NURS 7300: Unit 3 Review Questions

The nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement? a. "I need to have everything perfect. My life is organized down to the second." b. "I am better than everyone and they should emulate me." c. "I can't trust anybody that I meet, no matter where it is or who they are." d. "I don't have any friends and I don't like to do anything socially."

a. "I need to have everything perfect. My life is organized down to the second." Behaviorally, individuals with obsessive-compulsive personality disorder are perfectionists, maintaining a regulated, highly structured, strictly organized life. A need to control others and situations is common in their personal and work lives. Therefore, the statement about everything being perfect and life being organized reflects this characteristic. The statement about not having any friends and no social interaction reflects a schizoid personality disorder manifested by introversion and reclusiveness, difficulty making friends and lack of interest in social activity. The statement about not trusting anyone reflects a paranoid personality disorder. The statement about being better than anyone else reflects a narcissistic personality disorder, characterized by grandiosity an inexhaustible need for admiration. Individuals are benignly arrogant and feel themselves above the conventions of their cultural group.

An individual with which body mass index (BMI) would be classified as having mild anorexia nervosa? a. 17.4 kg/m2 b. 15.4 kg/m2 c. 16.2 kg/m2 d. 20 kg/m2

a. 17.4 kg/m2 The severity of anorexia nervosa is classified as follows: Mild: BMI ≥ 17 kg/m2; Moderate: BMI 16-16.99 kg/m2; Severe: BMI 15-15.99 kg/m2. A BMI of 20 kg/m2 would be considered normal.

When describing intellectual disability to a group of parents, the nurse would identify which of the following intelligent quotients (or less) as the usual threshold? a. 70 b. 50 c. 80 d. 60

a. 70 The usual threshold for intellectual disability is an intelligence quotient (IQ) of 70 or less (i.e., two standard deviations below the population mean).

Which of the following are examples of practical skills within the context of adaptive behavior? (Select all that apply.) a. Activities of daily living b. Travel c. Ability to follow rules d. Health care e. Self-esteem

a. Activities of daily living b. Travel d. Health care Practical skills involve activities of daily living, occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, use of telephone. Self-esteem and ability to follow rules are social skills.

Which hematologic complications are associated with alcohol abuse? (Select all that apply.) a. Anemia b. Leukemia c. Pancreatitis d. Ulcers e. Hematomas

a. Anemia b. Leukemia e. Hematomas Medical complications associated with the hematologic system related to alcohol abuse include anemia, leukemia, and hematomas. Gastrointestinal complications include pancreatitis, ulcers, and liver diseases.

Which of the following should be included in the education plan for a client diagnosed with anorexia nervosa? (Select all that apply.) a. Assertiveness b. Hydration c. Isometric exercise d. Limit setting e. Realistic goal setting

a. Assertiveness b. Hydration d. Limit setting e. Realistic goal setting Components of the education plan for clients diagnosed with anorexia nervosa should include limit setting, assertiveness, realistic goal setting, and hydration education. The client should be taught about nutrition and eating patterns. In many cases, exercise may need to be discouraged, not encouraged.

A client is brought to the emergency department by a friend who tells the staff that the client may have overdosed on cocaine. Which findings would help support this suspicion? (Select all that apply.) a. Cardiac arrhythmia b. Respiratory depression c. Seizures d. Chest pain e. Nystagmus

a. Cardiac arrhythmia b. Respiratory depression c. Seizures d. Chest pain Signs of overdose include cardiac dysrhythmias or arrest, increased or lowered blood pressure, chest pain, vomiting, seizures, psychosis, confusion, dyskinesias, dystonias, and coma. Nystagmus is a sign of inhalant overdose.

To be diagnosed with antisocial personality disorder (ASPD) as an adult, characteristics of which mental health disorder must be met? a. Conduct disorder b. Histrionic disorder c. Schizophrenia d. Obsessive-compulsive disorder

a. Conduct disorder To be diagnosed with ASPD, the individual must be at least 18 years old and have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years, such as aggression to people or animals, destruction of property, deceitfulness or theft, or serious violation of rules.

Which effects cause the nurse to suspect alcohol withdrawal syndrome? (Select all that apply.) a. Delirium tremens b. Tremors c. Seizures d. Increased temperature e. Decreased blood pressure

a. Delirium tremens b. Tremors c. Seizures d. Increased temperature Effects of alcohol withdrawal syndrome include tremors; seizures; increased temperature, pulse, and blood pressure; and delirium tremens.

Which mental health disorder is most commonly seen in a compulsive shoplifter? a. Depression b. Phobia c. Stress d. Anxiety

a. Depression Depression is the most common symptom identified in a compulsive shoplifter. Some shoplifting appears to be related to anxiety and stress in that it serves to relieve symptoms. In a few instances, brain damage has been associated with kleptomania. Shoplifting is not associated with a phobia.

Which medication is classified as a benzodiazepine? a. Diazepam b. Naltrexone c. Disulfiram d. Haloperidol

a. Diazepam Diazepam is classified as a benzodiazepine, one of the most commonly used medications. Naltrexone is a narcotic antagonist used in the treatment of alcohol or narcotic dependence. Haloperidol is an antipsychotic drug used in the treatment of hallucinations. Disulfiram is used in the treatment of alcohol abuse.

Those with borderline personality disorder (BPD) have a tendency to view things as absolute, with no perception of compromise. This type of thinking would be documented as which term? a. Dichotomous b. Abstract c. Disorganized d. Irrational

a. Dichotomous Those with BPD usually exhibit dichotomous thinking, or a tendency to view things as absolute, either black or white, good or bad, with no perception of compromise. This type of thought pattern would not be documented as abstract, irrational, or disorganized.

A client with an eating disorder states, "I've gained 2 pounds, so soon I'll be up by 100 pounds." The nurse interprets this as which of the following? a. Dichotomous thinking b. Magnification c. Catastrophizing d. Selective abstraction

a. Dichotomous thinking The client's statement reflects dichotomous, or all-or-nothing, thinking. Magnification would be reflected in a statement such as "I binged last night, so I can't go out with anyone." Selective abstraction would be reflected in a statement such as "I can only be happy 10 pounds lighter." Catastrophizing would be reflected in a statement such as "I purged last night for the first time in four months, now I'll never recover."

While interviewing a child, the nurse notes phonic tics. Which of the following might the nurse assess? (Select all that apply.) a. Grunting b. Jerking of the shoulders c. Voicing of obscenities d. Facial grimacing e. Throat clearing

a. Grunting c. Voicing of obscenities e. Throat clearing Phonic tics typically include repetitive throat clearing, grunting, or other noises but may also include more complex sounds, such as words; parts of words; and in a minority of clients, obscenities. Motor tics are usually quick, jerky movements of the eyes, face, neck, and shoulders, although they may involve other muscle groups as well. Occasionally, tics involve slower, more purposeful, or dystonic movements.

The nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance? a. Hallucinogen b. Opioid c. Cannabis d. Inhalant

a. Hallucinogen PCP is classified as a hallucinogen. Heroin and morphine are considered opioids. Examples of inhalants are adhesives, aerosols, and adhesives. Cannabis is also known as marijuana.

Which the following are criteria for hospitalization of clients with eating disorders? (Select all that apply.) a. Hypomagnesemia b. Heart rate near 40 beats/min c. Hypokalemia d. Poor motivation to recover e. Blood pressure less than 80/50 mm Hg

a. Hypomagnesemia b. Heart rate near 40 beats/min c. Hypokalemia d. Poor motivation to recover e. Blood pressure less than 80/50 mm Hg Criteria include a heart rate near 40 beats/min, hypokalemia, hypomagnesemia, poor motivation to recover, and a blood pressure of less than 80/50 mm Hg.

A client is brought to the emergency department following a car accident. The client's blood alcohol level (BAL) was 0.10%. Which symptom would the client likely exhibit? a. Impaired coordination b. Giddiness c. Lack of muscle control d. Emotional lability

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

After educating a group of students on ADHD, the instructor determines that additional education is required when the group identifies which as a typical characteristic? a. Language difficulty b. Inattention c. Impulsiveness d. Hyperactivity

a. Language difficulty A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.

Which response patterns occur in a person diagnosed with borderline personality disorder (BPD)? (Select all that apply.) a. Mood lability b. Impulsive behavior c. Paranoid ideation d. Anger issues e. Fear of abandonment

a. Mood lability b. Impulsive behavior c. Paranoid ideation d. Anger issues e. Fear of abandonment Response patterns of persons with BPD include mood lability, problems with anger, impulsive behavior, paranoid ideation, and fear of abandonment.

A client diagnosed with Tourette disorder may be prescribed an antipsychotic medication. Which are common side effects of this medication classification? (Select all that apply.) a. Muscle stiffness b. Weight loss c. Akathisia d. Hyperalertness e. Dulled thinking

a. Muscle stiffness c. Akathisia e. Dulled thinking The most frequently encountered side effects are drowsiness, dulled thinking, muscle stiffness, akathisia, increased appetite and weight gain, and acute dystonic reactions.

Which characteristics would a nurse assess in a client suspected of having paranoid personality disorder? (Select all that apply.) a. Need to be in a position of power in a relationship b. Outwardly argumentative c. Overly forgiving d. Warm, funny demeanor e. Suspiciousness and guarded behavior

a. Need to be in a position of power in a relationship b. Outwardly argumentative e. Suspiciousness and guarded behavior Paranoid personality disorder is characterized by a long-standing suspiciousness and mistrust of persons in general. Individuals with these traits refuse to assume personal responsibility for their own feelings, assign responsibility to others, and avoid relationships in which they are not in control or lose power. These individuals are suspicious, guarded, and hostile. They are consistently mistrustful of others' motives, even relatives and close friends. Actions of others are often misinterpreted as deception, deprecation, and betrayal, especially regarding loyalty or trustworthiness of friends and associates. People with paranoid personality disorder are unforgiving and hold grudges; their typical emotional responses are anger and hostility. They distance themselves from others and are outwardly argumentative and abrasive; internally, they feel powerless, fearful, and vulnerable. Their outward demeanor often seems cold, sullen, and humorless.

The nurse is caring for a child receiving a psychostimulant medication for treatment of attention deficit hyperactivity disorder (ADHD). Psychostimulants enhance which neurotransmitters in the brain? (Select all that apply.) a. Norepinephrine b. Epinephrine c. Dopamine d. Acetylcholine e. Serotonin

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

Individuals with anorexia often experience comorbid conditions. Which of the following would be most common? (Select all that apply.) a. Obsessive-compulsive disorder b. Depression c. Somatic symptom disorder d. Panic disorder e. Factitious disorder

a. Obsessive-compulsive disorder b. Depression d. Panic disorder Depression is common in individuals with anorexia nervosa, and these individuals are at risk to attempt suicide. However, anxiety disorders such as obsessive-compulsive disorder (OCD), phobias, and panic disorder are even more strongly associated with anorexia nervosa. Somatic symptom disorder and factitious disorder are not commonly associated with anorexia nervosa.

When assessing a client, the nurse recognizes which characteristics as describing a person with obsessive-compulsive personality disorder (OCPD)? (Select all that apply.) a. Preoccupation with orderliness b. Responsibilities not taken seriously c. Demonstration of compulsions and obsessions when anxious d. Perfectionism e. Routines guide actions

a. Preoccupation with orderliness d. Perfectionism e. Routines guide actions Persons with OCPD do not demonstrate obsessions and compulsions (as would a person with obsessive-compulsive disorder when anxious) but rather a pervasive pattern of preoccupation with orderliness, perfectionism, and control. These clients tend to be completely devoted to work, and approach even hobbies seriously.

Which descriptors are clinical characteristics of narcissistic personality disorder? (Select all that apply.) a. Preoccupied with fantasy b. Lack of empathy c. Arrogance d. Grandiosity e. Undervalue personal wealth

a. Preoccupied with fantasy b. Lack of empathy c. Arrogance d. Grandiosity People with narcissistic personality disorder are grandiose and lack empathy. They overvalue their personal worth, direct their affections toward themselves, and expect others to hold them in high esteem. They are benignly arrogant and preoccupied with fantasy.

What term refers to the ability to ingest an increasing amount of alcohol before experiencing a "high" and showing effects on cognitive and motor skills? a. Tolerance b. Addiction c. Relapse d. Detoxification

a. Tolerance People who use alcohol regularly usually develop alcohol tolerance, the ability to ingest an increasing amount of alcohol before experiencing a "high" and showing effects on their cognitive and motor skills. Detoxification is the process of safely and effectively withdrawing a person from an addictive substance, usually under medical supervision. Relapse is the recurrence of alcohol- or drug-dependent behaviors in an individual who has previously achieved and maintained abstinence for a significant time beyond the period of detoxification. Addiction is a condition of continued use of substances (or reward-seeking behaviors) despite adverse consequences.

Which would the nurse expect to assess in a client with a schizotypal personality disorder? (Select all that apply.) a. Unusual mannerisms b. Hallucination-like perceptions c. Undramatic d. Referential thinking e. Magical beliefs

a. Unusual mannerisms b. Hallucination-like perceptions d. Referential thinking e. Magical beliefs Schizotypal personality disorder is characterized by a pattern of social and interpersonal deficits. Cognitive perceptual symptoms are a primary characteristic and include magical beliefs (similar to delusions) and perceptual aberrations (similar to hallucinations). Other common symptoms include referential thinking (interpreting insignificant events as personally relevant) and paranoia (suspicious of others). Clients with schizotypal personality disorder are more dramatically eccentric than those with schizoid personality disorder, who are characteristically flat, colorless, and dull (Millon, 2011). These individuals are perceived as strikingly odd or strange in appearance and behavior, even to lay persons. They may have unusual mannerisms, an unkempt manner of dress that does not quite "fit together," and inattention to usual social conventions (e.g., avoiding eye contact, wearing clothes that are stained or ill-fitting, and being unable to join in the give-and-take banter of coworkers).

A client is diagnosed with Korsakoff amnestic syndrome. Which symptoms would the nurse likely assess? (Select all that apply.) a. Vision impairment b. Attention deficit c. Confabulation d. Hypertension e. Diaphoresis

a. Vision impairment b. Attention deficit c. Confabulation Korsakoff amnestic syndrome, associated with alcoholism, involves the heart, vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation, (telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Although Wernicke encephalopathy and Korsakoff amnestic syndrome can appear as two different disorders, they are generally considered to be different stages of the same disorder called Wernicke-Korsakoff syndrome. Wernicke encephalopathy represents the acute phase and Korsakoff amnestic syndrome the chronic phase. Diaphoresis and hypertension are not associated with this condition.

A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy? a. "I'm here to help you for as long as I can." b. "I will be seeing you during the daytime for this week." c. "Let's see how things go first and then how long you need me." d. "We will work on things until your physician says you can go home."

b. "I will be seeing you during the daytime for this week." A key to helping clients with BPD is recognizing their fears of both abandonment and intimacy as they relate to the nurse-client relationship. Informing the client of the length of this relationship allows the client to engage in, and prepare for, termination with minimal pain of abandonment. Therefore, the statement about seeing the client during the daytime for a week demonstrates understanding of this concept. The other statements are open-ended and do not address the length of the relationship.

Which statement by the client with borderline personality disorder (BPD) is an example of catastrophizing? a. "If I had not made him mad, he wouldn't have hit me." b. "This is the most awful thing that has ever happened to me." c. "I never get what I want." d. "No one ever listens to me."

b. "This is the most awful thing that has ever happened to me." An example of a statement using catastrophizing is, "This is the most awful thing that has ever happened to me." Examples of dichotomizing statements include, "No one ever listens to me" and "I never get what I want." A statement in which a self-attribution error has occurred is, "If I had not made him mad, he wouldn't have hit me."

In a person who abuses alcohol or is a chronic drinker, the alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or attempt to decrease consumption? a. 24 hours b. 12 hours c. 18 hours d. 48 hours

b. 12 hours In clients with alcoholism or in chronic drinkers, the alcohol withdrawal syndrome usually begins within 12 hours after abrupt discontinuation or attempt to decrease consumption.

The body can metabolize how much beer per hour without intoxication? a. 16 oz b. 12 oz c. 28 oz d. 14 oz

b. 12 oz The body can metabolize 1 oz of liquor, a 5-oz glass of wine, or a 12-oz can of beer per hour without intoxication.

For a person to be diagnosed with antisocial personality disorder, the individual must be at a minimum of what age? a. 7 years b. 18 years c. 21 years d. 13 years

b. 18 years Antisocial personality disorder diagnosis is given to individuals 18 years of age or older who fail to follow society's rules--that is they do not believe that society's rules are made for them and are consistently irresponsible.

Which behavioral pattern noted in clients diagnosed with borderline personality disorder (BPD) is associated with learned helplessness? a. Emotional vulnerability b. Active passivity c. Self-invalidation d. Apparent competence

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

A child is diagnosed with obsessive-compulsive disorder. When reviewing the child's medical record, which would the nurse most suspect as possibly being present? (Select all that apply.) a. Somatic symptom disorder b. Anxiety disorder c. Personality disorder d. Tic disorder e. Mood disorder

b. Anxiety disorder d. Tic disorder e. Mood disorder More than half of the cases of OCD in youth involve a comorbid disorder such as a tic, mood, or anxiety disorder. Personality and somatic symptom disorders are not associated comorbidities.

When describing the different clusters of personality disorders, the nurse includes which disorders as being characterized by dramatic, emotional or erratic behavior? (Select all that apply.) a. Paranoid b. Borderline c. Antisocial d. Obsessive-Compulsive e. Avoidant

b. Borderline c. Antisocial Cluster B personality disorders are described by dramatic, emotional or erratic behavior and include antisocial, borderline, histrionic and narcissistic personality disorders. Paranoid personality disorder is categorized as Cluster A, characterized by odd or eccentric behavior. Avoidant and obsessive-compulsive personality disorders are categorized as Cluster C, characterized by anxious or fearful behavior.

One of the biosocial theories of the etiology of borderline personality disorder involves the role of an invalidating environment, a social situation that negates private emotional responses and communication. The most severe form of invalidation occurs in which situation? a. Marriage b. Child sexual abuse c. Divorce d. Death of family member

b. Child sexual abuse The most severe form of invalidation occurs in situations of child sexual abuse. Often, the abusing adult has told the child that this is a "special secret" between them. The child experiences feelings of fear, pain, and sadness, yet this trusted adult continuously dismisses the child's true feelings and tells the child what he or she should feel. Divorce, marriage, and death of a family member are not the most severe forms of invalidation.

Dialectical behavior therapy (DBT) combines behavior therapy with which type of therapy? a. Art b. Cognitive c. Physical d. Occupational

b. Cognitive DBT combines cognitive and behavior therapy strategies. Clinicians partner with clients and focus on the many interconnected behaviors.

Historically, which of the following was the most widely accepted theory about anorexia nervosa? a. Reduction in brain-derived neurotrophic factor (BDNF) b. Conflicts of separation-individuation and autonomy c. Changes in the structure of the brain d. Learned behavior from internalized peer pressure

b. Conflicts of separation-individuation and autonomy Historically, the most widely accepted explanation of anorexia nervosa was the psychoanalytic paradigm that focused on conflicts of separation-individuation and autonomy. Other theories address learned behavior from internalized peer pressure, changes in brain structure and neuroendocrine and neurotransmitter changes, but none of these are most widely accepted.

Which are parental disorders associated with the development of separation anxiety in the child? a. Mania b. Depression c. Attention deficit hyperactivity disorder (ADHD) d. Schizophrenia

b. Depression Children of parents with at least one anxiety disorder are at increased risk of also having an anxiety disorder. The risk increases even more when two parents are affected. Parental depression is also associated with anxiety disorders in children. Schizophrenia, mania, and ADHD are not associated with separation anxiety in children.

Disulfiram has which effect on prothrombin time? a. Decrease b. Increase c. No effect

b. Increase Increased prothrombin time caused by disulfiram (Antabuse) may lead to a need to adjust the dosage of oral anticoagulant.

Which type of therapy is ideal for the client diagnosed with avoidant personality disorder (APD)? a. Medication therapy b. Long-term therapy c. Psychotherapy d. Short-term therapy

b. Long-term therapy Long-term therapy is ideal for clients diagnosed with APD because it takes time to make changes. The client's social dimension should be examined for activities that increase self-esteem and interventions focused on increasing activities that enhance self-esteem. Psychotherapy and medication therapy would not be appropriate.

The parents of a child diagnosed with ADHD ask the nurse about the Restricted Elimination Diet. When describing this diet, which would the nurse include as being allowed? (Select all that apply.) a. Beef b. Nuts c. Limited water d. Gluten-free grains e. Milk f. Fish

b. Nuts d. Gluten-free grains f. Fish The Restricted Elimination Diet has been shown to improve behavior in some children and can be used as an instrument to determine whether ADHD behaviors are induced by food. In this diet, all-natural, chemical-free foods are eaten, and most of the foods that are regularly eaten are removed. Fruits, vegetables, nuts, nut butters, beans, seeds, gluten-free grains (e.g., rice, quinoa), fish, lamb, wild game meats, organic turkey, and large amounts of water are consumed.

After reviewing information about the various impulse control disorders, a nurse demonstrates understanding of the information by identifying which disorder as involving a persistent pattern of disobedience and argumentativeness? a. Pyromania b. Oppositional defiant disorder c. Kleptomania d. Conduct disorder

b. Oppositional defiant disorder Oppositional defiant disorder is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance for frustration, and tendency to blame others for misfortunes, large and small. Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. In kleptomania, individuals cannot resist the urge to steal, and they independently steal items that they could easily afford. Irresistible impulses to start fires characterize pyromania: repeated fire setting with tension or arousal before setting fires; fascination or attraction to the fires; and gratification when setting, witnessing, or participating in the aftermath of fire.

A nurse is conducting an in-service program about personality disorders. When describing dependent personality disorder, which characteristic would the nurse include as typical of the person's behavior in interpersonal relationships? (Select all that apply.) a. Disagreeable b. Overly pleasing c. Conciliatory d. Placating e. Compliant

b. Overly pleasing c. Conciliatory d. Placating e. Compliant Individuals with dependent personality disorder cling to others in a desperate attempt to keep them close. In interpersonal relationships, they need excessive advice and reassurance. They are compliant, conciliatory, and placating. They rarely disagree with others and are easily persuaded. Friends describe them as gullible. They are warm, tender, and noncompetitive. They timidly avoid social tension and interpersonal conflicts.

Which characteristic is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)? a. Hyperactivity as a child b. Parental overcontrol c. Lack of nurturing d. Substance use within the family

b. Parental overcontrol The basis of the compulsive patterns seen in OCPD is parental overcontrol and overprotection that is consistently restrictive and sets distinct limits on the child's behavior. Lack of nurturing is not implicated in this disorder, nor is substance use within the family. Clients diagnosed with paranoid personality disorder may have been hyperactive as a child.

A nurse is working with an adolescent diagnosed with conduct disorder. The nurse is engaged in social skills training. If successful, which outcome would the nurse expect? a. Ability to examine responses after an emotional conflict b. Recognition of how actions affect others c. Ability to identify alternative solutions to a problem d. Enhanced thinking about consequences of choices

b. Recognition of how actions affect others Social skills training teaches adolescents with these behavior disorders to recognize the ways in which their actions affect others. Problem-solving skills training teaches these children to generate alternative solutions to social situations; sharpen thinking concerning the consequences of those choices; and evaluate responses after interpersonal conflicts.

A client is diagnosed with avoidant personality disorder. When assessing the client, which characteristics would be evident? (Select all that apply.) a. Absence of decision-making ability b. Sensitivity to negative comments c. Timidity d. Fear of rejection e. Overly outgoing nature

b. Sensitivity to negative comments c. Timidity d. Fear of rejection Avoidant personality disorder is characterized by avoiding social situations in which there is interpersonal contact with others. Individuals appear timid, shy, and hesitant, fear criticism and feel inadequate. These individuals are extremely sensitive to negative comments and disapproval, and appraise situations more negatively than others do. Clients with dependent personality disorder have little if any decision-making capability.

Fluoxetine includes a black box warning concerning which of the following? a. Renal failure b. Suicidality in children and adolescents c. Stroke d. Myocardial infarction

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

Which is an accurate statement regarding Tourette disorder? a. Tics are more frequent at school than at home. b. There are no diagnostic tests used for this disorder. c. Tics cannot be suppressed. d. The disorder worsens in early adulthood.

b. There are no diagnostic tests used for this disorder. Because there are no diagnostic tests used for this disorder, the diagnosis is based on the type and duration of tics present. The child can suppress the tics for brief periods. It is common to hear from parents that their child has more frequent tics at home than at school. The general trend is for tic symptoms to decline by early adulthood.

Which should be included in the education plan for a client receiving methylphenidate? a. There is no risk of dependence. b. Alcohol may be used in moderation. c. Adverse effects include hypertension and nervousness. d. The medication is usually taken after 5 PM.

c. Adverse effects include hypertension and nervousness. Methylphenidate has several adverse reactions, including hypertension, psychological dependence, and nervousness. The medication is usually not taken after 5 PM because of a risk of insomnia. Alcohol and over-the-counter products should be avoided.

Individuals with anorexia nervosa concentrate on which of the following body cues? a. Anxiety b. Weakness c. Controlling food intake d. Hunger

c. Controlling food intake Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.

Based on psychological theories, which element is believed to be critical to understanding personality disorders? a. Abuse b. Chaotic families c. Difficult temperament d. Functional attachments

c. Difficult temperament Scientists believe temperament is neurobiologically determined, and many believe that it is central to understanding personality disorders. Difficult attachments are common in antisocial personality disorders and are often the basis of aggressiveness and impulsivity. Issues such as abuse and chaotic families are identified by social theorists as contributing to antisocial personality disorders. In individuals with antisocial personality disorder, a failure to maintain or sustain stable attachments in early childhood can lead to avoidance of future attachments.

When teaching a client with antisocial personality disorder, which approach would be most appropriate for the nurse to use? a. Confrontational b. Challenging c. Direct d. Lecture

c. Direct Client education efforts have to be creative and thought provoking. In educating a person with ASPD, a direct approach is best, but the nurse must avoid "lecturing," which the client will resent. In teaching the client about positive health care practices, impulse control, and anger management, the best approach is to engage the client in a discussion about the issue, and then direct the topic to the major teaching points. These clients often take great delight in arguing or showing how the rules of life do not apply to them. A sense of humor is important, as are clear teaching goals and avoiding being sidetracked. Challenging or confronting the client would be inappropriate.

Clients diagnosed with anorexia nervosa undergo an intense physical and emotional process that overrides all physiologic body cues. This would be documented as which of the following? a. Perfectionism b. Interoceptive awareness c. Drive for thinness d. Body image distortion

c. Drive for thinness Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues. Body image distortion occurs when the individual perceives his or her body disparately from how society views it. Interoceptive awareness is a term used to describe the sensory response to emotional and visceral cues, such as hunger. Perfectionism consists of personal standards (the extent to which the individual sets and tries to achieve high standards for oneself) and concern over mistakes, and the consequences for their self-worth and others' opinions. Perfectionism is often involved in a drive for thinness, but it is not the primary physical and emotional process in this disorder.

A child is diagnosed with encopresis. Which is important for the nurse to do first? a. Encourage the parents to verbalize their anger about the situation. b. Assist child in learning to strengthen the muscles involved. c. Educate the parents and child about normal bowel function. d. Initiate a bowel retraining program.

c. Educate the parents and child about normal bowel function. Effective intervention begins with educating the parents and the child about normal bowel function, as well as the self-perpetuating cycle of fecal impaction and leakage of stool around the hardened mass of feces. The short-term goal of this educational effort is to decrease the anger and recrimination that often complicate the picture in these families. Because encopresis often results in a loss of bowel tone, it may help to motivate children by emphasizing the need to strengthen their muscles. In many cases, cleaning out the bowel is necessary before initiating behavioral treatment. The bowel catharsis is usually followed by administration of mineral oil, which is often continued during the bowel retraining program. A high-fiber diet is often recommended.

A client diagnosed with anorexia nervosa has difficulty regulating expression of feelings. The nurse identifies this as an issue related to which concern? a. Perfectionism b. Body image distortion c. Emotional dysregulation d. Drive for thinness

c. Emotional dysregulation Emotional dysregulation is a difficulty regulating expression of feelings. Emotional dysregulation and increased sensory sensitivity are linked to anorexia nervosa. Emotion dysregulation comprises one's inability to accept one's emotional responses, to accomplish goals in the midst of distress, and to be aware of and acknowledge the significance of developing and implementing coping strategies to influence and manage emotions effectively. Body image distortion occurs when the individual perceives his or her body disparately from how society views it. Drive for thinness is an intense physical and emotional process that overrides all physiologic body cues. Perfectionism consists of personal standards (the extent to which the individual sets and tries to achieve high standards for oneself) and concern over mistakes and their consequences for their self-worth and others' opinions.

A nurse is assessing a child who is suspected of having autism spectrum disorder. Which area would be critical to assess? (Select all that apply.) a. Nutrition b. Mobility c. Flexibility d. Behavior e. Communication

c. Flexibility d. Behavior e. Communication Although a thorough assessment of the child is important, communication, behaviors, and flexibility are critical assessment areas for the child with autism spectrum disorder.

What occurs when self-definition is poorly developed? a. Affective instability b. Dichotomous thinking c. Identity diffusion d. Dissociation

c. Identity diffusion Identity diffusion occurs when a person lacks aspects of personal identity, or when personal identity is poorly developed. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Dichotomous thinking occurs when a person evaluates experiences, people, and objects in terms of mutually exclusive categories. Dissociation occurs in instances when thinking, feelings, or behaviors occur outside a person's awareness.

When assessing a client with a histrionic personality disorder, which characteristic would the nurse expect to find? (Select all that apply.) a. Few friendships b. Untrusting of others c. Needs that are inflexible d. Gullible e. Sexually seductive

c. Needs that are inflexible d. Gullible e. Sexually seductive Persons with histrionic personality disorder are quick to form new friendships and just as quick to become demanding. Because they are trusting and easily influenced by other opinions, their behavior often appears inconsistent. Their strong dependency need makes them overly trusting and gullible. They are moody and often experience a sense of helplessness when others are disinterested in them. They are sexually seductive in their attempts to gain attention and often are uncomfortable within a single relationship.

When developing the plan of care for a client with borderline personality disorder (BPD), which areas would the nurse identify as most likely problematic? (Select all that apply.) a. Self-care b. Hydration c. Nutrition d. Sleep e. Self-harm f. Pain

c. Nutrition d. Sleep e. Self-harm Usually, clients with BPD are managing hydration, self-care, and pain well. Problem areas include sleep, nutrition, and self-harm.

A nurse is reviewing the history of a client diagnosed with antisocial personality disorder. Which would the nurse expect to find? (Select all that apply.) a. Overly empathetic to others b. History of a sustained monogamous relationship c. Rationalization for harming an individual d. Development of strict plans for the future e. Inflated view of self

c. Rationalization for harming an individual e. Inflated view of self Clients with antisocial personality disorder are impulsive and fail to plan ahead; rationalize having hurt, mistreated or stolen from another; show a lack of empathy; have an inflated and arrogant self-appraisal; and are irresponsible and exploitative in sexual relationships, often with a history of multiple sexual partners.

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter? a. Acetylcholine b. Norepinephrine c. Serotonin d. Dopamine

c. Serotonin The most frequently studied biochemical theory in bulimia nervosa relates to lowered brain serotonin neurotransmission. People with bulimia nervosa are believed to have altered modulation of central serotonin neuronal systems.

When a client diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense? a. Invalidating b. Projective identification c. Splitting d. Defending

c. Splitting Because clients with BPD view the world in absolutes, nurses and other treatment team members are alternately categorized as all good or all bad. This primitive defense is called splitting, and presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. This is not an example of defending, invalidating, or projective identification.

Which of the following is the leading cause of death in clients diagnosed with anorexia nervosa? a. Renal failure b. Respiratory failure c. Suicide d. Myocardial infarction

c. Suicide Suicide is the leading cause of death for individuals with anorexia nervosa. These individuals tend to commit suicide with highly lethal means in which rescue is unlikely. Renal failure, respiratory failure, and myocardial infarction are not the leading causes of death.

After teaching a community group about the different approaches used to treat chemical dependence, the nurse determines that the education was successful when the group identifies which concept as associated with the social approach? a. The dependence is viewed as a symptom of an underlying emotional problem. b. The person is considered weak and unable to say no. c. The environment, not the person, is responsible. d. The person is viewed as emotionally disturbed.

c. The environment, not the person, is responsible. Treatment using the social approach views the person as a victim of circumstance, with society and the environment causing the dependence. The psychiatric approach views the person as emotionally disturbed and the chemical dependence is a symptom of an underlying emotional problem. The moral approach views the person as weak and unable to say no.

A client is prescribed naltrexone as part of the treatment plan for alcohol and opioid abuse. When developing an education plan for the client about this drug, which information would the nurse need to keep in mind? a. Using small doses of heroin can lead to coma and death. b. The client will most likely report complaints of a metallic aftertaste. c. The individual should be free of opioids for at least 1 week. d. A naloxone challenge test will be needed within 2 weeks of starting the drug.

c. The individual should be free of opioids for at least 1 week. Naltrexone is not given unless the client has been opioid-free for 7 to 10 days. A naloxone challenge test is given before starting this drug, except in clients showing clinical signs of opioid withdrawal. Disulfiram, not naltrexone, is associated with a metallic taste. Heroin and other opioid drugs should be avoided, because although small doses may have no effect, large doses can cause death, serious injury, or coma.

Wernicke encephalopathy is a degenerative brain disorder characterized by which type of deficiency? a. Vitamin D b. Vitamin A c. Thiamine d. Vitamin C

c. Thiamine Wernicke encephalopathy, a degenerative brain disorder caused by a thiamine (vitamin B1) deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma.

A child with ADHD is prescribed methylphenidate. The mother reports that the child is having trouble sleeping. When assessing this concern, which question would be most appropriate for the nurse to ask? a. "Is he taking any over-the-counter medications?" b. "Are you crushing the sustained release tablet?" c. "Is he having any other concerns?" d. "When does he take the last dose of medication?"

d. "When does he take the last dose of medication?" The report of trouble sleeping is a side effect of the psychostimulants. The nurse should gather additional information about the child's sleep pattern and the schedule of medication, such as when the child takes the last dose. The drug is rarely taken after 5 PM. Crushing the sustained release preparation would affect absorption and effectiveness. The use of over-the-counter medications could accentuate the side effects of the stimulant, but this information would be important if the nurse determines that the drug schedule is appropriate. Asking about any other complaints, although helpful to determine the effects of the drug, does not address the mother's concern.

Disulfiram should not be administered until the client has abstained from alcohol for at least how long? a. 16 hours b. 4 hours c. 8 hours d. 12 hours

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

A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age? a. 12 years b. 10 years c. 7 years d. 15 years

d. 15 years For the diagnosis of antisocial personality disorder, a person would have evidence of a conduct disorder before 15 years of age.

At which age would a nurse expect that separation anxiety disorder would initially occur? a. 5-6 years b. 10-12 years c. 3-4 years d. 7-9 years

d. 7-9 years The prevalence of separation anxiety disorder is estimated at 1% to 4% of school-age children, with an age of onset between 7 and 9 years.

Which is the underlying issue in kleptomania? a. Low income b. Anxiety c. Need for recognition d. Act of stealing

d. Act of stealing In kleptomania, individuals cannot resist the urge to steal, and they independently steal items that they could easily afford. These items are not particularly useful or wanted. The underlying issue is the act of stealing. Low income, anxiety, and a need for recognition are not underlying issues seen with kleptomania.

While shopping in a grocery store, a client with borderline personality disorder (BPD) greets a neighbor with a great big hug. Then about 5 minutes later, the client walks past the neighbor and ignores him. What condition is the client is demonstrating? a. Dissociation b. Dichotomous thinking c. Identity diffusion d. Affective instability

d. Affective instability Affective instability (rapid and extreme shift in mood) is a core characteristic of BPD, and is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. For example, a person may greet a casual acquaintance with intense affection, yet later be aloof with the same acquaintance. Dichotomous thinking involves evaluating experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure, trustworthy or deceitful), which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects. Dissociation refers to times when thinking, feeling, or behaviors occur outside a person's awareness. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed.

Which substance is most often abused in the United States? a. Marijuana b. Cocaine c. Benzodiazepines d. Alcohol

d. Alcohol In the United States, alcohol is the most abused substance followed by marijuana. Cocaine and benzodiazepines are substances of abuse but are not the most abused substances.

Fluoxetine has been approved for the treatment of anorexia nervosa. Fluoxetine is from which of the following drug classifications? a. Antianxiety b. Antimanic c. Antiparkinsonian d. Antidepressant

d. Antidepressant The selective serotonin reuptake inhibitor (SSRI) fluoxetine is approved by the Food and Drug Administration for the treatment of anorexia nervosa, but it may not be as effective in the acute stages of the disorder as in the later periods. SSRIs are antidepressants. Fluoxetine is not classified as an antianxiety, antiparkinsonian, or antimanic medication.

Which of the following is a cardiac complication of an eating disorder? a. Thrombocytopenia b. Enlarged heart c. Hypertension d. Bradycardia

d. Bradycardia Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.

A nurse is developing a presentation for an adolescent community group on mental health and illness, focusing on mood disorders. Which would the nurse include as a major mental health issue in adolescents? a. Bipolar II b. Bipolar I c. Dysthymia d. Depression

d. Depression Mood disorders in children and adolescents are a major public health concern. The prevalence of diagnosed depression in children aged 3 to 17 is estimated to be 3.2%. Of these, nearly 75% have comorbid anxiety, and nearly 50% have additional behavior problems. Bipolar I or II comprise 2.9%.

A client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? (Select all that apply.) a. Enemas b. Diuretics c. Laxatives d. Exercising e. Dieting

d. Exercising e. Dieting Anorexia nervosa is categorized into two major types: restricting (dieting and exercising with no binge eating or misuse of laxatives, diuretics, or enemas) and binge eating and purging (binge eating and misuse of laxatives, diuretics, or enemas).

Brain dysfunction associated with borderline personality disorder (BPD) occurs in the limbic system and which lobe of the brain? a. Occipital b. Temporal c. Parietal d. Frontal

d. Frontal Biologic abnormalities are associated with three BPD characteristics: affective instability; transient psychotic episodes; and impulsive, aggressive, and suicidal behavior. Associated brain dysfunction occurs in the limbic system and frontal lobe and increases the behaviors of impulsiveness, parasuicide, and mood disturbance. Brain dysfunction of the temporal, parietal, and occipital lobes is not associated with BPD.

Which of the following is a laboratory finding in anorexia nervosa? a. Leukocytosis b. Respiratory alkalosis c. Hypocarotenemia d. Hypercholesterolemia

d. Hypercholesterolemia Laboratory findings that may be associated with anorexia nervosa are hypercholesterolemia, leukopenia, anemia, thrombocytopenia, and hypercarotenemia.

A client has a blood alcohol level of 0.05%. The nurse expects which behavior to occur? a. Difficulty driving b. Coma c. Stupor d. Impaired judgment

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

A client is experiencing severe alcohol withdrawal. Which effects would the nurse most likely assess? (Select all that apply.) a. Increased appetite b. Visible tremors c. Heart rate around 100 beats/min d. Marked diaphoresis e. Auditory hallucinations

d. Marked diaphoresis e. Auditory hallucinations A person experiencing severe alcohol withdrawal would exhibit marked diaphoresis, auditory and visual hallucinations, a heart rate between 120-140 beats/min, gross uncontrollable tremors, and an inability to eat or drink.

A child is diagnosed with Tourette disorder. The nurse understands that which most commonly occurs with this disorder? a. Communication disorder b. ADHD c. Intellectual disability d. Obsessive-compulsive disorder

d. Obsessive-compulsive disorder Some children with Tourette disorder have ADHD, and a substantial percentage have symptoms of OCD. Although any disorder can occur with Tourette disorder, obsessive-compulsive disorder frequently occurs with Tourette's.

Which nursing diagnosis would be a priority for a client diagnosed with borderline personality disorder (BPD)? a. Chronic Low Self-Esteem b. Disturbed Thought Process c. Ineffective Coping d. Risk for Self-Mutilation

d. Risk for Self-Mutilation One of the first diagnoses to consider with this client population is Risk for Self-Mutilation, because protection of the client from self-injury is always a priority. The other diagnoses may be appropriate for the client, but Risk for Self-Mutilation would be the priority.

Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of which characteristic? a. Medication noncompliance b. Agitation c. Splitting d. Threats of self-harm

d. Threats of self-harm Clients with BPD are usually admitted to an inpatient setting because of threats of self-harm. Observing for antecedents of self-injurious behavior and intervening before an episode is an important safety intervention. Clients who are agitated or are using the primitive defense mechanism of splitting are usually not admitted to an inpatient setting. The client should be educated on an outpatient basis for medication compliance unless the problem is a threat to himself or others.