MH 4 Review

The nurse is working to develop a therapeutic nurse-client relationship with a client diagnosed with paranoid personality disorderWhich technique(s) to develop the relationship will the nurse take to foster trust? Select all that apply.

1. Honor commitments to the client and be on time for scheduled appointments 2. Include the client when developing a plan of care

A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate?

"I will accompany you to the bathroom." Rationale: After each meal or snack, clients may be required to remain in view of staff for a period of time to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior

A client that tells the nurse that they are upset because their partner no longer wants to continue the relationship. Which statement made by the client indicates that the end of the relationship is related to the client's narcissistic personality disorder?

"I won't be alone long; everyone wants to be with me because I am beautiful."

The nurse observe a child with attention-deficit/hyperactivity disorder (ADHD) grab another child in a group session. Which response by the nurse is most effective in stopping the behavior?

"It's not alright to grab other children. When you want something ask them.*

The nurse is completing an evaluation on a client diagnosed with bulimia. Which of the following behaviors would indicate that the client is not progressing positively? Select all that apply:

1. The client request to go to her room after each meal 2. The client verbalized that her previous eating habits before her admission were fine as they were preventing her from gaining weight

A nurse working with children with autism spectrum disorder (ASD) hears an unlicensed assistive personnel (UAP) stating, "I don't know why we put in so much time educating these parents, they don't seem to care what we say." Which is the best response to the UAP about the importance of educating parents of children with ASD?

"We help parents feel relieved to have specific strategies that can help them and their child be more successful." Rationale: Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. Including parents in planning and providing care for the child with ADHD is important.

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching?

"We'll have him do his homework at the kitchen table with his brothers and sisters." Rationale: Doings his homework around his siblings will likely distract him and make it harder for him to concentrate

A nurse is working with clients diagnosed with personality disorders. Which technique(s) would be most important for the nurse to use to effectively deal with the frustration in providing care to this group of clients? Select all that apply.

1. Discuss feelings of anger or frustration with colleagues. 2. Employ ongoing communication with team members.

The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child? A) Break tasks into small steps. B) Let the child complete tasks at his own pace. C) Offer rewards when all tasks are completed. D) Set a time limit to complete all tasks.

A) Break tasks into small steps. Rationale: Before beginning any task, adults must gain the child's full attention. The adult should tell the child what needs to be done and break the task into smaller steps if necessary. This approach prevents overwhelming the child and provides the opportunity for feedback about each set of problems he or she completes.

The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action. 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.

A) It will assist the client to start basing decisions and actions on reality Rationale: One of the most effective interventions with paranoid or suspicious clients is helpingclients to learn to validate ideas before taking action; however, this requires the abilityto trust and to listen to one person. The rationale for this intervention is that clients canavoid problems if they can refrain from taking action until they have validated theirideas with another person. This helps prevent clients from acting on paranoid ideas orbeliefs. It also assists them to start basing decisions and actions on reality.

The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage the parents to use? A) Provide consistent consequences for behaviors. B) Set earlier curfews than the child's peers adhere to. C) Release the child from household responsibilities until he can demonstratedependable behavior. D) Avoid discussing feelings and expectations with the child.

A) Provide consistent consequences for behaviors. Rationale: Parents need to replace old patterns such as yelling, hitting, or simply ignoring behavior with more effective strategies. The nurse can teach parents age-appropriate activities and expectations for clients such as reasonable curfews, household responsibilities, and acceptable behavior at home. The parents may need to learn effective limit setting with appropriate consequences. Parents often need to learn to communicate their feelings and expectations clearly and directly to these clients. Some parents may need to let clients experience the consequences of their behavior rather than rescuing them.

The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child? A) That is not allowed here. You will lose a privilege. You need to stop. B) Stop what you are doing. Go to your room. C) I would appreciate if you would not do that. D) Why do you do these things?

A) That is not allowed here. You will lose a privilege. You need to stop. Rationale: The nurse must set limits on unacceptable behavior at the beginning of treatment. Limit setting involves three steps: (1) informing clients of the rule or limit; (2)explaining the consequences if clients exceed the limit; and (3) stating expected behavior.

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

A)Paranoid B) Antisocial D) Narcissistic Rationale: 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

During an admission interview, a client with anorexia nervosa complains of feeling cold all the time and asks the nurse why. Which of the following is the most appropriate response by the nurse? A "There is a loss of subcutaneous fat." B "You probably aren't dressing warmly enough." C "You might be getting a cold." D "Let me take your temperature."

A- "There is a loss of subcutaneous fat." Rationale: The client is likely cold all of the time due to being underweight (measurable by BMI) and having lessened subcutaneous fat which is used as insulation and temperature regulation.

For a female client with anorexia nervosa. Nurse Jimmy is aware that which goal takes the highest priority? A. The client will establish adequate daily nutritional intake B. The client will make a contract with the nurse that sets a target weight C. The client will identify self-perceptions about body size as unrealistic D. The client will verbalize the possible physiological consequences of self-starvation

A. The client will establish adequate daily nutritional intake Rationale: According to Maslow's hierarchy of needs. all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing. the nurse must first plan to help the client meet this basic. immediate physiological need. Options B. C. and D: The nurse may give lesser priority to goals that address long-term plans. self-perception. and potential complications.

For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? A. They tend to overprotect their children B. They usually have a history of substance abuse C. They maintain emotional distance from their children D. They alternate between loving and rejecting their children

A. They tend to overprotect their children Rationale: Clients with anorexia nervosa typically come from a family with parents who are controlling and overprotective. These clients use eating to gain control of an aspect of their lives .The characteristics described in options B. C. and D aren't typical of parents of children with anorexia.

The nurse is interviewing a client diagnosed with antisocial personality disorderThe client gives the nurse information about a recent physical altercation in which someone was injured and the client got blamed and will be arrested when leaving the facilityWhich action will the nurse take during assessment?

Check and validate information from other sources Rationale: 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

A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today and states that "Yesterday, the other nurse told them they didn't have to go to class if they didn't want to." Which is the best response by the nurse? A."Fine, but you're confined to your room and not allowed to socialize." B."You are obligated to attend class. Missing class is against the rules." C. "You and I both know that the nurse didn't say that." D. "Why do you keep fighting the system, just go along with the rules."

B) "You are obligated to attend class. Missing class is against the rules" Rationale: Reinforcing rules avoids a power struggle; the nurse must set limits on the unacceptable behavior of missing class. The nurse can negotiate with a client a behavioral contract outlining expected behaviors, limits, and rewards to increase treatment compliance. The nurse must avoid responses that will exacerbate conflict, like "Why do you keep fighting the system?" and "You and I both know you're lying." It would be inappropriate to comply with the adolescent's desire to miss school because this contravenes the rules.

A child with attention deficit/hyperactivity disorder (ADHD) tells the parents that they do not like how the medication makes them feel and the parents ask the nurse what they can do to decrease the side effects. Which is the best response by the nurse? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.

B) Have the child eat a good breakfast and snacks late in the day and at bedtime. Rationale: Giving stimulants during daytime hours usually effectively combats insomnia. Eating a good breakfast with the morning dose and substantial nutritious snacks late in the day and at bedtime helps the child to maintain an adequate dietary intake. Daytime napping for a child with ADHD is unrealistic and not developmentally necessary.

A nurse is discussing inpatient treatment options for a client who has an eating disorder. The client wants to try to manage the condition independently instead. Which response from the nurse is most appropriate?

Based on your condition I think inpatient treatment is your best chance of recovery but I will respect your decision

The nurse is competing the treatment plan for a client with bulimia. The nurse is aware that she should include this treatment as it has been found to be the most effective for bulimia

Cognitive behavioral therapy Rationale: 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

Patients with somatic symptom disorder are commonly referred to a psychiatrist even if they have a supportive relationship with their physician. The primary intervention of the psychiatrist is to provide psychotherapy to the patient. Which of the following types of psychotherapy is most likely used in patients with this disorder?

Cognitive behavioral therapy Rationale: cognitive behavioral therapy can help with depression, anxiety, and stress

In order to assume the sick role, intentionally produced physical or psychological symptoms are known as? A) Malingering B) Hypochondriasis C) Factitious disorder D) Munchausen's syndrome by proxy

C) Factitious disorder Rationale: Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Munchausen's syndrome by proxy occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim.

The nurse is attempting to establish a therapeutic nurse-client relationship with a client diagnosed with borderline personality disorder. Which action is most important for the nurse to do to establish this relationship? 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.

C)Respect the client's boundaries at all times Rationale: For the borderline personality disorder client, personal boundaries are unclear, and clients often have unrealistic expectations. Clients easily can misinterpret the nurse'sgenuine interest and caring as a personal friendship, and the nurse may feel flattered bya client's compliments. The nurse must be quite clear about establishing the boundariesof the therapeutic relationship to ensure that neither the client's nor the nurse'sboundaries are violated.

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

C)You may not use the phone to call your wife. Rationale: 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

The nurse is talking with a client that is diagnosed with histrionic personality disorder. Which statement made by the client does the nurse identify correlates with this diagnosis? A. "All of the other clients on this unit must follow the rules of the unit." B. "Why do you think others on the unit are being friendly to me." C. "No one is paying attention to me and I am so angry!" D. "I am just not sure what activity to do, will you tell me?

C. "No one is paying attention to me and I am so angry!" Rationale: Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking

A preadolescent client has been considered a neighborhood bully for several years. Peers avoid them, and the parent says, cannot believe a thing my child tells me.Recently, the client was observed shooting at several dogs with a pellet gun and setting fire to a vacant lot for the first timeA nurse would assess these behaviors as being most consistent with which disorder?

Conduct disorder

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling as the child is experiencing signs of which disorder? A) Oppositional defiant disorder B) Asperger's syndrome C) Attention deficit hyperactivity disorder D) Conduct disorder

D) Conduct disorder

When a young client is disruptive, the nurse responds, "You must take a time out." Which is the priority outcome for intervention with a time-out? A. The client will have increased socialization. B. The client will develop adequate coping skills C. The client will understand the consequences of poor behavior. D. The client will identify signs of increasing agitation.

D. The client will identify signs of increasing agitation. Rationale: Time-out is retreat to a neutral place so clients can regain self-control. It is not a punishment. When a client's behavior begins to escalate, such as when they yell at or threaten someone, a time-out may prevent aggression or acting out. Staff may need to institute a time-out for clients if they are unwilling or unable to do so. Eventually, the goal is for clients recognize signs of increasing agitation and take a self-instituted time-out to control emotions and outbursts

A nurse is caring for a client with somatic symptoms illness. When completing the assessment on this client, the nurse would complete an assessment for which other common associated disorder.

Depression

The nurse is working with an aggressive adolescent with behavioral disorder, and the client has been resistant to the treatment plan. Which action can the nurse take to keep the negative emotions from interfering with a positive outcome for the client?

Discuss feelings, fears, and frustrations with colleagues regarding the client Rationale: It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression.

A nurse is assessing a teenage client with diagnosis of body dysmorphic disorder. When completing the plan of care, which nursing diagnosis would the nurse most likely identify as the priority?

Disturbed body image

An adolescent is exhibiting out-of-control behavior and yelling and threatening another person on the behavioral health unit. Which is the priority action by the nurse and health care team?

Institute a time out Rationale: 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 areoften 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.

A child with attention-deficit/hyperactivity disorder (ADHD) arrives with a parent for a scheduled checkup. The nurse assesses that the child looks thin and has lost several pounds since the last visit 6 months ago. Which action will the nurse take to improve the child's nutritional status?

Encourage the parents to include finger foods several times a day.

The nurse is planning the care for a child with attention-deficit/hyperactivity disorder (ADHD). When discussing interventions with the parent, which nursing intervention will be the highest priority?

Ensure the child's safety due to impulsiveness

Individuals with somatoform disorders may often display a surprising indifference about their symptoms. This is sometimes known as

La Belle indifference

A toddler has been in the hospital receiving IV antibiotics and has been progressing positively. The child suddenly begins to decline and there is no known medical reason for this decline. The nurse notices that the toddler's mother was present when the child began to get worse . The nurse is aware that sometimes parents or caregivers make up or induce physical illnesses in their children and this is known as

Munchhausen by proxy

A nurse is doing an assessment on a client with bulimia. Which of the following would the nurse expect to find on this client?

Near normal body weight for height and age Rationale: The weight of clients with bulimia usually is in the normal range

The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time?

Praise the parents for doing their best in a difficult situation Rationale: The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Caring for a child as a nurse is very different from being responsible around the clock. The parents likely have other obstacles to carrying out effective discipline

Parents bring their child to the clinic and state to the nurse, "We just don't know what to do anymore. It must be a medical disorder because our child has never been in trouble or acted this way. They are lying, stealing, and destroying property." Which is likely to be the most effective intervention for this adolescent?

Prevention and early intervention

Patient with diagnosis of somatic symptom illness can sometimes learn that being sick can have benefits from others. Which of the following would the nurse educate the family are considered secondary gains for the patient? Select all that apply :

Receiving a back rub from spouse Getting a foot massage Rationale: Secondary gains involve increased attention and relief from normal responsibilities and expectations when clients are ill

The nurse is providing education to a client diagnosed with an eating disorder about the treatment options available to her. Which of the following statement made by the client indicated that the teaching has not been effective?

Relapse prevention strategies are not necessary once I have recovered

The school nurse is talking with the parent of a 7-year-old child who is having difficulty in the classroom due to a diagnosis of attention-deficit/hyperactivity disorder (ADHD). The child is having difficulty paying attention, listening, and completing tasks. Which suggestion can the nurse give for improvement to the parent?

Request that the child be seated in front of the teacher in the classroom.

A nurse is treating a client with the diagnosis of somatic symptom illness. Which medication type would the nurse expect to administer to this client as it has shown to be the most effective?

SSRIs Rationale: somatic symptom illness can be made worse if patient is feeling anxious or depressed, so SSRIs can help

At first presentation, physicians should take an extensive history and do a thorough examination of patients suspected of having somatic symptom disorder. During the history and physical examination, which of the following findings is most indicative of this disorder?

Symptoms decrease occasionally when the patient is not in a stressful situation

A nurse has been treating a client with somatic symptom illness for the past two months with the chief complaint of left knee pain. Today the client is complaining of right knee pain. Which of the following interventions from the nurse would be indicated?

The nurse will assess the client's right knee and report findings to the physician as this is a new complaint from the client. Rationale: The symptoms felt in somatic symptom illness are real and this is a change in status, so nurse should report to provider

A client has been referred to a mental health center by a juvenile court after being arrested for vandalism. At the mental health center, the client refuses to participate in scheduled activities. The client was seen pushing another client, causing the person to fall. Which approach by nursing staff would be most therapeutic?

establishing firm limits

The nurse is caring for a client with schizotypal personality disorder that was experiencing transient psychotic episodes that lead to admission. The client was unkempt and appeared not to have bathed for quite some time. When planning the care of this client, which will be the focus of the nursing intervention(s)? Select all that apply.

development of self care skills development of social skills improve functioning in the community Rationale: Schizotypal personality disorder is characterized by a pervasive pattern of social andinterpersonal deficits marked by acute discomfort with and reduced capacity for closerelationships as well as by cognitive or perceptual distortions and behavioraleccentricities

The mother of a child with ADHD tells the school nurse that her child's teacher has called a conference. Of which of the following statements is true regarding evaluation of treatments for the child with ADHD?

often the parents or teacher notice positive outcomes of treatment Rationale: Parents and teachers are likely to notice positive outcomes of treatment before the child does