exam 2 !!!!

A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called A) systematic desensitization. B) flooding. C) cognitive restructuring. D) exposure therapy.

A

A client is learning to cope with anxiety and stress. The expected outcome is that the client will A) change reactions to stressors. B) ignore situations that cause stress. C) limit major stressors in his or her life. D) avoid anxiety at all costs.

A

A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" The nurse is using this response to A) appraise his situation more realistically. B) assist the client to make alternative plans for the future. C) assess if the client has health problems compounded by stress. D) clarify the client's meaning.

A

When teaching a client with generalized anxiety disorder, which is the highest priority for the nurse to teach the client to avoid? A) Caffeine B) High-fat foods C) Refined sugars D) Sodium

A

Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective? A) Anxiety is learned in childhood through interactions with caregivers. B) Anxiety is learned throughout life as a response to life experiences. C) Anxiety stems from an unconscious attempt to control awareness. D) Anxiety results from conforming to the norms of a cultural group.

A

Which of the following statements about the assessment of persons with anxiety and anxiety disorders is most accurate? A) When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition. B) Panic attacks are the most common late-life anxiety disorders. C) An elder person with anxiety may be experiencing ruminative thoughts. D) Agoraphobia that occurs in late life may be related to trauma experienced or anticipated.

A

Which of the following theories about anxiety is based upon intrapsychic theories? A) A person's innate anxiety is the stimulus for behavior. B) Anxiety is generated from problems in interpersonal relationships. C) A nurse can help the client to achieve health by attending to interpersonal and physiologic needs. D) Anxiety is learned through experiences.

A

A client who has an eating disorder is becoming dependent on the nurse for direction in food choices. Which approach by the nurse would demonstrate the nurse's self- awareness? A) Approach the client with an adult-like objectivity. B) Give the support and direction that the client is seeking. C) Give approval for positive changes seen in the client. D) Take care of the needs that the client is neglecting.

A) Approach the client with an adult-like objectivity. Avoid sounding parental when teaching about nutrition or why laxative use is harmful. Presenting information factually without chiding the client will obtain more positive results. Be empathetic and nonjudgmental, although this is not easy. Remember the client's perspective and fears about weight and eating. Do not label clients as ìgoodî when they avoid purging or eat an entire meal. Otherwise, clients will believe they are ìbadî on days when they purge or fail to eat enough food.

A 15-year-old female is admitted for treatment of anorexia nervosa. Which is a characteristic of anorexia nervosa? A) Body weight less than normal for age, height, and overall physical health B) Amenorrhea for at least two cycles C) Absence of hunger feelings D) Erosion of dental enamel

A) Body weight less than normal for age, height, and overall physical health Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. Clients with anorexia have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. In addition, clients have a preoccupation with food and food-related activities and can have a variety of physical manifestations. Physical problems or anorexia nervosa include amenorrhea, constipation, overly sensitive to cold, lanugo hair on body, hair loss, dry skin, dental caries, pedal edema, bradycardia, enlarged parotid glands, hypothermia, and electrolyte imbalance. These clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue. Dental erosion is characteristic of bulimia nervosa.

Which of the following would be most supportive for family and friends of a client with an eating disorder? A) Emotional support, love, and attention. B) Focus on food intake, calories, and weight. C) Unlimited access to unhealthy foods that the client enjoys. D) Positive reinforcement for weight gain.

A) Emotional support, love, and attention. The nurse explains to family and friends that they can be most helpful by providing emotional support, love, and attention. They can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight. Eating disorders can be viewed on a continuum with clients with anorexia eating too little or starving themselves, clients with bulimia eating chaotically, and clients with obesity eating too much.

The nurse understands that which biologic factors may influence the development of an eating disorder? Select all that apply. A) Family history of eating disorders B) Dysfunction of the hypothalamus C) Norepinephrine imbalances D) First-degree relatives with psychotic disorder E) Decreased serotonin levels

A) Family history of eating disorders B) Dysfunction of the hypothalamus C) Norepinephrine imbalances E) Decreased serotonin levels Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families, or it may directly involve a dysfunction of the hypothalamus. A family history of mood or anxiety disorders (e.g., obsessive-compulsive disorder) places a person at risk for an eating disorder. Low norepinephrine levels are seen in clients during periods of restricted food intake. Also, low epinephrine levels are related to the decreased heart rate and blood pressure seen in clients with anorexia. Low levels of serotonin as well as low platelet levels of monoamine oxidase have been found in clients with bulimia and the binge and purge subtype of anorexia nervosa.

When preparing a client with bulimia for discharge, the nurse suggests that the client and family continue with family therapy on an outpatient basis. Which of the following is the rationale for this suggestion? A) Family members often need to learn role independence and autonomy. B) Family members need to learn to monitor for signs of client relapse. C) Family relationships need to be strengthened due to a lifetime of disengagement. D) Family members often feel jealous of the attention the client has been receiving in treatment.

A) Family members often need to learn role independence and autonomy. Dysfunctional relationships with significant others often are a primary issue for clients with eating disorders. In addition, support groups in the community or via the internet can offer support, education, and resources to clients and their families or significant others.

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which client statement would let the nurse know that this has been effective? A) ìI am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging.î B) ìI am beginning to understand how my lack of self-control is hurting me.î C) ìI am keeping a record of everything I eat and how I am feeling every day.î D) ìI am getting more comfortable confronting people when I have conflict with them.

A) I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging. Self-monitoring is a cognitive-behavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, and interactions surrounding eating and binging or purging episodes. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity.

Which factors may contribute to the frequency of eating disorders in adolescents? Select all that apply. A) Media portrayal of slimness as an ideal B) Body dissatisfaction in adolescent females C) Stress-free existence of adolescents D) Body image disturbance E) Seeking autonomy F) Seeking to develop a unique identity

A) Media portrayal of slimness as an ideal B) Body dissatisfaction in adolescent females D) Body image disturbance E) Seeking autonomy F) Seeking to develop a unique identity Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. In families in which enmeshment exists, adolescents begin to control their eating through severe dieting and thus gain control over their weight. Adolescent girls who express body dissatisfaction are most likely to experience adverse outcomes. The need to develop a unique identity, or a sense of who one is as a person, is another essential task of adolescence. It coincides with the onset of puberty, which initiates many emotional and physiologic changes. Self-doubt and confusion can result if the adolescent does not measure up to the person she or he wants to be. Advertisements, magazines, and movies that feature thin models reinforce the cultural belief that slimness is attractive. Body image disturbance occurs when there is an extreme discrepancy between one's body image and the perceptions of others and extreme dissatisfaction with one's body image.

Which of the following are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply. A) To provide better care for the client B) To help understand the role anxiety plays in performing nursing responsibilities C) To help the nurse to mask his or her own feelings of anxiety D) So the nurse can identify that his or her own needs are more important than the clients E) To help nurses to function at a high level

A, B, E

When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities? Select all that apply. A) Provide a safe environment. B) Request a prescription for an antianxiety agent. C) Offer the client therapy to calm down D) Ensure the client's privacy. E) Engage the client in recreational activities.

A, D

The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which of the following in the discharge teaching? Select all that apply. A) Continued development of positive coping skills B) Weaning off of medications as necessary C) Lessening the amount of daily responsibilities D) Continued practice of relaxation techniques E) Development of a regular exercise program

A, D, E

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

Ans: A Feedback: In the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to deescalate the client's emotion and behavior. Conveying empathy for the client's anger or frustration is important. The nurse can encourage the client to express his or her angry feelings verbally, suggesting that the client is still in control and can maintain that control. Use of clear, simple, short statements is helpful.

One evening, a client with schizophrenia leaves his room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which of the following responses would be best? A) "I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice." B) "The voices are part of your illness, and they will leave in time." C) "This guarding responsibility can make you tired. You rest for now, and I'll guard a while." D) "You are just imagining these things. Do not pay any attention to the voices."

Ans: A Feedback: Acknowledging that the client hears a voice validates that the client's experience is real to him, while presenting reality. "The voices are part of your illness, and they will leave in time," is not appropriate to the client's statement. "This guarding responsibility can make you tired. You rest for now, and I'll guard a while," reinforces the client's delusion. "'You are just imagining these things. Do not pay any attention to the voices," does not deal with the patient in a serious manner.

The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning his head as if listening to another person. The nurse assesses this behavior to indicate that the client is experiencing auditory hallucinations and says, A) "Are you hearing something?" B) "It's a beautiful day, isn't it?" C) "Would you like to go to your room to talk?" D) "Would you like to take some of your PRN medication?"

Ans: A Feedback: Asking the client if he is hearing something validates the nurse's assessment and focuses on the client's experience. The other choices do not address the situation of the client experiencing auditory hallucinations at the present time.

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

Ans: A Feedback: Because face-to-face contact is more uncomfortable, clients may be able to make written requests or to use the telephone for business. The nurse can also role-play interactions that clients would have with people; this allows clients to practice clear and logical requests to obtain services or to conduct personal business. It helps to identify one person with whom clients can discuss unusual or bizarre beliefs, such as a social worker or a family member. These clients are uncomfortable around others, and this is not likely to change and cannot be suppressed.

A client who has suspicion has been placed in a room with a roommate. The night nurse reports that this client has been awake for the past 3 nights. The likely explanation for his wakefulness is which of the following? A) He is fearful of what his roommate might do to him while he sleeps. B) He is a light sleeper and unaccustomed to a roommate. C) He is watching for an opportunity to escape. D) He is worrying about his family problems.

Ans: A Feedback: Clients who have suspicion trust no one and believe others are going to harm them. Being fearful of his roommate, being a light sleeper and unaccustomed to a roommate, and worrying about family problems would not be the most likely reasons why this client has been awake for the past three nights. The other explanations are not as likely.

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

Ans: A Feedback: Clients with dependent personality disorder are very passive, so asking questions to gain information is an assertive first step in problem solving. Being polite, controlling emotional outbursts, and requesting assistance appropriately are not behaviors that would increase problem-solving skills.

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

Ans: A Feedback: One of the most effective interventions with paranoid or suspicious clients is helping clients to learn to validate ideas before taking action; however, this requires the ability to trust and to listen to one person. The rationale for this intervention is that clients can avoid problems if they can refrain from taking action until they have validated their ideas with another person. This helps prevent clients from acting on paranoid ideas or beliefs. It also assists them to start basing decisions and actions on reality.

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

Ans: A Feedback: Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. 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.

A college freshman is admitted to the hospital with a diagnosis of schizophrenia. Friends reported that she had been in her room for 2 days in a trance-like state, not eating nor speaking to anyone. Which of the following is the highest priority for this client? A) Assessing fluid intake and output B) Completing an assessment of mental status C) Obtaining more data about her college experiences D) Providing for adequate rest

Ans: A Feedback: Physiologic homeostasis is a priority for this client. Completing an assessment of mental status, obtaining data about college experiences, and providing adequate rest are not the highest priority.

A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, "This person is my guide and tells me what I must do every day." The nurse would best describe this type of thinking as which of the following? A) Referential delusion B) Grandiose delusion C) Thought insertion D) Personalization

Ans: A Feedback: Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. Grandiose delusions are characterized by the client's claim to association with famous people or celebrities, or the client's belief that he or she is famous or capable of great feats. Thought insertion is the belief that others are placing thoughts in their mind against their will. Personalization is not a psychotic characteristic of schizophrenia.

All of the following are included in the plan of care for a client with schizophrenia. Which nursing intervention should the nurse perform first when caring for this client? A) Observe for signs of fear or agitation B) Maintain reality through frequent contact C) Encourage to participate in the treatment milieu D) Assess community support systems

Ans: A Feedback: Safety for both the client and the nurse is the priority when providing care for the client with schizophrenia. The nurse must observe for signs of building agitation or escalating behavior such as increased intensity of pacing, loud talking or yelling, and hitting or kicking objects. The nurse must then institute interventions to protect the client, nurse, and others in the environment.

Which of the following interventions by the nurse will increase the client's sense of security? A) Allowing the client to perform the rituals B) Distracting the client from rituals with other activities C) Encouraging the client to talk about the purpose of the rituals D) Stopping the client from performing the rituals

Ans: A Feedback: The client performs rituals to decrease anxiety and will feel most secure when performing the rituals. The other choices would not promote a sense of security of the client.

Which of the following is the most important variable in determining the likelihood of success in improving life for a client with OCD? A) The client must be willing to make changes in his or her behavior. B) The client must acknowledge that the behavior is not in his or her control. C) The client must allow the nurse to decide the appropriate intervention for him or her. D) The client must be willing to try all new relaxation techniques.

Ans: A Feedback: The most important variable is that the client is willing to make changes in his or her behavior. The nurse must not interrupt the client from performing rituals as this will cause anxiety, and the client will need to begin the ritual again. The client and nurse together must determine which interventions will be used. The client will likely need to use relaxation techniques but should have input into deciding which ones.

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

Ans: A Feedback: The treatment of individuals with a personality disorder often focuses on mood stabilization, decreasing impulsivity, and developing social and relationship skills. In addition, clients perceive unmet needs in a variety of areas, such as self-care (keeping clean and tidy); sexual expression (dissatisfaction with sex life); budgeting (managing daily finances); psychotic symptoms; and psychological distress. Typically psychotic symptoms and psychological distress are often the only areas addressed by health-care providers.

The client with schizophrenia tells the nurse that rats have started to eat his brain. The best response by the nurse would be, A) "Have you discussed this with your physician?" B) "How could that be possible?" C) "You cannot have rats in your brain." D) "You look OK to me."

Ans: A Feedback: This sounds like a new symptom, so talking with the physician is important; the client may need to have his medication reevaluated. "How could that be possible," puts the client on the defensive. "You cannot have rats in your brain," refers to the response as being unbelievable. "You look OK to me," is inappropriate and not therapeutic.

A person suffering from schizophrenia has little emotional expression when interacting with others. The nurse would document the client's affect as which of the following? Select all that apply. A) Flat B) Blunt C) Bright D) Inappropriate E) Pleasant

Ans: A, B Feedback: Clients with schizophrenia are often described as having blunted affect (few observable facial expressions) or flat affect (no facial expression). The client may exhibit an inappropriate expression or emotions incongruent with the context of the situation. It is not likely that the affect of a person with schizophrenia would be pleasant.

The nurse correctly identifies that which of OCDs self-soothing behaviors may involve self-destruction of the body of a person who has OCD? Select all that apply. A) Dermatillomania B) Trichotillomania C) Onychophagia D) Kleptomania E) Oniomania

Ans: A, B, C Feedback: Dermatillomania, or skin-picking, is a self-soothing behavior; that is, the behavior is an attempt of people to soothe or comfort themselves, not that picking itself is necessarily a positive sensation. Trichotillomania, or chronic, repetitive hair pulling, is a self-soothing behavior that can cause distress and functional impairment. Onychophagia, or nail biting, is a self-soothing behavior. Kleptomania, or compulsive stealing, and oniomania, or compulsive buying, are reward-seeking behaviors.

The student nurse correctly identifies that which of the following are characteristics of hoarding disorder? Select all that apply. A) Excessive acquisition of animals or apparently useless things B) Cluttered living spaces that become uninhabitable C) Significant distress or impairment for the individual D) Obsessive cleaning of environment E) Disposing of articles that are of no value

Ans: A, B, C Feedback: Hoarding involves excessive acquisition of animals or apparently useless things; cluttered living spaces that become uninhabitable; and significant distress or impairment for the individual. Obsessive cleaning of the environment and disposing of articles that are of no value are not characteristics of hoarding.

Which are important in the limit-setting technique to deal with manipulative behavior? Select all that apply. A) Stating the behavioral limit B) Identifying the consequences if the limit is exceeded C) Identifying the expected or desired behavior D) Providing choices E) Allowing flexibility

Ans: A, B, C Feedback: Limit setting is an effective technique that involves three steps: 1. Stating the behavioral limit (describing the unacceptable behavior) 2. Identifying the consequences if the limit is exceeded 3. Identifying the expected or desired behavior Providing choices and allowing flexibility would be counterproductive as the expectations must be consistent.

Which of the following are important for the nurse to remember when teaching relaxation and behavioral techniques to a client with OCD? Select all that apply. A) It is important to teach the client to use relaxation techniques when the client's anxiety is low. B) The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. C) The client must be willing to engage in exposure and response prevention. D) The client must be forced to use relaxation techniques. E) It is unnecessary to assess the baseline of ritualistic behaviors in the client with OCD.

Ans: A, B, C Feedback: The intervention should take place when the client's anxiety is low, so he or she can learn more effectively. The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. The client must be willing to engage in exposure and response prevention. The client cannot be forced to use relaxation techniques. It is necessary to assess the baseline of frequency and duration of anxiety and ritualistic behaviors in the client with OCD.

Which of the following questions would best help the nurse to evaluate the effectiveness of antipsychotic medications for a client who has schizophrenia? Select all that apply. A) Have the symptoms you were experiencing disappeared? B) If the symptoms have not disappeared, are you able to carry out your daily life despite the persistence of some psychotic symptoms? C) Are you committed to taking the medication as prescribed? D) Are you satisfied with your quality of life? E) Do you have access to community agencies that will help you to live successfully in this community?

Ans: A, B, C, D Feedback: The client's perception of the success of treatment plays a part in evaluation. In a global sense, evaluation of the treatment of schizophrenia is based on the following: • Have the client's psychotic symptoms disappeared? If not, can the client carry out his or her daily life despite the persistence of some psychotic symptoms? • Does the client understand the prescribed medication regimen? Is he or she committed to adherence to the regimen? • Does the client believe that he or she has a satisfactory quality of life? The question, "Do you have access to community agencies that will help you to live successfully in this community?" is an appropriate question to ask to evaluate the plan of care but does not directly relate to antipsychotic medications.

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

Ans: A, B, D Feedback: Paranoid, antisocial, and narcissistic personalities need a serious, straightforward approach that includes limit setting and a matter-of-fact approach. Schizotypal personalities need to improve community functioning through social skills training. Avoidant personalities require support and reassurance to promote self-esteem.

The nursing student correctly identifies which of the following statements are true of the etiology of OCD? Select all that apply. A) The cognitive model for OCD etiology focuses on childhood and environmental experiences of growing up. B) The etiology of OCD is not definitively explained at this time. C) OCD is caused by immune dysfunction. D) The primary etiology of OCD is genetics. E) Cognitive models may partially explain why people develop OCD.

Ans: A, B, E Feedback: Different studies of the etiology of OCD show promise, but have yet to definitively explain how or why people develop OCD. Cognitive models of OCD have been long accepted as a partial explanation for OCD. The cognitive model focuses on childhood and environmental experiences of growing up. Heritable, genetic factors are a significant influence on thinking, and environmental influences are not solely responsible. Immune dysfunction may play a role in the etiology of OCD.

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

Ans: A, C Feedback: Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Appropriate nursing interventions include teaching social skills and providing factual feedback about behavior. Acceptance of the behavior will cause the behavior to be intensified. Trying to meet the client's needs for attention is an inappropriate intervention since these clients are already seeking attention.

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

Ans: A, C Feedback: Talking to colleagues about feelings of frustration will help you to deal with your emotional responses, so you can be more effective with clients. Clear, frequent communication with other health-care providers can help to diminish the client's manipulation. Set realistic goals and remember that behavior changes in clients with personality disorders take a long time. Progress can be very slow.

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

Ans: A, C, D Feedback: Schizotypal personality disorder is characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities. Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. Antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others—and with the central characteristics of deceit and manipulation. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Obsessive-compulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency.

When performing discharge planning for a client who has schizophrenia, the nurse anticipates barriers to adhering to the medication regimen. The nurse assesses which of the following as improving the likelihood that the client will follow the prescribed medication regimen? Select all that apply. A) Short-term memory intact B) History of missing appointments C) Receives monthly disability checks D) Walking is primary mode of transportation E) States location of pharmacy nearest his residence

Ans: A, C, E Feedback: Sometimes clients intend to take their medications as prescribed but have difficulty remembering when and if they did so. They may find it difficult to adhere to a routine schedule for medications. Clients may have practical barriers to medication compliance, such as inadequate funds to obtain expensive medications, lack of transportation or knowledge about how to obtain refills for prescriptions, or inability to plan ahead to get new prescriptions before current supplies run out.

A client with schizophrenia has returned to the clinic because of an increase in symptoms. The client reports he stopped taking his meds because he did not like the side effects. The nurse educates the client about managing uncomfortable side effects. Which of the following is included in the teaching plan? Select all that apply. A) Suck on hard candy as desired B) Spend at least 30 minutes outside in the sun daily C) Use stool softeners as needed D) Decrease the amount of daily fluid intake E) Maintain a balanced calorie-controlled diet

Ans: A, C, E Feedback: Unwanted side effects are frequently reported as the reason clients stop taking medications. Interventions, such as eating a proper diet and drinking enough fluids, using a stool softener to avoid constipation, sucking on hard candy to minimize dry mouth, or using sunscreen to avoid sunburn, can help to control some of these uncomfortable side effects.

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

Ans: B Feedback: During escalation, the client's responses represent escalating behaviors that indicate movement toward a loss of control, including pale or flushed face, yelling, swearing, agitated, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to solve the problem or think clearly. This phase is followed by the crisis phase. During a period of emotional and physical crisis, the client loses control. Behaviors may include loss of emotional and physical control, throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, and inability to communicate clearly.

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

Ans: B Feedback: During the escalation phase of aggression, a person may exhibit yelling and threatening, clenched fist, threatening gestures. During the triggering phase of aggression, a person may exhibit signs and symptoms and behaviors including restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger.

During the nursing assessment, a client describes constantly hearing voices mumbling in the background. The client denies that the voices are telling him to do anything harmful. The nurse documents that the client is experiencing which of the following? A) Command hallucinations B) Auditory hallucinations C) Olfactory hallucinations D) Gustatory hallucinations

Ans: B Feedback: Auditory hallucinations, the most common type, involve hearing sounds, most often voices, talking to or about the client. Command hallucinations are voices demanding that the client take action, often to harm self or others, and are considered dangerous. Olfactory hallucinations involve smells or odors. Gustatory hallucinations involve a taste lingering in the mouth or the sense that food tastes like something else.

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

Ans: B Feedback: Because clients with personality disorders take a long time to change their behaviors, attitudes, or coping skills, nurses working with them easily can become frustrated or angry. These clients continually test the limits, or boundaries, of the nurse-client relationship with attempts at manipulation. Nurses must discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings.

The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders? A) Hoarding disorder B) Body dysmorphic disorder C) Pyromania D) Body identity integrity disorder

Ans: B Feedback: Body dysmorphic disorder is a preoccupation with imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life. Elective cosmetic surgery is sought repeatedly to "fix the flaw," yet after surgery, the person is still dissatisfied or finds another flaw in appearance. It becomes a vicious cycle. Hoarding disorder is a progressive, debilitating, compulsive disorder that involves excessive acquisition of animals or apparently useless things; cluttered living spaces that become uninhabitable; and significant distress or impairment for the individual. Pyromania is the desire to start fires. Body identity integrity disorder is the term given to people who feel alienated from a part of their body and desire amputation.

The nurse is working with a client with schizophrenia, disorganized type. It is time for the client to get up and eat breakfast. Which of the following statements by the nurse would be most effective in helping the client prepare for breakfast? A) "I'll expect you in the dining room in 20 minutes." B) "It's time to put your dress on now." C) "Stay right there and I'll get your clothes for you." D) "Why don't you stay here and I'll get your tray for you."

Ans: B Feedback: Clients with schizophrenia may have significant self-care deficits. The client needs clear direction, with tasks broken into small steps, to begin to participate in her own self-care. The other choices do not support the client effectively. "I'll expect you in the dining room in 20 minutes," is authoritarian and does not allow the client dignity. "Stay right here, and I'll get your clothes for you," is also authoritarian and does not allow the client dignity. "Why don't you stay here and I'll get your tray for you," is kinder but it robs the client of the opportunity to do for himself or herself as much as possible.

The client with schizophrenia believes the student nurses are there to spy on the clients. The client is suffering from which of the following symptoms? A) Hallucinations B) Delusions C) Anhedonia D) Ideas of reference

Ans: B Feedback: Delusions are fixed false beliefs that have no basis in reality. Hallucinations are false sensory perceptions or perceptual experiences that do not exist in reality. Ideas of reference are false impressions that external events have special meaning for the person. Anhedonia is feeling no joy or pleasure from life or any activities or relationships.

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

Ans: B Feedback: For the borderline personality disorder client, personal boundaries are unclear, and clients often have unrealistic expectations. Clients easily can misinterpret the nurse's genuine interest and caring as a personal friendship, and the nurse may feel flattered by a client's compliments. The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client's nor the nurse's boundaries are violated.

A client with schizophrenia is seen sitting alone and talking out loud. Suddenly, the client stops and turns as if listening to someone. The nurse approaches and sits down beside the client. Which of the following is the best initial response by the nurse? A) "You must be pretty bored to be sitting here talking to an invisible person." B) "I don't hear or see anyone else; what are you hearing and seeing?" C) "I can tell you are hearing voices, but they are not real." D) "How long have you known the person you are talking to?"

Ans: B Feedback: Intervening when the client experiences hallucinations requires the nurse to focus on what is real and to help shift the client's response toward reality. Initially, the nurse must determine what the client is experiencing—that is, what the voices are saying or what the client is seeing. In command hallucinations, the client hears voices directing him or her to do something, often to hurt self or someone else. For this reason, the nurse must elicit a description of the content of the hallucination so that health-care personnel can take precautions to protect the client and others as necessary. The nurse might say, "I don't hear any voices; what are you hearing?" "How long have you known the person you are talking to?" would reinforce the client's hallucination.

The student nurse correctly identifies that which one of the following statements is true regarding clients with OCD? A) Since the client is aware that his or her behavior is bizarre, the client should just stop the behavior. B) Clients with OCD seem normal on the outside but suffer from overwhelming fear and anxiety. C) Once a person is successfully treated for OCD, he or she has been cured. D) Persons with OCD must avoid stress.

Ans: B Feedback: Most times, clients with OCD seem normal on the outside but suffer from overwhelming fear and anxiety. OCD is often chronic in nature, with symptoms that wax and wane over time. Just because the client has some success in managing thoughts and rituals, it does not mean he or she will never need professional help in the future. It is not likely possible for persons with OCD to avoid stress.

Which of the following is essential for the nurse to communicate to the client with OCD and to the client's family? A) The client's diagnosis should be kept secret from everyone outside the immediate family and friends. B) The importance of medication compliance and that it may be necessary for medication to be changed to find the one that works best. C) It is important for the client to avoid following a routine. D) It is helpful for others to give unsolicited advice about other activities the client with OCD can engage in.

Ans: B Feedback: Teaching about the importance of medication compliance to combat OCD is essential. It is neither possible nor desirable to keep the client's diagnosis a secret. To accomplish tasks efficiently, the client initially may need additional time to allow for rituals. When the client has completed the ritual or the tie allotted has passed, the client must then engage in the expected activity. At home, the client can continue to follow a daily routine or written schedule that helps him or her to stay on tasks and accomplish activities and responsibilities. It is not helpful for others to give unsolicited advice about other activities the client with OCD can engage in as this will add to the guilt and shame that people with OCD experience.

Which of the following statements about the typical history of illness that would be assessed in a client who has OCD is consistent with OCD? A) OCD usually requires hospitalization. B) OCD treatment is usually outpatient. C) OCD only affects the client's ability to perform ADLs and work, not his or her leisure life. D) Most people seek treatment as soon as they observe the symptoms.

Ans: B Feedback: The client usually seeks treatment only when obsessions become too overwhelming or when compulsions interfere with daily life (work, ADLs, or leisure) or both. Clients are hospitalized only when they have become completely unable to carry out their daily routines. Most treatment is outpatient. The client often reports that rituals began many years before; some begin as early as childhood. The more responsibility the client has as he or she gets older, the more the rituals interfere with the ability to fulfill these responsibilities.

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

Ans: B Feedback: The four temperament traits are harm avoidance, novelty seeking, reward dependence, and persistence. People with high harm avoidance exhibit fear of uncertainty, social inhibition, shyness with strangers, rapid fatigability, and pessimistic worry in anticipation of problems. Avoidant personalities are individuals who appear anxious or fearful. Schizoid personality disorder is a related disorder that is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others—and with the central characteristics of deceit and manipulation.

Which of the following is an important part of therapeutic communication for clients who have OCD? A) To encourage the client to keep the obsession secret. B) To encourage the client to discuss his or her obsession with the nurse. C) The nurse must have the same obsession as the client. D) The nurse must instruct the client to discuss the obsession.

Ans: B Feedback: The nurse encourages the client to talk about the feelings and to describe them in as much detail as the client can tolerate. Because many clients try to hide their rituals and to keep obsessions secret, discussing these thoughts, behaviors, and resulting feelings with the nurse is an important step. It is not necessary for the nurse to have the same obsession as the client.

The nurse enters the room of a client with schizophrenia the day after he has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. The best response by the nurse would be, A) "I can see you want to be alone. I'll come back another time." B) "You don't need to talk right now. I'll just sit here for a few minutes." C) "I've got some other things I can do now. I hope you'll feel like talking later." D) "You would feel better if you would tell me what you're thinking."

Ans: B Feedback: This response indicates acceptance of the client and shows genuine interest in him, building rapport and trust. Initially, the client may tolerate only 5 or 10 minutes of contact at one time. Establishing a therapeutic relationship takes time, and the nurse must be patient. The nurse must maintain nonverbal communication with the client, especially when verbal communication is not very successful. This involves spending time with the client, perhaps through fairly length periods of silence. The presence of the nurse is a contact with reality for the client and also can demonstrate the nurse's genuine interest and caring to the client. The other choices are not consistent with what is therapeutic for the client.

Before eating a meal, a client with obsessive-compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. When evaluating the progress of the client, what is the most important treatment objective for this client? A) Allow ample time for completion of all rituals before each meal. B) Gradually decrease the amount of time spent for performing rituals. C) Increase the client's acceptance of the need for medication to control rituals. D) Omit one ritualistic behavior every 4 days until all rituals are eliminated.

Ans: B Feedback: Treatment has been effective when OCD symptoms no longer interfere with the client's ability to carry out responsibilities. When obsessions occur, the client manages resulting anxiety without engaging in complicated or time-consuming rituals. He or she reports regained control over his or her life and the ability to tolerate and manage anxiety with minimal disruption. Ritualistic behaviors may be decreased gradually over time.

Which of the following are central components of a psychiatric rehabilitation and recovery program? Select all that apply. A) Working with clients to have an improved quality of life according to society's point of view B) Working with clients to manage their own lives C) Working with clients to make effective treatment decisions D) Working with clients to have an improved quality of life according to his or her point of view. E) Working with clients to diagnose their problem early

Ans: B, C, D Feedback: Psychiatric rehabilitation has the goal of recovery for clients with major mental illness that goes beyond symptom control and medication management. Working with clients to manage their own lives, make effective treatment decisions, and have an improved quality of life—from the client's point of view—are central components of such programs.

The nurse reviews current literature and identifies that which of the following are included in current studies of biologic theories regarding the etiology of schizophrenia? Select all that apply. A) That there is a particular pathologic structure associated with the disease. B) That genetics is the cause of schizophrenia. C) Persons with schizophrenia have decreased brain volume and abnormal brain function in the frontal and temporal areas of persons with schizophrenia. D) The brain activity of persons with schizophrenia differs from people who do not have schizophrenia. E) That the etiology of schizophrenia may be related to the body's response to exposure of a virus.

Ans: B, C, D, E Feedback: In the first half of the 20th century, studies focused on trying to find a particular pathologic structure associated with the disease, largely through autopsy. Such a site was not discovered. The biologic theories of schizophrenia focus on genetic factors, neuroanatomic and neurochemical factors (structure and function of the brain), and immunovirology (the body's response to exposure to a virus).

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

Ans: B, C, D, E Feedback: It can take clients with a personality disorder a long time to change their behaviors, attitudes, or coping skills; and nurses working with them easily can become frustrated or angry. The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes because clients with personality disorders look as though they are capable of functioning more effectively. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. Team members may have differing opinions about individual clients.

Which of the following would be appropriate outcomes for a client with OCD? Select all that apply. A) The client will stop engaging in the compulsive activity. B) The client will spend less time performing rituals. C) The client will complete daily routine activities within a realistic time frame. D) The client will conceal the behavior from all persons to avoid anxiety. E) The client will demonstrate effective use of behavior therapy techniques.

Ans: B, C, E Feedback: Outcomes for clients with OCD include the following: • The client will complete daily routine activities within a realistic time frame. • The client will demonstrate effective use of relaxation techniques. • The client will discuss feelings with another person. • The client will demonstrate effective use of behavior therapy techniques. • The client will spend less time performing rituals.

The parents of a young adult male who has schizophrenia ask how they can recognize when their son is beginning to relapse. The nurse teaches the family to look for which of the following? Select all that apply. A) Excessive sleeping B) Fatigue C) Irritability D) Increased inhibition E) Negativity

Ans: B, C, E Feedback: Teaching the client and family members to prevent or manage relapse is an essential part of a comprehensive plan of care. This includes providing facts about schizophrenia, identifying the early signs of relapse, and teaching health practices to promote physical and psychological well-being. Early signs of relapse include impaired cause-and-effect reasoning, impaired information processing, poor nutrition, lack of sleep, lack of exercise, fatigue, poor social skills, social isolation, loneliness, interpersonal difficulties, lack of control, irritability, mood swings, ineffective medication management, low self-concept, looking and acting different, hopeless feelings, loss of motivation, anxiety and worry, disinhibition, increased negativity, neglecting appearance, and forgetfulness.

Which of the following are features of the thinking of a person who has OCD according to the cognitive model? Select all that apply. A) The person with OCD employs a minimalist approach to all aspects of his or her life. B) The person with OCD believes one's thoughts are overly important and has a need to control those thoughts as they overestimate the threat posed by their thoughts. C) The person with OCD is always aware that his or her behavior is related to OCD. D) The person with OCD is concerned with perfectionism and has an intolerance of uncertainty. E) The person with OCD has an inflated personal responsibility

Ans: B, D, E Feedback: The cognitive model describes the person's thinking as (1) believing one's thoughts are overly important; that is, "If I think it, it will happen," and therefore having a need to control those thoughts; (2) perfectionism and the intolerance of uncertainty; and (3) inflated personal responsibility (from a strict moral or religious upbringing) and overestimation of the threat posed by one's thoughts. The person with OCD would not employ a minimalist approach to all aspects of his or her life—he or she is likely to perform some tasks at extreme levels. The persons with OCD may not always be aware that their behavior is related to OCD.

The nurse is assessing for negative symptoms of schizophrenia in a newly admitted client. The nurse would note which behavior as indicative of a negative symptom? A) Difficulty staying on subject when responding to assessment questions B) Belief of owning a transportation device allowing for travel to the center of the Earth C) Hesitant to answer the nurse's questions during the assessment interview D) Mimicking the postural changes made by the nurse during the assessment interview

Ans: C Feedback: A negative symptom of schizophrenia is alogia, or the tendency to speak very little or to convey little substance of meaning (poverty of content). Associative looseness (fragmented or poorly related thoughts and ideas), delusions (fixed false beliefs that have no basis in reality), and echopraxia (imitation of the movements and gestures of another person whom the client is observing) are all positive symptoms.

A client with schizophrenia is reluctant to take his prescribed oral medication. The most therapeutic response by the nurse to this refusal is, A) "I can see that you're uncomfortable now, so we can wait until tomorrow." B) "If you refuse these pills, you'll have to get an injection." C) "What is it about the medicine that you don't like?" D) "You know you have to take this medicine for your own good."

Ans: C Feedback: Asking the client why he does not like his medication explores the client's reason for refusal, which is the first step in resolving the issue. The nurse must determine the barriers to compliance for each client. Threatening the client with an injection is assault. Waiting until tomorrow puts off the inevitable. Telling him it is for his own good is not the most therapeutic response in order to get the client to take his medication.

Which of the following treatment modalities is most effective for OCD? A) Behavioral techniques B) Medication C) Behavioral techniques and medication D) Ignoring it

Ans: C Feedback: Behavioral techniques and medication are the most effective treatment modalities for OCD. This would be more effective than either behavioral techniques or medication alone. It is not appropriate to ignore OCD as it will only get worse until the client is unable to engage in activities of daily living.

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

Ans: C Feedback: Clients with borderline personality disorder have issues with boundaries; by respecting the client's boundaries, the nurse can assist the client to develop better boundary control.

6. What would the nurse expect to assess in a client with narcissistic personality disorder? A) Genuine concern for others B) Mistrust of others C) Grandiose and superior self-concept D) Dependence on others for decision making

Ans: C Feedback: Clients with narcissistic personality disorder believe themselves superior to others and expect to be treated as such.

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

Ans: C Feedback: Cognitive restructuring is a technique useful in changing patterns of thinking by helping clients to recognize negative thoughts and feelings and to replace them with positive patterns of thinking. Thought stopping is a technique to alter the process of negative or self-critical thought patterns. When the thoughts begin, the client may actually say "Stop!" in a loud voice to stop the negative thoughts. Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. Assertive communication involves using "I" statements.

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

Ans: C Feedback: Failure to complete a developmental task jeopardizes the person's ability to achieve future developmental tasks. Self-directed people are realistic and effective and can adapt their behavior to achieve goals. Highly cooperative people are described as empathic, tolerant, compassionate, supportive, and principled. People low in self-directedness are helpless and unreliable. Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the universe.

A client diagnosed with schizophrenia is laughing and talking while sitting alone. Which of the following is the best response by the nurse? A) State, "Can you share your joke with me?" B) To sit with the client quietly until the client is ready to talk C) State, "Tell me what's happening." D) State, "You look lonely here. Let's join the others in the day room."

Ans: C Feedback: Having the client tell the nurse what is happening explores what the client is experiencing and engages the client in reality interaction. Answer choices A, B, and C are not appropriate responses by the nurse in this situation.

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

Ans: C Feedback: Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Clients usually seek treatment for depression, unexplained physical problems, and difficulties in relationships. Obsessive-compulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. 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.

The nurse is preparing a client with schizophrenia for discharge. The nurse asks the client, "How are you going to care for yourself at home?" The purpose of the nurse's question is to assess the client's A) self concept. B) judgment. C) insight. D) social support system.

Ans: C Feedback: Insight refers to the client's degree of self-awareness and realistic view of life. It can be severely impaired in schizophrenia. Over time, some clients can learn about the illness, anticipate problems, and seek appropriate assistance as needed. Judgment refers to appropriate decision-making ability and is based on the ability to interpret the environment correctly. At times, lack of judgment is so severe that clients cannot meet their needs for safety and protection and place themselves in harm's way.

7. Which term describes the extent to which a person considers himself to be an integral part of the universe? A) Cooperativeness B) Self-directedness C) Self-transcendence D) Character

Ans: C Feedback: Self-transcendence describes the extent to which a person considered himself or herself to be an integral part of the universe. Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Character consists of concepts about the self and the external world.

Which of the following attitudes would be best for the nurse when the client who has schizophrenia acts as though the nurse is not trustworthy or that his or her integrity is being questioned? A) That the client is correct and the nurse is not trustworthy B) That the client wants to insult the nurse C) That the client's behavior is a part of the illness D) That the nurse's actions have failed

Ans: C Feedback: Suspicious or paranoid behavior on the client's part may make the nurse feel as though he or she is not trustworthy or that his or her integrity is being questioned. The nurse must recognize this type of behavior as part of the illness and not interpret or respond to it as a personal affront. The nurse must not take responsibility for the success or failure of treatment efforts or view the client's status as a personal success or failure.

A client states, "I am dead. I have come back from the dead." An appropriate response by the nurse is, A) "What is it like to feel dead?" B) "No you did not die. People don't come back from the dead." C) "Show me what you did in art therapy this morning." D) "I'll get your medicine and you'll feel better."

Ans: C Feedback: The client experiencing delusions utterly believes them and cannot be convinced they are false or untrue. It is the nurse's responsibility to present and maintain reality by making simple statements. The nurse must avoid openly confronting the delusion or arguing with the client about it. The nurse also must avoid reinforcing the delusional belief by "playing along" with what the client says.

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

Ans: C Feedback: The client may attempt to bend the rules "just this once" with numerous excuses and justifications. The nurse's refusal to be manipulated or charmed will help decrease manipulative behavior. Avoid any discussion about why requirements exist. State the requirement in a matter-of-fact manner. Avoid arguing with the client.

A student nurse is having a first experience in an inpatient psychiatric unit and is frightened by the behaviors of the clients with schizophrenia. The student should take which of the following actions to deal with fear? A) Express fear to the psychiatrist during rounds B) Pretend to not be afraid C) Stay in an open area while talking with the clients D) Insist that the instructor accompanies the student at all times.

Ans: C Feedback: The nurse also may be genuinely frightened or threatened if the client's behavior is hostile or aggressive. The nurse must acknowledge these feelings and take measures to ensure his or her safety. This may involve talking to the client in an open area rather than in a more isolated location or having an additional staff person present rather than being alone with the client. If the nurse pretends to be unafraid, the client may sense the fear anyway and feel less secure, leading to a greater potential for the client to lose personal control. It is not possible for the instructor to accompany the student at all times.

A client who has schizophrenia is having a conversation with the nurse suddenly stops talking in the middle of a sentence. The client is experiencing which type of thought disruption? A) Thought withdrawal B) Thought insertion C) Thought blocking D) Thought broadcasting

Ans: C Feedback: The nurse can assess thought content by evaluating what the client actually says. For example, clients may suddenly stop talking in the middle of a sentence and remain silent for several seconds to 1 minute (thought blocking). They also may state that they believe others can hear their thoughts (thought broadcasting), that others are taking their thoughts (thought withdrawal), or that others are placing thoughts in their mind against their will (thought insertion).

The nurse is providing education to a group of persons from several community agencies about hoarding by elder persons. Which of the following is important for the nurse to emphasize? A) Treatment will likely start to be effective in the short term. B) If the person had help to clean up his or her environment, the hoarding would be cured. C) It is not beneficial to tell the client that his or her thoughts and rituals interfere with his or her life or that his or her ritual actions really have no lasting effect on anxiety. D) One agency should be able to address all of the client's needs.

Ans: C Feedback: Treatment for hoarding in older adults may need to continue over a long period of time to reach successful outcomes. Most persons who are hoarders will not seek assistance to clean up their environment because they feel ashamed. If the environment were to be cleaned up and no other intervention employed, the person would continue to hoard. It is not beneficial to tell the clients that their thoughts and rituals interfere with their life or that their ritual actions really have no lasting effect on anxiety—they already know that. Multiple community agencies may be needed to deal with hoarding in the older adult.

Which of the following is the desired outcome for a client with OCD? A) That the client will no longer experience any signs or symptoms of OCD B) That the client will no longer experience anxiety C) That the OCD symptoms no longer interfere with the client's responsibilities D) To relieve the client with OCD of any responsibilities

Ans: C Feedback: Treatment has been effective when OCD symptoms no longer interfere with the client's ability to carry out responsibilities. The client will likely continue to experience signs or symptoms of OCD and anxiety, but the client will be able to manage the resulting anxiety without engaging in complicated or time-consuming rituals. It is not possible or desirable to relieve the client with OCD of any responsibilities.

Which of the following is a realistic outcome for the care of a person with a personality disorder? A) Outcomes that focus on satisfaction with daily life B) Outcomes that focus on the client's perception of others C) Outcomes that focus on increased client insight D) Outcomes that focus on change in behavior

Ans: D Feedback: The treatment focus often is behavioral change. Although treatment is unlikely to affect the client's insight or view of the world and others, it is possible to make changes in behavior.

The client with schizophrenia makes the following statement, "I just don't know how to count. The sky turned to fire. I have a ball in my head." The nurse documents this entire statement as an example of A) flight of ideas. B) ideas of reference. C) delusional thinking. D) associative looseness.

Ans: D Feedback: Associative looseness is demonstrated through fragmented or poorly related thoughts and ideas. The series of disconnected thoughts best exemplifies this concept. Some of the statements contain delusions, or fixed false beliefs that have no basis in reality. Flight of ideas refers to rapidly flowing thoughts that are more connected than the client's statement. Ideas of reference are false impressions that external events have special meaning for the person.

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

Ans: D Feedback: Be consistent and firm with the care plan. Do not make independent changes in rules or consequences. Any change should be made by the staff as a group and conveyed to all staff members working with this client. Consistency is essential. If the client can find just one person to make independent changes, any plan will become ineffective. Client changes can be expected to be gradual and minimal. While all team members need to be apprised of the treatment plan, the main reason is to avoid inconsistencies. Staff's frustrations must be dealt with appropriately, but the primary focus for all treatment planning should be centered on meeting the client's needs.

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

Ans: D Feedback: Clients believe others are just like them, that is, ready to exploit and use others for their own gain. These clients are devoid of personal emotions, and actually the self is quite shallow and empty. These clients view relationships as serving their needs and pursue others only for personal gain. There is no competition because these clients believe they are only taking care of themselves because no one else will.

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

Ans: D Feedback: Clients with schizoid disorder often work well in jobs with minimal interpersonal demands. "Being a loner really limits your employment opportunities," is not a positive suggestion for this client. "Maybe your friend could see it there is a night position available at a convenience store," does not promote independence in finding a job, and a job at a convenience store would entail interpersonal demands. "Perhaps working part-time at a fast-food restaurant would be something you could do," would not be correct because working in a fast-food restaurant would involve the use of many interpersonal skills.

The most commonly supported neuroanatomic theory of schizophrenia suggests which etiology? A) Excessive amounts of dopamine and serotonin in the brain B) Ineffective ability of the brain to use dopamine and serotonin C) Insufficient amounts of dopamine in the brain D) Decreased brain tissue in the frontal and temporal regions of the brain

Ans: D Feedback: Decreased brain tissue in the frontal and temporal regions of the brain is the most commonly supported neuroanatomic theory that suggests the etiology of schizophrenia. The other theories are neurochemical.

A client asks the nurse upon discharge, "What should I do if I forget to take my medicine?" The nurse should explain to the client which of the following? A) "Just double the dose next time it is scheduled." B) "Skip that dose and resume your regular with the next dose." C) "Don't miss doses, or you will not maintain therapeutic drug levels." D) "If you remember within 3 to 4 hours later than it is due, take it then. If you remember more than 4 hours after it was due, do not take that dose."

Ans: D Feedback: If a client forgets a dose of antipsychotic medication, advise the client to take it if the dose is only 3 to 4 hours late. If the missed dose is more than 4 hours late or the next dose is due, ask the client to omit the forgotten dose.

The nurse is caring for her first client with obsessive-compulsive disorder. During the treatment team meeting, the nurse shares her frustration as to the client's inability to stop washing his hands. The nurse manager offers which one of the following explanations? A) The hand washing represents a way to exert independence from the staff. B) The client is not aware of the excessive hand washing. C) The client does not think anything is abnormal with washing his hands repeatedly. D) The client feels terrible but cannot stop washing his hands to try to get rid of his anxiety.

Ans: D Feedback: It may be difficult for nurses and others to understand why the person cannot simply stop performing the bizarre behaviors interfering with his or her life. Nurses must understand what anxiety behaviors are and how anxiety behaviors work, not just for client care but to help understand the role anxiety plays in performing nursing responsibilities.

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

Ans: D Feedback: Managing emotions, especially anger and frustration, can be a major problem. Taking a time-out or leaving the area and going to a neutral place to regain internal control are often helpful strategies. Time-outs help clients to avoid impulsive reactions and angry outbursts in emotionally charged situations, regain control of emotions, and engage in constructive problem solving.

All of the following are nursing diagnoses identified for a client with schizophrenia. The student nurse correctly anticipates which diagnosis will resolve when the client's negative symptoms improve? A) Impaired verbal communication B) Risk for other-directed violence C) Disturbed thought processes D) Social isolation

Ans: D Feedback: NANDA diagnoses commonly established based on the assessment of psychotic symptoms or positive signs are as follows: - Risk for other-directed violence - Risk for suicide - Disturbed thought processes - Disturbed sensory perception - Disturbed personal identity - Impaired verbal communication NANDA diagnoses based on the assessment of negative signs and functional abilities include the following: - Self-care deficits - Social isolation - Deficient diversional activity - Ineffective health maintenance - Ineffective therapeutic regimen management

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

Ans: D Feedback: People who behave in a passive-aggressive way often do things late or in error as a means of protest rather than directly expressing their dissatisfaction or unwillingness. Answer choice A is consistent with anxiety disorders. Answer choice B correlates with behaviors seen in obsessive-compulsive disorder. Dependence on others for decisions occurs in clients with dependent personality disorder.

A client with schizophrenia is attending a follow-up appointment at the community mental health clinic. The client reports to the nurse, "I stopped taking the antipsychotic medication because I can't get a hard-on with my girlfriend anymore." Which of the following should the nurse recommend to enhance the client's well-being? A) "It sounds like that is a problem for you. Don't you still find her to be sexy enough?" B) "Sexual dysfunction is a temporary side effect and should get better once your body is used to the medication." C) "You should avoid having sex with your girlfriend anyway. Do you really want her to get pregnant?" D) "It is important for you to take an antipsychotic medication. You may need a different type that will be less likely to affect your sexual functioning. I would like to call your physician about this."

Ans: D Feedback: Some side effects, such as those affecting sexual functioning, are embarrassing for the client to report, and the client may confirm these side effects only if the nurse directly inquires about them. This may require a call to the client's physician or primary provider to obtain a prescription for a different type of antipsychotic.

A client with schizophrenia is admitted to the inpatient unit. He does not speak when spoken to but has been observed talking to himself on occasion. What would be the priority objective at this time? A) The client will begin talking with other clients B) The client will express his feelings freely C) The client will increase his socialization with others D) The client will increase his reality orientation

Ans: D Feedback: The client needs to be oriented to reality before he can participate in other therapeutic activities. The other choices would not be priority goals for this patient right now.

The student nurse correctly recognizes that which one of the following findings is best supported by genetic studies in the etiology of schizophrenia? A) If a person has schizophrenia, distant relatives are also at risk. B) That there is no relationship at all between schizophrenia and genetics. C) That there is a weak correlation between genetics and schizophrenia. D) That schizophrenia is at least partially inherited.

Ans: D Feedback: The most important studies have centered on twins; these findings have demonstrated that if one identical twin has schizophrenia, the other twin has a 50% chance of developing it as well. Fraternal twins have only a 15% risk. This finding indicates that schizophrenia is at least partially inherited.

4. A nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then display negativity. The nursing student may be showing signs of which personality disorder or behavior? A) Paranoid B) Borderline C) Narcissistic D) Passive-aggressive behavior

Ans:D Feedback: Passive-aggressive behavior is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances. Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy.

A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at and listening to the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly. The professor understands that the student is likely experiencing which level of stress? A) Mild B) Moderate C) Severe D) Panic

B

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? A) Co-dependence B) Control issues C) Self-discipline D) Sexual identity

B) Control issues Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self- discipline, and sexual identity are not pertinent issues to address with the family.

Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? A) Imbalanced nutrition less than body requirements B) Disturbed body image C) Deficient knowledge (nutritious eating patterns) D) Social isolation

B) Disturbed body image The client's dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutrition less than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.

The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? A) Provide the client a diet of mainly vegetables and salads. B) Encourage the entire family to engage in a balanced and regular dietary pattern. C) Encourage autonomy by allowing the client to have total control over food choices. D) Insist that the client complete all meals provided.

B) Encourage the entire family to engage in a balanced and regular dietary pattern. The nurse provides extensive teaching about basic nutritional needs and the effects of restrictive eating, dieting, and the binge and purge cycle. Clients need encouragement to set realistic goals for eating throughout the day. Eating only salads and vegetables during the day may set up clients for later binges as a result of too little dietary fat and carbohydrates. The client with an eating disorder will not make healthy food choices independently. It is also not possible for family and friends to force the client to eat.

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the teaching has been effective? A) ìI know if I eat pasta, I'll binge. B) ìI'll eat small meals and snacks regularly. C) ìI'll take my medication when I feel the urge to binge. D) ìI'll limit my intake of carbohydrates and fats.

B) I'll eat small meals and snacks regularly. Teaching is effective when the client recognizes the need to return to nutritious eating patterns. Answer choices A, C, and D would not be appropriate responses to teaching regarding bulimia nervosa.

The nurse is assessing a client with bulimia nervosa. Which of the following symptoms would the nurse expect to find? Select all that apply. A) Cold intolerance B) Normal weight for height C) Dental erosion D) Hypotension E) Metabolic alkalosis

B) Normal weight for height C) Dental erosion E) Metabolic alkalosis The weight of clients with bulimia usually is in the normal range, although some clients are overweight or underweight. Recurrent vomiting destroys tooth enamel, and incidence of dental caries and ragged or chipped teeth increases in these clients. Metabolic alkalosis often results from vomiting. Cold intolerance and hypotension are symptoms associated with emaciation seen in anorexia nervosa.

Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? A) Leave the client alone to relax during meals. B) Offer liquid protein supplements if the client is unable to complete meal. C) Observe the client for 30 minutes after all meals. D) Weigh the client weekly in the same clothing at the same time of day.

B) Offer liquid protein supplements if the client is unable to complete meal. Nursing interventions designed to establish nutritional eating patterns include sitting with the client during meals and snacks, giving a liquid protein supplement to replace any food not eaten to ensure consumption of the total number of prescribed calories, adhering to treatment program guidelines regarding restrictions, observing the client following meals and snacks for 1 to 2 hours, weighing client daily in uniform clothing, and being alert for attempts to hide or discard food or inflate weight.

When documenting the mental status exam findings in the chart of a client with anorexia, the nurse notes poor judgment and insight. Which client statement would support this impression? A) ìI know I have a problem. I need help.î B) ìOthers are just trying to keep me from looking good.î C) ìI know my weight is a little below normal.î D) ìThose weight charts are for normal people. I am not normal.

B) Others are just trying to keep me from looking good. Clients with anorexia have very limited insight and poor judgment about their health status. They do not believe they have a problem; rather, they believe others are trying to interfere with their ability to lose weight and to achieve the desired body image. Facts about failing health status are not enough to convince these clients of their true problems.

A 16-year-old female with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome? A) The client will accept herself as having value and worth. B) The client will admit she has a fear of gaining weight. C) The client will follow a nutritionally balanced diet for her age. D) The client will identify her problems and potential alternative coping strategies.

B) The client will admit she has a fear of gaining weight. Admitting her fears is an initial step in recovery. Accepting herself as having value and worth, following a nutritionally balanced diet, and identifying problems and potential alternative coping strategies are examples of long-term outcomes.

The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement would indicate that teaching was effective? A) ìWe will eat our evening meals together with no exceptions.î B) ìWe will negotiate resolutions to family conflicts.î C) ìWe will spend less time discussing troublesome family members.î D) ìWe will give her frequent encouragement for eating well and maintaining her weight.

B) ìWe will negotiate resolutions to family conflicts. Families of clients with eating disorders typically put too much emphasis on food and are less skilled at discussing family conflicts and allowing the client to begin gaining independence. ìWe will eat our evening meals together with no exception,î allows little or no compromise; the client needs to be able to make decisions for him or herself. ìWe will spend less time discussing troublesome family members,î indicates that the client is a problem to the family. ìWe will give her frequent encouragement for eating well and maintaining her weightî indicates that family members can express concern about the client's health, but it is rarely helpful to focus on food intake, calories, and weight.

Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply. A) Sigmund Freud's theory B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory D) Pavlov's theory

B, C

The student nurse correctly identifies that according to Selye (1956, 1974), which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs? A) Resistance B) Exhaustion C) Alarm reaction D) Autonomic

C

Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa? A) Changing her irrational thinking about her body B) Establishing a target weight to be achieved by discharge C) Restoring nutritional status to normal D) Gaining insight into the effects of anorexia on her physical health

C) Restoring nutritional status to normal Physiologic safety and homeostasis are the priority concerns. Changing of thought pattern, establishing a target weight, and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa.

The nurse is assisting the client with anorexia to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings? A) ìAre you sad? B) ìYou look anxious. C) ìTell me what you are feeling right now. D) ìTell me when you feel bad.

C) Tell me what you are feeling right now. Because clients with anorexia have problems with self-awareness, they often have difficulty identifying and expressing feelings. Therefore, they often express these feelings in terms of somatic complaints such as feeling fat or bloated. The nurse can help clients begin to recognize emotions by asking them to describe how they are feeling and allowing adequate time for response. The nurse should not ask, ìAre you sad?î or ìAre you anxious?î because a client may quickly agree rather than struggle for an answer. The nurse encourages the client to describe her or his feelings. This approach can eventually help clients to recognize their emotions and to connect them to their eating behaviors.

A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" The best response by the nurse would be, A) "Both therapies are effective. You can eventually choose one or the other." B) "You cannot get the full effect of your medications without cognitive therapy as well." C) "As soon as your medications reach therapeutic level, you can omit the therapy." D) "Medications combined with therapy help you change how well you function."

D

An anxiolytic agent, lorazepam (Ativan), has been prescribed for the client. Which of the following statements by the client would indicate to the nurse that client education about this medication has been effective? A) "My anxiety will be eliminated if I take this medication as prescribed." B) "This medication presents no risk of addiction or dependence." C) "I will probably always need to take this medication for my anxiety." D) "This medication will relax me, so I can focus on problem solving."

D

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to A) approach the client and ask, "What's wrong?" B) call for help and say, "Calm down." C) turn and walk away from the room without saying anything. D) stand at the doorway and say, "You seem upset."

D

The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which one of the following characteristics? A) Focusing only on immediate task B) Faster rate of speech C) Narrowed perceptual field D) Heightened focus

D

Which one of the following can be a positive outcome of using defense mechanisms? A) Defense mechanisms can inhibit emotional growth. B) Defense mechanisms can lead to poor problem-solving skills. C) Defense mechanisms can create difficulty with relationships. D) Defense mechanisms can help a person to reduce anxiety.

D

All of the following nursing diagnoses are appropriate for the care of a client with anorexia. Which nursing diagnosis has the highest priority? A) Activity intolerance B) Ineffective coping C) Chronic low self-esteem D) Imbalanced nutrition: less than body requirements

D) Imbalanced nutrition: less than body requirements Nursing diagnoses for clients with eating disorders include imbalanced nutrition less than/more than body requirements, activity intolerance, ineffective coping, and chronic low self-esteem. When prioritizing nursing diagnoses, physical needs must be met before psychosocial needs (apply Maslow's hierarchy of needs). Of the physical needs, nutritional imbalances pose a more acute threat than decreased activity levels. When addressing psychosocial needs, improving coping skills will eventually lead to rise in self-esteem.

While assessing the family dynamics of a client with an eating disorder, which of the following does the nurse most likely discover? A) Multiple siblings B) Lack of interest in the client by other family members C) Supportive and encouraging relationships D) Over controlling parents

D) Over controlling parents Two essential tasks of adolescence are the struggle to develop autonomy and the establishment of a unique identity. Autonomy may be difficult in families that are overprotective or in which enmeshment (lack of clear role boundaries) exists. Such families do not support members' efforts to gain independence, and teenagers may feel as though they have little or no control over their lives. They begin to control their eating through severe dieting and thus gain control over their weight. Losing weight becomes reinforcing: by continuing to lose, these clients exert control over one aspect of their lives.

During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which would indicate to the nurse that this client might have anorexia nervosa? A) Episodes of overeating and excessive weight gain B) Expressions of a positive self-concept C) Flexible thought patterns and spontaneity D) Severe weight loss due to self-imposed dieting

D) Severe weight loss due to self-imposed dieting Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

Which of the following are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A) Positive reframing B) Decatastrophizing C) Assertiveness training D) Humor E) Unlearning

A, B, C, E

The nurse knows that which of the following are stages in Selye's general adaptation syndrome? Select all that apply. A) Alarm reaction stage B) Resistance stage C) Coping stage D) Exhaustion stage E) Panic stage

A, B, D

A client who suffers from frequent panic attacks describes the attack as feeling disconnected from himself. The nurse notes in the client's chart that the client reports experiencing A) hallucinations. B) depersonalization. C) derealization. D) denial.

B

A nurse is working with a client to develop assertive communication skills. The nurse documents achievement of treatment outcomes when the client makes a statement such as, A) "I'm sorry. I'm not picking this up very quickly." B) "I feel upset when you interrupt me." C) "You are pushing me too hard." D) "I'm not going to let people push me around anymore."

B

Which of the following statements about the use of defense mechanisms in persons with anxiety disorders are accurate? Select all that apply. A) Defense mechanisms are a human's attempt to reduce anxiety. B) Persons are usually aware when they are using defense mechanisms. C) Defense mechanisms can be harmful when overused. D) Defense mechanisms are cognitive distortions. E) The use of defense mechanisms should be avoided. F) Defense mechanisms can control the awareness of anxiety.

A, C, D, F

The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach? A) ìIs there any way you can look at that sandwich as fuel for your body? B) ìYou have to eat in moderation for good nutrition. C) ìYou seem to have a really hard time controlling your eating patterns. D) ìIs this your way of showing your family that you can make decisions?

A) "Is there any way you can look at that sandwich as fuel for your body? CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept.

Which techniques would be most effective for a client who has situational phobias? Select all that apply. A) Flooding B) Reminding the person to calm down C) Systematic desensitization D) Assertiveness training E) Decatastrophizing

A, C

The nursing student understands correctly when identifying which objective is appropriate for all clients with anxiety disorders? A) The client will experience reduced anxiety and accept the fact that underlying conflicts cannot be treated. B) The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations. C) The client will experience reduced anxiety and learn to control primitive impulses. D) The client will experience reduced anxiety and strive for insight through psychoanalysis.

B

The student nurse correctly identifies that which one of the following statements applies to the parasympathetic nervous system? A) It is activated during the alarm reaction stage. B) It is activated during the resistance stage. C) It is activated during the exhaustion stage. D) It is commonly referred to as the fight, flight, or freeze response.

B

Which of the following would be key points for the nurse to remember when working with persons who are suffering from anxiety disorders? A) It is important for the nurse to "fix" the client's problems. B) Remember to practice techniques to manage stress and anxiety in your own life. C) If you have any uncomfortable feelings, do not tell anyone about them. D) Remember that only people who suffer from anxiety disorders have stress that can interfere with daily life and work.

B

Which may help a person to overcome an eating disorder that causes weight gain? A) Being ashamed of his or her body image B) Believing that gaining weight is a side effect of unhealthy lifestyle behaviors and losing weight is a side effect of healthy lifestyle behaviors C) Being reminded that every morsel of food he or she consumes will make him or her fat D) Knowing that his or her current weight is abnormal

B) Believing that gaining weight is a side effect of unhealthy lifestyle behaviors and losing weight is a side effect of healthy lifestyle behaviors Cognitive-behavioral therapy has been found to be the most effective treatment for bulimia. Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept. All of the other statements are factors that may reinforce the continuing cycle of an eating disorder.

Which eating disorder is characterized by consuming an amount of food much larger than a person would normally eat and of near-normal weight? Afterward, the client may purge the food or exercise excessively, and between binges, the client may eat low- calorie foods or fast. A) Anorexia nervosa B) Bulimia nervosa C) Pica D) Rumination

B) Bulimia nervosa Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. The amount of food consumed during a binge episode is much larger than a person would normally eat. Between binges, the client may eat low-calorie foods or fast. Anorexia nervosa is a life- threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. The weight of clients with bulimia usually is in the normal range. Pica is persistent ingestion of nonfood substances. Rumination is repeated regurgitation of food that is then rechewed, reswallowed, or spit out.

What is the primary difference between anorexia nervosa and bulimia nervosa? A) Anorexia has a psychological basis, whereas the cause of bulimia is biologic. B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. C) Bulimia can be life threatening, whereas anorexia is seldom so. D) There is no real difference between these two types of disorders.

B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families.

A client asks how his prescribed alprazolam (Xanax) helps his anxiety disorder. The nurse explains that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders? A) Serotonin B) Norepinephrine C) GABA D) Dopamine

C

A client is currently experiencing a panic attack. Which of the following is the most appropriate response by the nurse? A) "Just try to relax." B) "There is nothing here to harm you." C) "You are safe. Take a deep breath." D) "What are you feeling right now?"

C

A client says to the nurse, "I just can't talk in front of the group. I feel like I'm going to pass out." The nurse assesses the client's anxiety to be at which level? A) Mild B) Moderate C) Severe D) Panic

C

The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which of the following schedules for practicing stress management techniques? A) Practice the techniques each morning and night as part of a daily routine. B) Use the techniques as needed when experiencing severe anxiety. C) Practice the techniques when relatively calm. D) Expect to practice the techniques when meeting with a therapist.

C

The nurse is teaching about postoperative wound care. As the wound is uncovered, the client begins mumbling, breathing rapidly, and trying to get out of bed, and the client does not respond when the nurse calls his name. Which of the following should be the nurse's first action? A) Ask the client to describe his feelings. B) Proceed with wound care quickly. C) Replace the dressing on the wound. D) Get the assistance of another nurse.

C

The nurse understands that before a client with an eating disorder can accept their body image, he or she must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills? A) Coping skills are dependent on a supportive upbringing. B) When body image is positive, the client will develop better coping skills. C) Being able to cope in healthy ways improves the ability to accept a realistic body image. D) Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.

C) Being able to cope in healthy ways improves the ability to accept a realistic body image. When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image.

Which of the following interventions would be appropriate for a client with anorexia nervosa? A) Allowing the client to eat whenever she feels hungry B) Insisting that the client sit in the dining room until all food is eaten C) Having the client in view of staff for 90 minutes after each meal D) Permitting the client to eat any food she chooses, as long as she is eating

C) Having the client in view of staff for 90 minutes after each meal Many clients with anorexia also have purging behavior; even those who have not purged previously may begin to do so when they are unable to restrict their eating. Answer choices A, B, and D do not promote healthy eating behaviors.

Which nursing statement is most effective in communicating a positive expectation of the client? A) ìI'll give you 90 minutes to eat.î B) ìI will allow you space to eat in peace.î C) ìI will sit here quietly with you while you eat.î D) ìThere are people who would truly appreciate this food.

C) I will sit here quietly with you while you eat. This statement reflects the nurse's expectation that the client will eat, yet the nurse still will provide adequate supervision. The other choices are not appropriate means of assuming a positive expectation of the client.

Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client's distorted body image? A) Amitriptyline (Elavil) B) Cyproheptadine (Periactin) C) Olanzapine (Zyprexa) D) Fluoxetine (Prozac)

C) Olanzapine (Zyprexa) Several classes of drugs have been studied, but few have shown clinical success. Amitriptyline (Elavil) and the antihistamine cyproheptadine (Periactin) in high doses (up to 28 mg/day) can promote weight gain in clients with anorexia nervosa. Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions) and associated weight gain. Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored. However, close monitoring is needed because weight loss can be a side effect.

A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? A) Dieting helps build a positive self-image in children. B) Dieting during childhood restricts essential nutrients needed for normal growth. C) Dieting at an early age teaches healthy eating habits. D) Dieting at an early age may lead to the development of eating disorders.

D) Dieting at an early age may lead to the development of eating disorders. A specific cause for eating disorders is unknown. Initially, dieting may be the stimulus that leads to their development. Dieting is also associated with the risk factor of dissatisfaction with body image. Children need well-balanced diets rather than calorie restriction diets. Eating patterns during childhood are often carried into adulthood.

The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? A) Careless B) Outspoken C) Defiance D) Eager to please

D) Eager to please Family members often describe clients with anorexia nervosa as perfectionists with above-average intelligence, achievement oriented, dependable, eager to please, and seeking approval before their condition began. Parents describe clients as being ìgood, causing us no troubleî until the onset of anorexia. Likewise, clients with bulimia often are focused on pleasing others and avoiding conflict.

15. Disclosure of client information beyond the interdisciplinary team without consent of the client is a breach of A) beneficence. B) confidentiality. C) duty. D) veracity.

Ans: B Feedback: Confidentiality involves the disclosure of information only to authorized individuals. Beneficence is one's duty to benefit or to promote good for others. Duty is the existence of a legally recognized relationship. Veracity is the duty to be honest and truthful.

The nursing student answers the test item correctly when identifying which one of the following statements is true? A) Anxiety and fear are the same. B) Anxiety is unavoidable. C) Anxiety is always harmful. D) Fear is feeling threatened by an unknown entity.

B

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

Ans: A Feedback: When the client becomes physically aggressive (crisis phase), the staff must take charge of the situation for the safety of the client, staff, and other clients. Psychiatric facilities offer training and practice in safe techniques for managing behavioral emergencies, and only staff with such training should participate in the restraint of a physically aggressive client. Verbal expression and problem solving are ineffective once a client has reached the crisis phase. The priority is to maintain safety and regain control.

7. Which is most likely to be the subject of an aggressive attack from a client with mental illness? A) Other people B) The client C) Animals D) Objects

Ans: B Feedback: Clients with psychiatric disorders are more likely to hurt themselves than other people.

5. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior? A) Triggering B) Escalation C) Crisis D) Postcrisis

Ans: C Feedback: Interventions during the triggering and escalation phases are key to prevent physically aggressive behavior. During the crisis phase, behavior escalation may lead to physical aggression. During the postcrisis phase, the physically aggressive behavior has stopped and the client returns to the level of functioning before the aggressive incident.

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

Ans: B Feedback: The use of restraints is warranted only when the client's safety is in jeopardy and other, less restrictive measures have not been effective. The nurse does not base her decision on the client's mood or court order. Just because there is a physician's order for use of restraints, this does not mean that they are appropriate in every situation; this is based on nursing judgment.

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

Ans: B Feedback: Verbally expressing angry feelings is a safe and appropriate way to deal with anger. Isolation and catharsis can increase angry and hostile feelings. The other choices are not appropriate responses in this situation.

The nurse knows that which one of the following statements is true about stress and anxiety? A) All people handle stress in the same way. B) Stress is a person's reaction to anxiety. C) Anxiety occurs when a person has trouble dealing with life situations, problems, and goals. D) Stress is the wear and tear that life causes on the body.

D

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

Ans: C Feedback: Acceptance occurs when the person shows evidence of coming to terms with death. Denial is shock and disbelief regarding the loss. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Anger may be expressed toward God, relatives, friends, or health-care providers.

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

Ans: A, C, E Feedback: Universal reactions include the initial response of shock and social disorientation, attempts to continue a relationship with the deceased, anger with those perceived as responsible for the death, and a time for mourning. Not all cultures bury their deceased. Some cultures mourn privately, not turning to the support of others.

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

Ans: A Feedback: Examples of outcomes for the grieving client are as follows: - Identify the effects of his or her loss. - Identify the meaning of his or her loss. - Seek adequate support while expressing grief. - Develop a plan for coping with the loss. - Apply effective coping strategies while expressing and assimilating all dimensions of human response to loss in his or her life. - Recognize the negative effects of the loss on his or her life. - Seek or accept professional assistance if needed to promote the grieving process.

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

Ans: A Feedback: The nurse must be aware of how he or she deals with anger before helping clients do so. The nurse who is afraid of angry feelings may avoid a client's anger, which allows the client's behavior to escalate. If the nurse's response is angry, the situation can escalate into a power struggle, and the nurse loses the opportunity to "talk down" the client's anger. Identifying how you handle angry feelings is an initial task. Once the nurse understands his or her own experiences with anger, the clients can be helped through learning the use of assertive communication and conflict resolution. Increasing your skills in dealing with your angry feelings will help you to work more effectively with clients. Activating a crisis response is a late option in dealing with anger.

17. A nurse is questioning whether it is ethical to seclude a client because of loud and intrusive behavior on the unit. What is the ethical principle that will best guide the decision on appropriate use of seclusion? A) Autonomy B) Beneficence C) Justice D) Veracity

Ans: A Feedback: Autonomy refers to the person's right to self-determination and independence. Beneficence refers to one's duty to benefit or to promote good for others. Justice refers to fairness, that is, treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs. Veracity is the duty to be honest or truthful.

14. The physician has prescribed Haldol 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response? A) Accept the client's decision B) Obtain a discharge order for noncompliance C) Tell the client that he is too sick to refuse D) Restrain the client and give the medication IM

Ans: A Feedback: Clients have the right to refuse medication even when they are psychotic. The client cannot be discharged just because he refuses to take his medications. In this situation, it is not appropriate for the nurse to tell the client that he is too sick to refuse. Restraints are not an appropriate means of getting the client to take the medication.

5. Under which conditions would it be in the client's best interest for the court to appoint a conservator, or legal guardian? Select all that apply. A) Gravely disabled B) Mentally incompetent C) Noncompliant D) Unable to provide basic needs when resources exist E) Act only on his or her own interests

Ans: A, B, D Feedback: The appointment of a conservator or legal guardian is a separate process from civil commitment. People who are gravely disabled; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require appointment of a conservator. In these cases, the court appoints a person to act as a legal guardian who assumes many responsibilities for the person.

28. The term "standards of care" refers to expectations of nursing performance. Standards of care are developed from which of the following? Select all that apply. A) Code of Ethics for Nurses with Interpretive Statements B) Licensure examinations C) State Nurse Practice Acts D) Agency job descriptions E) Professional nursing organizations

Ans: A, C, D, E Feedback: Standards of care are developed from professional standards, state nurse practice acts, federal agency regulations, agency policies and procedures, job descriptions, and civil and criminal laws.

6. 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.

Ans: A Feedback: 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.

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

Ans: B Feedback: Many people view anger as a negative and abnormal feeling in addition to feeling guilty about being angry; the nurse can help the client see anger as a normal, acceptable emotion. Giving choices on how to express anger would not be the next step in the planning stage. Pointing out the senselessness of anger and telling the client not to be angry all the time are not appropriate responses in this situation.

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

Ans: B Feedback: Some clients with depression have anger attacks that are sudden intense spells of anger that typically occur in situation where the depressed person feels emotionally trapped. Anger attacks involve verbal expressions of anger or rage but no physical aggression. Persons with delusions, dementia, and delirium are most likely to become physically aggressive.

30. The staff on an inpatient psychiatric unit is very busy and fall behind on periodic assessment of a severely depressed client. During the rounds, the client is discovered to have completed a suicide attempt in the bathroom. Which type of lawsuit could the client's family file? A) Malpractice B) Breach of duty C) Assault D) Injury or damage

Ans: A Feedback: Clients or families can file malpractice lawsuits in any case of injury, loss, or death. Not all injury or harm to a client can be prevented, nor do all client injuries result from malpractice. The issues are whether or not the client's actions were predictable or foreseeable (and, therefore, preventable) and whether or not the nurse carried out appropriate assessment, interventions, and evaluation that met the standards of care. In the mental health setting, lawsuits most often are related to suicide and suicide attempts. Breach of duty and injury or damage are two of the four elements of malpractice. Assault involves causing a person to fear being touched in an injurious way without consent.

27. Which one of the following is the most common reason for ethical dilemmas being a challenge to nurses? A) Ethical dilemmas are often charged with emotion. B) There are no clear ethical codes established for guidance. C) A multitude of laws must be understood to make a clear decision. D) Clients are not familiar with the ethical code that nurses must follow.

Ans: A Feedback: Ethical dilemmas are often complicated and charged with emotion, making it difficult to arrive at fair or "right" decisions. ANA has established a Code of Ethics for Nurses. Few ethical decisions are guided strictly by legal precedent. Clients are not obligated to follow the professions' ethical principles.

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

Ans: A Feedback: Anger can be a normal and healthy reaction when situations or circumstances are unfair or unjust, personal rights are not respected, or realistic expectations are not met. If the person can express his or her anger assertively, problem solving or conflict resolution is possible. Anger becomes negative when the person denies it, suppresses it, or expresses it inappropriately. A person may deny or suppress (i.e., hold in) angry feelings if he or she is uncomfortable expressing anger. Catharsis can increase rather than alleviate angry feelings. Effective methods of anger expression, such as using assertive communication, to express anger should replace angry aggressive outbursts.

10. The nurse is working with a client who lost her youngest child 2 months ago. When the nurse approaches, the client, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases her response to the client on the understanding of which of the following? A) Hostility is a common behavioral response to grief. B) It is too soon after the loss to empathize with the client. C) Personality traits such as aggressiveness are exaggerated during the grief process. D) The nurse may have nonverbally indicated a judgmental attitude toward the client.

Ans: A Feedback: Behavioral responses to grief are often the easiest to observe. Irritability and hostility toward others reveal anger and frustration in the grief process.

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

Ans: A Feedback: Safety is the priority; the nurse needs assistance to remove other clients and to deal with the violent outburst. The other interventions may be implemented after calling for assistance.

6. Anger management is likely to be included in the care of clients with which of the following psychiatric diagnoses? Select all that apply. A) Alzheimer's dementia B) Schizophrenia C) Anorexia nervosa D) Acute alcohol intoxication E) Generalized anxiety disorder

Ans: A, B, D Feedback: Although most clients with psychiatric disorders are not aggressive, clients with a variety of psychiatric diagnoses can exhibit angry, hostile, and aggressive behavior. Clients with paranoid delusions may believe others are out to get them; believing they are protecting themselves, they retaliate with hostility or aggression. Some clients have auditory hallucinations that command them to hurt others. Aggressive behavior also is seen in clients with dementia, delirium, head injuries, intoxication with alcohol or other drugs, and antisocial and borderline personality disorders.

4. Which of the following clients would most likely be mandated outpatient treatment? A) A client who is addicted to alcohol who has two DUI offenses B) A client with schizophrenia who lives in a single family home with siblings C) A client with bipolar disorder who has quit three jobs in the last 6 months D) A homeless client who has been arrested for petty theft of groceries from a convenience store.

Ans: A Feedback: Mandatory outpatient treatment is sometimes also called conditional release or outpatient commitment. Court-ordered outpatient treatment is most common among persons with severe and persistent metal illness who have had frequent and multiple contacts with mental health, social welfare, and criminal justice agencies. This supports the notion that clients are given several opportunities to voluntarily comply with outpatient treatment recommendations and that court-ordered treatment is considered when those attempts have been repeatedly unsuccessful.

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

Ans: A Feedback: One of the cognitive responses to grief involves the grieving person making sense of the loss. He or she undergoes self-examination and questions accepted ways of thinking. The loss challenges old assumptions about life. Anger, sadness, and anxiety are the predominant emotional responses to loss. The grieving person may direct anger and resentment toward the dead person and his or her health practices, family members, or health-care providers or institutions.

7. 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 of the following is the appropriate response by the nurse to the caller? A) "I cannot confirm or deny the existence of any client here." B) "You will need to be placed on the client's contact list before I can discuss any information with you." C) "The person you are asking for is not a client here." D) "Hold 1 minute while I get the client for you."

Ans: A Feedback: 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 not, which violates client privacy and confidentiality.

24. A client being served in a busy inpatient psychiatric unit becomes very noisy and combative. The other clients are complaining about the noise and are afraid that they will be hurt by the client. The nurse determines that the best course of action for all involved is to seclude the client until the client is able to regain control of his behavior. On which ethical principle did the nurse base this decision? A) Utilitarianism B) Deontology C) Nonmaleficence D) Veracity

Ans: A Feedback: Utilitarianism is a theory that bases decisions on the "greatest good for the greatest number." While the client may experience a temporary loss of freedom, all of the clients on the nursing unit and their visitors will benefit by not being at risk for harm from this client. Deontology is a theory that says decisions should be based on whether or not an action is morally right with no regard for the result or consequences. It may not be considered morally right to deny this client his freedom for any amount of time, irrespective of the consequences (harm to others). Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. In this circumstance, it could be argued that secluding the client could be maleficence, but it also could be argued that the other clients' rights to not be harmed would be violated by not secluding this client until he is able to regain control of his behavior. Justice refers to fairness, that is, treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs. It could be argued that the client was not treated fairly when he was secluded, but it also could be argued that the others were not treated fairly if the client was allowed to continue to freely engage in the disrupting behavior.

26. Which of the following dilemmas involve the ethical principle of fidelity? Select all that apply. A) When the nurse is unable to agree with the policies or common practices of an agency B) When the nurse is faced with a decision to violate a policy that is harmful to the client C) When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients D) When the nurse understands that a combative client must be secluded against their will to prevent harm to others E) When the client refuses to take medication and the nurse respects the client's right to refuse medication

Ans: A, B Feedback: When the nurse is unable to agree with the policies or common practices of an agency, the nurse is facing a dilemma about fidelity, which refers to the obligation to honor commitments and contracts. When the nurse is faced with a decision to violate a policy that is harmful to the client, the nurse is facing a dilemma about fidelity—that is, should the nurse be faithful to the employing agency or the individual client being cared for. When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients, the nurse is acting in accord with the ethical principle of justice. When the nurse understands that a combative client must be secluded against his or her will to prevent harm to others, the nurse is following the ethical principle of utilitarianism. When a client refuses to take medications and the nurse respects the client's right to refuse medication, the nurse is enacting the ethical principle of autonomy.

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

Ans: A, B, C Feedback: Group and planned activities such as playing card games, watching and discussing movies, or participating in informal discussions give the clients the opportunity to talk about events or issues when they are calm. Scheduling one-to-one interactions with clients indicates the nurse's genuine interest in the client and a willingness to listen to the client's concerns, thoughts, and feelings. Knowing what to expect enhances the client's feelings of security. Avoiding discussions does not give clients the opportunity to talk about events or issues when they are calm. If clients have a conflict or dispute with one another, the nurse can offer the opportunity for problem solving or conflict resolution. Expressing angry feelings appropriately, using assertive communication statements, and negotiating a solution are important skills clients can practice. These skills will be useful for the client when he or she returns to the community.

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

Ans: A, B, C Feedback: Eventually, the bereaved person begins to reestablish a sense of personal identity, direction, and purpose for living. He or she gains independence and confidence. New ways of managing life emerge and new relationships form. The person's life is reorganized and seems "normal" again, although different than that before the loss. The person still misses the deceased, but thinking of him or her no longer evokes painful feelings.

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

Ans: A, C, D, E Feedback: The spouse of a person who died 7 years ago and visits the grave several times a day is likely experiencing complicated grieving as this is a prolonged period of time with expression of grief that is exaggerated. A driver whose spouse and children all died as a result of his driving drunk likely experiences feelings of guilt as well as loss. An adult who insisted for many years that he or she hated his or her deceased parent is likely experiencing complicated grief as he or she has experienced an ambivalent attachment. The parent of a child who died after having left the child in a car on a hot day is likely experiencing guilt as well as loss.

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

Ans: A, C, E Feedback: Anger is an emotional response to a real or perceived provocation. Anger energizes the body physically for self-defense, when needed, by activating the "fight-or-flight" response mechanism of the sympathetic nervous system. Hostility is different than anger. Physical aggression is behavior in which a person attacks or injures another person or that involves destruction of property. Hostility is also referred to as verbal aggression. Anger is a normal human emotion. Hostility is an emotion that is expressed through negative behavior. Physical aggression is behavior. Hostility may lead to physical aggression.

2. Which of the following would be circumstances when a client could be subjected to involuntary hospitalization? Select all that apply. A) When a client states that he or she intends to commit suicide and is making plans to do so. B) When a client does not bathe regularly or change clothes often. C) When a client states that he or she intends to harm others by a deliberate act. D) When a client who has diabetes refuses to follow the prescribed diet. E) When a client is unable to control his or her rage and is assaulting everyone around him or her.

Ans: A, C, E Feedback: Health-care professionals respect the wishes of a client who does not wish to be hospitalized and treated unless clients are a danger to themselves or others (i.e., they are threatening or have attempted suicide or represent a danger to others). When a client states that he or she intends to commit suicide and is making plans to do so, the client is threatening suicide and could be subjected to involuntary hospitalization. When a client does not bathe regularly or change clothes often, the client is neglecting his or her hygiene, but it is unlikely that this could be construed as an imminent risk of harm to self. When a client states that he or she intends to harm others by a deliberate act, the client could be considered representing a danger to others. When a client who has diabetes refuses to follow the prescribed diet, the client is acting within his or her own right to comply with the recommendations of their health-care provider. When a client is unable to control his or her rage and is assaulting everyone around him or her, the client would be considered a danger to others.

20. Which of the following are criteria that must be adhered to when instituting the short-term use of restraint or seclusion? Select all that apply. A) The client is aggressive. B) The client is being punished. C) The client is imminently dangerous to himself or herself or to others. D) The client is physically and emotionally self-controlled. E) All other means of calming the client have been unsuccessful.

Ans: A, C, E Feedback: Short-term use of restraint or seclusion is permitted only when the client is imminently aggressive and dangerous to himself or herself or to others, and all other means of calming the client have been unsuccessful. The nurse must frequently contact the client and reassure the client that restraint is a restorative, not a punitive, procedure. If the client is physically and emotionally self-controlled, there is no reason for the client to be restrained or secluded.

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

Ans: A, C, E Feedback: While observing for client responses in the dimensions of grieving, the nurse explores three critical components in assessment: • Adequate perception regarding the loss • Adequate support while grieving for the loss • Adequate coping behaviors during the process The time to experience the loss varies significantly from person to person, and the reality is that there may not be adequate opportunities to say goodbye to the person.

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

Ans: A, D, E Feedback: Nurses must identify how they handle angry feelings and assess their use of assertive communication and conflict resolution. Increasing their skills in dealing with their angry feelings will help the nurses to work more effectively with the client. Nurses must not take the client's anger or aggressive behavior personally or as a measure of their effectiveness as a nurse. Nurses must discuss situations or the care of potentially aggressive clients with experienced nurses. Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior.

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

Ans: B Feedback: Earliest signs of anger include restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, and anger. Escalated signs include pale or flushed face, yelling, swearing, agitation, threatening, demanding, increased muscle tension such as clenched fists, threatening gestures, hostility, and loss of ability to solve the problem or think clearly. Remorse is seen after the anger crisis when attempts are made at reconciliation.

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

Ans: B Feedback: Giving the client an ultimatum is likely to foster hostile or aggressive behavior; the other measures are all appropriate for a client with a history of aggression.

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

Ans: B Feedback: In a psychiatric setting, engaging the hostile person is most effective to prevent the behavior from escalating to physical aggression. In the psychiatric setting, it is not possible to get as far away from them as possible. Yelling at the client will likely escalate the hostility. Ensuring that the client gets his or her way may eliminate frustration that may lead to acting out, but is unrealistic and not ultimately helpful to the client.

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

Ans: B Feedback: Assessment begins with exploration of the client's perception of the loss. A client who is scheduled for a mastectomy would possibly be having anticipatory loss of a physiologic nature. It would not be appropriate to discuss the client's plans for reconstructive surgery as this is not likely what is causing the client to be quiet and show little emotion. It is important to ascertain whether the client truly understands the surgery when witnessing the client's signature of the operative consent, but there is no indication that this is what is being addressed at this time. It would not be appropriate to assume that the client is depressed or not. It would be better to explore the client's perception of the loss.

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

Ans: B Feedback: Assessment begins with exploration of the client's perception of the loss. What does the loss mean to the client? The question is valuable for beginning to facilitate the grief process. Further assessment and intervention will be determined based largely on the client's perception of the event.

18. A nurse is performing safety assessments on a client in mechanical restrains as required by policy. Which action by the nurse demonstrates the ethical principle of nonmaleficence? A) Explaining the behavioral requirements for release of restraint to the client B) Assuring that the restraints are not causing injury to the client C) Applying restraints based solely on assessment findings and not on attitude toward the client D) Releasing the client when stated behavioral control is achieved

Ans: B Feedback: Assuring that the restraints are not causing injury to the client is an example of nonmaleficence, or doing no harm. Explaining the behavioral requirements for release of restraint to the client is providing the client the autonomy to choose behaviors. Applying restraints based solely on assessment findings and not on attitude toward the client is displaying justice. Releasing the client when stated behavioral control is achieved is displaying veracity, or being honest and truthful.

11. Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error? A) Confidentiality allows for the disclosure of information under specific circumstances. B) If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights. C) Privileged communication does not apply to medical records, and they can be used in court. D) Clients can never be held against their will.

Ans: B Feedback: Being committed and/or incompetent does not negate the Patient's Bill of Rights. However, if a guardian is appointed, the client loses the right to enter into legal contracts or agreements that require a signature. Confidentiality does allow for the disclosure of information under specific circumstances such as to another health-care provider who has a need to know or if the client specifically consents that information be shared with persons of his or her choice and also the duty to warn if the client threatens to harm others. Privileged communication relates to the privacy of what was discussed during therapy sessions and this can be documented in medical records. Clients may be held against their will if they are committed to a facility for psychiatric care until they no longer pose a danger to themselves or to anyone else.

1. A client made threats to harm his parents if they come too close to him. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for which of the following? A) Confidentiality B) Right to freedom C) Periodic treatment review D) Choice of providers

Ans: B Feedback: Civil commitment or involuntary hospitalization curtails the client's right to freedom (the ability to leave the hospital when he or she wishes). All other client rights, however, remain intact.

22. A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful? A) The nurse did not have a duty. B) The nurse did not breach duty. C) The client did not suffer some type of loss, damage, or injury. D) There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

Ans: B Feedback: For a malpractice suit to be successful, the client or family needs to prove the following four elements: (1) Duty: a legally recognized relationship (i.e., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. (2) Breach of duty: the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. (3) Injury or damage: the client suffered some type of loss, damage, or injury. (4) Causation: the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. The nurse did have a duty to the client. The nurse did not breach this duty by the nursing actions. The client did experience loss of autonomy from being restrained. Since there was no breach of duty, there was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

19. An adult client is put in restraints after all other attempts to reduce aggression have failed. Which of the following is required now that restraints have been instituted? A) Review of the appropriateness of restraints every 8 hours B) A face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint. C) A documented nursing assessment every 4 hours D) Constant one-on-one supervision during the first hour and then video monitoring

Ans: B Feedback: For adult clients, use of restraint and seclusion requires a face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint or seclusion and every 8 hours thereafter, a physician's order every 4 hours, documented assessment by the nurse every 1 to 2 hours, and close supervision of the client. Staff must monitor a client in restraints continuously on a 1:1 basis for the duration of the restraint period. A client in seclusion is monitored 1:1 for the first hour and then may be monitored by audio and video equipment.

25. The nurse is attending an in-service training on safe take-down techniques for aggressive clients. Preparation for safe physical handling prepares the nurse to practice which ethical principle? A) Veracity B) Nonmaleficence C) Justice D) Autonomy

Ans: B Feedback: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Safe take-down techniques are used to avoid unintentional harm to the client. Veracity is the duty to be honest or truthful. Justice refers to fairness, that is treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs. Autonomy refers to the person's right to self-determination and independence.

16. A client who is depressed and suicidal is scheduled for electroconvulsive therapy (ECT), which requires consent. Legally, who should sign the consent for this treatment? A) A member of the treatment team B) The client C) The client's spouse D) The psychiatrist

Ans: B Feedback: The client has the right to sign (or refuse to sign) the consent. The other parties listed do not have the legal right to sign for the client unless they are the client's legal guardian.

12. When is a nurse legally obligated to breach confidentiality? A) At any time a client is threatening B) If threats are made to an identifiable third party C) Whenever the client becomes aggressive D) When the client violates the nurse's boundaries

Ans: B Feedback: The duty to warn a third party exists when a client threatens harm to that identifiable third party; the client's confidentiality is overridden. Answer choices A, C, and D are not situations in which confidentiality may be breached. Decisions about the duty to warn third parties usually are made by psychiatrists or by qualified mental health therapists in outpatient settings. It is not permissible for a nurse to breach confidentiality at any time a client is threatening, or becomes aggressive or violates the nurse's boundaries.

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

Ans: B Feedback: Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavement-associated symptoms.

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

Ans: B Feedback: Types of loss include safety loss (loss of a safe environment), loss of security and a sense of belonging (loss of a loved one affects the need to love and the feeling of being loved), loss of self-esteem (any change in how a person is valued at work or in relationships or by him or herself), or loss related to self-actualization (external or internal crisis that blocks or inhibits strivings toward fulfillment).

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

Ans: B, C, D Feedback: The interaction of the dimensions of human response is fluid and dynamic. What a person thinks about during grieving affects his or her feelings, and those feelings influence his or her behavior. The critical factors of perception, support, and coping are interrelated as well and provide a framework for assessing and assisting the client. Genetic risk and religion are not critical components to assess in a grieving person.

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

Ans: B, C, D, E Feedback: Circumstances that can result in disenfranchised grief include a relationship that has no legitimacy, the loss itself is not recognized, the griever is not recognized, or the loss involves social stigma. A young adult whose spouse has just died suddenly is not likely to experience disenfranchised grief because of their legal relationship. A family whose long-time pet snake had died is likely to experience disenfranchised grief because the death of a pet is not seen as socially significant. A nurse who had just witnessed the death of a patient is at risk for disenfranchised grief because the needs of nurses and hospital chaplains are not recognized. A couple who had just experienced a pregnancy loss are at increased risk for disenfranchised grief because the loss of an unborn child is not recognized. The gay lover of a man who just died from AIDS is at risk for disenfranchised grief as the relationship had no legitimacy and the loss involves social stigma. The mother and sister of a soldier who was killed in war would not likely experience disenfranchised grief because they have a kin relationship with the decedent.

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

Ans: C Feedback: As the client regains control (recovery phase), he or she is encouraged to talk about the situation or triggers that led to the aggressive behavior. The nurse should help the client relax, perhaps sleep, and return to a calmer state. Talking about the event at a later time does let the client rest, but it does less to address the client's feelings associated with the angry outburst. It is too early postcrisis to discuss behavior change for the future as the client needs to recover from intense emotions first.

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

Ans: C Feedback: Bouffée delirante, a condition observed in West Africa and Haiti, is characterized by a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. Hwa-Byung or hwabyeong is a culture-bound syndrome that literally translates as anger syndrome, or fire illness, attributed to the suppression of anger. Amok is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects.

10. A client who had agreed to be hospitalized for depression problems has decided that now she wants to leave the hospital. The mental health staff caring for her realizes that at present she can legally A) be discharged if evaluated through administrative hearings. B) be retained in the hospital against her will. C) leave the hospital after giving written notice of her intent to do so. D) leave without discussing the situation with anyone.

Ans: C Feedback: Clients who are not dangerous to themselves or others can leave the hospital against medical advice. The other choices are not appropriate.

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

Ans: C Feedback: Following an aggressive episode, clients may have difficulty expressing themselves; short, concise statements and questions will get needed information. Humor or open-ended questions may be frustrating or annoying for the client. It is not safe for the nurse to provide close contact under these circumstances.

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

Ans: C Feedback: If the client progresses to the escalation phase (period when client builds toward loss of control), the nurse must take control of the situation. The nurse should provide directions to the client in a calm, firm voice. The client should be directed to take a time-out for cooling off in a quiet area or his or her room. Clearing others from the area or alerting security does not help the client regain control. Administering a sedative is not the least restrictive intervention at this time.

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

Ans: C Feedback: The nurse can help clients express anger appropriately by serving as a model and by role-playing assertive communication techniques. Assertive communication uses "I" statements that express feelings and are specific to the situation; for example, "I feel angry when you interrupt me," or "I am angry that you changed the work schedule without talking to me." Statements such as these allow appropriate expression of anger and can lead to productive problem-solving discussions and reduced anger.

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

Ans: C Feedback: When the client is able to verbalize angry feelings, this is progress from having an outburst. The client is not trying to control the situation. Manipulation occurs when a person tries to persuade another to act in a desired way. Regression occurs when one retreats to an earlier level of functioning and development.

29. A client underwent a procedure before the nurse verified the client's signature on the consent form. The client actually did not sign the form before the procedure. If the client is dissatisfied with the outcome of the procedure and files a suit against the health-care team, which kind of case can the client file? A) Negligence B) Malpractice C) Battery D) False Imprisonment

Ans: C Feedback: Battery involves harmful or unwarranted contact with a client. False imprisonment is defined as the unjustifiable detention of a client such as the inappropriate use of restraint or seclusion. Negligence is an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances. Clients or families can file malpractice lawsuits in any case of injury, loss, or death.

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

Ans: C Feedback: Bereavement refers to the process by which a person experiences the grief. Anticipatory grieving is when people facing imminent loss begin to grapple with the very real possibility of the loss or death in the near future. Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially. Mourning is the outward expression of grief.

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

Ans: C Feedback: Clients often set goals such as living until a certain time or to experience a particular event, and then they will be ready to die: that is the bargain. Acceptance occurs when the person shows evidence of coming to terms with death. Anger may be expressed toward God, relatives, friends, or health-care providers. Depression results when awareness of the loss becomes acute.

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

Ans: C Feedback: Finding a support group indicates that the client recognizes her need for help and is taking action to get the support she needs. The other choices are not indications that the client's coping skills are adequate for the situation.

3. A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff? A) Calling security and asking them to detain the client B) Allowing the client to leave with community resources for follow-up care C) Contacting the psychiatrist for initiation of commitment proceedings D) Contacting the client's family to request they convince the client to stay

Ans: C Feedback: If a voluntary client who is dangerous to himself or herself or to others signs a request for discharge, the psychiatrist may file for a civil commitment to detain the client against his or her will until a hearing can take place to decide the matter.

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

Ans: C Feedback: It is essential to accept the person's feelings without trying to dissuade him or her from feeling angry or upset. The nurse needs to encourage the person to express any and all feelings without trying to calm or placate him or her.

4. A married couple has just received the news that the husband has terminal cancer. The wife tells the nurse, "Maybe if we get another opinion and start treatment right way there is a chance of survival." The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief? A) Denial B) Anger C) Bargaining D) Depression

Ans: C Feedback: Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn: (1) Denial is shock and disbelief regarding the loss. (2) Anger may be expressed toward God, relatives, friends, or health-care providers. (3) Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. (4) Depression results when awareness of the loss becomes acute. (5) Acceptance occurs when the person shows evidence of coming to terms with death.

18. Which of the following is most likely to prevent the client from experiencing complicated grief? A) Tendency to suppress emotions B) History of depression C) Places trusts familiar others D) Dependent on others to meet needs

Ans: C Feedback: People who are vulnerable to complicated grieving include those with low self-esteem, low trust in others, a previous psychiatric disorder, previous suicide threats or attempts, or absent or unhelpful family members.

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

Ans: C Feedback: Rather than assuming that he or she understands a particular culture's grieving behaviors, the nurse must encourage clients to discover and use what is effective and meaningful to them.

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

Ans: C Feedback: The nurse can help the client to reach out and accept what others want to give in support of his or her grieving process. Help the client shift from an unconscious mechanism of denial to conscious coping with reality by using reflective communication skills. Do not force people through the coping process by insisting they take certain actions.

31. A client comes to the physician's office for an annual checkup. During the interview, the nurse learns that the client's husband died unexpectedly of a heart attack 2 months ago. The most appropriate response by the nurse would be, A) "At least you and your husband enjoyed life right until the end." B) "It's better to go quickly like your husband did instead of suffering." C) "The loss of your husband must be very painful for you." D) "You'll feel better after you get over the shock of your husband's death."

Ans: C Feedback: The nurse makes an empathetic response, acknowledging the client's loss. "At least you and your husband enjoyed life right until the end," is judgmental. "It's better to go quickly like your husband did instead of suffering," does not address the client's grief. "You'll feel better after you get over the shock of your husband's death," is false reassurance. Thus, choices A, B, and D would not be the most appropriate responses.

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

Ans: D Feedback: Do not take the client's anger or aggressive behavior personally or as a measure of your effectiveness as a nurse. The client's aggressive behavior, however, does not necessarily reflect the nurse's skills and abilities. Clients should not dictate nurses' behaviors. The nurse is not responsible for angering the client. Individuals are responsible for their own emotional control. If the nurse cannot maintain boundaries, assistance should be sought form a supervisor.

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

Ans: D Feedback: Engaging the attention of the dominant person will diffuse the situation and stop the argument from continuing. The other choices would not be appropriate actions in this situation. The nurse placing herself in between two arguing clients is a safety concern.

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

Ans: D Feedback: Four to six trained staff members are needed to restrain, with four staff members each handling a limb and one protecting the client's head and one helps control the client's torso, if needed. When a client becomes physically aggressive, the staff must take charge of the situation for the safety of the client, staff, and other clients. Only staff with training in safe techniques for managing behavioral emergencies should participate. All staff may not have had this training, and if the team is not working in a cooperative and coordinated fashion, it is less safe to restrain the client. The nurse should follow the facility's protocols and standards for restraint and seclusion. Staff should inform the client that his or her behavior is out of control and that the staff is taking control to provide safety and prevent injury.

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

Ans: D Feedback: In the postcrisis phase, the nurse should not lecture or chastise the client for the aggressive behavior but should discuss the behavior in a calm, rational manner. The client can be given feedback for regaining control, with the expectation that he or she will be able to handle feelings or events in a nonaggressive manner in the future.

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

Ans: D Feedback: The nurse recognizes and validates the client's feelings and offers to focus on those feelings and what the client needs. In this situation, the client is not at a point where he can be calm. Taking away privileges will not help the current situation. "I don't want to hear that kind of language; don't ever do that again" is demeaning to the client.

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

Ans: D Feedback: Use of restraints is a temporary, short-term way of ensuring the safety of everyone until the client regains behavioral control; it is not a punishment. The other choices are not appropriate explanations of the use of restraints.

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

Ans: D Feedback: Women must recognize that anger awareness and expression are necessary for their growth and development. Anger is a normal human emotion and is often perceived as a negative feeling. However, anger becomes negative when denied, suppressed, or expressed inappropriately. Anger that is expressed inappropriately can lead to hostility and aggression. Catharsis can increase rather than alleviate angry feelings. Men are often socialized to believe that it is acceptable to express anger, while women are often socialized to maintain and enhance relationships with others and avoid expression of emotions such as anger.

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

Ans: D Feedback: Adaptive denial, in which the client gradually adjusts to the reality of the loss, can help the client let go of previous (before the loss) perceptions while creating new ways of thinking about himself or herself, others, and the world. While taking in the loss in its entirety all at once seems overwhelming, gradually dealing with the loss in smaller increments seems much more manageable. Help the client shift from an unconscious mechanism of denial to conscious coping with reality by using reflective communication skills.

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

Ans: D Feedback: As the bereaved person begins to understand the loss's permanence, he or she recognizes that patterns of thinking, feeling, and acting attached to life with the deceased must change. As the person relinquishes all hope of recovering the lost one, he or she inevitably experiences moments of depression, apathy, or despair. The acute sharp pain initially experienced with the loss becomes less intense and less frequent.

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

Ans: D Feedback: Choice D would indicate that the client is proceeding as though there is no impending loss, so the nurse would need to assist the client with grieving as the client is in denial. The other choices are positive coping behaviors toward death.

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

Ans: D Feedback: Disenfranchised grief is grief over a loss that is not or cannot be acknowledged openly, mourned, publicly, or supported socially. Anticipatory grief occurs when a person experiences imminent loss and begin to grapple with the very real possibility of loss or death in the near future. It is not absence of grief as the woman is grieving. It is not currently complicated grief as the loss has just occurred and does not seem out of proportion to the loss.

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

Ans: D Feedback: Safety loss is the loss of a safe environment. That feeling of safety is shattered when public violence occurs. Examples of physiologic loss include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility. A loss of self-esteem includes any change in how a person is valued at work or in relationships or by himself or herself can threaten self-esteem. Loss related to self-actualization includes an external or internal crisis that blocks or inhibits strivings toward fulfillment that may threaten personal goals and individual potential.

24. A couple came to the emergency department with their 5-month-old son. He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to A) accept that they could do nothing to prevent this death. B) delay the grieving process until they are ready to cope. C) minimize their discussion of the death with others. D) plan funeral arrangements for their son.

Ans: D Feedback: Funerals are often the beginning outward sign of mourning and help begin the grieving process. This couple will need to talk about their son's death repeatedly as they begin to grieve. It will not likely be possible for them to accept that they could do nothing to prevent this death within this time period, but they must begin to hear this. They should not delay the grieving process.

13. A client was brought to the emergency department by police after neighbors complained that he was loud and disruptive. The client is paranoid and upset and states, "No one can be trusted." Which of the criteria for involuntary admission does this client meet? A) Dangerous to self. B) Dangerous to others. C) Gravely disabled. D) He does not meet any of the necessary criteria.

Ans: D Feedback: Having a mental illness alone is not sufficient for an involuntary commitment. In this situation, the client is not a danger to himself or others and is not gravely disabled.

8. Which of the following client situations most urgently requires the nurse to break confidentiality and warn a third party? A) An abused woman states, "I have dreams that he is dead." B) A mother states, "Sometimes I feel like killing my kids!" C) A paranoid woman states, "I'll get them before they get me." D) A jealous man states, "I am getting my gun and going to shoot my wife's lover!"

Ans: D Feedback: Mental health clinicians have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions otherwise protected by privilege. The clinician must base his or her decision to warn others on the following: Is the client dangerous to others? Is the danger the result of serious mental illness? Is the danger serious? Are the means to carry out the threat available? Is the danger targeted at identifiable victims? Is the victim accessible?

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

Ans: D Feedback: Relationships between lovers, friends, neighbors, foster parents, colleagues, and caregivers may be long-lasting and intense, but people suffering loss in these relationships may not be able to mourn publicly with the social support and recognition given to family members. In addition, some relationships are not always recognized publicly or sanctioned socially such as extramarital affairs. The grief process is more complex because the usual supports that facilitate grieving and healing are absent. Therefore, nurses should be mindful to provide needed support.

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

Ans: D Feedback: The bereaved person can often take a break from the exhausting process of grieving. Going back to a routine of work or focusing on other members of the family may provide that respite. Familiar routines can affirm the client's talents and abilities and can renew feelings of self-worth.

9. A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but she consistently refuses "any drugs." The staff realizes that legally this client can A) be coerced to accept treatment. B) be committed by her family to receive needed treatment. C) have her family sign permission for treatment. D) continue to refuse treatment.

Ans: D Feedback: The client maintains the right to refuse treatment even if it is needed when she is not dangerous to herself or others. If a client able to give consent, she cannot be coerced into doing so, have her family sign permission for her, or be committed by the family to receive treatment unless she is a danger to herself or others.

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

Ans: D Feedback: The client's symptoms are characteristics of depression, which usually occurs when awareness of the loss becomes acute. Anger may be expressed toward God, relatives, friends, or health-care providers. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. Denial is shock and disbelief regarding the loss.

21. Placing a client in restraints before using other methods of intervention violates which of the client's rights? A) Receive confidential and respectful care B) Provide informed consent C) Refuse treatment D) Receive treatment in the least restrictive environment

Ans: D Feedback: The least restrictive environment means that the client must be free of restraint or seclusion unless it is necessary. Less restrictive treatments must be tried and found to be ineffective before more restrictive measures can be used. It is not necessary for the client to provide informed consent for restraints to be used when appropriate. A client may not refuse restraints if they are to be used when appropriate.

23. Ensuring that the client has informed consent before agreeing to a treatment regimen displays which of the following ethical principles? A) Fidelity B) Nonmaleficence C) Justice D) Autonomy

Ans: D Feedback: The nurse respects the client's autonomy through client's rights, informed consent, and encouraging the client to make choices about his or her health care. The nurse has a duty to take actions that promote the client's health (beneficence) and that do not harm the client (nonmaleficence). The nurse must treat all clients fairly (justice), be truthful and honest (veracity), and honor all duties and commitments to clients and families (fidelity).

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

Ans: D Feedback: The opportunity to hold the baby may help the woman deal with the first stage of grieving: denial; it also allows her to express emotions over the loss. Asking the client, "Can I do anything for you," is a closed-ended question and will likely be replied to with a yes or no answer. Stating, "If something was wrong, it's better this way," is not sensitive to the woman's loss. Stating "Your son is in heaven with God now," would be inappropriate because it may not be consistent with the woman's beliefs.