Part 2

19. A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits, because she thinks I don't care." 4. "I don't have a green thumb. Any old fool can grow a rose."

ANS: 4 Page: 392 Feedback 1 Stating, "It's all my fault for trusting him," is not an example of a discounting positive. 2 Stating, "I don't play games. I never win," is not an example of a discounting positive. 3 Stating, "She never visits because she thinks I don't care," is not an example of a discounting positive. 4 Examples of automatic thoughts in depression include discounting positives; for example, "The other questions were so easy. Any dummy could have gotten them right."

15. A nurse is listening to a lecture on the environmental theory. Which statement(s) by the nurse indicates that teaching has been effective?(Select all that apply.) 1. "Personality characteristics in old age are correlated with early life characteristics." 2. "Carcinogens can affect aging." 3. "Trauma can affect the aging process." 4. "The effects of sunlight can have an effect on the aging process." 5. "Decline in the immune system can affect the aging process."

ANS: 2, 3, 4 Page: 671 1. This statement is reflective of the personality theory. 2. The environmental theory states that carcinogens can affect aging process. 3. The environmental theory states that trauma can affect the aging process. 4. The effects of sunlight can affect the aging process. 5. A decline in the immune system can affect the aging process, according to the autoimmune theory.

8. Both situational and intrapersonal factors most likely contribute to an individual's stress response. Which factor would a nurse categorize as intrapersonal? 1. Occupational opportunities 2. Economic conditions 3. Degree of flexibility 4. Availability of social supports

ANS: 3 Page: 489 Feedback 1 Occupational opportunities would not be categorized as intrapersonal. 2 Economic conditions would not be categorized as intrapersonal. 3 Intrapersonal factors that might influence an individual's ability to adjust to a painful life change include social skills, coping strategies, the presence of psychiatric illness, degree of flexibility, and level of intelligence. 4 Availability of social supports would not be categorized as intrapersonal.

11. A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? 1. Place client in restraints until the aggression subsides. 2. Sedate the client with neuroleptic medications. 3. Hold client's head steady and apply a helmet. 4. Distract the client with a variety of games and puzzles.

ANS: 3 Page: 634-635 Feedback 1 The client should not be placed in restraints as this may cause further agitation or injury. 2 Sedating the client is not indicated, and is usually the treatment for Tourette's syndrome. 3 The most appropriate intervention for head banging is to hold the client's head steady and apply a helmet. The helmet is the least restrictive intervention and will serve to protect the client's head from injury. 4 Distraction with games would be ineffective.

5. A raped client answers a nurse's questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this client's responses? 1. The client may be lying about the incident. 2. The client may be experiencing a silent rape reaction. 3. The client may be demonstrating a controlled response pattern. 4. The client may be having a compounded rape reaction.

ANS: 3 Page: 711 Feedback 1 The client is not likely lying about the incident. 2 The client is not likely to be experiencing a silent rape reaction. 3 This client is most likely demonstrating a controlled response pattern. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying sobbing, smiling, restlessness, and tension. 4 The client is not likely having a compounded rape reaction.

9. When a home health nurse administers an outpatient's injection of haloperidol decanoate (Haldol decanoate), which level of care is the nurse providing? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

ANS: 3 Page: 739 Feedback 1 Primary prevention is aimed at preventing services before they are needed. 2 Secondary prevention is aimed at early detection and fast intervention. 3 When administering medication in an outpatient setting, the nurse is providing a tertiary prevention level of care. Tertiary prevention services are aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning. 4 Case management level of care is not a term associated with the public health model.

8. The nurse is working with a client diagnosed with binge eating disorder. Which medication should the nurse expect to teach the client about? 1. Lisdexamfetamine (Vyvanse) 2. Dexfenfluramine (Redux) 3. Sibutramine (Meridia) 4. Pemoline (Cylert)

ANS: 1 Page: 584-585 Feedback 1 The nurse should teach the client about Lisdexamfetamine (Vyvanse). This medication has shown to be successful in the treatment of binge eating disorder. 2 Dexfenfluramine has been removed from the market because of its association with serious heart and lung disease. 3 Several deaths have been associated with the use of sibutramine by high-risk clients. Based on pressure from the U.S. Food and Drug Administration, the manufacturer issued a recall of the drug in October 2010. 4 Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

1. A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that teaching has been effective? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident." 4. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

ANS: 2 Page: 449 Feedback 1 This statement does not indicate understanding. 2 The nursing instructor should evaluate that learning has occurred when the student knows that clients with phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimuli produces an immediate anxiety response. Even though the disorder is relatively common among the general population, people seldom seek treatment unless the phobia interferes with ability to function. 3 This statement indicates that further teaching is necessary. 4 This statement indicates that teaching has not been effective.

10. Which situation is an example of selective amnesia? 1. A client cannot relate any lifetime memories. 2. A client can describe driving to Ohio but cannot remember the car accident that occurred. 3. A client often wanders aimlessly after sunset. 4. A client cannot provide personal demographic information during admission assessment.

ANS: 2 Page: 510 Feedback 1 In the generalized type, the individual has amnesia for his or her identity and total life history. 2 In selective amnesia, the individual can recall only certain incidents associated with a stressful event for a specific period after the event. 3 Wandering aimlessly is not an example of selective amnesia. 4 This is not an example of selective amnesia.

3. Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with SSD? 1. The client will admit to fabricating physical symptoms to gain benefits by day three. 2. The client will list three potential adaptive coping strategies to deal with stress by day two. 3. The client will comply with medical treatments for physical symptoms by day three. 4. The client will openly discuss physical symptoms with staff by day four.

ANS: 2 Page: 515-518 Feedback 1 The client is experiencing real symptoms and is not likely to admit to fabricating symptoms. 2 The nurse should determine that an appropriate outcome for a client diagnosed with SSD would be for the client to list three potential adaptive coping strategies to deal with stress by day two. 3 The outcome may not be realistic for this client, and may require more time. 4 This outcome may not be realistic for the client.

1. The nurse educator is lecturing a group of nursing students on depression in adolescents. Which statement indicates that teaching has been effective? 1. "Adolescents are not likely to suffer from depression." 2. "Depressed adolescents always seek immediate treatment." 3. "Many symptoms are attributed to normal adjustments of adolescents." 4. "Suicide is not common among depressed adolescents."

ANS: 3 Page: 388 Feedback 1 Adolescents commonly suffer from depression. 2 Depressed adolescents may not immediately seek treatment. 3 Many symptoms of depression may attributed to normal adjustments of adolescents. 4 Suicide is common among depressed adolescents.

10. Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder? 1. Adjustment disorder 2. Generalized anxiety disorder 3. Panic disorder 4. Posttraumatic stress disorder

ANS: 4 Page: 494 Feedback 1 EMDR has not been empirically validated for adjustment disorder. 2 EMDR has not been empirically validated for generalized anxiety disorder. 3 EMDR has not been empirically validated for panic disorder. 4 EMDR has been used for depression, adjustment disorder, phobias, addictions, generalized anxiety disorder, and panic disorder. However, at present, EMDR has only been empirically validated for trauma-related disorders, such as PTSD and acute stress disorder.

3. A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing response? 1. "Your child has a chemical imbalance of the brain, which leads to altered perceptions." 2. "Your child's hallucinations are caused by medication interactions." 3. "Your child has too little serotonin in the brain, causing delusions and hallucinations." 4. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: 1 Page: 342-343 Feedback 1 The nurse should explain that a chemical imbalance of the brain leads to altered perceptions. 2 The client hearing voices is experiencing an auditory hallucination, which is not caused by medication. 3 Serotonin excess is thought to cause hallucinations. 4 Abnormal hormonal changes have not precipitated auditory hallucinations.

14. A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? 1. Sore throat, fever, and malaise 2. Akathisia and hypersalivation 3. Akinesia and insomnia 4. Dry mouth and urinary retention

ANS: 1 Page: 348 Feedback 1 The nurse should intervene immediately if the client experiences signs of an infectious process—such as a sore throat, fever, and malaise—when taking the atypical antipsychotic drug clozapine. Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur, leading to infection. 2 Akathisia and hypersalivation does not indicate the client's risk for infection. 3 Akinesia and insomnia does not indicate the client's risk for infection. 4 Dry mouth and urinary retention does not indicate the client's risk for infection.

9. A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? 1. Thyroid-stimulating hormone (TSH) level of 25 U/mL 2. Potassium (K+) level of 4.2 mEq/L 3. Sodium (Na+) level of 140 mEq/L 4. Calcium (Ca2+) level of 9.5 mg/dL

ANS: 1 Page: 380 Feedback 1 A diagnosis of major depressive episode may be ruled out if the client's lab results reveal a TSH level of 25 U/mL. Normal levels of TSH range from 2 to 10 U/mL. High levels of TSH indicate low thyroid function. The client's high TSH value may indicate hypothyroidism, which can lead to depressive symptoms. The DSM-5 criteria for the diagnosis of major depressive episode states that this diagnosis must not be attributable to the direct physiological effects of another medical condition. 2 Potassium levels do not lead to depression. 3 Sodium levels do not lead to depression. 4 Calcium levels do not lead to depression.

4. Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client? 1. On his or her side, to prevent aspiration 2. In high Fowler's position, to prevent increased intracranial pressure 3. In Trendelenburg's position, to promote blood flow to vital organs 4. In prone position, to prevent airway blockage

ANS: 1 Page: 405-406 Feedback 1 The nurse should place a client who has received ECT on his or her side to prevent aspiration. 2 High Fowler's does not prevent aspiration. 3 Trendelenburg does not prevent aspiration. 4 Prone position does not prevent aspiration.

20. A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response? 1. "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended." 2. "You must have misunderstood. An MAOI like Emsam always has dietary restrictions." 3. "Only oral MAOIs require dietary restrictions." 4. "All transdermal MAOIs do not require dietary modifications."

ANS: 1 Page: 408-410 Feedback 1 Dietary restrictions at this dose are not recommended. 2 Dietary modifications are recommended, however, at the 9 mg/24 hr and 12 mg/24 hr dosages. 3 All forms of Emsam require dietary modification at dosages of 9 mg/24 hr and 12 mg/24 hr. 4 This statement is inaccurate regarding transdermal MAOIs.

10. A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs. by the end of the week?" 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

ANS: 1 Page: 427-430 Feedback 1 The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 lbs. by the end of the week. Because of the hyperactive state, the client will have difficulty sitting still to consume large meals. 2 Accompanying the client to the cafeteria is not realistic. 3 Initiating total parenteral nutrition is not realistic. 4 Education is important, but is unrealistic to help the client gain weight by the end of the week.

4. A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

ANS: 1 Page: 427-430 Feedback 1 The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt. 2 Anxiety: severe R/T hyperactivity does not address the client's risk for suicide. 3 Imbalanced nutrition: less than body requirements R/T refusal to eat does not address the client's risk for suicide. 4 Dysfunctional grieving R/T loss of employment does not address the client's risk for suicide.

7. A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

ANS: 1 Page: 449-450 Feedback 1 The most appropriate nursing response to the client's concerns is to empathize with the client and provide encouragement that panic attacks only last a short period. Panic attacks usually last minutes but can, rarely, last hours. 2 This statement is not the most appropriate nursing response. 3 When the nurse states that "Most people who experience panic attacks..." the nurse depersonalizes and belittles the client's feeling. 4 This statement is not therapeutic for the client.

5. Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

ANS: 1 Page: 455-456 Feedback 1 A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions. 2 Clients with OCD experience obsessions and compulsions. Clients with obsessive-compulsive personality disorder do not. 3 The nurse would not recognize these symptoms as differentiating the disorders. 4 This statement is inaccurate regarding these disorders.

14. A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

ANS: 1 Page: 470 Feedback 1 The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. This intervention is used when taking lithium (Eskalith) for the treatment of bipolar disorder. 2 The client should not be stopped abruptly. 3 The drug should not be taken in conjunction with alcohol. 4 The client should understand that taking extra doses of a benzodiazepine may result in addiction.

8. A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that teaching has been effective? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." 3. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

ANS: 1 Page: 470-472 Feedback 1 The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine in which the major risk is physical dependence and tolerance, which may encourage abuse. It can be used on an as-needed basis to reduce anxiety and its related symptoms. 2 This statement indicates that teaching has not been effective. 3 This statement indicates that further teaching is necessary. 4 This statement does not indicate understanding.

18. A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? 1. History of alcohol use disorder 2. History of personality disorder 3. History of schizophrenia 4. History of hypertension

ANS: 1 Page: 471 Feedback 1 The nurse should question a prescription of alprazolam for acute anxiety if the client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance use disorder may be more likely to abuse other addictive substances. 2 History of personality disorder would not cause the nurse to question the order. 3 History of schizophrenia would not cause the nurse to question the order. 4 History of hypertension would not cause the nurse to question the order.

2. Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)? 1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to "normal" daily events. 3. Depressive symptoms occur in PTSD and not in AD. 4. Depressive symptoms occur in AD and not in PTSD.

ANS: 1 Page: 476-477 Feedback 1 PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events, such as divorce, failure, or rejection. 2 PTSD results from exposure to an extreme traumatic event. 3 Depressive symptoms can also occur in AD. 4 Depressive symptoms can also occur in PTSD.

9. A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client's problem? 1. Rates anxiety as 4 out of 10 by discharge 2. States anxiety level has decreased by day one 3. Accomplishes activities of daily living independently 4. Demonstrates ability for adequate social functioning by day three

ANS: 1 Page: 482-483 Feedback 1 An outcome statement must be client-centered, specific, measurable, and contain a time frame, so that it can be evaluated effectively. 2 A "decrease" in anxiety is vague rather than specific, and expecting an anxiety decrease by day one may also be unrealistic. 3 Accomplishing activities of daily living independently does not address the anxiety nursing diagnosis. 4 Demonstrating the ability for adequate social functioning does not address the anxiety nursing diagnosis.

12. By which biological mechanism does EMDR achieve its therapeutic effect? 1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown. 2. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness. 3. EMDR achieves its therapeutic effect by causing an increase in memory access. 4. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

ANS: 1 Page: 494 Feedback 1 Some studies have indicated that eye movements cause a decrease in imagery vividness and distress, as well as an increase in memory access. EMDR is thought to relieve anxiety associated with the traumatic event. However, the exact biological mechanisms by which EMDR achieves its therapeutic effects are unknown. 2 EMDR does not achieve its effect by decreasing imagery vividness. 3 EMDR does not achieve its effect by increasing memory access. 4 EMDR does not achieve its effect by decreasing trauma associated with anxiety.

14. A nurse recognizes which treatment as most commonly used for AD and its appropriate rationale? 1. Psychotherapy; to examine the stressor and confront unresolved issues 2. Fluoxetine (Prozac); to stabilize mood and resolve symptoms 3. Eye movement desensitization therapy; to reprocess traumatic events 4. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

ANS: 1 Page: 496 Feedback 1 Psychotherapy is the most common treatment used for AD. 2 AD is not commonly treated with medications. 3 Eye movement desensitization and reprocessing therapy is not used to treat adjustment disorders. 4 Anxiolytic and antidepressant medications may be prescribed as adjuncts to psychotherapy but should not be given as the first line of treatment.

2. A nurse is working with a client diagnosed with SSD. What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)? 1. The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not. 2. The client diagnosed with SSD experiences a change in the quality of self-awareness, and the client diagnosed with IAD does not. 3. The client diagnosed with SSD disorder has a perceived disturbance in body image or appearance, and the client diagnosed with IAD does not. 4. The client diagnosed with SSD only experiences anxiety about the possibility of illness, and the client diagnosed with IAD does not.

ANS: 1 Page: 505 Feedback 1 Individuals experiencing somatic symptoms without corroborating pathology are considered to have SSD, and those with minimal or no somatic symptoms would be diagnosed with IAD, a diagnosis new to the DSM-5. 2 Clients with IAD experience a change in self-awareness 3 Clients with IAD experience a change in body image. 4 Clients with SSD experience corroborating pathology.

11. Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which nursing care should be included for this client? 1. Deal with physical symptoms in a detached manner. 2. Challenge the validity of physical symptoms. 3. Meet dependency needs until the physical limitations subside. 4. Encourage a discussion of feelings about the lower-extremity problem.

ANS: 1 Page: 518-520 Feedback 1 The nurse should assist the client in dealing with physical symptoms in a detached manner. This client should be diagnosed with a conversion disorder in which symptoms affect voluntary motor or sensory functioning with or without apparent impairment of consciousness. Examples include paralysis, aphonia, seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia, and hallucinations. 2 The nurse should not challenge the validity of the symptoms. 3 The nurse should encourage the client to be as independent as possible. 4 The nurse should deal with the physical symptoms in a detached manner.

12. Which combination of diagnoses and appropriate pharmacological treatments are correctly matched? 1. SSD: predominantly pain; treated with venlafaxine (Effexor) 2. IAD; treated with cefadroxil (Duricef) 3. Conversion disorder; treated with cyclobenzaprine (Flexeril) 4. Depersonalization-derealization disorder; treated with mometasone (Elocom)

ANS: 1 Page: 524 Feedback 1 The nurse should anticipate that the diagnosis of SSD: predominantly pain can be effectively treated with venlafaxine. Antidepressants are often used with somatic symptom disorder when the predominant symptom is pain. They have been shown to be effective in relieving pain, independent of influences on mood. 2 Treatment with cefadroxil (Duricef) is not appropriate for this client. 3 Treatment with cyclobenzaprine (Flexeril) is not appropriate for this client. 4 Treatment with mometasone (Elocom) is not appropriate.

9. A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

ANS: 1 Page: 569 Feedback 1 The nurse should understand that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia do not. 2 Clients with anorexia can experience amenorrhea. 3 Clients with bulimia nervosa typically do not experience these symptoms. 4 Clients with bulimia often have tooth enamel erosion.

3. A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide? 1. The emesis produced during purging is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.

ANS: 1 Page: 570 Feedback 1 The nurse should explain to the client diagnosed with bulimia nervosa that his or her teeth will eventually deteriorate, because the emesis produced during purging is acidic and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance. 2 This does not correlate with tooth enamel deterioration. 3 This does not lead to tooth enamel deterioration. 4 This statement does not educate the client about tooth enamel deterioration caused by vomiting.

19. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

ANS: 1 Page: 593 Feedback 1 The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T paranoid thinking. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that result in a constant threat readiness. They are often tense and irritable, which increases the likelihood of violent behavior. 2 Risk for suicide R/T altered thought is not the priority nursing diagnosis. 3 Altered sensory perception R/T increased levels of anxiety is not the priority nursing diagnosis. 4 Social isolation R/T inability to relate to others is not the priority nursing diagnosis.

8. Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response? 1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. 2. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant personality disorder do not. 3. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. 4. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

ANS: 1 Page: 594, 598 Feedback 1 The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone. 2 Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships. 3 Clients diagnosed with schizoid personality disorder may exhibit odd and eccentric behaviors but not to the extent of psychosis. 4 Clients with schizoid personality disorder do not have a history of psychosis.

5. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder (BPD)? 1. Being firm, consistent, and empathic, while addressing specific client behaviors 2. Promoting client self-expression by implementing laissez-faire leadership 3. Using authoritative leadership to help clients learn to conform to society norms 4. Overlooking inappropriate behaviors to avoid providing secondary gains

ANS: 1 Page: 605-608 Feedback 1 The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting. 2 This type of leadership style would not be therapeutic to the client with BPD. 3 The best approach is a firm, consistent and empathetic approach to client needs. 4 These actions would not be therapeutic to the client.

15. A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child's behavior. Which student response indicates an appropriate evaluation of the situation? 1. "This child's behavior must be evaluated according to developmental norms." 2. "This child has symptoms of attention deficit/hyperactivity disorder." 3. "This child has symptoms of the early stages of autistic disorder." 4. "This child's behavior indicates possible symptoms of oppositional defiant disorder."

ANS: 1 Page: 627 Feedback 1 The student's evaluation of the situation is appropriate when indicating a need for the client to be evaluated according to developmental norms. The DSM-5 indicates that emotional problems exist if the behavioral manifestations are not age-appropriate, deviate from cultural norms, or create deficits or impairments in adaptive functioning. 2 Stating "This child has symptoms of attention deficit-hyperactivity disorder" does not indicate appropriate evaluation. 3 Stating "This child has symptoms of the early stages of autistic disorder" does not indicate appropriate evaluation. 4 Stating "This child's behavior indicates possible symptoms of oppositional defiant disorder" does not indicate appropriate evaluation.

14. A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis? 1. The client will name own body parts as separate from others by day five. 2. The client will establish a means of communicating personal needs by discharge. 3. The client will initiate social interactions with caregivers by day four. 4. The client will not harm self or others by discharge.

ANS: 1 Page: 634-635 Feedback 1 An appropriate outcome for this client is to name own body parts as separate from others. The nurse should assist the client in the recognition of separateness during self-care activities, such as dressing and feeding. The long-term goal for disturbed personal identity is for the client to develop an ego identity. 2 The client will establish a means of communicating personal needs by discharge does not address the diagnosis. 3 The client will initiate social interactions with caregivers by day four does not address the diagnosis. 4 The client will not harm self or others by discharge does not address the diagnosis.

5. After an adolescent diagnosed with attention deficit/hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.

ANS: 1 Page: 637-638 Feedback 1 The pharmacological action of Ritalin causes a decrease in appetite, which often leads to weight loss. 2 While hyperactivity causes an increased caloric expenditure, it is caused by the use of Ritalin, with decreases appetite. 3 Ritalin does not cause nausea. 4 Methylphenidate is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability.

12. When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome? 1. Neuroleptic medications 2. Antimanic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications

ANS: 1 Page: 648 Feedback 1 The nurse should recognize that neuroleptic (antipsychotic) medications are effective in the treatment of Tourette's syndrome. These medications are used to reduce the severity of tics and are most effective when combined with psychosocial therapy. 2 Antimanic medications are not an appropriate treatment choice. 3 Tricyclic antidepressant medications are not an appropriate treatment choice. 4 Monoamine oxidase inhibitor medications are not an appropriate treatment choice.

6. A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data? 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. 2. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. 3. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and, therefore, improvement is likely. 4. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

ANS: 1 Page: 653 Feedback 1 The nurse should determine that childhood-onset conduct disorder is more severe than adolescent-onset type. These individuals are likely to develop antisocial personality disorder in adulthood. 2 Individuals with this subtype are usually boys and frequently display physical aggression and have disturbed peer relationships. 3 Childhood-onset conduct disorder is not diagnosed before the age of 5, but rather when symptoms emerge. 4 Childhood-onset conduct disorder has treatment options available.

14. Which individual is most likely to be below the poverty level in the United States? 1. A 70-year-old Hispanic woman living alone 2. A 72-year-old African American man living alone 3. A 68-year-old Asian American woman living with family 4. A 75-year-old Latino American man living with family

ANS: 1 Page: 670-671 Feedback 1 Approximately 3.5 million persons aged 65 years or older were below the poverty level in 2010. Older women had a higher poverty rate than older men, and older Hispanic women living alone had the highest poverty rate. 2 A 72-year-old African American man living alone is not the most likely to be below the poverty level in the United States. 3 A 68-year-old Asian American woman living with family is not the most likely to be below the poverty level in the United States. 4 A 75-year-old Latino American man living with family is not the most likely to be below the poverty level in the United States.

12. An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client? 1. Electroconvulsive therapy (ECT) 2. Neuroleptic therapy 3. An antiparkinsonian agent 4. An anxiolytic agent

ANS: 1 Page: 678 Feedback 1 The nurse should anticipate that ECT will be ordered to treat this client's symptoms of depression. ECT remains one of the safest and most effective treatments for major depression in older adults. The response to ECT may be slower in older clients, and the effects may be of limited duration. 2 Neuroleptic therapy is not a therapeutic intervention for the client with major depressive disorder. 3 An antiparkinsonian agent is not a therapeutic intervention for the client with major depressive disorder. 4 An anxiolytic agent is not a therapeutic intervention for the client with major depressive disorder.

2. A son, who recently brought his extremely confused parent to a nursing home for admission, reports feelings of guilt. Which is the appropriate nursing response? 1. "Support groups are held here on Mondays for children of residents in similar situations." 2. "You did what you had to do. I wouldn't feel guilty if I were you." 3. "Support groups are available to low-income families." 4. "Your parent is doing just fine. We'll take very good care of him."

ANS: 1 Page: 689-692 Feedback 1 The most appropriate response by the nurse is to offer support to the son by presenting available support groups. Caregivers can often experience negative emotions and guilt. Release of these emotions can serve to prevent caregivers from developing psychopathology such a depression. 2 This statement does not offer solutions to the son's feelings. 3 This statement may degrade what the son is feeling. 4 This statement does not validate the son's feelings.

3. A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included? 1. Power and control are central to the dynamic of domestic violence. 2. Poor communication and social isolation are central to the dynamic of domestic violence. 3. Erratic relationships and vulnerability are central to the dynamic of domestic violence. 4. Emotional injury and learned helplessness are central to the dynamic of domestic violence.

ANS: 1 Page: 704-706 Feedback 1 The nursing instructor should include the concept that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession. 2 Poor communication and social isolation are not central to the dynamic of domestic violence. 3 Erratic relationships and vulnerability are not central to the dynamic of domestic violence. 4 Emotional injury and learned helplessness are not central to the dynamic of domestic violence.

1. A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child may have been physically abused? 1. The child shrinks at the approach of adults. 2. The child begs or steals food or money. 3. The child is frequently absent from school. 4. The child is delayed in physical and emotional development.

ANS: 1 Page: 706-707 Feedback 1 The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child. 2 Stealing money or food does not indicate physical abuse. 3 Frequently missing school does not indicate physical abuse. 4 Developmental delays do not indicate physical abuse.

13. Which assessment data should a school nurse recognize as a sign of physical neglect? 1. The child is often absent from school and seems apathetic and tired. 2. The child is very insecure and has poor self-esteem. 3. The child has multiple bruises on various body parts. 4. The child has sophisticated knowledge of sexual behaviors.

ANS: 1 Page: 706-707 Feedback 1 The nurse should recognize that a child who is often absent from school and seems apathetic and tired may be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care. 2 Insecurity and poor self-esteem are not signs of physical neglect. 3 Bruising is a sign of physical abuse. 4 Sophisticated sexual behaviors is a sign of sexual abuse.

8. A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? 1. "I know that it was not my fault." 2. "My boyfriend has trouble controlling his sexual urges." 3. "If I don't put myself in a dating situation, I won't be at risk." 4. "Next time I will think twice about wearing a sexy dress."

ANS: 1 Page: 712-714 Feedback 1 The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth. 2 Stating "My boyfriend has trouble controlling his sexual urges" does not indicate that the client is handling the situation in a healthy manner. 3 Stating "If I don't put myself in a dating situation, I won't be at risk" does not indicate that the client is handling the situation in a healthy manner. 4 Stating "Next time I will think twice about wearing a sexy dress" does not indicate that the client is handling the situation in a healthy manner.

6. A school nurse provides education on drug abuse to a high school class. This nursing action is an example of which level of preventive care? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Primary intervention

ANS: 1 Page: 726 Feedback 1 Providing nursing education on drug abuse to a high school class is an example of primary prevention. Primary prevention services are aimed at reducing the incidence of mental health disorders within the population. 2 Secondary prevention is aimed at early detection and prompt intervention. 3 Tertiary prevention is aimed at reduction of symptoms. 4 Primary intervention is not a term associated with the public health model.

4. A client at the mental health clinic tells the case manager, "I can't think about living another day, but don't tell anyone about the way I feel. I know you are obligated to protect my confidentiality." Which case manager response is most appropriate? 1. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care." 2. "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk." 3. "You seem to be preoccupied with self. You should concentrate on hope for the future." 4. "This information is secure with me because of client confidentiality."

ANS: 1 Page: 739 Feedback 1 The most appropriate response by the case manager is to explain that sharing the information with the treatment team is critical to the client's care. This case manager's priority is to ensure client safety and to inform others on the treatment team of the client's suicidal ideation. 2 Stating "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk" does not protect the client's safety, which is the priority. 3 Stating "You seem to be preoccupied with self. You should concentrate on hope for the future" does not protect the client's safety, which is the priority. 4 Stating "This information is secure with me because of client confidentiality" does not protect the client's safety, which is the priority.

3. A nurse discharges a female client to home after delivering a stillborn infant. The client finds that neighbors have dismantled the nursery that she and her husband planned. According to Worden, how could this intervention affect the woman's grieving task completion? 1. This intervention may hamper the woman from continuing a relationship with her infant. 2. This intervention would help the woman forget the sorrow and move on with life. 3. This intervention communicates full support from her neighbors. 4. This intervention would motivate the woman to look to the future and not the past.

ANS: 1 Page: 760 Feedback 1 The nurse should anticipate that this intervention could hinder the woman from continuing a relationship with her infant. The first task in Worden's grief process is to accept the reality of the loss. It is common for individuals to refuse to believe that the loss has occurred. 2 This intervention could complicate the grieving process. 3 The intervention could isolate the women from others. 4 This intervention could prevent the women from grieving the loss and moving forward.

5. What term should a nurse use when assessing a response to grieving that includes a sudden physical collapse and paralysis, and which cultural group would be associated with this behavior? 1. "Falling out" in the African American culture 2. "Body rocking" in the Vietnamese American culture 3. "Conversion disorder" in the Jewish American culture 4. "Spirit possession" in the Native American culture

ANS: 1 Page: 765-766 Feedback 1 The nurse should use the term falling out to describe a sudden physical collapse and paralysis in the African American culture. The individuals may also experience an inability to see or speak yet maintain hearing and understanding. 2 "Body rocking" in the Vietnamese American culture does not include a sudden physical collapse and paralysis. 3 "Conversion disorder" in the Jewish American culture does not include a sudden physical collapse and paralysis. 4 "Spirit possession" in the Native American culture does not include a sudden physical collapse and paralysis.

7. A nursing instructor is teaching about the typical grieving behaviors of Chinese Americans. Which student statement would indicate that more instruction is necessary? 1. "In this culture, the color red is associated with death and is considered bad luck." 2. "In this culture, there is an innate fear of death." 3. "In this culture, emotions are not expressed openly." 4. "In this culture, death and bereavement are centered on ancestor worship."

ANS: 1 Page: 766 Feedback 1 The nursing instructor should evaluate that more instruction is needed if a student states that the color red is associated with death and bad luck in the Chinese culture. Chinese Americans consider the color white as associated with death and is considered bad luck. Red is the ultimate color of luck in this culture. 2 Stating "In this culture, there is an innate fear of death" is not accurate regarding the Chinese American. 3 Stating "In this culture, emotions are not expressed openly" is not accurate regarding the Chinese American. 4 Stating "In this culture, death and bereavement are centered on ancestor worship" is not accurate regarding the Chinese American.

16. Which of the following rationales by a nurse explain to parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (Select all that apply.) 1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitter levels vary considerably in accordance with age. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant.

ANS: 1, 2 Page: 424-425 Feedback 1. It is difficult to diagnose a child or adolescent with bipolar disorder, because bipolar symptoms mimic attention deficit hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitters levels do not vary according to age. 4. Bipolar disorder can be diagnosed for the age of 18. 5. Genetic predisposition can be a reliable diagnostic determinant.

11. A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) 1. Binge eating with a diagnosis of obesity 2. Bingeing and purging with a diagnosis of bulimia nervosa 3. Weight loss with a diagnosis of anorexia nervosa 4. Amenorrhea with a diagnosis of anorexia nervosa 5. Emaciation with a diagnosis of bulimia nervosa

ANS: 1, 2 Page: 585 Feedback 1. The nurse should identify that topiramate is the drug of choice when treating binge eating with a diagnosis of obesity. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight. 2. The nurse should identify that topiramate is the drug of choice when treating bingeing and purging with a diagnosis of bulimia nervosa. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight. 3. Topiramate (Topamax) is not the drug of choice for weight loss with a diagnosis of anorexia nervosa. 4. Topiramate (Topamax) is not the drug of choice for amenorrhea with a diagnosis of anorexia nervosa. 5. Topiramate (Topamax) is not the drug of choice for emaciation with a diagnosis of bulimia nervosa.

16. Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.) 1. Low self-esteem 2. Powerlessness 3. Disturbed personal identity 4. Knowledge deficit 5. Nonadherence

ANS: 1, 2 Page: 709 Feedback 1. An adult survivor of incest would most likely have low self-esteem. 2. An adult survivor of incest would most likely have a sense of powerlessness. 3. An adult survivor of incest would not likely have disturbed personal identity. 4. An adult survivor of incest would not likely have a knowledge deficit. 5. An adult survivor of incest would not likely have nonadherence.

25. A nursing instructor is teaching about the new DSM-5 diagnostic category of disruptive mood dysregulation disorder (DMDD). Which of the following information should the instructor include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

ANS: 1, 2, 3 Page: 389 Feedback 1. The APA has included a new diagnostic category in the Depressive Disorders chapter of the DSM-5. This childhood disorder is called disruptive mood dysregulation disorder. Criteria for the diagnosis include, but are not limited to, the following: verbal rages or physical aggression toward people or property. 2. The APA has included a new diagnostic category in the Depressive Disorders chapter of the DSM-5. This childhood disorder is called disruptive mood dysregulation disorder. Criteria for the diagnosis include, but are not limited to, the following: verbal rages or physical aggression toward people or property. 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested both behaviorally and/or verbally. 5. Symptoms of DMDD must be present for 12 months, not 18 or more months, to meet diagnostic criteria.

14. Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply.) 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. Restrict sodium content. 5. Restrict fluids to 1,500 mL per day.

ANS: 1, 2, 3 Page: 434, 439-440 Feedback 1. The nurse should instruct the client taking lithium to avoid excessive use of caffeine. 2. The nurse should instruct the client taking lithium to maintain a consistent sodium intake. 3. The nurse should instruct the client taking lithium to consume at least 2,500 to 3,000 mL of fluid per day. 4. Fluid restriction can impact lithium levels. 5. Sodium restriction can impact lithium levels.

26. Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) 1. The client will relate one empathetic statement to another client in group by day two. 2. The client will identify one personal limitation by day one. 3. The client will acknowledge one strength that another client possesses by day two. 4. The client will list four personal strengths by day three. 5. The client will list two lifetime achievements by discharge.

ANS: 1, 2, 3 Page: 597 Feedback 1. The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include relating empathetic statements to other clients. 2. The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include identifying one personal limitation. 3. The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include acknowledging one strength in another client. 4. Narcissistic personality disorder is characterized by an exaggerated sense of self-worth, a lack of empathy, and exploitation of others. 5. Asking the client to discussed lifetime achievements is not therapeutic due to the inflated sense of self.

21. Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? (Select all that apply.) 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

ANS: 1, 2, 3 Page: 627-628 Feedback 1. The nurse should recognize a family history of Tay-Sachs disease as risk factors that would predispose a child to IDD. 2. The nurse should recognize a family history of childhood meningococcal infections as risk factors that would predispose a child to IDD. 3. The nurse should recognize a family history of deprivation of nurturance and social contact as risk factors that would predispose a child to IDD. 4. A diagnosis of maternal major depressive disorder would not predispose a child to IDD.

18. The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.) 1. Hyperthyroidism 2. Hypothyroidism 3. Hyperadrenalism 4. Hypoadrenalism 5. Hyperaphia

ANS: 1, 2, 3, 4 Page: 348-349 Feedback 1. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders such as hyperthyroidism. 2. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hypothyroidism. 3. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hyperadrenalism. 4. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hypoadrenalism. 5. Hyperaphia is an excessive sensitivity to touch.

20. A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms might the nurse expect to assess? (Select all that apply.) 1. Feelings of guilt that precipitate social isolation 2. Aggressive behavior that affects job performance 3. Relationship problems 4. High levels of anxiety 5. Escalating symptoms lasting less than one month

ANS: 1, 2, 3, 4 Page: 477 Feedback 1. Characteristic symptoms of PTSD include guilt feelings. 2. Characteristic symptoms of PTSD include aggressive behaviors. 3. Characteristic symptoms of PTSD include relationship problems. 4. Characteristic symptoms of PTSD include high levels of anxiety. 5. The full-symptom picture must present for more than 1 month and cause significant interference with social, occupational, and other areas of functioning.

19. A client diagnosed with an adjustment disorder says to the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing responses? (Select all that apply.) 1. "Medications can interfere with your ability to find a more permanent solution." 2. "Medications may mask the real problem at the root of this diagnosis." 3. "Adjustment disorders are not commonly treated with medications." 4. "Psychoactive drugs carry the potential for physiological and psychological dependence." 5. "Psychoactive drugs will be prescribed only if your problems persist for more than three months."

ANS: 1, 2, 3, 4 Page: 495-496 Feedback 1. Adjustment disorders are not commonly treated with medications because of interfering with finding a permanent solution. 2. Adjustment disorders are not commonly treated with medications because of masking the real problem. 3. Adjustment disorder is not commonly treated with medication. 4. Adjustment disorders are not commonly treated with medications because of the potential for addiction. 5. Adjustment disorder is not commonly treated with medication.

24. A client is prescribed phenelzine (Nardil). Which of the following statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food and medication labels." 4. "I'm going to miss my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

ANS: 1, 2, 3, 5 Page: 408, 410 Feedback 1. The client needs to tell other physicians about taking MAOIs, because of the risk of drug interactions. 2. The nurse should evaluate that teaching has been successful when the client states that phenelzine should not be taken in conjunction with the use of alcohol. 3. The nurse should evaluate that teaching has been successful when the client states that phenelzine should not be taken in conjunction with foods high in tyramine. 4. The client will not have to give up caffeinated coffee with this medication. 5. This medication should not be stopped abruptly.

28. A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Ego-centrism and goal setting based on personal gratification. 2. Incapacity for mutually intimate relationships. 3. Frequent feelings of being down, miserable, or hopeless. 4. Disregard for and failure to honor financial and other obligations. 5. Intense feelings of nervousness, tenseness, or panic.

ANS: 1, 2, 4 Page: 611 Feedback 1. According to the DSM-5, the client must exhibit egocentrism and goal setting based on personal gratification. 2. The client does not need to have an incapacity for mutually intimate relationships. 3. According to the DSM-5, the client must frequently feel down and hopeless. 4. The client needs to have a disregard for and failure to honor financial and other obligations. 5. The client does not need to experience intense feelings of nervousness, tenseness, or panic.

17. A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.) 1. "Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner." 2. "Intimate partner violence is used to gain power and control over the other intimate partner." 3. "Fifty-one percent of victims of intimate violence are women." 4. "Women ages 25 to 34 experience the highest per capita rates of intimate violence." 5. "Victims are typically young married women who are dependent housewives."

ANS: 1, 2, 4 Page: 704-706 Feedback 1. Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. 2. It is used to gain power and control over the other intimate partner. 3. Eighty-five percent of victims of intimate violence are women. 4. Women ages 25 to 34 experience the highest per capita rates of intimate violence. 5. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives.

15. In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (Select all that apply.) 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by abuse between their parents. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay.

ANS: 1, 2, 4 Page: 704-706 Feedback 1. When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation. 2. When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that substance abuse is a common factor in abusive relationships. 3. Children can be affected by domestic violence from infancy. 4. When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that women in abusive relationships usually feel isolated and unsupported. 5. Economic factors often play a role in the victim's decision to stay.

17. Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.) 1. Group therapy 2. Medication management 3. Deterrent therapy 4. Supportive family therapy 5. Social skills training

ANS: 1, 2, 4, 5 Page: 365-368 Feedback 1. The nurse should recognize that group therapy plays an integral part of rehabilitative programs for clients diagnosed with schizophrenia spectrum disorder. 2. The nurse should recognize that medication management plays an integral part of rehabilitative programs for clients diagnosed with schizophrenia spectrum disorder. 3. Deterrent therapy is not a part of rehabilitative programs. 4. The nurse should recognize that supportive family therapy plays an integral part of rehabilitative programs for clients diagnosed with schizophrenia spectrum disorder. 5. The nurse should recognize that social skills training plays an integral part of rehabilitative programs for clients diagnosed with schizophrenia spectrum disorder.

11. A nurse is leading a bereavement group. Which of following members of the group should the nurse identify as being at high risk for complicated grieving? (Select all that apply.) 1. A widower who has recently experienced the death of two good friends 2. A man whose wife died suddenly after a cerebrovascular accident 3. A widow who removed life support after her husband was in a vegetative state for a year 4. A woman who had a competitive relationship with her recently deceased brother 5. A young couple whose child recently died of a genetic disorder

ANS: 1, 2, 4, 5 Page: 762-763 Feedback 1. The nurse should identify that individuals are at a high risk for complicated grieving when the individual experienced a number of recent losses. 2. The nurse should identify that individuals are at a high risk for complicated grieving when the bereaved person was strongly dependent on the lost entity. 3. Having a year to process grief while her husband was in a vegetative state would reduce the widow's risk for the problem of complicated grieving. 4. The nurse should identify that individuals are at a high risk for complicated grieving when, the relationship with the lost entity was highly ambivalent. 5. The nurse should identify that individuals are at a high risk for complicated grieving when the loss is that of a young person.

24. An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. History of an eating disorder 4. History of delusional thinking 5. Skin picking

ANS: 1, 2, 5 Page: 456-457 Feedback 1. The DSM-5 lists preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others as a diagnostic criterion for the diagnosis of BDD. Also listed is that at some point during the course of the disorder, the person has performed repetitive behaviors, such as mirror checking. 2. The DSM-5 lists preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others as a diagnostic criterion for the diagnosis of BDD. Also listed is that at some point during the course of the disorder, the person has performed repetitive behaviors, such as excessive grooming. 3. History of eating disorders is not a symptom that support the diagnosis of body dysmorphic disorder. 4. History of delusional thinking is not a symptom that support the diagnosis of body dysmorphic disorder. 5. The DSM-5 lists preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others as a diagnostic criterion for the diagnosis of BDD. Also listed is that at some point during the course of the disorder, the person has performed repetitive behaviors, such as skin picking.

22. A nurse recognizes which of the following as the best predictors of PTSD in Vietnam veterans? (Select all that apply.) 1. The severity of the stressor 2. The degree of ego strength 3. The degree of psychosocial isolation in the recovery environment 4. The attitudes of society regarding the experience 5. The presence of preexisting psychopathology

ANS: 1, 3 Page: 477, 479-480 Feedback 1. In research with Vietnam veterans, it was shown that the best predictors of PTSD were the severity of the stressor. 2. Ego strength is not the best predictor of PTSD in Vietnam veterans. 3. In research with Vietnam veterans, it was shown that the best predictors of PTSD were the degree of psychosocial isolation in the recovery environment. 4. Attitudes of society is not the best predictor of PTSD in Vietnam veterans. 5. Preexisting psychopathology is not the best predictor of PTSD in Vietnam veterans.

16. A client is diagnosed with functional neurological symptom disorder (FNSD). Which of the following symptoms is the client most likely to exhibit? (Select all that apply.) 1. Anosmia 2. Anhedonia 3. Akinesia 4. Aphonia 5. Amnesia

ANS: 1, 3, 4 Page: 507 Feedback 1. FNSD can also be termed conversion disorder. Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. The client would likely exhibit anosmia. 2. The client would not likely exhibit anhedonia. 3. FNSD can also be termed conversion disorder. Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. The client would likely exhibit akinesia. 4. FNSD can also be termed conversion disorder. Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. The client would likely exhibit aphonia. 5. The client would not likely exhibit amnesia.

15. Which of the following have been assessed as the most common types of mental illness identified among homeless individuals? (Select all that apply.) 1. Schizophrenia 2. Body dysmorphic disorder 3. Antisocial personality disorder 4. Neurocognitive disorder 5. Conversion disorder

ANS: 1, 3, 4 Page: 745-750 Feedback 1. A number of studies have been conducted, primarily in large, urban areas, which have addressed the most common types of mental illness identified among homeless individuals. Schizophrenia is frequently described as the most common diagnosis. 2. Body dysmorphic disorder is not among the most common types of mental illnesses among homeless individuals. 3. Other prevalent disorders include personality disorders, such as antisocial personality disorder. 4. Other prevalent disorders include neurocognitive disorders. 5. Conversion disorder is not among the most common types of mental illnesses among homeless individuals.

12. An instructor is teaching nursing students about Worden's grief process. According to Worden, which of the following client behaviors would delay or prolong the grieving process? (Select all that apply.) 1. Refusing to allow oneself to think painful thoughts 2. Indulging in the pain of loss 3. Using alcohol and drugs 4. Idealizing the object of loss 5. Recognizing that time will heal

ANS: 1, 3, 4 Page: 760-761 Feedback 1. The nurse should identify that refusing to allow oneself to think painful thoughts will delay or prolong the grieving process. 2. Indulging in the pain of loss will not delay the grieving process. 3. The nurse should identify that using alcohol and drugs will delay or prolong the grieving process. 4. The nurse should identify that idealizing the object of loss will delay or prolong the grieving process. 5. Recognizing that time will heal does not delay the grieving process.

23. A nurse has been caring for a client diagnosed with generalized anxiety disorder. Which of the following nursing interventions would address this client's symptoms? (Select all that apply.) 1. Encourage the client to recognize the signs of escalating anxiety. 2. Encourage the client to avoid any situation that causes stress. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products.

ANS: 1, 3, 4, 5 Page: 461-465 Feedback 1. Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety. 2. Avoiding situations that cause stress is not an appropriate intervention. Avoidance does not help the client overcome anxiety and not all situations are easily avoidable. 3. Nursing interventions that address GAD symptoms should include encouraging the client to employ relaxation techniques. 4. Nursing interventions that address GAD symptoms should include encouraging the client to cognitively reframe thoughts about anxiety-provoking situations. 5. Nursing interventions that address GAD symptoms should include encouraging the client to avoid caffeinated products.

27. A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client's care? (Select all that apply.) 1. This client has personality traits that are deeply ingrained and difficult to modify. 2. This client needs medication to treat the underlying physiological pathology. 3. This client uses manipulation, making the implementation of treatment problematic. 4. This client has poor impulse control that hinders compliance with a plan of care. 5. This client is likely to have secondary diagnoses of substance abuse and depression.

ANS: 1, 3, 4, 5 Page: 611 Feedback 1. The nurse should consider that individuals diagnosed with antisocial personality disorders have deeply ingrained personality traits. 2. This client does not require medication to treat this disorder. 3. The nurse should consider that individuals diagnosed with antisocial personality disorders use manipulation. 4. The nurse should consider that individuals diagnosed with antisocial personality disorders have poor impulse control. 5. The nurse should consider that individuals diagnosed with antisocial personality disorders often have secondary diagnoses of substance abuse or depression.

15. A client is diagnosed with IAD. Which of the following symptoms is the client most likely to exhibit? (Select all that apply.) 1. Obsessive-compulsive behaviors 2. Pseudocyesis 3. Anxiety 4. Flat affect 5. Depression

ANS: 1, 3, 5 Page: 506-507 Feedback 1. The nurse should expect that a client diagnosed with IAD would exhibit obsessive-compulsive behaviors. 2. The client would not likely exhibit pseudocyesis. 3. The nurse should expect that a client diagnosed with IAD would exhibit anxiety. 4. The client would not likely exhibit a flat affect. 5. The nurse should expect that a client diagnosed with IAD would exhibit depression.

17. A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis? (Select all that apply.) 1. "Have you taken any new medications recently?" 2. "Have you recently traveled away from home?" 3. "Have you recently experienced any traumatic event?" 4. "Have you ever felt detached from your environment?" 5. "Have you had any history of memory problems?"

ANS: 1, 3, 5 Page: 518-520 Feedback 1. The nurse should assess the client for possible causes of amnesia, which may include side effects of new medications. 2. This question would not help confirm the diagnosis. 3. The nurse should assess the client for possible causes of amnesia, which may include experiencing a traumatic event. 4. This question would not be beneficial in helping the nurse confirm the diagnosis. 5. The nurse should assess the client for possible causes of amnesia, which may include having a history of memory problems.

12. A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) 1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 2. "In this disorder, binge eating occurs, on average, at least once a week for three months." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 4. "In this disorder, distress regarding binge eating is present." 5. "In this disorder, distress regarding binge eating is absent."

ANS: 1, 3, 5 Page: 571 Feedback 1. According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. 2. This statement regarding binge eating is accurate, indicating that teaching has been effective. 3. The new time frame criteria in the DSM-5 states that binge eating must occur, on average, at least once a week for three months not two days a week for six months. 4. This statement indicates that teaching has been effective. 5. The DSM-5 criteria states that distress regarding binge eating would be present.

25. A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.) 1. The client has been diagnosed with sickle cell anemia. 2. The client has an inflated self-appraisal and feels a sense of entitlement. 3. The client has a history of a substance use disorder. 4. The client is odd and eccentric but not delusional. 5. The client has an intellectual developmental disorder.

ANS: 1, 3, 5 Page: 591 Feedback 1. The DSM-5 states that impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). The nurse would question the diagnosis of a personality disorder in a client with sickle cell anemia. 2. This nurse would not question this diagnosis. 3. The DSM-5 states that impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). The nurse would question the diagnosis of a personality disorder in a client with substance use disorder. 4. The nurse would not likely question this diagnosis, due to the client's behavior. 5. The DSM-5 states that impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). The nurse would question the diagnosis of a personality disorder in a client with intellectual developmental disorder.

13. Which of the following types of care should the interdisciplinary team of hospice provide? (Select all that apply.) 1. Physical care available on a 24/7 basis 2. Counseling on the addictive properties of pain-management medications 3. Discussions related to death and dying 4. Explorations of new aggressive treatments 5. Assistance with obtaining spiritual support and guidance

ANS: 1, 3, 5 Page: 770 Feedback 1. The nurse should identify that the interdisciplinary team of hospice provides physical care available on a 24/7 basis. 2. The interdisciplinary team of hospice does not provide counseling on the addictive properties of pain-management medications. 3. The nurse should identify that the interdisciplinary team of hospice provides discussions related to death and dying. 4. The interdisciplinary team of hospice does not provide explorations of new aggressive treatments. 5. The nurse should identify that the interdisciplinary team of hospice provides assistance with obtaining spiritual support and guidance.

22. A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

ANS: 1, 4 Page: 382 Feedback 1. The nurse should anticipate that a client with a diagnosis of dysthymic disorder would experience a sad mood on most days for more than two years. 2. The client would need to be sad on most days for more than two years to meet the requirements for dysthymic disorder. 3. The client would not have a labile mood. 4. The essential feature of dysthymia is a chronically depressed mood, which can have an early or late onset. 5. The client would not experience pressured speech when communicating.

21. A college student has been diagnosed with generalized anxiety disorder. Which of the following symptoms should the campus nurse expect this client to exhibit? (Select all that apply.) 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

ANS: 1, 4, 5 Page: 450 Feedback 1. The nurse should expect that a client diagnosed with GAD would experience fatigue. 2. The client would not likely experience anorexia. 3. The client would not likely experience hyperventilation. 4. The nurse should expect that a client diagnosed with GAD would experience insomnia. 5. The nurse should expect that a client diagnosed with GAD would experience irritability.

15. A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis? 1. The client has experienced impaired reality testing for a 24-hour period. 2. The client has experienced auditory hallucinations for the past 3 hours. 3. The client has experienced bizarre behavior for 1 day. 4. The client has experienced confusion for 3 weeks.

ANS: 2 Page: 348 Feedback 1 Impaired reality testing for a 24-hour period is typical of brief psychotic disorder and would not cause the nurse to question this diagnosis. 2 This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month. 3 Bizarre behavior for 1 day is typical of brief psychotic disorder and would not cause the nurse to question this diagnosis. 4 Confusion for 3 weeks is typical of brief psychotic disorder and would not cause the nurse to question this diagnosis.

1. A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? 1. Assess for medication nonadherence. 2. Note escalating behaviors and intervene immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors.

ANS: 2 Page: 350-351 Feedback 1 Assessing for medication nonadherence does not indicate that the client's safety may be at risk. 2 The nurse should note escalating behaviors and intervene immediately, to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe. 3 Interpreting attempts at communication does not indicate that the client's safety may be at risk. 4 Assessing triggers for bizarre, inappropriate behaviors does not indicate that the client's safety may be at risk.

12. A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? 1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. 2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. 3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. 4. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: 2 Page: 351 Feedback 1 Anhedonia and anergia are negative symptoms of schizophrenia. 2 The nurse should recognize that positive symptoms of schizophrenia include, but are not limited to, paranoid delusions, neologisms, and echolalia. 3 Echolalia and paranoid delusions are positive symptoms. 4 Paranoid delusions are a positive symptom.

9. Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? 1. Establishing personal contact with family members 2. Being reliable, honest, and consistent during interactions 3. Sharing limited personal information 4. Sitting close to the client to establish rapport

ANS: 2 Page: 355-360 Feedback 1 Establishing personal contact with family is important, but the nurse must first establish a relationship with the client. 2 The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior. 3 Sharing limited personal information can occur after a relationship has been established with the client. 4 Sitting close to the client is important, but it does not establish rapport.

5. A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder? 1. Altered communication R/T feelings of worthlessness AEB anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

ANS: 2 Page: 380 Feedback 1 Altered communication R/T feelings of worthlessness AEB anhedonia does not address a behavioral symptom of this disorder. 2 A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive episode. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, curled-up position, and no attention to personal hygiene and grooming. 3 Altered thought processes R/T hopelessness AEB persecutory delusions does not address a behavioral symptom of this disorder. 4 Altered nutrition: less than body requirements R/T high anxiety AEB anorexia does not address a behavioral symptom of this disorder.

11. What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems.

ANS: 2 Page: 382 Feedback 1 The assessment does not decrease social isolation. 2 The nurse should determine that a client with a diagnosis of major depressive episode needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders. 3 Physical health complications are not likely to arise from antidepressant therapy. 4 Not all depressed clients avoid addressing health and medical problems.

18. The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms? 1. Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia) 4. Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)

ANS: 2 Page: 391-392 Feedback 1 The symptoms of the maternity blues include tearfulness, despondency, anxiety, and subjectively impaired concentration appearing in the early puerperium. 2 Symptoms of postpartum depression are associated with fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, and expressions of great concern about her inability to care for her baby. 3 Postpartum melancholia is characterized by a lack of interest in, or rejection of, the baby, or a morbid fear that the baby may be harmed. 4 Postpartum depressive psychosis is characterized by a lack of interest in, or rejection of, the baby, or a morbid fear that the baby may be harmed.

17. A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

ANS: 2 Page: 392 Feedback 1 The Zung Self-rating Depression Scale is a self-rating scale. 2 One of the most widely used clinician-administered scales is the Hamilton Depression Rating Scale. 3 The Beck Depression Inventory is a self-rating scale. 4 The Abnormal Involuntary Movement Scale is a rating scale that measures involuntary movements associated with tardive dyskinesia.

14. A nurse is working with a client who has just been prescribed buproprion (Wellbutrin). Which statement by the client indicates that further education is necessary? 1. "I will begin using sunblock when outdoors." 2. "If I miss a dose, I will just take two pills the next day to catch up." 3. "I will only discontinue the medication under the guidance of my physician." 4. "I will use caution when driving and using dangerous machinery."

ANS: 2 Page: 405-407 Feedback 1 The client should use sunblock or protective clothing as skin sensitivity may occur. 2 Clients should never double up on a dose if they miss a day, as this could increase the risk of seizures or other adverse reactions. 3 Clients should only discontinue any medication under the guidance of their physician. 4 Clients should use caution when driving or operating dangerous machinery, as drowsiness and dizziness can occur.

16. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response? 1. "This combination of drugs can lead to delirium tremens." 2. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." 3. "That's a good idea. There have been good results with the combination of these two drugs." 4. "The only disadvantage would be the exorbitant cost of the MAOI."

ANS: 2 Page: 408 Feedback 1 The combination would not lead to delirium tremens. 2 The nurse should explain to the client that combining an MAOI and fluvoxamine, an SSRI, can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches, with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread." 3 This statement by the nurse would be inappropriate, and potentially life threatening. 4 This statement by the nurse is not accurate.

21. After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

ANS: 2 Page: 408-410 Feedback 1 Tyramine is only an issue when MAOI medications are prescribed. 2 Imipramine is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect. 3 Alcohol potentiates the effects of antidepressants. 4 Concomitant use of St. John's wort and SSRIs, not tricyclics, increases, not decreases the effects of the drug.

2. A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-lb. weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

ANS: 2 Page: 419-422 Feedback 1 Knowledge deficit R/T bipolar disorder AEB concern about symptoms does not identify the client's sudden 12-lb. weight loss. 2 The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity AEB weight loss. Because of the client's rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition and physical health. 3 Risk for suicide R/T powerlessness AEB insomnia and anorexia does not identify the client's sudden 12-lb. weight loss. 4 Altered sleep patterns R/T mania AEB insomnia for the past 3 nights does not identify the client's sudden 12-lb. weight loss.

12. A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1. Increase the dosage of fluoxetine. 2. Discontinue the fluoxetine and rethink the client's diagnosis. 3. Order benztropine (Cogentin) to address extrapyramidal symptoms. 4. Order olanzapine (Zyprexa) to address altered thoughts.

ANS: 2 Page: 424-425 Feedback 1 Increasing the dosage would not help this client. 2 A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis. It would be inappropriate to increase the dosage of fluoxetine. 3 The client is not having extrapyramidal symptoms. 4 The client is not having altered thoughts.

13. Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication adherence 2. Empowerment of the consumer 3. Total absence of symptoms 4. Improved psychosocial relationships

ANS: 2 Page: 433-434 Feedback 1 Medication adherence is not the basic premise of the recovery model for bipolar disorder. 2 The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. 3 Absence of symptoms is not the basic premise of the recovery model for bipolar disorder. 4 Improved psychosocial relationships is not the basic premise of the recovery model for bipolar disorder.

5. A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

ANS: 2 Page: 435-438 Feedback 1 Sertraline (Zoloft) does not counteract the weight-increasing effects of lithium. 2 The nurse should anticipate that the physician may prescribe valproic acid in order to increase this client's medication adherence. Valproic acid is an anticonvulsant medication that can be used to treat bipolar disorder. One of the side effects of this medication is weight loss. 3 Trazodone (Desyrel) does not counteract the weight increasing effects of lithium. 4 Paroxetine (Paxil) does not counteract the weight increasing effects of lithium.

9. A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

ANS: 2 Page: 449-450 Feedback 1 This statement is not therapeutic to the family member. 2 The most appropriate response by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept. 3 This statement is misleading to the family member. 4 This statement is inaccurate and misleading.

20. A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that teaching has been effective? 1. Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2. Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3. Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4. Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

ANS: 2 Page: 451 Feedback 1 This statement indicates that teaching has not been effective. 2 The onset of the symptoms of agoraphobia most commonly occurs in the 20s and 30s and persists for many years. 3 This statement indicates that further teaching is necessary. 4 This statement is inaccurate and indicates a need for further education.

13. A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

ANS: 2 Page: 455-456 Feedback 1 This may not be realistic for the client. 2 An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. 3 Participating in three activities on the first day may not be realistic for this client. 4 The nurse should plan realistic outcomes for the client.

17. A nursing student questions an instructor regarding the order for fluvoxamine (Luvox) 300 mg daily for a client diagnosed with obsessive-compulsive disorder. Which instructor response is most accurate? 1. High doses of tricyclic medications will be required for effective treatment of OCD. 2. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. 3. The dose of Luvox is low because of the side effect of daytime drowsiness. 4. The dose of this SSRI is outside the therapeutic range and needs to be questioned.

ANS: 2 Page: 472 Feedback 1 High doses of tricyclic medications are not required for treatment of OCD. 2 The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the Food and Drug Administration for the treatment of OCD. 3 Common side effects include headache, sleep disturbances, and restlessness. 4 The dosage is needed for effective treatment.

4. A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that teaching has been effective? 1. "How clients perceive events and view the world affect their response to trauma." 2. "The psychic numbing in PTSD is a result of negative reinforcement." 3. "The individual becomes addicted to the trauma owing to an endogenous opioid response." 4. "Believing that the world is meaningful and controllable can protect an individual from PTSD."

ANS: 2 Page: 480 Feedback 1 This statement indicates that further education is necessary. 2 Learning theorists view negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior. Psychic numbing decreases or protects an individual from emotional pain and, therefore, the learned response is the repetition of this behavior. 3 This statement is incorrect, indicating that further teaching is needed. 4 This statement indicates that teaching has not been effective.

11. After a teaching session about grief, a client says to the nurse, "I seem to be stuck in the anger stage of grieving over the loss of my son." How would the nurse assess this statement, and in what phase of the nursing process would this occur? 1. Assessment phase; nursing actions have been successful in achieving the objectives of care. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

ANS: 2 Page: 481, 484 Feedback 1 This statement is assessed in the evaluation phase, not the assessment phase. 2 In the evaluation phase of the nursing process, reassessment is conducted to determine if the nursing actions have been successful in achieving the objectives of care. The implementation of client teaching has enabled the client to verbalize an understanding of the grief process and his or her position in the process. Therefore, the nurse's actions can be evaluated as successful. Without the evaluation phase, it would be difficult for the nurse to determine if actions have been successful. 3 This statement is assessed in the evaluation phase, not the implementation phase. 4 This statement is assessed in the evaluation phase, not the diagnosis phase.

17. A client has been extremely nervous ever since a person died as a result of the client's drunk driving. When assessing for the diagnosis of AD, within what time frame should the nurse expect the client to exhibit symptoms? 1. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident. 2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident. 3. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident. 4. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident.

ANS: 2 Page: 484 Feedback 1 Exhibiting symptoms within 1 year does not meet the DSM-5 diagnostic criteria for adjustment disorders. 2 According to the DSM-5 diagnostic criteria for adjustment disorders, the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within 3 months of the onset of the stressor. 3 Exhibiting symptoms within 6 months does not meet the DSM-5 diagnostic criteria for adjustment disorders. 4 Exhibiting symptoms within 9 months does not meet the DSM-5 diagnostic criteria for adjustment disorders.

6. A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client's concerns. 4. Encourage attending a grief therapy group.

ANS: 2 Page: 485-486 Feedback 1 After the nurse has assessed the stage of grief, the client can be encouraged to journal feelings. 2 Prior to implementing all other nursing interventions presented, the nurse must assess the stage of grief in which the client is fixed. Appropriate nursing interventions are always based on accurate assessments. 3 After the nurse has assessed the stage of grief, the client can be given community resources. 4 After the nurse has assessed the stage of grief, the client can be encouraged to attend a grief therapy group.

13. A client receiving EMDR therapy says, "After only two sessions of my therapy, I am feeling great. Now I can stop and get on with my life." Which of the following nursing responses is most appropriate? 1. "I am thrilled that you have responded so rapidly to EMDR." 2. "To achieve lasting results, all eight phases of EMDR must be completed." 3. "If I were you, I would complete the EMDR and comply with doctor's orders." 4. "How do you feel about continuing the therapy?"

ANS: 2 Page: 495 Feedback 1 This statement does not educate the client about completing all phases of EMDR. 2 Clients often feel relief quite rapidly with EMDR. However, to achieve lasting results, it is important that each of the eight phases be completed. The nurse's most appropriate response should be to give information to correct the client's misconceptions about the therapy. 3 In this answer, the nurse is subjectively giving advice rather than providing objective information. 4 This statement is inappropriate because the client has already stated feelings about continuing EMDR.

13. A nurse is reviewing progress notes on a newly admitted client. One progress note reveals that the client purposefully inserted a contaminated catheter into the urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder? 1. Illness anxiety disorder 2. Factitious disorder 3. Functional neurological symptom disorder 4. Depersonalization-derealization disorder

ANS: 2 Page: 508-509 Feedback 1 Illness anxiety disorder is the fear of having an illness or disease. 2 Factitious disorders involve conscious, intentional feigning of physical or psychological symptoms. Individuals with factitious disorder pretend to be ill in order to receive emotional care and support commonly associated with the role of "patient." Individuals become very inventive in their quest to produce symptoms. Examples include self-inflicted wounds, injection or insertion of contaminated substances, manipulating a thermometer to feign a fever, urinary tract manipulation, and surreptitious use of medications. 3 Functional neurological symptom disorder, or conversion disorder, is the loss of body function with no known medical cause. 4 Depersonalization-derealization disorder occurs when an individual switches between different personalities.

6. The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." 3. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

ANS: 2 Page: 572 Feedback 1 This statement is not therapeutic to the family. 2 The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of anorexia nervosa. 3 This statement is untrue, as family dynamics are linked to eating disorders. 4 This statement may cause family members to become defensive.

21. A highly emotional client presents at an outpatient clinic appointment and states, "My dead husband returned to me during a séance." Which personality disorder should a nurse associate with this behavior? 1. Obsessive-compulsive personality disorder 2. Schizotypal personality disorder 3. Narcissistic personality disorder 4. Borderline personality disorder

ANS: 2 Page: 595 Feedback 1 This type of behavior is not typical of clients with obsessive-compulsive disorder. 2 The nurse should associate schizotypal personality disorder with this behavior. The behaviors of people diagnosed with schizotypal personality disorder are odd and eccentric but do not decompensate to the level of schizophrenia. 3 This type of behavior is not typical of clients with narcissistic personality disorder. 4 This type of behavior is not typical of clients with borderline personality disorder.

22. A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? 1. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." 2. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." 3. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." 4. "They pay particular attention to details, which can interfere with the development of relationships."

ANS: 2 Page: 596 Feedback 1 This statement indicates that further education is necessary. 2 The instructor should evaluate that learning has occurred when the student des cribes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs. 3 This statement indicates a need for further teaching. 4 This statement indicates that learning has not occurred.

7. A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which statement best explains the etiology of this client's personality disorder? 1. Childhood nurturance was provided from many sources, and independent behaviors were encouraged. 2. Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged. 3. Childhood nurturance was provided exclusively from one source, and independent behaviors were encouraged. 4. Childhood nurturance was provided from many sources, and independent behaviors were discouraged.

ANS: 2 Page: 599 Feedback 1 Nurturance from many sources does not lead to the development of dependent personality disorder. 2 The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy. 3 Encouragement of independent behaviors does not lead to dependent personality disorder. 4 This scenario does not lead to dependent personality disorder.

11. When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? 1. The use of highly lethal methods to commit suicide 2. The use of suicidal gestures to elicit a rescue response from others 3. The use of isolation and starvation as suicidal methods 4. The use of self-mutilation to decrease endorphins in the body

ANS: 2 Page: 601 Feedback 1 Using highly lethal methods of suicide are not typical of clients with borderline personality disorders. 2 The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others. 3 The use of isolation and starvation is not typical of clients with borderline personality disorders. 4 Self-mutilation is not typical of clients with borderline personality disorders.

16. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? 1. A client diagnosed with antisocial personality disorder. 2. A client diagnosed with borderline personality disorder. 3. A client diagnosed with schizoid personality disorder. 4. A client diagnosed with paranoid personality disorder.

ANS: 2 Page: 602-603 Feedback 1 A client diagnosed with antisocial personality disorder would not likely admit to an inpatient facility for self-destructive behaviors. 2 The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilating behaviors. Most gestures are designed to elicit a rescue response. 3 A client diagnosed with schizoid personality disorder would not likely admit to an inpatient facility for self-destructive behaviors. 4 A client diagnosed with paranoid personality disorder would not likely admit to an inpatient facility for self-destructive behaviors.

20. From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Contract with the client to reinforce positive behaviors with unit privileges. 3. Teach the purpose of anti-anxiety medications to improve medication compliance. 4. Encourage the client to journal feelings to improve awareness of abandonment issues.

ANS: 2 Page: 605-608 Feedback 1 The client should not be secluded, as this may trigger more inappropriate behaviors and lead to mistrust of health care staff. 2 The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change. 3 Teaching the client about medications is important, but reinforcing behaviors is the most appropriate. 4 Encouraging the client to journal feelings is not the most appropriate nursing intervention.

4. A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? 1. Allow the clients to apply the democratic process when developing unit rules. 2. Maintain consistency of care by open communication to avoid staff manipulation. 3. Allow the client spokesman to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of autocratic leadership.

ANS: 2 Page: 605-608 Feedback 1 The nursing staff should maintain consistency and maintain authority. 2 The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors. 3 This approach does not best handle the situation. 4 The nursing staff should maintain consistency and order.

1. During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior? 1. "You are very disrespectful. You need to learn to control yourself." 2. "I understand that you are angry, but this behavior will not be tolerated." 3. "What behaviors could you modify to improve this situation?" 4. "What antipersonality disorder medications have helped you in the past?"

ANS: 2 Page: 613-614 Feedback 1 This statement may escalate the client's behavior. 2 The appropriate nursing response is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism. 3 The nurse should set limits on the client's behavior. 4 This statement is not therapeutic to the client.

16. A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD? 1. Risk for injury R/T self-mutilation 2. Altered social interaction R/T nonadherence to social convention 3. Altered verbal communication R/T delusional thinking 4. Social isolation R/T severely decreased gross motor skills

ANS: 2 Page: 629 Feedback 1 Risk for injury R/T self-mutilation is not the best nursing diagnosis. 2 The appropriate nursing diagnosis associated with this degree of IDD is altered social interaction R/T nonadherence to social convention. A client with an IQ of 47 would be diagnosed with moderate intellectual developmental disorder and may also experience some limitations in speech communications. 3 Altered verbal communication R/T delusional thinking is not the best nursing diagnosis. 4 Social isolation R/T severely decreased gross motor skills is not the best nursing diagnosis.

8. A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the child's mother? 1. Children with mild IDD need constant supervision. 2. Children with mild IDD develop academic skills up to a sixth-grade level. 3. Children with mild IDD appear different from their peers. 4. Children with mild IDD have significant sensory-motor impairment.

ANS: 2 Page: 629 Feedback 1 The child may not need constant supervision. 2 The nurse should inform the child's mother that children with mild IDD develop academic skills up to a sixth-grade level. 3 The child may not appear different than peers. 4 The child may not have a significant sensory-motor impairment.

2. Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate IDD? 1. Meeting all of the client's self-care needs to avoid injury to the client 2. Providing simple directions and praising client's independent self-care efforts 3. Avoid interfering with the client's self-care efforts in order to promote autonomy 4. Encouraging family to meet the client's self-care needs to promote bonding

ANS: 2 Page: 630-631 Feedback 1 The nurse should allow the client to perform self-care activities independently, but should intervene when necessary. 2 Providing simple directions and praise is an appropriate intervention for a teenager diagnosed with moderate IDD. Individuals with moderate mental retardation can perform some activities independently and may be capable of academic skill to a second-grade level. 3 The nurse should intervene when necessary. 4 The client's independence should be encouraged.

3. A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing response is most appropriate? 1. "Researchers really don't know what causes autistic spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored." 2. "Poor parenting doesn't cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control." 3. "Research has shown that the mother appears to play a greater role in the development of autistic spectrum disorder than the father." 4. "Lack of early infant bonding with the mother has shown to be a cause of autistic spectrum disorder. Did you breastfeed or bottle-feed?"

ANS: 2 Page: 631-633 Feedback 1 This statement may place unintentional blame on the mother. 2 The most appropriate response by the nurse is to explain to the parent that autistic spectrum disorder is believed to be caused by abnormalities in brain structure or function, not poor parenting. 3 This statement is not therapeutic. 4 This statement is inaccurate and may place unintentional blame on the mother.

10. A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client's plan of care? 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.

ANS: 2 Page: 634-635 Feedback 1 Encouraging and rewarding peer contact does not help the child feel more secure. 2 The nurse should provide consistent caregivers as part of the plan of care for a child diagnosed with autistic spectrum disorder. Children diagnosed with autistic spectrum disorder have an inability to trust. Providing consistent caregivers allows the client to develop trust and a sense of security. 3 Providing a variety of safe daily activities does not make the child feel more secure. 4 Maintain close physical contact throughout the day does not help the child feel more secure.

17. A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

ANS: 2 Page: 637 Feedback 1 The Ritalin dosage should not be doubled. 2 The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development. 3 Ritalin can cause weight loss and should be given after breakfast. 4 Ritalin increases ability to concentrate and learn.

7. Which finding should a nurse expect when assessing a child diagnosed with separation anxiety disorder? 1. The child has a history of antisocial behaviors. 2. The child's mother is diagnosed with an anxiety disorder. 3. The child previously had an extroverted temperament. 4. The child's mother and father have an inconsistent parenting style.

ANS: 2 Page: 657-658 Feedback 1 The nurse would not expect a history of antisocial behaviors. 2 The nurse should expect to find a mother diagnosed with an anxiety disorder when assessing a child with separation anxiety. Some parents instill anxiety in their children by being overprotective or by exaggerating dangers. Research studies speculate that there is a hereditary influence in the development of separation anxiety disorder. 3 The nurse would not expect a history of an extroverted temperament. 4 The nurse would not expect a history of an inconsistent parenting style.

13. Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders? 1. Involving parents in designing and implementing the treatment process 2. Reinforcing positive actions to encourage repetition of desirable behaviors 3. Providing opportunities to learn appropriate peer interactions 4. Administering psychotropic medications to improve quality of life

ANS: 2 Page: 661-662 Feedback 1 Involving parents is important but not a behavioral approach. 2 The nurse should reinforce positive actions to encourage repetition of desirable behaviors when caring for children diagnosed with disruptive behavior disorder. Behavior therapy is based on the concepts of classical conditioning and operant conditioning. 3 Providing opportunities to learn is not a behavioral approach. 4 Administering medications is not a behavioral approach.

13. A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client? 1. The nurse should document using the term older. 2. The nurse should document using the term elderly. 3. The nurse should document using the term aged. 4. The nurse should document using the term very old.

ANS: 2 Page: 669 Feedback 1 The U.S. Census Bureau has developed a system for classification of older Americans. In it, "older" refers to persons aged 55-64 years old. 2 The U.S. Census Bureau classifies a 70-year-old individual as elderly. 3 The U.S. Census Bureau has developed a system for classification of older Americans. In it, "aged" refers to persons aged 75-84 years old. 4 The U.S. Census Bureau has developed a system for classification of older Americans. In it, "very old" refers to persons aged 85 years old and older.

6. A student nurse asks the instructor, "Which psychiatric disorder is most likely initially diagnosed in the elderly?" Which instructor response gives the student accurate information? 1. "Schizophrenia is most likely diagnosed later in life." 2. "Major depressive disorder is most likely diagnosed later in life." 3. "Phobic disorder is most likely diagnosed later in life." 4. "Dependent personality disorder is most likely diagnosed later in life."

ANS: 2 Page: 671 Feedback 1 Schizophrenia is not most likely diagnosed later in life. 2 Major depressive disorder is most likely to be identified later in life. Depression among older adults can be increased by physical illness, functional disability, cognitive impairment, and loss of a spouse. 3 Phobic disorder is not most likely diagnosed later in life. 4 Dependent personality disorder is not most likely diagnosed later in life.

9. An older, emaciated client is brought to an emergency department by the client's caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate? 1. The client will honestly reveal the nature of the injuries. 2. The client may deny or minimize the injuries. 3. The client may have forgotten what caused the injuries. 4. The client will ask to be placed in a nursing home.

ANS: 2 Page: 685-686 Feedback 1 The nurse would not expect the client to reveal the nature of the injuries. 2 The nurse should anticipate that the client may deny or minimize the injuries. The older client may be unwilling to disclose information, because of fear of retaliation, embarrassment about the existence of abuse in the family, protectiveness toward a family member, or unwillingness to bring about legal action. 3 The nurse would not anticipate that the client may have forgotten the cause of the injuries. 4 The nurse would not anticipate that the client will ask to be placed in a nursing home.

7. An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention? 1. Implement complete bedrest. 2. Advocate for a complete physical exam. 3. Address self-esteem needs. 4. Advocate for individual psychotherapy.

ANS: 2 Page: 686-687 Feedback 1 Implementing complete bedrest should not be the initial nursing intervention. 2 The initial nursing intervention should be to advocate for a complete physical exam. Sudden onset of dizziness, weakness, and confusion could indicate a problem with the client's cardiovascular or respiratory symptoms. Physical symptoms should be thoroughly assessed prior to attributing symptoms to psychological causes. 3 Addressing self-esteem needs should not be the initial nursing intervention. 4 Advocating for individual psychotherapy should not be the initial nursing intervention.

3. A family asks why their father is attending activity groups at the long-term care facility. The son states, "My father worked hard all of his life. He just needs some rest at this point." Which is the appropriate nursing response? 1. "I'm glad we discussed this. We'll excuse him from the activity groups." 2. "The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation." 3. "The groups are optional. Only clients at high functioning levels would benefit." 4. "If your father doesn't go to these activity groups, he will be at high risk for developing cognitive problems."

ANS: 2 Page: 689-692 Feedback 1 Group activities help better the life of the client. 2 The most appropriate nursing response is to educate the family that the purpose of activity groups is to provide social interaction, sensory stimulation, and reality orientation. Groups can also serve to increase self-esteem and reduce depression. 3 All clients would benefit in some manner from group activities. 4 This statement does not provide education to the family.

4. A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred? 1. "Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives." 2. "Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution." 3. "Reminiscence therapy is a social group where members chat about past events and future plans." 4. "Reminiscence therapy encourages members to share positive memories of significant life transitions."

ANS: 2 Page: 693 Feedback 1 This statement indicates that learning has not occurred. 2 Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. Stimulation of life memories serve to help older clients work through their losses and maintain self-esteem. Reminiscence therapy can take place in one-on-one or group settings. 3 This statement indicates that further education is necessary. 4 This statement indicates that teaching has not been effective.

14. A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, "My father has recently moved back to town." What should the nurse suspect? 1. Possible major depressive disorder 2. Possible history of childhood incest 3. Possible histrionic personality disorder 4. Possible history of childhood physical abuse

ANS: 2 Page: 709 Feedback 1 The nurse would not expect a possible major depressive disorder. 2 The nurse should suspect that this client may have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders. 3 The nurse would not expect a possible histrionic personality disorder. 4 The nurse would not expect a possible history of childhood physical abuse.

4. A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? 1. Discourage the client from discussing the rape, because this may lead to further emotional trauma. 2. Remain nonjudgmental while actively listening to the client's description of the violent rape event. 3. Meet the client's self-care needs by assisting with showering and perineal care. 4. Probe for further, detailed description of the rape event.

ANS: 2 Page: 712-714 Feedback 1 The client should be encouraged to discuss the rape. 2 The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process. 3 Showering would not be an appropriate nursing intervention and may destroy evidence. 4 Probing for further detail would not be appropriate.

10. A client diagnosed with schizophrenia is hospitalized owing to an exacerbation of psychosis related to nonadherence with antipsychotic medications. Which level of care does the client's hospitalization reflect? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

ANS: 2 Page: 731 Feedback 1 Primary prevention aims are preventing the need of services. 2 The client's hospitalization reflects the secondary prevention level of care. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment. 3 Tertiary prevention aims at reducing the symptoms of a disease or illness. 4 Case management level of care is not a term associated with the public health model.

3. A nursing instructor is teaching about case management. What student statement indicates that learning has occurred? 1. "Case management is a method used to achieve independent client care." 2. "Case management provides coordination of services required to meet client needs." 3. "Case management exists mainly to facilitate client admission to needed inpatient services." 4. "Case management is a method to facilitate physician reimbursement."

ANS: 2 Page: 739 Feedback 1 This statement indicates that further education is needed. 2 The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames. 3 This statement indicates that learning has not occurred. 4 This statement indicates that further teaching is required.

12. A homeless client comes to an emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease, which has recently become more prevalent among the homeless community, should a nurse suspect? 1. Meningitis 2. Tuberculosis 3. Encephalopathy 4. Mononucleosis

ANS: 2 Page: 745-750 Feedback 1 Meningitis has not recently become more prevalent. 2 The nurse should suspect that the homeless client has contracted tuberculosis. Tuberculosis is a growing problem among individuals who are homeless, owing to being in crowded shelters, which are ideal conditions for the spread of respiratory tuberculosis. Prevalence of alcoholism, drug addiction, HIV infection, and poor nutrition also impact the increase of contracted cases of tuberculosis. 3 Encephalopathy has not recently become more prevalent. 4 Mononucleosis has not recently become more prevalent.

1. A client is diagnosed with terminal cancer. Which situation represents Kübler-Ross's grief stage of "anger"? 1. The client registers for an Ironman marathon to be held in 9 months. 2. The client is a devout Catholic but refuses to attend church and states that his faith has failed him. 3. The client promises God to give up smoking if allowed to live long enough to witness a grandchild's birth. 4. The client gathers family in order to plan a funeral and make last wishes known.

ANS: 2 Page: 759 Feedback 1 This is stage one, or denial. 2 The nurse should assess that the client is in the "anger" stage of grieving when the client refuses to attend church and states that his faith has failed him. Anger is the second stage of Kübler-Ross's grief process, in which the reality of the situation is realized, and the individual has feelings of sadness, guilt, shame, helplessness, and hopelessness. 3 This is the bargaining stage. 4 This is stage five, or acceptance.

2. A nurse is caring for an Irish client who has recently lost his wife. The client tells the nurse that he is planning an elaborate wake and funeral. According to George Engel, what purpose would these rituals serve? 1. To delay the recovery process initiated by the loss of the client's wife 2. To facilitate the acceptance of the loss of the client's wife 3. To avoid dealing with grief associated with the loss of the client's wife 4. To eliminate emotional pain related to the loss of the client's wife

ANS: 2 Page: 760 Feedback 1 These rituals do not serve to delay the recovery process initiated by the loss of the client's wife. 2 The nurse should anticipate that the purpose of these rituals is to facilitate the acceptance of the loss of the client's wife. Resolution of the loss is the fourth stage in Engel's grief process, in which the bereaved experiences a preoccupation with the loss, which gradually decreases over time. 3 These rituals do not serve to avoid dealing with grief associated with the loss of the client's wife. 4 These rituals do not serve to eliminate emotional pain related to the loss of the client's wife. ANS: 1

10. Which is the most accurate description of the nursing diagnosis of dysfunctional grieving? 1. Inability to form a valid appraisal of a loss and to use available resources 2. The experience of distress, with accompanying sadness, which fails to follow norms 3. A perceived lack of control over a current loss situation 4. Aloneness perceived as imposed by others and as a negative or threatening state

ANS: 2 Page: 762-763 Feedback 1 Inability to form a valid appraisal of a loss and to use available resources is not the most accurate description of the nursing diagnosis of dysfunctional grieving. 2 The nurse should define dysfunctional grieving as the experience of distress, with accompanying sadness, which fails to follow norms. Three types of pathological grief reactions are delayed or inhibited grief, distorted (exaggerated) grief response, and chronic or prolonged grieving. One crucial difference between normal and dysfunctional grieving is the loss of self-esteem marked my feelings of guilt or worthlessness that may precipitate depression. 3 A perceived lack of control over a current loss situation is not the most accurate description of the nursing diagnosis of dysfunctional grieving. 4 Aloneness perceived as imposed by others and as a negative or threatening state is not the most accurate description of the nursing diagnosis of dysfunctional grieving.

6. Which grieving behaviors should a nurse anticipate when caring for a Navajo client who recently lost a child? 1. Celebrating the life of a deceased person with festivities and revelry 2. Not expressing grief openly and reluctance to touch the dead body 3. Holding a prayerful vigil for a week following the person's death 4. Expressing grief openly and publicly and erecting an altar in the home to honor the dead

ANS: 2 Page: 767 Feedback 1 The nurse would not anticipate that the client will celebrate the life of a deceased person with festivities and revelry. 2 The nurse should identify that a Navajo client who recently lost a child would not express grief openly and would be reluctant to touch the dead body. Navajo Indians do not bury the body of a deceased person for four days after death, and they conduct a cleaning ceremony prior to burial. The dead are buried with their shoes on the wrong feet and rings on their index fingers. 3 The nurse would not anticipate that the client will hold a prayerful vigil for a week following the person's death. 4 The nurse would not anticipate that the client will express grief openly and publicly and erecting an altar in the home to honor the dead.

22. A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which of the following commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Assertiveness training 5. Aversion therapy

ANS: 2, 3 Page: 468 Feedback 1. Benzodiazepine therapy would not be an appropriate treatment option for the client and could possibly worsen the client's phobia. 2. The nurse should explain to the client that systematic desensitization and imploding are the most common behavioral therapies used for treating phobias. Systematic desensitization involves the gradual exposure of the client to anxiety-provoking stimuli. 3. The nurse should explain to the client that systematic desensitization and imploding are the most common behavioral therapies used for treating phobias. Imploding is the intervention used in which the client is exposed to extremely frightening stimuli for prolonged periods of time. 4. Assertiveness training would not be an appropriate treatment option for the client and could possibly worsen the client's phobia. 5. Aversion therapy would not be an appropriate treatment option for the client and could possibly worsen the client's phobia.

23. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities that occur with age 2. Drastic temperature and barometric pressure changes 3. A seasonal increase in social interactions 4. Variations in serotonergic functioning 5. Inaccessibility of resources for dealing with life stressors

ANS: 2, 3, 4 Page: 379 Feedback 1. Gender differences are not likely to contribute to the client's sadness and melancholia. 2. The nurse should identify drastic temperature and barometric pressure changes as contributing to the etiology of the client's symptoms. 3. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November). 4. Variations in serotonergic functioning are not likely to contribute to the client's sadness and melancholia. 5. Inaccessibility of resources for dealing with life stressors is not likely to contribute to the client's sadness and melancholia.

21. A family asks the nurse why their son was diagnosed with PTSD and others in the accident were not. Which of the following information should the nurse offer? (Select all that apply.) 1. An individual's religious affiliation can affect response to trauma. 2. Responses are affected by how an individual handled previous trauma. 3. Protectiveness of family and friends can help an individual deal with trauma. 4. Control over the possibility of recurrence can affect the response to trauma. 5. The time in which the trauma occurred can affect the individual's response.

ANS: 2, 3, 4, 5 Page: 477, 479-480 Feedback 1. However, an individual's specific religious affiliation should have no bearing or influence. 2. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of (2) the individual. 3. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of (3) the recovery environment. 4. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of (3) the recovery environment. 5. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of (1) the traumatic experience.

14. Which of the following are characteristics of a Program of Assertive Community Treatment (PACT), as described by the National Alliance on Mental Illness (NAMI)? (Select all that apply.) 1. PACT offers nationally based treatment to people with serious and persistent mental illnesses. 2. PACT is a type of case-management program. 3. The PACT team provides services 24 hours a day, 7 days a week, 365 days a year. 4. The PACT team provides highly individualized services directly to consumers. 5. PACT is a multidisciplinary team approach.

ANS: 2, 3, 4, 5 Page: 739-740 Feedback 1. NAMI defines PACT as a service-delivery model that provides comprehensive, locally, not nationally, based treatment to people with serious and persistent mental illnesses. 2. PACT is a type of case-management program. 3. The PACT team provides these services 24 hours a day, 7 days a week, 365 days a year. 4. PACT is a type of case-management program that provides highly individualized services directly to consumers. 5. It is a team approach and includes members from psychiatry, social work, nursing, substance abuse, and vocational rehabilitation.

22. Which of the following findings should a nurse identify that would contribute to a client's development of ADHD? (Select all that apply.) 1. The client's father was a smoker. 2. The client had a low birth weight. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

ANS: 2, 4 Page: 636-638 Feedback 1. Smoking does not lead to the development of ADHD. 2. The nurse should identify that a low birth weight would predispose a client to the development of ADHD. 3. Lactose intolerance does not lead to the development of ADHD. 4. The nurse should identify that having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. 5. A diagnosis of dyslexia does not lead to the development of ADHD.

13. Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.) 1. An acutely suicidal teenager 2. A chronically mentally ill woman who has a history of medication nonadherence 3. A socially isolated older individual 4. A depressed individual who is able to contract for safety 5. A client who is hearing voices that tell the client to harm s

ANS: 2, 4 Page: 740-741 Feedback 1. A suicidal teenager is not an appropriate candidate for a structured day program. 2. The nurse should recommend a structured day program for a chronically mental ill woman who has a history of medication nonadherence. 3. A socially isolated older adult is not an appropriate candidate for a structured day program. 4. The nurse should recommend a structured day program for a depressed individual who is able to contract for safety. 5. A client hearing voices is not an appropriate candidate for a structured day program.

23. A client diagnosed with posttraumatic stress disorder (PTSD) states, "Why did my doctor prescribe an antidepressant rather than an antianxiety drug for me?" Which of the following are the most appropriate nursing responses? (Select all that apply.) 1. "I'm not sure, because antianxiety drugs have been approved by the FDA for PTSD." 2. "Antidepressants are now considered first-line treatment choice for PTSD." 3. "Many people have adverse reactions to antianxiety drugs." 4. "Because of their addictive properties, antianxiety drugs are less desirable." 5. "There have been no controlled studies on the effect of antianxiety drugs on PTSD."

ANS: 2, 4, 5 Page: 495 Feedback 1. Paroxetine and sertraline (antidepressant drugs), not antianxiety drugs, have been approved by the FDA for the treatment of PTSD. 2. Antidepressants are now considered the first-line treatment of choice for PTSD. 3. Adverse reactions can occur with the use of anxiolytic drugs, but these reactions are not common. 4. Their addictive properties make them less desirable than other medications used in the treatment of PTSD. 5. There has been an absence of controlled studies demonstrating the efficacy of benzodiazepines for the treatment of PTSD.

7. A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client? 1. Disturbed sensory perception 2. Altered thought processes 3. Risk for violence: directed toward others 4. Risk for injury

ANS: 3 Page: 342-343 Feedback 1 Disturbed sensory perception does not accurately capture the client's risk based on the client's current statements. 2 Altered thought processes do not accurately capture the client's risk based on the client's current statements. 3 The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices commanding him to kill someone is at risk for other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions. 4 Risk for injury does not accurately capture the client's risk based on the client's current statements.

6. A client diagnosed with schizophrenia spectrum disorder states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? 1. "Did you take your medicine this morning?" 2. "You are not going to hell. You are a good person." 3. "The voices must sound scary, but the devil is not talking to you. This is part of your illness." 4. "The devil only talks to people who are receptive to his influence."

ANS: 3 Page: 342-343 Feedback 1 Questioning the client about medications does not validate the client's feelings. 2 This statement does not validate the client's feelings or redirect the client back to reality. 3 The most appropriate nursing response is to reassure the client while not reinforcing the hallucination. Reminding the client that "the voices" are a part of the illness is a way to help the client accept that the hallucinations are not real. It is also important for the nurse to connect with the client's fears and inner feelings. 4 This statement does not validate the client's feelings.

10. A paranoid client diagnosed with schizophrenia spectrum disorder states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? 1. Magical thinking; administer an antipsychotic medication. 2. Persecutory delusions; orient the client to reality. 3. Command hallucinations; warn the psychiatrist. 4. Altered thought processes; call an emergency treatment team meeting.

ANS: 3 Page: 342-343 Feedback 1 The nurse is not legally responsible for reporting magical thinking. 2 The nurse is not legally responsible for reporting persecutory delusions. 3 The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. Clients demonstrating a risk for violence could potentially be physically, emotionally, and/or sexually harmful to others or to self. 4 Altered thought process is not a legally reportable assessment finding.

4. Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response? 1. "Tell him to stop discussing the voices." 2. "Ignore what he is saying, while attempting to discover the underlying cause." 3. "Focus on the feelings generated by the hallucinations and present reality." 4. "Present objective evidence that the voices are not real."

ANS: 3 Page: 342-343 Feedback 1 This option could cause the client to shut down. 2 The client should not be ignored, but should be encouraged to discuss what is occurring. 3 The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should accept that their child is experiencing the hallucination but should not reinforce this unreal sensory perception. 4 This option would not be appropriate in the care of the schizophrenic client.

16. A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client's symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)? 1. Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not. 2. Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not. 3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 4. Catatonic features may be associated with BPD, whereas SIPD has no catatonic features.

ANS: 3 Page: 348 Feedback 1 Hallucinations and delusions are associated with SIPD and BPD. 2 Hallucinations and delusions are associated with BPD and SIPD. 3 Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 4 Catatonic features may be associated with SIPD.

2. A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? 1. The side effects of medications 2. Deep breathing techniques to decrease stress 3. How to make eye contact when communicating 4. How to be a leader

ANS: 3 Page: 365 Feedback 1 Teaching the side effects of medication does not help the client obtain better social skills. 2 Teaching deep breathing exercises does not help the client obtain better social skills. 3 The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients to communicate needs and to establish relationships. 4 Teaching leadership skills do not help the client obtain better social skills.

13. An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

ANS: 3 Page: 368-369 Feedback 1 Slow, deep breaths do not reduce the client's risk of a syncopal episode. 2 Watching diet and physical activity does not reduce the client's risk of a syncopal episode. 3 The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, the additive effect of these drugs places the client at risk for developing orthostatic hypotension. 4 Wearing sunscreen does not reduce the client's risk of a syncopal episode.

11. A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Restlessness and muscle rigidity 4. Reports of hearing disturbing voices

ANS: 3 Page: 370 Feedback 1 The symptom of tactile hallucinations would be addressed by an antipsychotic medication, such as haloperidol. 2 Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. 3 An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity. 4 Reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol.

6. A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations 4. Encouraging client to express feelings related to suicide

ANS: 3 Page: 380 Feedback 1 Obtaining an order for locked seclusion until client is no longer suicidal is not therapeutic for the client. 2 Conducting 15-minute checks to ensure safety would not keep the client safe at all times. 3 The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide. 4 Encouraging client to express feelings related to suicide does not keep the client safe.

10. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? 1. According to psychoanalytic theory, depression is a result of negative perceptions. 2. According to object-loss theory, depression is a result of overprotection. 3. According to learning theory, depression is a result of repeated failures. 4. According to cognitive theory, depression is a result of anger turned inward.

ANS: 3 Page: 381-382 Feedback 1 The psychoanalytic theory does not best explain the etiology of the client's depression. 2 The object-loss theory does not best explain the etiology of the client's depression. 3 The nurse should assess that, according to learning theory, this client's depressive symptoms may have resulted from repeated failures. The learning theory is a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed. 4 The cognitive theory does not best explain the etiology of the client's depression.

13. A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam? 1. To rule out bipolar disorder 2. To rule out schizophrenia 3. To rule out neurocognitive disorder 4. To rule out personality disorder

ANS: 3 Page: 388-392 Feedback 1 A mini-mental exam is not completed to rule out bipolar disorder. 2 A mini-mental exam is not completed to rule out schizophrenia. 3 A mini-mental status exam should be performed to rule out neurocognitive disorder. The client may be experiencing reversible dementia, which can occur as a result of depression. 4 A mini-mental exam is not completed to rule out personality disorder.

3. A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

ANS: 3 Page: 405-406 Feedback 1 Oxygen is not administered to prevent increased intracranial pressure. 2 Oxygen is not administered to prevent diminished vital signs. 3 The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. 4 Oxygen is not administered to prevent a blocked airway.

8. A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I may experience drowsiness or dizziness while taking this medication." 3. "I do not need to quit smoking." 4. "I will stop drinking alcohol now that I am taking this medication."

ANS: 3 Page: 405-407 Feedback 1 Clients should continue to take the medication even if symptoms have not subsided. 2 Clients may experience drowsiness and dizziness while taking this medication, therefore care should be used when driving or operating dangerous machinery. 3 Clients should not smoke when taking this medication, as smoking increases the metabolism of tricyclic antidepressants. 4 The client should avoid alcohol while taking this medication.

3. A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night. 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

ANS: 3 Page: 419-422 Feedback 1 The client's safety and physical health is the most important. 2 Safety is the priority. 3 The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the client's safety and physical health as most important 4 The nurse should always prioritize safety.

11. A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1. During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.

ANS: 3 Page: 425-426 Feedback 1 These symptoms are present in both hyper- and hypomania. 2 Decreased need for sleep can be present in hypomania. 3 Three or more of the following symptoms may be experienced in both hypomanic and manic episodes: Inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas and racing thoughts, distractibility, increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). If there are psychotic features, the episode is, by definition, manic. 4 These symptoms can be present in hypomania.

7. A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

ANS: 3 Page: 427 Feedback 1 Weight loss is not typical with this drug. 2 Clients gain weight regardless of diet with Lithium therapy. 3 The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication adherence and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication. 4 Weight gain is a common side effect with this medication.

2. Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate? 1. "Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications." 2. "Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not." 3. "Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life." 4. "Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life."

ANS: 3 Page: 451-453 Feedback 1 Clients with social anxiety disorder may need medication to manage symptoms. 2 Clients with SPD are distressed by symptoms experienced in all settings. 3 Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others. 4 This statement in not accurate regarding SPD.

19. During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? 1. Complicated grieving 2. Altered family processes 3. Ineffective coping 4. Body image disturbance

ANS: 3 Page: 461 Feedback 1 The child is not suffering from complicated grieving. 2 The child is not suffering from altered family process. 3 Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a diagnosis of hair-pulling disorder, or trichotillomania, may be assigned. 4 The client is not suffering from body image disturbance.

10. A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

ANS: 3 Page: 461-462 Feedback 1 Relaxations exercises would not replace needed carbon dioxide in the blood. 2 Placing the client in Trendelenburg would not be an effective measure. 3 The nurse can meet this client's physiological need by having the client breathe into a paper bag. Hyperventilation may occur during periods of extreme anxiety. Hyperventilation causes the amount of carbon dioxide (CO2) in the blood to decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope. If hyperventilation occurs, assist the client to breathe into a small paper bag held over the mouth and nose. Six to 12 natural breaths should be taken, alternating with short periods of diaphragmatic breathing. 4 BuSpar is not a fast acting antianxiety medication, and, therefore, would not help the client's anxiety.

12. A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. The psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

ANS: 3 Page: 461-465 Feedback 1 The client does not use imagination during the process of systematic desensitization. 2 This statement is not accurate regarding systematic desensitization. 3 The nurse should explain to the client that when participating in systematic desensitization, he or she will go through a series of increasingly anxiety-provoking steps that will gradually increase tolerance. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles. 4 Systematic desensitization does not occur in only one session.

11. A college student is unable to take a final exam due to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should the campus nurse assign for this client? 1. Non-adherence R/T test taking 2. Ineffective role performance R/T helplessness 3. Altered coping R/T anxiety 4. Powerlessness R/T fear

ANS: 3 Page: 463 Feedback 1 Non-adherence R/T test taking does not accurately capture what the client is experiencing. 2 Ineffective role performance R/T helplessness does not accurately capture what the client is experiencing. 3 The priority nursing diagnosis for this client is altered coping R/T anxiety. The nurse should assist in implementing interventions that will improve the client's healthy coping skills and reduce anxiety. 4 Powerlessness R/T fear does not accurately capture what the client is experiencing.

4. Which treatment should the nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

ANS: 3 Page: 470 Feedback 1 Long-term treatment with diazepam (Valium) is not appropriate treatment for clients diagnosed with generalized anxiety disorder. 2 Acute symptom control with citalopram (Celexa) is not appropriate treatment for clients diagnosed with generalized anxiety disorder. 3 The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics. 4 Acute symptom control with ziprasidone (Geodon) is not appropriate treatment for clients diagnosed with generalized anxiety disorder.

3. Which client would a nurse recognize as being at highest risk for the development of an adjustment disorder? 1. A young married woman 2. An elderly unmarried man 3. A young unmarried woman 4. A young unmarried man

ANS: 3 Page: 477 Feedback 1 AD is not common in this group. 2 Although more common in the young, it can occur at any age. 3 Adjustment disorders are more common in women, unmarried persons, and younger people. 4 AD is more common in women.

15. A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client's plan of care? 1. The client will have no flashbacks. 2. The client will be able to feel a full range of emotions by discharge. 3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge. 4. The client will refrain from discussing the traumatic event.

ANS: 3 Page: 482-483 Feedback 1 Having no flashbacks by discharge is an unrealistic goal. 2 Experiencing a full range of emotions by discharge is an unrealistic goal. 3 Obtaining adequate sleep without zolpidem by discharge is a goal that should be included in the client's plan of care. 4 Clients are encouraged, not discouraged, to discuss the traumatic event.

5. As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? 1. Anxiety 2. Altered thought processes 3. Complicated grieving 4. Altered sensory perception

ANS: 3 Page: 489 Feedback 1 Although the client may also experience anxiety, the symptom presented in the question is extreme guilt. 2 There is no evidence presented in the question to indicate altered thought processes. 3 The client's survivor guilt is disrupting the normal process of grieving. 4 There is no evidence presented in the question to indicate altered sensory perception.

1. A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which personality disorder characteristics? 1. Experiences intense and chaotic relationships with fluctuating attitudes toward others 2. Socially irresponsible, exploitative, guiltless, and disregards rights of others 3. Self-dramatizing, attention seeking, overly gregarious, and seductive 4. Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange

ANS: 3 Page: 506 Feedback 1 The client is not likely to experience intense and chaotic relationships. 2 The client is not likely to be socially irresponsible or exploitive. 3 The nurse should anticipate that a client diagnosed with SSD would be self-dramatizing, attention seeking, and overly gregarious. It has been suggested that, in somatic symptom disorder, there may be some overlapping of personality characteristics and features associated with histrionic personality disorder. These symptoms include heightened emotionality, impressionistic thought and speech, seductiveness, strong dependency needs, and a preoccupation with symptoms and oneself. 4 The client is not likely to be perceived as timid or withdrawn.

9. According to the DSM-5 diagnostic criteria for dissociative amnesia (DA), what symptom would be essential to meet the criteria for the subcategory of dissociative fugue? 1. An inability to recall important autobiographical information 2. Clinically significant distress in social and occupational functioning 3. Sudden unexpected travel or bewildered wandering 4. "Blackouts" related to alcohol toxicity

ANS: 3 Page: 510-511 Feedback 1 An inability to recall important autobiographical information is a basic criterion for the diagnosis of DA. 2 Clinically significant distress in social and occupational functioning is a basic criterion for the diagnosis of DA. 3 Dissociative fugue is characterized by a sudden, unexpected travel away from customary place of daily activities, or by bewildered wandering, with the inability to recall some or all of one's past. 4 The DSM-5 also states that symptoms cannot be attributable to the direct physiological effects of a substance (e.g., alcohol, a drug of abuse, a medication).

7. A client diagnosed with DID switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function? 1. It is a means to attain secondary gain. 2. It is a means to explore feelings of excessive and inappropriate guilt. 3. It serves to isolate painful events so that the primary self is protected. 4. It serves to establish personality boundaries and limit inappropriate impulses.

ANS: 3 Page: 511-512 Feedback 1 The switch is not to attain secondary gain. 2 The switch is not to explore feelings of excessive and inappropriate guilt. 3 The nurse should anticipate that a client who switches personalities when confronted with destructive behavior is dissociating in order to isolate painful events so that the primary self is protected. The transition between personalities is usually sudden, dramatic, and precipitated by stress. 4 The switch is not to establish personality boundaries and limit inappropriate impulses.

6. An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority? 1. Encourage exploration of sexual abuse. 2. Encourage guided imagery. 3. Establish trust and rapport. 4. Administer antianxiety medications.

ANS: 3 Page: 518-520 Feedback 1 Encouraging exploration of sexual abuse can occur after establishing rapport. 2 Encouraging guided imagery can occur after establishing rapport. 3 The nurse should prioritize establishing trust and rapport when beginning to work with a client diagnosed with DID. DID was formerly called multiple personality disorder. Trust is the basis of every therapeutic relationship. Each personality views itself as a separate entity and must be treated as such to establish rapport. 4 Administering antianxiety medications can occur after establishing rapport.

1. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment.

ANS: 3 Page: 572 Feedback 1 Home environments that maintain loose personal boundaries do not typically lead to anorexia nervosa. 2 Home environments that place an overemphasis on food do not typically lead to anorexia nervosa. 3 The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against the parents viewed by the child as a means of gaining and remaining in control. 4 Home environments that condone corporal punishment do not typically lead to anorexia nervosa.

7. A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. The client gained two pounds in one week. 2. The client focused conversations on nutritious food. 3. The client demonstrated healthy coping mechanisms that decreased anxiety. 4. The client verbalized an understanding of the etiology of the disorder.

ANS: 3 Page: 574 Feedback 1 Gaining two pounds in one week is not an appropriate indicator of a positive client behavioral change. 2 Focusing on conversations on nutritious foods is not an appropriate indicator of a positive client behavioral change. 3 The nurse should identify that a client who demonstrates healthy coping mechanisms to decrease anxiety indicates a positive behavioral change. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behavior. 4 Verbalizing an understanding of eating disorders in important, but is not appropriate indicator of a positive client behavioral change.

2. A client's altered body image is evidenced by claims of "feeling fat," even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive personal ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.

ANS: 3 Page: 575-577 Feedback 1 Consuming adequate calories to sustain a normal weight may be unrealistic for this client. 2 Ceasing strenuous exercise programs may be unrealistic for this client. 3 The nurse should identify that the appropriate outcome for this client is to perceive personal ideal body weight and shape as normal. 4 Not expressing a preoccupation with food may be unrealistic for this client.

3. A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? 1. Provide objective evidence that reasons for violence are unwarranted. 2. Initially restrain the client to maintain safety. 3. Use clear, calm statements and a confident physical stance. 4. Empathize with the client's paranoid perceptions.

ANS: 3 Page: 593 Feedback 1 This approach may not be effective with this client at this time, because the paranoid client does not accept responsibility for actions. 2 This approach may escalate the client's behavior, and increase feelings of fear and mistrust. 3 The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude provides the client with a feeling of safety and security. 4 The nurse should present reality at all times.

14. Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety. 3. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis. 4. Clients diagnosed with schizoid personality disorder avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate self on a continual basis.

ANS: 3 Page: 594 Feedback 1 This statement is untrue regarding these disorders. 2 Clients with schizoid personality disorder experience anxiety in many different settings. 3 A client diagnosed with schizoid personality disorder exhibits a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder prefer being alone to being with others and avoid social situations, social contacts, and activities. 4 Clients with schizoid personality disorder would isolate on a continual basis.

10. Looking at a slightly bleeding paper cut, the client screams, "Somebody help me quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder? 1. Schizoid personality disorder 2. Obsessive-compulsive personality disorder 3. Histrionic personality disorder 4. Paranoid personality disorder

ANS: 3 Page: 596 Feedback 1 Clients with schizoid personality disorder have a difficult time forming personal relationships. 2 Clients with obsessive-compulsive disorder perform ritualistic behavior. 3 The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over-gregarious, and seductive. 4 Clients with paranoid personality disorder have mistrust and are suspicious of others.

13. Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? 1. Interpreting the compliment as a secret code used to increase personal power 2. Feeling the compliment was well deserved 3. Being grateful for the compliment but fearing later rejection and humiliation 4. Wondering what deep meaning and purpose is attached to the compliment

ANS: 3 Page: 598 Feedback 1 Interpreting the compliment as a secret code used to increase personal power is not a typical response for this client. 2 Feeling the compliment was well deserved is not a typical response for this client. 3 The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations. 4 Wondering what deep meaning and purpose is attached to the compliment is not a typical response for this client.

6. Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? 1. A physically healthy client who is dependent on meeting social needs by contact with 15 cats. 2. A physically healthy client who has a history of depending on intense relationships to meet basic needs. 3. A physically healthy client who lives with parents and depends on public transportation. 4. A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide security.

ANS: 3 Page: 599 Feedback 1 Having contact with cats or other animals is not characteristic of a client with dependent personality disorder. 2 Using relationships to meet basic needs is not characteristic of a client with dependent personality disorder. 3 A physically healthy adult client who lives with parents and depends on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors. 4 Having a serious personality is not characteristics of a client with dependent personality disorder.

15. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? 1. The client experiences unwanted, intrusive, and persistent thoughts. 2. The client experiences unwanted, repetitive behavior patterns. 3. The client experiences inflexibility and lack of spontaneity when dealing with others. 4. The client experiences obsessive thoughts that are externally imposed.

ANS: 3 Page: 599-600 Feedback 1 Experiencing unwanted and intrusive thoughts is not consistent with the diagnosis of obsessive-compulsive personality disorder. 2 Unwanted, repetitive behaviors is not consistent with a diagnosis of obsessive-compulsive personality disorder. 3 The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules. 4 Externally imposed obsessive thoughts are not consistent with a diagnosis of obsessive-compulsive personality disorder.

2. At 11 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate? 1. "Go ahead and use the phone. I know this pending divorce is stressful." 2. "You know better than to break the rules. I'm surprised at you." 3. "It is after the 10 p.m. phone curfew. You will be able to call tomorrow." 4. "A divorce shouldn't be considered until you have had a good night's sleep."

ANS: 3 Page: 613-614 Feedback 1 The nurse should remain consistent with the unit rules. 2 This statement may escalate the client's behavior. 3 The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration. 4 This statement is not therapeutic to the client.

17. When planning care for clients diagnosed with personality disorders, what should be the goal of treatment? 1. To stabilize the client's pathology by using the correct combination of psychotropic medications 2. To change the characteristics of the dysfunctional personality 3. To reduce personality trait inflexibility that interferes with functioning and relationships 4. To decrease the prevalence of neurotransmitters at receptor sites

ANS: 3 Page: 615, 617 Feedback 1 There are no psychotropic medications approved specifically for the treatment of personality disorders. 2 Personality disorders are often difficult and, in some cases, seem impossible to treat. 3 The goal of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships. 4 Decreasing the prevalence of neurotransmitters at receptor sites is not the goal of treatment.

4. In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome? 1. The client will communicate all needs verbally by discharge. 2. The client will participate with peers in a team sport by day four. 3. The client will establish trust with at least one caregiver by day five. 4. The client will perform most self-care tasks independently.

ANS: 3 Page: 634-635 Feedback 1 It may not be realistic for the client to communicate all needs verbally by discharge. 2 It may not be realistic for the client to participate in a team sport. 3 The most realistic client outcome for a child diagnosed with autistic spectrum disorder is for the client to establish trust with at least one caregiver. Trust should be evidenced by facial responsiveness and eye contact. This outcome relates to the nursing diagnosis impaired social interaction. 4 It may not be realistic for the client to perform self-care tasks independently.

19. A mother questions the decreased effectiveness of methylphenidate (Ritalin) prescribed for her child's ADHD. Which nursing response best addresses the mother's concern? 1. "The physician will probably switch from Ritalin to a central nervous system stimulant." 2. "The physician may prescribe an antihistamine with the Ritalin to improve effectiveness." 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." 4. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

ANS: 3 Page: 637-638 Feedback 1 Ritalin is a nervous system stimulant, this statement provides false information. 2 Antihistamines would not improve the effectiveness of Ritalin; this statement provides false information. 3 The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur. 4 These are not signs of an allergic reaction to Ritalin.

18. Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder? 1. Modify environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behavior and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors.

ANS: 3 Page: 656-657 Feedback 1 After safety has been established, the nurse can modify environment to decrease stimulation and provide opportunities for quiet reflection. 2 After safety has been established, the nurse can convey unconditional acceptance and positive regard. 3 The priority nursing intervention when caring for a child diagnosed with conduct disorder should be to recognize escalating aggressive behavior and to intervene before violence occurs. This intervention serves to keep the client and others safe, which is the priority nursing concern. 4 After safety has been established, the nurse can provide immediate positive feedback for appropriate behaviors.

11. An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime? 1. Altered cortical and intellectual functioning 2. Altered respiratory and gastrointestinal functioning 3. Altered liver and kidney functioning 4. Altered endocrine and immune system functioning

ANS: 3 Page: 674 Feedback 1 The nurse would not need to consider altered cortical and intellectual functioning. 2 The nurse would not need to consider altered respiratory and gastrointestinal functioning. 3 The nurse should question the use of antidepressant medication in a client with altered liver and kidney function. Antidepressant medication should be administered with consideration for age-related physiological changes in absorption, distribution, elimination, and brain receptor sensitivity. Because of these changes, medications can reach high levels despite moderate oral dosage. 4 The nurse would not need to consider altered endocrine and immune system functioning.

8. An older client who lives with a caregiver is admitted to an emergency department with a fractured arm. The client is soaked in urine and has dried fecal matter on lower extremities. The client is 6 feet tall and weighs 120 pounds. Which condition should the nurse suspect? 1. Inability for the client to meet self-care needs 2. Alzheimer's disease 3. Abuse and/or neglect 4. Caregiver role strain

ANS: 3 Page: 684-685 Feedback 1 The nurse would not expect that the client is unable to complete self-care. 2 The nurse would not expect Alzheimer's disease. 3 The nurse should expect that this client is a victim of elder abuse or neglect. Indicators of elder physical abuse include bruises, fractures, burns, and other physical injury. Neglect may be manifested as hunger, poor hygiene, unattended physical problems, or abandonment. 4 The nurse would not expect caregiver role strain.

10. A client in the middle stage of Alzheimer's disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication? 1. Discourage attempts at verbal communication owing to increased client frustration. 2. Increase the volume of the nurse's communication responses. 3. Verbalize the nurse's perception of the implied communication. 4. Encourage the client to communicate by writing.

ANS: 3 Page: 686-687 Feedback 1 The nurse should also keep explanations simple. 2 The nurse should use face-to-face interaction. 3 The most appropriate nursing intervention is to verbalize the nurse's perception of the implied communication. 4 The nurse should speak slowly without shouting.

1. A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living. Which nursing intervention is most appropriate to maintain the client's self-esteem? 1. Leave the client alone in the bathroom to test ability to perform self-care. 2. Assign a variety of caregivers to increase potential for socialization. 3. Allow client to choose between two different outfits when dressing for the day. 4. Modify the daily schedule often to maintain variety and decrease boredom.

ANS: 3 Page: 689-692 Feedback 1 The nurse should also provide appropriate supervision to keep the client safe. 2 The nurse should also maintain consistency of caregivers. 3 The most appropriate nursing intervention to maintain this client's self-esteem is to allow the client to choose between two different outfits when dressing for the day. 4 The nurse should also maintain a structured daily routine to minimize confusion.

10. When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? 1. Phase I: The tension-building phase 2. Phase II: The acute battering incident phase 3. Phase III: The honeymoon phase 4. Phase IV: The resolution and reorganization phase

ANS: 3 Page: 705-706 Feedback 1 This scenario is not an example of Phase I: The tension-building phase. 2 This scenario is not an example of Phase II: The acute battering incident phase. 3 The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again. 4 This scenario is not an example of Phase IV: The resolution and reorganization phase.

9. A client asks, "Why does a rapist use a weapon during the act of rape?" Which is the most appropriate nursing response? 1. "To decrease the victimizer's insecurity" 2. "To inflict physical harm with the weapon" 3. "To terrorize and subdue the victim" 4. "To mirror learned family behavior patterns related to weapons"

ANS: 3 Page: 710 Feedback 1 Rapists do not use weapons to decrease their own insecurities. 2 Rapists do not use weapons to inflict physical harm. 3 The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience, from violent attack to insistence on sexual intercourse by an acquaintance or spouse. 4 Rapists do not use weapons to mirror learned family behavior patterns related to weapons.

12. A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense? 1. Controlled response pattern 2. Compounded rape reaction 3. Expressed response pattern 4. Silent rape reaction

ANS: 3 Page: 711 Feedback 1 In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. 2 The client is not experiencing a compounded rape reaction. 3 The nurse should recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension. 4 The client is not experiencing a silent rape reaction.

7. A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid next time he will kill me." Which is the appropriate nursing response? 1. "Leopards don't change their spots, and neither will he." 2. "There are things you can do to prevent him from losing control." 3. "Let's talk about your options so that you don't have to go home." 4. "Why don't we call the police so that they can confront your husband with his behavior?"

ANS: 3 Page: 712-714 Feedback 1 Imposing judgments is nontherapeutic. 2 Giving advice to the client is nontherapeutic. 3 The most appropriate response by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions on their own without the nurse being the "rescuer." 4 This statement is nontherapeutic to the client.

1. A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act? 1. Many prospective clients did not meet criteria for mental illness diagnostic-related groups. 2. Zoning laws discouraged the development of community mental health centers. 3. States could not match federal funds to establish community mental health centers. 4. There was not a sufficient employment pool to staff community mental health centers.

ANS: 3 Page: 723 Feedback 1 A client who did not meet criteria for mental illness was not a deterring factor. 2 Zoning laws were not a deterring factor. 3 A deterring factor to the proper implementation of the Community Mental Health Centers Act of 1963 was that states could not match federal funds to establish community mental health centers. This act called for the construction of comprehensive community mental health centers to offset the effect of deinstitutionalization, the closing of state mental health hospitals. 4 Insufficient staffing was not a deterring factor.

2. A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care? 1. Teaching an adolescent about pregnancy prevention 2. Teaching a client the reportable side effects of a newly prescribed neuroleptic medication 3. Teaching a client to cook meals, make a grocery list, and establish a budget 4. Teaching a client about his or her new diagnosis of bipolar disorder

ANS: 3 Page: 725 Feedback 1 Teaching about pregnancy prevention is primary prevention. 2 Teaching about side effects of a new medication and bipolar disorder is secondary prevention. 3 The nurse who teaches a client to cook meals, make a grocery list, and establish a budget is implementing care within the parameters of tertiary prevention. Tertiary prevention consists of services aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning. 4 Teaching about bipolar disorder to a newly diagnosed client is secondary prevention.

7. A newly admitted homeless client diagnosed with schizophrenia states, "I have been living in a cardboard box for two weeks. Why did the government let me down?" Which is an appropriate nursing response? 1. "Your discharge from the state hospital was done prematurely. Had you remained in the state hospital longer, you would not be homeless." 2. "Your premature discharge from the state hospital was not intended for patients diagnosed with chronic schizophrenia." 3. "Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success." 4. "Your discharge from the state hospital was based on presumed family support, and this was not forthcoming."

ANS: 3 Page: 745-750 Feedback 1 This is inaccurate because the client was not discharged prematurely. 2 This is inaccurate because the client was not discharged prematurely due to schizophrenia. 3 The most accurate nursing response is to explain to the client that the resources were not available to make transitioning out of a state hospital a success. There are several factors that are thought to contribute to homelessness among the mentally ill: deinstitutionalization, poverty, lack of affordable housing, lack of affordable health care, domestic violence, and addiction disorders. 4 This statement is not accurate based on the client's situation.

8. A nurse assigns a client the nursing diagnosis of complicated grieving. According to Bowlby, which long-term outcome would be most appropriate for this nursing diagnosis? 1. The client will accomplish the recovery stage of grief by year one. 2. The client will accomplish the acceptance stage of grief by year one. 3. The client will accomplish the reorganization stage of grief by year one. 4. The client will accomplish the emotional relocation stage of grief by year one.

ANS: 3 Page: 759 Feedback 1 Accomplishing the recovery stage of grief by year one may not be appropriate for this client. 2 The reorganization stage of grieving is the final stage in which the individual accepts the loss and new goals and patterns are established. 3 The nurse should identify that, according to Bowlby, an appropriate long-term outcome for this client is to accomplish the reorganization stage of grief by year one. Until the client can recognize and accept personal feelings regarding the loss, grief work cannot progress. 4 Accomplishing the emotional relocation stage of grief by year one may not be realistic for this client.

9. A nurse assesses a woman whose husband died 13 months ago. She isolates herself, screams at her deceased spouse, and is increasingly restless. According to Bowlby, this widow is in which stage of the grieving process? 1. Stage I: Numbness or protest 2. Stage II: Disequilibrium 3. Stage III: Disorganization and despair 4. Stage IV: Reorganization

ANS: 3 Page: 759 Feedback 1 The widow is not in Stage I: Numbness or protest. 2 The widow is not in Stage II: Disequilibrium. 3 The nurse should identify that this client is in the third stage of Bowlby's grief process, called disorganization and despair. This stage is characterized by feelings of despair in response to the realization that the loss has occurred. The individual experiences helplessness, fear, and hopelessness. Perceptions of visualizing or being in the presence of the lost one may occur. 4 The widow is not in Stage IV: Reorganization.

5. A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Thought insertion 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

ANS: 4 Page: 350-351 Feedback 1 Thought insertion is not a potential symptom of schizophrenia. 2 The client with paranoid delusions is very suspicious of others and their intentions. 3 The client with magical thinking believes that thoughts have power over others. 4 The nurse is assessing for the potential symptom of delusions of reference. A client that believes he or she receives messages through the radio is experiencing delusions of reference. These delusions involve the client interpreting events within the environment as being directed toward himself or herself. Clients with delusions of reference believe that others are trying to send them messages in various ways, or they must break a code to receive a message.

8. Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder? 1. Provide neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

ANS: 4 Page: 355 Feedback 1 Changing lighting and providing music does not reduce the client's risk for violence. 2 Maintaining eye contact does not reduce the client's risk for violence. 3 Therapeutic touch does not reduce the client's risk for violence. 4 The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence. The nurse should observe the patient while carrying out routine tasks.

7. A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis? 1. The client is disheveled and malodorous. 2. The client refuses to interact with others and isolates self in room. 3. The client is unable to feel any pleasure. 4. The client has maxed-out charge cards and exhibits promiscuous behaviors.

ANS: 4 Page: 380 Feedback 1 The client being disheveled and malodorous meets the diagnosis requirements of major depressive episode. 2 The client refusing to interact with others meets the diagnosis requirements of major depressive episode. 3 The client being unable to feel any pleasure meets the diagnosis requirements of major depressive episode. 4 The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior is exhibiting signs of mania. The DSM-5 criteria state that there must never have been a manic episode or a hypomanic episode to meet the criteria for the diagnosis of major depressive episode.

12. A nurse is planning care for a 13-year-old client who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

ANS: 4 Page: 390 Feedback 1 Paroxetine (Paxil) is not approved to treat depression in adolescents. 2 Sertraline (Zoloft) is not approved to treat depression in adolescents. 3 Citalopram (Celexa) is not approved to treat depression in adolescents. 4 Fluoxetine (Prozac) has been approved by the FDA to treat depression in children and adolescents, and escitalopram was approved in 2009 for treatment of depression in adolescents aged 12 to 17 years. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

2. When planning care for a depressed client, which correctly written outcome should be a nurse's first priority? 1. The client will promise not to physically harm self. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during hospital stay.

ANS: 4 Page: 393 Feedback 1 The outcome should be specific. 2 The outcome should be realistic. 3 The outcome should have a time frame. 4 The nurse's first priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's first priority.

15. An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

ANS: 4 Page: 408 Feedback 1 The client would have serotonin syndrome. 2 The nurse would not anticipate this to be the cause. 3 The nurse would not expect ingestion of an SSRI and MAOI. 4 The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

1. A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

ANS: 4 Page: 419-422 Feedback 1 Exhibiting looseness of association and being euphoric is not associated with bipolar disorder. 2 Magical thinking is not associated with bipolar disorder. 3 Labile mood and delusions of reference are not associated with bipolar disorder. 4 The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting mood swings from euphoria to irritability. Grandiosity refers to the attitude that one's abilities are better than everyone else's.

9. A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. "Treatment is compromised when clients can't sleep." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

ANS: 4 Page: 426 Feedback 1 The most critical challenge is not when clients can't sleep. 2 The most critical challenge is not when irritability interferes with social interactions. 3 The most critical challenge is not when clients have no insight into their problems. 4 The nursing student is accurate when stating that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose not to take their medications. Clients diagnosed with bipolar disorder feel most productive and creative during manic episodes. This may lead to purposeful medication nonadherence. Symptoms of bipolar disorder will reemerge if medication is stopped.

8. A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

ANS: 4 Page: 434, 439 Feedback 1 These symptoms do not indicate consumption of foods high in tyramine. 2 These symptoms do not indicate lithium carbonate discontinuation syndrome. 3 These symptoms do not indicate development of lithium carbonate tolerance. 4 The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure proper dosage.

6. A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse asks the nurse how Zyprexa works. Which is the appropriate nursing response? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

ANS: 4 Page: 435-438 Feedback 1 Zyprexa calms hyperactivity. 2 Zyprexa does not prevent extrapyramidal side effects. 3 Zyprexa does not increase the effectiveness of the immune system. 4 The nurse should explain to the client's spouse that olanzapine can calm hyperactivity until the lithium carbonate takes effect. Lithium carbonate may take 1 to 3 weeks to begin to decrease hyperactivity. Monotherapy with the traditional mood stabilizers like lithium carbonate, or atypical antipsychotics like olanzapine, has been determined to be the first-line treatment for bipolar I disorder.

6. A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an emergency department reveals no pathology. Which medical diagnosis should the nurse suspect, and what nursing diagnosis should be the nurse's first priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Mild anxiety disorder and a nursing diagnosis of anxiety 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of anxiety

ANS: 4 Page: 449-450 Feedback 1 Generalized anxiety disorder and a nursing diagnosis of fear does not capture the client's symptoms. 2 Mild anxiety disorder and a nursing diagnosis of anxiety does not capture the client's symptoms. 3 Pain disorder and a nursing diagnosis of altered role performance does not capture the client's symptoms. 4 The nurse should suspect that the client has exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.

3. What symptoms should the nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Hyperventilation is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is commonly seen in panic disorder and absent in GAD.

ANS: 4 Page: 449-451 Feedback 1 Generalized anxiety disorder is chronic in nature. 2 Clients do not often experience chest pain or hyperventilation with GAD, but do with panic disorder. 3 Hyperventilation occurs with panic disorder. 4 The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

16. A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

ANS: 4 Page: 463 Feedback 1 Attempting to distract the client is not an appropriate intervention, because it does not help the client gain insight. 2 Seeking medication increase is not an appropriate intervention, because it does not help the client gain insight. 3 Locking the client's room is not an appropriate intervention, because it does not help the client gain insight. 4 The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to control interrupting anxiety, he or she must first learn to recognize precipitating factors.

15. The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that teaching has been effective? 1. "There is nothing that I can do to that will reduce anxiety." 2. "Medication is available, but only for those who have had anxiety for a year or more." 3. "If I ignore the symptoms of anxiety, it will go away." 4. "Practicing yoga or meditation may help reduce my anxiety."

ANS: 4 Page: 464 Feedback 1 There are many actions that the client can take to reduce anxiety. 2 Medication is available for the treatment of anxiety, regardless of time that the client has been diagnosed. 3 Ignoring the symptoms of anxiety does not make it go away. 4 Practicing yoga or meditation may help reduce the symptoms of anxiety.

1. A nursing instructor is teaching about trauma and stressor-related disorders. Which statement by one of the students indicates that further instruction is needed? 1. "The trauma that women experience is more likely to be sexual assault and child sexual abuse." 2. "The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury." 3. "After exposure to a traumatic event, only 10 percent of victims develop posttraumatic stress disorder (PTSD)." 4. "Research shows that PTSD is more common in men than in women."

ANS: 4 Page: 476 Feedback 1 This statement indicates that teaching has been effective. 2 This statement is correct, indicating that no further teaching is needed. 3 This statement is accurate, indicating the teaching has been effective. 4 Research shows that PTSD is more common in women than in men. This student statement indicates a need for further instruction.

7. Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1. Anxiety, feelings of hopelessness, and worry 2. Truancy, vandalism, and fighting 3. Nervousness, worry, and jitteriness 4. Depressed mood, tearfulness, and hopelessness

ANS: 4 Page: 477 Feedback 1 Anxiety and worry would not be expected. 2 Truancy, vandalism, and fighting would not be expected. 3 Nervousness and jitteriness would not be expected. 4 AD with depressed mood is the most commonly diagnosed adjustment disorder. The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depression. The symptoms—such as depressed mood, tearfulness, and feelings of hopelessness—exceed what is an expected or normative response to an identified stressor.

16. A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis? 1. The client worries continually and appears nervous and jittery. 2. The client complains of a depressed mood, is tearful, and feels hopeless. 3. The client is belligerent, violates others' rights, and defaults on legal responsibilities. 4. The client complains of many physical ailments, refuses to socialize, and quits her job.

ANS: 4 Page: 487, 489 Feedback 1 Constant worrying and appearing jittery are not symptoms of adjustment disorder. 2 Depressed mood, tearfulness and feeling hopeless are not symptoms of adjustment disorder. 3 The client who is belligerent, violates others' rights, and defaults on legal responsibilities, is not showing symptoms of an adjustment disorder. 4 The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories. Manifestations may include physical complaints, social withdrawal, or work or academic inhibition, without significant depressed or anxious mood.

18. A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder? 1. The 60-year-old, because of memory deficits 2. The 60-year-old, because of decreased cognitive processing ability 3. The 20-year-old, because of limited cognitive experiences 4. The 20-year-old, because of lack of developmental maturity

ANS: 4 Page: 489 Feedback 1 The 60-year-old client is less likely to be diagnosed with adjustment disorder, regardless of memory deficits. 2 The 60-year-old client is less likely to be diagnosed with adjustment disorder, regardless of cognitive processing ability 3 The 60-year-old client is less likely to be diagnosed with adjustment disorder, regardless of limited cognitive experiences. 4 Research indicates that there is a predisposition to the diagnosis of adjustment disorder when there is limited developmental maturity. By comparison, the 20-year-old does not have the developmental maturity, life experiences, and coping mechanisms that the 60-year-old might possess.

4. Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain, may experience? 1. Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications 2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor 3. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion 4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

ANS: 4 Page: 506 Feedback 1 Choosing a new doctor and euphoric feelings do not accurately describe primary and secondary gains for this client. 2 These feelings listed do not accurately describe primary and secondary gains for this client. 3 The primary and secondary gains listed do not accurately describe primary and secondary gains for this client. 4 The nurse should identify that primary gains are those that allow the client to avoid an unpleasant activity (stressful family reunion) and that secondary gains are those in which the client receives emotional support or attention (get-well cards).

5. A nursing instructor is teaching about the etiology of IAD from a psychodynamic perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred? 1. "They tend to have a familial predisposition to this disorder." 2. "When the sick role relieves them from stressful situations, their physical symptoms are reinforced." 3. "They misinterpret and cognitively distort their physical symptoms." 4. "They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems."

ANS: 4 Page: 506-507 Feedback 1 These clients do not tend to have familial disposition for the disorder. 2 Physical symptoms are not reinforced when the sick role relieves them from stressful situations. 3 They do not misinterpret or cognitively distort their physical symptoms. 4 The nurse should understand that from a psychoanalytical perspective, IAD occurs because physical problems are more acceptable than psychological problems.

14. A nursing instructor is teaching about the DSM-5 diagnosis of depersonalization-derealization disorder (D-DD). Which student statement indicates a need for further instruction? 1. "Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time." 2. "Clients with this disorder can experience unreality or detachment with respect to their surroundings." 3. "During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted." 4. "During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning."

ANS: 4 Page: 512 Feedback 1 This statement is correct, indicating that further education is not necessary. 2 This statement does not indicate a need for further education. 3 This statement indicates that teaching has been effective. 4 D-DD is characterized by a temporary change in the quality of self-awareness, which often takes the form of feelings of unreality, changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body. Depersonalization (a disturbance in the perception of oneself) is differentiated from derealization, which describes an alteration in the perception of the external environment. The DSM-5 states that during the depersonalization and/or derealization experiences, reality testing remains intact. This student statement indicates a need for further instruction.

8. A client is diagnosed with DID. What is the primary goal of therapy for this client? 1. To recover memories and improve thinking patterns 2. To prevent social isolation 3. To decrease anxiety and need for secondary gain 4. To collaborate among sub-personalities to improve functioning

ANS: 4 Page: 518-520 Feedback 1 To recover memories and improve thinking patterns is not the primary goal of therapy. 2 To prevent social isolation is not the primary goal of therapy. 3 To decrease anxiety and need for secondary gain is not the primary goal of therapy. 4 The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among sub-personalities to improve functioning. Some clients choose to pursue a lengthy therapeutic regimen to achieve integration, a blending of all the personalities into one. The goal is to optimize the client's functioning and potential.

5. A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder? 1. "Skaters need to be thin to improve their daily performance." 2. "All the skaters on the team are following an approved 1,200-calorie diet." 3. "The exercise of skating reduces my appetite but improves my energy level." 4. "I am angry at my mother. I can only get her approval when I win competitions."

ANS: 4 Page: 572 Feedback 1 Stating that skaters need to be thin is not likely to contribute to the development of anorexia nervosa. 2 Stating that all skaters are following an approved diet is not likely to contribute to the development of anorexia nervosa. 3 This statement is not likely to contribute to the development of anorexia nervosa. 4 The client reflects insight when referring to feelings toward family dynamics that may have influenced the development of the disease. Families who are overprotective and perfectionistic can contribute to the development of anorexia nervosa.

10. A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? 1. Altered nutrition less than body requirements 2. Altered social interaction 3. Impaired verbal communication 4. Altered family processes

ANS: 4 Page: 575-577 Feedback 1 Altered nutrition less than body requirements is not the priority at this time. 2 Altered social interaction is not the priority at this time. 3 Impaired verbal communication is not the priority at this time. 4 The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.

4. A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's uncontrollable behaviors. 4. It allows clients to maintain control.

ANS: 4 Page: 584 Feedback 1 Behavior modification does not help the client correct distorted body image. 2 Behavior modification does not help the client address underlying client anger. 3 Behavior modification does not help the client manage uncontrollable behaviors. 4 Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques function to restore healthy weight.

9. Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? 1. Altered thought processes R/T increased stress 2. Risk for suicide R/T loneliness 3. Risk for violence: directed toward others R/T paranoid thinking 4. Social isolation R/T inability to relate to others

ANS: 4 Page: 594 Feedback 1 Altered thought processes R/T increased stress would not be an appropriate diagnosis. 2 Risk for suicide R/T loneliness would not be an appropriate diagnosis. 3 Risk for violence: directed toward others R/T paranoid thinking would not be an appropriate diagnosis. 4 An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are not sociable.

23. During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder? 1. "I don't have a problem. My family is inflexible, and my relatives are out to get me." 2. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" 3. "I spend all my time tending my bees. I know a whole lot of information about bees." 4. "I am getting a message from the beyond that we have been involved with each other in a previous life."

ANS: 4 Page: 595 Feedback 1 Stating, "I don't have a problem. My family is inflexible, and relatives are out to get me," is not typical of schizotypal personality disorder. 2 Stating, "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" is not typical of schizotypal personality disorder. 3 "I spend all my time tending my bees. I know a whole lot of information about bees," is not typical of schizotypal personality disorder. 4 The nurse should assess that a client who states that he or she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The person experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

24. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

ANS: 4 Page: 598-599 Feedback 1 Risk for violence: directed toward others R/T paranoid thinking is not the priority nursing diagnosis. 2 Risk for suicide R/T altered thought is not the priority nursing diagnosis. 3 Altered sensory perception R/T increased levels of anxiety is not the priority nursing diagnosis. 4 The priority nursing diagnosis for a client diagnosed with avoidant personality disorder should be social isolation R/T inability to relate to others. These clients avoid close or romantic relationships, interpersonal attachments, and intimate sexual relationships.

12. A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? 1. "You really don't have to go by that schedule. I'd just stay home sick." 2. "There has got to be a hidden agenda behind this schedule change." 3. "Who do you think you are? I expect to interact with the same nurse every Saturday." 4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

ANS: 4 Page: 599-600 Feedback 1 The statement, "You really don't have to go by that schedule. I'd just stay home sick," is not typical of the client with obsessive-compulsive disorder 2 The statement, "There has got to be a hidden agenda behind this schedule change," is not typical of the client with obsessive-compulsive disorder 3 The statement, "Who do you think you are? I expect to interact with the same nurse every Saturday," is not typical of the client with obsessive-compulsive disorder. 4 The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

18. Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder? 1. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." 2. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." 3. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." 4. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

ANS: 4 Page: 603 Feedback 1 Stating, "The night nurse is evil. You have to stay," is not a behavior associated with a client with borderline personality disorder. 2 Stating, "I will be up all night if you don't stay with me," is not a behavior associated with a client with borderline personality disorder. 3 Stating, "Please don't go! I can't sleep without you being here." 4 The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with borderline personality disorder. Repetitive, self-mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others.

1. Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder (IDD)? 1. The client can perform some self-care activities independently. 2. The client has more advanced speech development. 3. Other than possible coordination problems, the client's psychomotor skills are not affected. 4. The client communicates wants and needs by "acting out" behaviors.

ANS: 4 Page: 629 Feedback 1 The client would not be able to perform self-care activities independently. 2 The client will not necessarily have advanced speech development. 3 Individuals diagnosed with severe IDD require complete supervision and have minimal verbal skills and poor psychomotor development. 4 The nurse should identify that a client diagnosed with severe IDD may communicate wants and needs by "acting out" behaviors. Severe IDD indicates an IQ between 20 and 34.

9. A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate IDD. Which student statement indicates that further instruction is needed? 1. "These clients can work in a sheltered workshop setting." 2. "These clients can perform some personal care activities." 3. "These clients may have difficulties relating to peers." 4. "These clients can successfully complete elementary school."

ANS: 4 Page: 629 Feedback 1 This statement indicates that teaching has been effective. 2 This statement indicates understanding. 3 This statement indicates that learning has occurred. 4 The nursing student needs further instruction about moderate IDD, because individuals diagnosed with moderate IDD are capable of academic skill up to a second-grade level. Moderate IDD reflects an IQ range of 35 to 49.

20. After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize? 1. Arguing and annoying older sibling over the past year 2. Angry and resentful behavior over a 3-month period 3. Initiating physical fights for more than 18 months 4. Arguing with authority figures for more than 6 months

ANS: 4 Page: 650 Feedback 1 The DSM-5 rules out the diagnosis of ODD when only siblings are involved in argumentative interactions. 2 Angry and resentful behavior over more than 6 months, not 3 months, would be considered a symptom of ODD. 3 Initiating physical fights is a symptom of conduct disorder, not ODD. 4 Arguing with authority figures for more than 6 months is listed by the DSM-5 as a symptom for the diagnosis of ODD.

5. A couple resides in a long-term care facility. The husband is admitted to the psychiatric unit after physically abusing his wife. He states, "My wife is having an affair with a young man, and I want it investigated." Which is the appropriate nursing response? 1. "Your wife is not having an affair. What makes you think that?" 2. "Why do you think that your wife is having an affair?" 3. "Your wife has told us that these thoughts have no basis in fact." 4. "I understand that you are upset. We will talk about it."

ANS: 4 Page: 689-692 Feedback 1 This statement degrades what the client is experiencing. 2 This statement may not be therapeutic to the client. 3 This statement does not validate the client's feelings. 4 The most appropriate response by the nurse is to empathize with the client and encourage the client to talk about the situation. The nurse should remain nonjudgmental and help maintain client's orientation, memory, and recognition.

6. A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate response? 1. "These clients don't know life any other way, and change is not an option until they have improved insight." 2. "These clients have limited cognitive skills and few vocational abilities to be able to make it on their own." 3. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." 4. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

ANS: 4 Page: 706 Feedback 1 Stating "These clients don't know life any other way, and change is not an option until they have improved insight" is not the most appropriate response. 2 Stating "These clients have limited cognitive skills and few vocational abilities to be able to make it on their own" is not the most appropriate response. 3 Stating "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation" is not the most appropriate response. 4 The nursing supervisor is accurate when stating that clients who are in abuse relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.

2. A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect? 1. The woman may be exhibiting a controlled response pattern. 2. The woman may have a history of childhood neglect. 3. The woman may be exhibiting codependent characteristics. 4. The woman may be a victim of incest.

ANS: 4 Page: 708-709 Feedback 1 The nurse would not expect that the client is exhibiting a controlled response pattern. 2 The nurse would not expect a history of childhood neglect. 3 The nurse would not expect codependency. 4 The nurse should suspect that this client may be a victim of incest. Many women who are battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive relationships often grew up in an abusive home.

11. Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? 1. Have ready access to a gun and learn how to use it. 2. Research lawyers that can aid in divorce proceedings. 3. File charges of assault and battery. 4. Have ready access to the number of a safe house for battered women.

ANS: 4 Page: 712-714 Feedback 1 The nurse would not provide information on keeping a gun to the client. 2 The nurse would not provide information on divorce attorneys. 3 The nurse would not provide information on filing charges of assault and battery. 4 The nurse should provide information about the accessibility of safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear.

5. When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention? 1. Teaching assertiveness skills in order to meet assessed needs 2. Supplying the couple with guidelines related to marital seminar leadership 3. Teaching the couple about various methods of birth control 4. Counseling the couple related to open and honest communication skills

ANS: 4 Page: 726-727 Feedback 1 Teaching assertiveness skills in order to meet assessed needs is tertiary prevention. 2 Supplying the couple with guidelines related to marital seminar leadership is primary prevention. 3 Teaching the couple about various methods of birth control is primary prevention. 4 Counseling the couple related to open and honest communication skills is a reflection of a nursing intervention at the secondary level of prevention. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

8. An instructor is teaching nursing students about the difference between partial and inpatient hospitalization. In what way does partial hospitalization differ from traditional inpatient hospitalization? 1. Partial hospitalization does not provide medication administration and monitoring. 2. Partial hospitalization does not use an interdisciplinary team. 3. Partial hospitalization does not offer a comprehensive treatment plan. 4. Partial hospitalization does not provide supervision 24 hours a day.

ANS: 4 Page: 740-741 Feedback 1 Partial hospitalization provides medication administration and monitoring. 2 Partial hospitalization uses an interdisciplinary team. 3 Partial hospitalization offers a comprehensive treatment plan. 4 The instructor should explain that partial hospitalization does not provide supervision 24 hours a day. Partial hospitalization programs generally offer a comprehensive treatment plan formulated by an interdisciplinary team, including medication administration. They have proved to be an effective method of preventing hospitalization.

11. When attempting to provide health-care services to the homeless, what should be a realistic concern for a nurse? 1. Most individuals that are homeless reject help. 2. Most individuals that are homeless are suspicious of anyone who offers help. 3. Most individuals that are homeless are proud and will often refuse charity. 4. Most individuals that are homeless relocate frequently.

ANS: 4 Page: 745-750 Feedback 1 It is inaccurate to state that most homeless reject help. 2 It is inaccurate to state that most homeless are suspicious of those who offer help. 3 It is inaccurate to state that most homeless refuse charity. 4 A realistic concern in the provision of health-care services to the homeless is that individuals who are homeless relocate frequently. Frequent relocation confounds service delivery and interferes with providers' efforts to ensure appropriate care.

4. A teenager has recently lost a parent. Which grieving behavior should a school nurse expect when assessing this client? 1. Denial of personal mortality 2. Preoccupation with the loss 3. Clinging behaviors and personal insecurity 4. Acting-out behaviors, exhibited in aggression and defiance

ANS: 4 Page: 764-765 Feedback 1 The nurse would not expect denial of personal mortality. 2 The nurse would not expect preoccupation with the loss. 3 The nurse would not expect clinging behaviors and personal insecurity. 4 The school nurse should anticipate that the teenager will exhibit aggression and acting out. Adolescents have the ability to understand death on an adult level yet have difficulty tolerating the intense feelings associated with the death of a loved one. It is often easier for adolescents to talk with peers about feelings than with other adults.

15. A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

ANS: 4, 5 Page: 420-421 Feedback 1. Symptoms last at least one year. 2. Clients have numerous periods with hypomanic episodes. 3. The symptoms are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not elsewhere classified. 4. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 5. Depressive symptoms that do not meet the criteria for a major depressive episode.