attention deficit-hyperactivity disorder (ADHD) tells the nurse that when she is reading storybooks to her son, about halfway through the story he becomes distracted, fidgets, and stops paying attention. The nurse suggests that the mother: 1. Talk with a louder voice 2. Shorten the rest of the story 3. Encourage her son to pay attention 4. Use therapeutic holding for the rest of the story
2. Shorten the rest of the story **Shortening the story nonjudgmentally limits the activity while supporting the child's self-esteem; the child with ADHD cannot control his inattention and hyperactivity.
An anxious client reports experiencing pain in the abdomen and feeling empty and hollow. A diagnostic workup reveals no physical causes of these clinical findings. What term best reflects what the client is experiencing? 1. Dissociation 2. Somatization 3. Stress response 4. Anxiety reaction
2. Somatization **Somatization is erroneously attributing an anxious feeling to a body system or part.
A client demonstrating manic behavior is elated and sarcastic. The client is constantly cursing and using foul language and has the other clients on the unit terrified. Initially the nurse should: 1. Demand that the client stop the behavior immediately 2. Tell the client firmly that the behavior is unacceptable 3. Ask the client to identify what is precipitating the behavior 4. Increase the client's medication or get a prescription for another drug
2. Tell the client firmly that the behavior is unacceptable
One morning a female client with the diagnosis of schizophrenia tells the nurse that she is Joan of Arc and is going to be burned at the stake. What is the most therapeutic response by the nurse? 1. "Tell me more about being Joan of Arc." 2. "We both know that you're not Joan of Arc." 3. "It seems like the world is a pretty scary place for you." 4. "You're safe here, because we won't let you be burned."
3. "It seems like the world is a pretty scary place for you."
On the day after admission a suicidal client asks a nurse, "Why am I being watched around the clock, and why can't I walk around the whole unit?" Which reply is most appropriate? 1. "Why do you think we're observing you?" 2. "What makes you think we're observing you?" 3. "We're concerned that you might try to harm yourself." 4. "We're following your doctor's instructions, so there must be a reason."
3. "We're concerned that you might try to harm yourself."
One day the nurse and a young adult client sit together and draw. The client draws a face with horns and says, "This is me. I'm a devil." What is the best response by the nurse? 1. "I don't see a devil; why do you see a devil?" 2. "Let's go to the mirror to see what you look like." 3. "When I look at you I see a person, not a devil." 4. "You're not a devil; why do you talk about yourself like that?"
3. "When I look at you I see a person, not a devil."
One morning a client with the diagnosis of acute depression says to the nurse, "God is punishing me for my past sins." What is the best response by the nurse? 1. "Why do you think that?" 2. "God is punishing you for your sins?" 3. "You really seem to be upset about this." 4. "If you feel this way, you should talk to a member of the clergy."
3. "You really seem to be upset about this."
In her eighth month of pregnancy, a 24-year-old client is brought to the hospital by the police, who were called when she barricaded herself in a ladies' restroom of a restaurant. During admission the client shouts, "Don't come near me! My stomach is filled with bombs, and I'll blow up this place if anyone comes near me." The nurse concludes that the client is exhibiting: 1. Ideas of reference 2. Loose associations 3. Delusional thinking 4. Tactile hallucinations
3. Delusional thinking
The nursing staff is discussing the best way to develop a relationship with a new client who has antisocial personality disorder. What characteristic of clients with antisocial personality should the nurses consider when planning care? 1. Engages in many rituals 2. Feels independent of others 3. Exhibits lack of empathy for others 4. Possesses limited communication skills
3. Exhibits lack of empathy for others
A nurse is caring for a client who uses ritualistic behavior. What common antiobsessional medication does the nurse anticipate will be prescribed? 1. Benztropine (Cogentin) 2. Amantadine (Symmetrel) 3. Fluvoxamine (Luvox) 4. Diphenhydramine (Benadryl)
3. Fluvoxamine (Luvox)
A client is admitted to the psychiatric hospital after many self-inflicted nonlethal injuries over the preceding month. Of which level of suicidal behavior is the client's behavior reflective? 1. Threats 2. Ideation 3. Gestures 4. Attempts
3. Gestures
A client is admitted to a psychiatric hospital with the diagnosis of schizoid personality disorder. Which initial nursing intervention is a priority for this client? 1. Helping the client enter into group recreational activities 2. Convincing the client that the hospital staff is trying to help 3. Helping the client learn to trust the staff through selected experiences 4. Arranging the client's contact with others so it is limited while she is in the hospital
3. Helping the client learn to trust the staff through selected experiences **Demonstrating that the staff can be trusted is a vital initial step in the therapy program.
A nurse uses behavior modification to foster toilet-training efforts in a cognitively impaired child. What reward should the nurse provide to reinforce appropriate use of the toilet? 1. Candy bar 2. Piece of fruit 3. Hug with praise 4. Choice of rewards
3. Hug with praise **Secondary reinforcers involve social approval; a hug meets this requirement.
A client is found to have a borderline personality disorder. What behavior does the nurse consider is most typical of these clients? 1. Inept 2. Eccentric 3. Impulsive 4. Dependent
3. Impulsive **Impulsive, potentially self-damaging behaviors are typical of clients with this personality disorder.
A nurse is interacting with a depressed, suicidal client. What themes in the client's conversation are of most concern to the nurse? (Select all that apply.) 1. Power 2. Betrayal 3. Loneliness 4. Hopelessness 5 . Indecisiveness
3. Loneliness 4. Hopelessness
hen attempting to evaluate the behavior of an older adult with a diagnosis of vascular dementia, a nurse knows that the client is probably: 1. Incapable of using any defense mechanisms 2. Using one method of defense for every situation 3. Making exaggerated use of old, familiar mechanisms 4. Attempting to develop new defense mechanisms to meet the current situation
3. Making exaggerated use of old, familiar mechanisms
A client with a history of chronic alcoholism is admitted to the mental health unit. What does the nurse identify as the cause of a client's use of confabulation? 1. Ideas of grandeur 2. Need to get attention 3. Marked loss of memory 4. Difficulty accepting the truth
3. Marked loss of memory
The parents of a child with attention deficit-hyperactivity disorder ask the nurse about using medication. What is the most frequently prescribed medication for this disorder? 1. Lorazepam (Ativan) 2. Haloperidol (Haldol) 3. Methylphenidate (Ritalin) 4. Methocarbamol (Robaxin)
3. Methylphenidate (Ritalin) **Methylphenidate (Ritalin) appears to act by stimulating release of norepinephrine from nerve endings in the brainstem.
A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? (Select all that apply.) 1. Labiality of affect 2. Specific food cravings 3. Neglect of personal hygiene 4. "I don't know" answers to questions 5. Apathetic response to the environment
3. Neglect of personal hygiene 4. "I don't know" answers to questions 5. Apathetic response to the environment
A client with a conversion disorder is experiencing paralysis of a leg. The nurse can expect this client to: 1. Experience a spread of the paralysis to other body parts 2. Require continuous psychiatric treatment to maintain independent function 3. Recover use of the affected leg but, under stress, to again experience these symptoms 4. Follow an unpredictable emotional course in the future, depending on exposure to stress
3. Recover use of the affected leg but, under stress, to again experience these symptoms
It is determined that a staff nurse has a drug abuse problem. As an initial intervention the staff nurse should be: 1. Counseled by the staff psychiatrist 2. Dismissed from the job immediately 3. Referred to the employee assistance program 4. Forced to promise to abstain from drugs in the future
3. Referred to the employee assistance program **Referring to the employee assistance program is a nonpunitive approach that attempts to help the nurse as an individual and as a professional.
What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder? 1. Encouraging the client to verbalize feelings of anxiety 2. Having the client list the behaviors used to reduce anxiety 3. Removing as many stimuli from the client's environment as possible 4. Administering PRN medications prescribed by the health care provider
3. Removing as many stimuli from the client's environment as possible
A nurse is caring for a group of children with the diagnosis of autism. Which signs and symptoms are associated with this disorder? (Select all that apply.) 1. Lack of appetite 2. Depressed mood 3. Repetitive activities 4. Self-injurious behaviors 5. Lack of communication with others
3. Repetitive activities 4. Self-injurious behaviors 5. Lack of communication with others
A client who has been hospitalized with schizophrenia tells the nurse, "My heart has stopped and my veins have turned to glass!" What should the nurse conclude that the client is experiencing? 1. Echolalia 2. Hypochondriasis 3. Somatic delusion 4. Depersonalization
3. Somatic delusion **A somatic delusion is a fixed false belief about one's body.
When a nurse sits next to a depressed client and begins to talk, the client responds, "I'm stupid and useless. Talk with the other people who are more important." Which response is most therapeutic? 1. "Everyone is important." 2. "Do you feel that you're not important?" 3. "Why do you feel that you're not important?" 4. "I want to talk with you because you are important to me."
4. "I want to talk with you because you are important to me."
A nurse approaches a depressed client who is sitting alone in the dayroom. What is best for the nurse to say to the client? 1. "May I sit with you for a while?" 2. "Just call me if you'd like to talk." 3. "Do you mind if I sit and talk with you?" 4. "I'll be sitting with you for a while today."
4. "I'll be sitting with you for a while today."
A client with a diagnosis of antisocial personality disorder is being discharged from the hospital. The client asks the nurse, "Can I have your phone number so I can call you for a date?" What is the best response by the nurse? 1. "We are not permitted to date clients." 2. "It is against my professional ethics to date clients." 3. "I'm glad you like me, but I can't give out my phone number." 4. "Our relationship is professional; therefore I will not see you socially."
4. "Our relationship is professional; therefore I will not see you socially."
A nurse is caring for several clients with major thought disorders such as schizophrenia. They are all being treated with neuroleptic drugs. How do these drugs act in the body to promote mental health? 1. By inhibiting enzymes at the postsynaptic receptor site 2. By decreasing serotonin at the postsynaptic receptor site 3. By increasing dopamine uptake at the postsynaptic receptor site 4. By blocking access to dopamine receptors at the postsynaptic receptor site
4. By blocking access to dopamine receptors at the postsynaptic receptor site
A client who has been admitted with a diagnosis of schizophrenia says to the nurse, "Yes, it's March. March is Little Women. That's literal, you know." These statements illustrate: 1. Echolalia 2. Neologisms 3. Flight of ideas 4. Loosening of associations
4. Loosening of associations
A client with a history of substance abuse is brought to the emergency department. The client is having seizures, is hypertensive, and has hyperthermia. What drug should the nurse consider that the client may have been abusing? 1. Alcohol 2. Fentanyl 3. Oxycodone 4. Methamphetamine
4. Methamphetamine
What is important when the nurse plans care for a client with paranoid ideation? 1. Avoiding placing demands on the client 2. Eliminating stress so that the client can relax 3. Giving the client difficult tasks to provide stimulation 4. Providing the client with opportunities for nonthreatening social interaction
4. Providing the client with opportunities for nonthreatening social interaction
A 30-year-old female client asks the nurse to change her room, stating that she hates her roommate and can't stand to be in the same room with her. Just as she finishes speaking, her roommate enters and the client tells her she missed her and has been all over the unit looking for her. The nurse recognizes that the client is using: 1. Projection 2. Sublimation 3. Passive aggression 4. Reaction formation
4. Reaction formation
A client is admitted to the mental health unit after attempting suicide. When a nurse approaches, the client is tearful and silent. What is the best initial nursing intervention? 1. Sitting quietly next to the client and waiting for the client to start speaking 2. Observing the behavior, recording it, and notifying the health care provider 3. Saying, "You're crying. That means you feel bad about attempting suicide and really want to live." 4. Saying, "I see that you're crying. Tell me what's going on in your life, and we can work on helping you."
4. Saying, "I see that you're crying. Tell me what's going on in your life, and we can work on helping you."
A client with schizophrenia plans an activity schedule with the help of the treatment team. A written copy is posted in the client's room. What should the nurse say when it is time for the client to go for a walk? 1. "It's time for you to go for a walk now." 2. "Do you want to take your scheduled walk now?" 3. "When would you like to go for your walk today?" 4. "You're supposed to be going for your walk now."
1. "It's time for you to go for a walk now." **Telling the client that it is time to take a walk is concise and does not require decision-making; it is therefore less likely to increase anxiety
A nurse recalls that language development in the autistic child resembles: 1. Echolalia 2. Stuttering 3. Scanning speech 4. Pressured speech
1. Echolalia **The autistic child repeats sounds or words spoken by others.
When caring for clients who are demonstrating manic behavior, the nurse must constantly reevaluate these clients' physical needs. What characteristic about these clients makes this particularly important? 1. Will withdraw to their rooms if left alone 2. Have difficulty making their needs known 3. May gain too much weight from overeating 4. May become exhausted from excessive activity
4. May become exhausted from excessive activity
A nurse is caring for several clients who are going through withdrawal from alcohol. The primary reason for the ingestion of alcohol by clients with a history of alcohol abuse is that they: 1. Are dependent on it 2. Lack the motivation to stop 3. Have no other coping mechanism 4. Enjoy the associated socialization
1. Are dependent on it
A client with the diagnosis of bulimia nervosa, purging type, is admitted to the mental health unit after an acute episode of bingeing. Which clinical manifestation is most important for the nurse to evaluate? 1. Weight gain 2. Dehydration 3. Hyperactivity 4. Hyperglycemia
2. Dehydration
A 6-year-old child has been wetting the bed at night since the birth of a baby brother. What defense mechanism is the child using to cope with the stress of accepting a new family member? 1. Regression 2. Repression 3. Dissociation 4. Displacement
1. Regression **Regression is the return to an earlier and more comfortable developmental level.
A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine? 1. Risk for self-injury 2. Potential for seizure 3. Danger of dehydration 4. Probability of injuring others
1. Risk for self-injury
A severely depressed client is to have electroconvulsive therapy (ECT). What should a nurse include when discussing this therapy with the client? 1. Sleep will be induced and the treatment will not cause pain. 2. The treatment is totally safe with the new methods of administration. 3. The client may ask any question, but it is better not to talk about the therapy. 4. The client may experience some unrecoverable short-term and long-term memory loss.
1. Sleep will be induced and the treatment will not cause pain.
A woman who gave birth to a second child 3 weeks ago is depressed and having difficulty caring for her children. At the end of the day both of the children are dirty, wet, and crying. The woman tells her husband that she "just can't take this anymore." The husband calls the women's health clinic and asks what he should do. What is the best response by the nurse? 1. Telling him that his wife may be suffering from depression and needs emergency care 2. Telling him that fatigue is expected and that his wife needs to take rest periods during the day 3. Reassuring him that his wife is experiencing postpartum blues that will lessen in several days 4. Advising him to make an appointment for his wife to see her practitioner if the problem continues
1. Telling him that his wife may be suffering from depression and needs emergency care
A client with paranoid schizophrenia tells the nurse, "My neighbors are spying on me because they want to rob me and take money." While hospitalized, the client complains of being poisoned by the food and of being given the wrong medication. The nurse evaluates the client's response to medications and therapy. Which finding leads the nurse to conclude that the client's reality testing has improved? 1. The client eats the food provided on the hospital tray. 2. The client discusses his discharge plans with the staff. 3. The client questions each medication when it is administered. 4. The client asks permission to make phone calls to the hospital administration.
1. The client eats the food provided on the hospital tray. **Because the client was admitted while complaining that the food was poisoned, eating the food on the tray indicates that the client feels safe.
A nurse works with school-age children who have conduct disorder, childhood-onset type. The nurse knows that these children are at risk for progression to another disorder during adolescence. For signs of which disorder should the nurse evaluate their current behavior? 1. Oppositional defiant 2. Antisocial personality 3. Pervasive developmental 4. Attention deficit-hyperactivity
2. Antisocial personality
A teenager with anorexia nervosa is admitted to the adolescent unit of a mental health facility and signs a contract calling for her to gain weight or lose privileges. There is no weight gain after a week. What should the nurse explain to the client? 1. The prearranged consequences will go into effect. 2. Death from starvation could occur if the client does not eat. 3. Stricter goals will be instituted if the initial goals are not met. 4. It may be necessary to become involved with meal preparation.
1. The prearranged consequences will go into effect.
When talking with a female client who displays many of the emotional and physiological symptoms of panic disorder, the nurse should: 1. Use short sentences and an authoritative voice 2. Describe to her the possible reasons for her anxiety 3. Keep asking questions because she is probably not going to volunteer much information 4. Suggest that she refrain from crying because most of the time crying makes matters worse
1. Use short sentences and an authoritative voice **During a panic attack the attention span is shortened, making it difficult to follow long sentences.
While watching television in the dayroom a client who has demonstrated withdrawn, regressed behavior suddenly screams, bursts into tears, and runs from the room to the far end of the hallway. What is the most therapeutic intervention by the nurse? 1. Walking to the end of the hallway where the client is standing 2. Accepting the action as the impulsive behavior of a sick person 3. Asking another client in the dayroom why the client acted as she did 4. Documenting the incident in the client's record while the memory is fresh
1. Walking to the end of the hallway where the client is standing
What should the nurse identify as the foremost basis for the development of schizophrenia? 1. Seasonal perspective 2. Biological perspective 3. Immunological perspective 4. Psychoanalytical perspective
2. Biological perspective
The nurse is caring for a client with a somatoform disorder, conversion-type paralysis. What is the best nursing approach? 1. Discussing topics other than the paralysis 2. Explaining the reason for the physical problem 3. Asking how the client feels about being paralyzed 4. Encouraging the client to slowly walk around the room
1. Discussing topics other than the paralysis
What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation? 1. Electroconvulsive therapy 2. Short-term psychoanalysis 3. Nondirective psychotherapy 4. High doses of anxiolytic drugs
1. Electroconvulsive therapy **Electroconvulsive therapy, which interrupts established patterns of behavior, helps relieve symptoms and limits suicide attempts in clients with severe, intractable depression that does not respond to antidepressant medication.
A nurse is planning activities for a withdrawn client who is hallucinating. Which activity will be most therapeutic for the client? 1. Going for a walk with the nurse 2. Watching a movie with other clients 3. Joining a card game with other clients 4. Playing solitaire alone in the dayroom
1. Going for a walk with the nurse **Going for a walk with the nurse facilitates one-on-one interaction and the development of a trusting relationship.
A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall, is unkempt, and obviously has not washed in several days. What should the nurse say when trying to help this client shower? 1. "Would you like a shower?" 2. "I'll help you take your shower now." 3. "When do you want your shower, now or later?" 4. "You'll feel so much better if you have a shower."
2. "I'll help you take your shower now."
A client is lonely and extremely depressed, and the health care provider prescribes a tricyclic antidepressant. The client asks the nurse what the medication will do. What is the best response by the nurse? 1. "This drug will help you forget why you're lonely and depressed." 2. "The medication will increase your appetite and make you feel better." 3. "You'll start to feel much better after taking this medication for 2 or 3 days." 4. "You'll feel less depressed when you take this with the monoamine oxidase inhibitor."
2. "The medication will increase your appetite and make you feel better."
A depressed client is brought to the emergency department after taking an overdose of a sedative. After lavage the client says, "Let me die. I'm no good." What is the most appropriate response by the nurse? 1. "Tell me why you did this." 2. "You must have been upset to try to take your life." 3. "Of course you're good; we'll take excellent care of you." 4. "You've been through a rough time; let me take care of you."
2. "You must have been upset to try to take your life."
An adult client charged with molesting a child is admitted for psychiatric evaluation. When a nurse invites the client to come to dinner, the client refuses and says, "I don't want anyone to see me. Leave me alone." What is the best response by the nurse? 1. "Certainly. I'll respect your wishes." 2. "You sound upset; let's talk about it." 3. "It'll be easier to face other people right away." 4. "Only the staff members know why you're here."
2. "You sound upset; let's talk about it."
What is the best initial nursing approach to take with a self-accusatory, guilt-ridden client? 1. Contradicting the client's persecutory delusions 2. Accepting the client's statements as the client's beliefs 3. Medicating the client when these thoughts are expressed 4. Redirecting the client whenever a negative topic is mentioned
2. Accepting the client's statements as the client's beliefs
When working with a client who is in an alcohol detoxification program, it is most important for the nurse to: 1. Support the client's need for nurture 2. Address the client's holistic needs 3. Discuss with the client the negative effects of alcohol 4. Promote the client's compliance with the program through gentle prodding
2. Address the client's holistic needs
A client in the outpatient clinic is denying that he is addicted to alcohol. He tells the nurse that he is not an alcoholic and that it is his nagging wife who causes him to drink. What is the most therapeutic response by the nurse? 1. "I don't think that your wife is the problem." 2. "Everyone is responsible for his own actions." 3. "Perhaps you should have marriage counseling." 4. "Why do you think that your wife is the cause of your problems?"
2. "Everyone is responsible for his own actions."
What client response should the nurse anticipate when an attempt is made to prevent a client from carrying out ritualistic behavior? 1. Relief 2. Anger 3. Gratitude 4. Embarrassment
2. Anger
A nurse begins a therapeutic relationship with a client with the diagnosis of schizotypal personality disorder. What is the best initial nursing action? 1. Setting limits on manipulative behavior 2. Encouraging participation in group therapy 3. Respecting the client's need for social isolation 4. Recognizing that seductive behavior is expected
3. Respecting the client's need for social isolation
At times a client's anxiety level is so high that it blocks attempts at communication and the nurse is unsure of what is being said. To clarify understanding, the nurse says, "Let's see whether we mean the same thing." What communication technique is being used by the nurse? 1. Reflecting feelings 2. Making observations 3. Seeking consensual validation 4. Attempting to place events in sequence
3. Seeking consensual validation
When talking with one of the day nurses, a client with the diagnosis of anorexia nervosa states that the day nurses give better care and are nicer than the night nurses. The client also asks a question that the day nurse knows was already answered by one of the night nurses. What conclusion should the nurse make about the client? 1. The client needs assistance in exploring and verbalizing feelings about the night nurses 2. The client is trying to develop a bond of trust with a staff member that should be supported 3. The client is trying to divide the staff, and the behavior should be reported to the other staff members 4. The client has negative feelings about the night nurses, and the nurses should be informed of these feelings.
3. The client is trying to divide the staff, and the behavior should be reported to the other staff members
A nurse, planning care for a client who is an alcoholic, knows that the most serious life-threatening effects of alcohol withdrawal usually begin after a specific time interval. How many hours after the last drink do they occur? 1. 8 to 12 2. 12 to 24 3. 24 to 72 4. 72 to 96
3. 24 to 72
A client with a history of alcoholism is found to have Wernicke encephalopathy associated with Korsakoff syndrome. What does the nurse anticipate will be prescribed? 1. Traditional phenothiazine 2. Judicious use of antipsychotics 3. Intramuscular injections of thiamine 4. Oral administration of chlorpromazine
3. Intramuscular injections of thiamine
When attempting to evaluate the behavior of an older adult with a diagnosis of vascular dementia, a nurse knows that the client is probably: 1. Incapable of using any defense mechanisms 2. Using one method of defense for every situation 3. Making exaggerated use of old, familiar mechanisms 4. Attempting to develop new defense mechanisms to meet the current situation
3. Making exaggerated use of old, familiar mechanisms
A client who is hallucinating actively approaches the nurse and reports, "I'm hearing voices that are saying bad things about me." What should the nurse do? 1. Respond, "I don't hear the voices." 2. Suggest that the client join other clients in playing cards 3. Encourage the client not to listen to what the voices are saying 4. Reply, "I'll stay with you for a while because you seem frightened."
4. Reply, "I'll stay with you for a while because you seem frightened." **When the client's perceptions are especially frightening, the nurse must let the client know that the fears are recognized as real and frightening, even if the nurse does not share these perceptions. Staying with the client will convey concern and reduce the fears. Responding, "I don't hear the voices" is nontherapeutic; the voices are real to the client.
A nurse stops by the room of a newly admitted depressed client and offers to walk with the tearful client to the evening meal. The client looks intently at the nurse but says nothing. What is the best response by the nurse? 1. "I'll be at the desk if you need me." 2. "You must tell me what you're feeling now." 3. "We'll walk together to dinner when you calm down." 4. "It must be very difficult for you to be on a psychiatric unit."
4. "It must be very difficult for you to be on a psychiatric unit."
An adolescent female with an antisocial personality disorder plans to live with her parents after discharge. The parents request advice on how to respond to their daughter's unruly behavior. What is the most therapeutic response by the nurse? 1. "Discuss her behavior with her and encourage her to develop self-control." 2. "Avoid setting expectations for her behavior and react to each situation as it arises." 3. "Help her find new friends and encourage her to get a job and assume responsibility for herself." 4. "Set clear limits, explain the consequences if she disregards them, and firmly and consistently apply them."
4. "Set clear limits, explain the consequences if she disregards them, and firmly and consistently apply them."
A male client with the diagnosis of a bipolar disorder, depressed episode, is found lying on the floor in his room in the psychiatric unit. He states, "I don't deserve a comfortable bed; give it to someone else." The best response response by the nurse is: 1. "Everyone has a bed. This one is yours." 2. "You are not allowed to sleep on the floor." 3. "I don't understand why you're on the floor." 4. "You're a valuable person. You don't need to lie on the floor."
4. "You're a valuable person. You don't need to lie on the floor."
What clinical manifestation best indicates to the nurse that the mental status of a client with the diagnosis of schizophrenia, paranoid type, is improving? 1. Absence of mild to moderate anxiety 2. Development of insight into the problem 3. Decreased need to use defense mechanisms 4. Ability to function effectively in activities of daily living
4. Ability to function effectively in activities of daily living
A psychologist has been a client on a mental health unit for 3 days. The client has questioned the authority of the treatment team, advised other clients that their treatment plans are wrong, and been disruptive in group therapy. What is the most appropriate nursing intervention? 1. Telling the other clients to disregard what the client is saying 2. Ignoring the client's disruptive behavior and waiting for it to subside 3. Restricting the client's contact with other clients until the disruptive behavior ceases 4. Accepting that the client is unable to control this behavior and setting appropriate limits
4. Accepting that the client is unable to control this behavior and setting appropriate limits
