psych 2 practice questions

A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? 1. I'm scared that you're going to leave me. 2. I'll go to group therapy if you'll let me smoke. 3. I need to feel that everyone admires me. 4. I sometimes feel better if I cut myself.

Answer: 1 Rationale: Clients who have avoidant personality disorder often have a fear of abandonment. This type of statement is expected

A nurse is caring for a client who has bullimia nervosa and has stopped purging behavior. The client tells the nurse about fears of gaining weight. Which of the following responses should the nurse make? 1. Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet. 2. Instead of worrying about your weight, try to focus on other problems at this time. 3. I understand you have concerns about your weight, but first, let's talk about your recent accomplishments. 4. You are not overweight, and the staff will ensure that you do not gain weight.

Answer: 3 Rationale: This statement acknowledges the client's concern and then focuses the conversation on the client's accomplishments, which can promote client self-esteem and self-image.

During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events? A. Avoidance of stress is an important goal for living. B. Control over one's response to stress is possible. C. Most people have no control over their level of stress. D. Significant others are important to provide care and concern.

Correct Answer: B. Control over one's response to stress is possible. When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience. With practice, individuals learn to process emotions, thoughts, and sensations as they arise. Individuals learn to modify their reflexive conditioning from automatically reacting or worrying about the future to a more adaptive, measured response with greater awareness of the present moment. The literature is replete with evidence suggesting that, with practice, individuals can become more mindful, increasing their capacity to fully process emotions, thoughts, and sensations as they arise. Option A: Stress can be positive and growth-enhancing as well as harmful. Effective techniques for stress management are varied. They typically include behaviors that improve physical health, such as nutrition and exercise, but may also incorporate strategies that improve cognitive and emotional functioning. The stress-reduction approach based on mindfulness practices has recently enjoyed an explosion of interest from a variety of healthcare and epidemiological researchers. The concept of mindfulness, which originates from practices of Buddhism, is defined as a focused awareness of one's experience, and a purposeful and non-judgmental focus on the present moment. Option C: The belief that one has some control is a significant factor in minimizing stress response. Paradoxically, positive changes seem especially likely to occur when one can let go of the struggle of trying to change or control the process. This perspective lies at the core of empirically validated acceptance-based intervention models. A focus on the present moment can potentially help decondition habitual reaction patterns and increase response flexibility. From a cognitive perspective, this suggests that viewing present circumstances as new and unique experiences increases one's capacity for generating multiple alternative response options. Option D: Novice mindfulness practitioners also engage in "informal" practice as they learn to observe their own thoughts and sensations and explore a new stance as a nonjudgmental observer of their own life. Attending one's own experience may set up a dynamic cognitive interaction that can facilitate a capacity to respond to ongoing experiences as if they are occurring for the first time, typically referred to as "beginner's mind." This interrupts the automatic processes of relying on previously conditioned stress reactions.

Mandy, a nurse who works at Nurseslabs Rehabilitation Center is assessing a client for recent stressful life events. She recognizes that stressful life events are both: A. Desirable and growth-promoting B. Positive and negative C. Undesirable and harmful D. Predictable and controllable

Correct Answer: B. Positive and negative The concept of stressful life events is based on the research of Holmes and Rahe, who found that both positive and negative changes result in stress. Stressful life events, or life event stressors, are undesirable, unscheduled, nonnormative, and/or uncontrollable discrete, observable events with a generally clear onset and offset that usually signify major life changes. Stressful life events have significant negative consequences for both physical and psychological well-being. Option A: Broadly defined, stressors are events or conditions that threaten the operating integrity of an organism (Wheaton & Montazer, 2010). The concepts of stress and stressor were first introduced by Hans Selye (1956) whose experiments indicated that repeated and prolonged exposure to noxious conditions and stimuli increased susceptibility to disease and illness in laboratory animals. Option C: Stressful life events are not always undesirable and harmful. The second approach defines stressful events as those that are consensually seen as harmful or threatening (e.g., Brown & Harris 1989, Cohen et al. 2016). Imminence of harm, intensity, duration, and the extent to which an event is objectively uncontrollable are all factors that contribute to the potential magnitude of consensual threat (Lazarus & Folkman 1984, Rabkin & Struening 1976). As mentioned above, although the magnitude of the threat represented by different life events is often thought to be cumulative (e.g., as assumed by stressful life event checklists), there is also evidence that the maximum risk for disease occurs when a single event meets a high criterion for threat (Wethington et al. 1995), with additional events not adding to the total risk. Option D: Some stressful life events can be predictable and controllable; however, many life events are entirely unpredictable. With some limited exceptions (e.g., natural disasters, accidental deaths of friends or family members), stressful event exposures do not occur at random but instead are influenced by both individual differences in environmental circumstances and psychological characteristics. Personality factors may also be hidden causes of stressor exposure. For example, divorce is more common in those whose personality is characterized by greater neuroticism or lesser conscientiousness and agreeableness (Roberts et al. 2007). In addition, some cognitive styles, such as a tendency to attribute negative events to stable, global, and internal causes, can lead individuals to experience more stressful life events.

The nurse evaluates the treatment of Mrs. Montez with somatoform disorder as successful if: A. Mrs. Montez practices self-medication rather than changing health care providers. B. Mrs. Montez recognizes that physical symptoms increase anxiety level. C. Mrs. Montez researches treatment protocols for various illnesses. D. Mrs. Montez verbalizes anxiety directly rather than displacing it.

Correct Answer: D. Mrs. Montez verbalizes anxiety directly rather than displacing it. Mrs. Montez with somatoform disorder unconsciously displaces anxiety onto physical symptoms. The ability to recognize and verbalize anxious feelings directly rather than displacing them is a criterion of treatment success. Clients may keep a detailed journal of their physical symptoms; the nurse might ask them to describe the situation at the time such as whether they were alone or with others, whether any disagreements were occurring, and so forth. Option A: Teach the client coping strategies. Emotion-focused strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities; problem-focused coping strategies include problem-solving methods, applying the process to identified problems, and role-playing interactions with others. Option B: Provide education about feared or actual medical conditions. This helps the client understand the condition in a more realistic light and helps alleviate fear and anxiety about a particular health concern. Discuss symptoms with the client and when they began, what makes them better or worse and how they have been managing these symptoms. This helps make a more definitive diagnosis and helps determine how to best treat the client. Helping the client determine the etiology of symptoms helps them to recognize and avoid situations that make symptoms worse. Option C: This indicates the continuation of the problem. Encourage behavior modification such as praising the client and offering more attention when symptoms improve. Change the focus from what's wrong to what's right. Helps the client feel accomplished and more positive about improvements in health condition instead of focusing on the symptoms.

The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework? Select all that apply. A. Administering anti-anxiety medication as prescribed. B. Encouraging the client to restructure thoughts. C. Helping the client to use controlled relaxation breathing. D. Helping the client examine evidence of stressors. E. Questioning the client about early childhood relationships. F. Teaching the client about anxiety and panic.

Correct Answers: B, C, D, F These are all appropriate techniques based on the framework of cognitive-behavioral therapy. The main approaches to the treatment of panic disorder include both psychological and pharmacological interventions. Psychological interventions consist of cognitive-behavioral therapy. As an added benefit in patients with a panic disorder that also has concomitant comorbid medical conditions, there are components of their therapeutic regimens which may also secondarily improve their respective medical illnesses. Option A: Antidepressants and benzodiazepines are the mainstays of pharmacologic treatment. Among the different classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) are recommended over monoamine oxidase inhibitors and tricyclic antidepressants. SSRIs are considered the first-line treatment option for patients with panic disorder. Option B: Suggest that the client substitute positive thoughts for negative ones. Emotion connected to thought, and changing to a more positive thought can decrease the level of anxiety experienced. This also gives the client an alternative way of looking at the problem. Include the client in making decisions related to selection of alternative coping strategies. Allowing the client choices provides a measure of control and serves to increase feelings of self-worth. Option C: Breathing training is a method of reducing panic symptomatology by utilizing capnometry biofeedback to decrease the number of episodes of hyperventilation. Several of these slow breathing techniques have been shown to benefit patients with asthma and hypertension. Hyperventilation reduction can help patients with cardiovascular disease. Anxiety and stress-reduction techniques can lower adverse outcomes in cardiovascular illness by decreasing sympathetic activity. Option D: Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help the client to understand how facing these feelings, rather than suppressing them, can result in more adaptive coping abilities. Verbalization of feelings in a non threatening environment may help the client come to terms with unresolved issues. Discuss the process of thinking about the feared object/situation before it occurs. Anticipation of a future phobic reaction allows the client to deal with the physical manifestations of fear. Option E: Encourage the client to share the seemingly unnatural fears and feelings with others, especially the nurse therapist. Clients are often reluctant to share feelings for fear of ridicule and may have repeatedly been told to ignore feelings. Once the client begins to acknowledge and talk about these fears, it becomes apparent that the feelings are manageable. Option F: Explore things that may lower fear level and keep it manageable (e.g. singing while dressing, repeating a mantra, practicing positive self-talk while in a fearful situation); provides the client with a sense of control over the fear. Distracts the client so that fear is not totally focused on and allowed to escalate. Educate the patient and/or SO that anxiety. disorders are treatable. Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimen may include antidepressants and anxiolytics.

The school nurse assesses for anorexia nervosa in an adolescent girl. Which of the following findings are characteristic of this disorder? Select all that apply. A. Bradycardia B. Hypotension C. Chronic pain in one or more sites D. Fear of having a serious illness E. Irregular or absent menses F. Refusal to maintain a minimally normal weight

Correct Answer: A, B, E, F These are all characteristics of anorexia nervosa. Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. Option A: Cardiac complications are arguably one of the most severe medical issues stemming from anorexia. Bradycardia (heart rate less than 60 beats per minute) and hypotension (blood pressure less than 90/50) are among the most common physical findings in anorexia, with bradycardia seen in up to 95 percent of patients. Option B: Bradycardia (pulse <60) and hypotension are among the most common physical findings in patients with anorexia nervosa, with bradycardia seen in up to 95% of patients. Anorexia nervosa should be considered in the differential for unexplained bradycardia in the outpatient setting. Low blood pressure and heart rate universally increase to normal levels after refeeding and restoration of normal weight. Option C: Chronic pain in one or more sites is common for somatoform pain disorder. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) category of Somatic Symptom Disorders and Other Related Disorders represents a group of disorders characterized by thoughts, feelings, or behaviors related to somatic symptoms. This category represents psychiatric conditions because the somatic symptoms are excessive for any medical disorder that may be present. Option D: Fear of having a serious illness is common in hypochondriasis. Illness anxiety disorder (IAD) is a recent term for what used to be diagnosed as hypochondriasis, or hypochondria. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms. Yet IAD patients' concerns are to them very real. Even if they go to doctors and no illnesses are found, they are generally not reassured and their obsessive worry continues. Option E: Of patients with anorexia nervosa, 20-25 percent may experience amenorrhea before the onset of significant weight loss, and 50-75 percent will experience amenorrhea during the course of dieting and its weight loss. In some patients with anorexia nervosa, amenorrhea occurs only after more marked weight loss. Overall, the development of amenorrhea is most strongly correlated to loss of body weight. Option F: Many exercise compulsively for extended periods of time. Patients with anorexia nervosa develop multiple complications related to prolonged starvation and purging behaviors.

A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? 1. Chlordiazepoxide 2. Bupropion 3. Disulfiram 4. Carbamazepine

Answer: 3 Rationale: The nurse should expect to administer disulfiram to help the client maintain abstinence from alcohol. Chlordiazepoxide is indicated for acute alcohol withdrawal rather than to maintain abstinence from alcohol; Bupropion is indicated for nicotine withdrawal rather than to maintain abstinence from alcohol; Carbamazepine is indicated for acute alcohol withdrawal rather than to maintain abstinence from alcohol.

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1. Client reports not going to work for the past week. 2. Client complains of not being able to "do anything" anymore. 3. Client arrives at the clinic neat and appropriate in appearance. 4. Client reports sleeping 12 hours per night and 3 to 4 hours during the day.

Answer: 3 Rationale: Depressed individuals sleep for long periods, are unable to go to work, and feel as if they cannot "do anything." When these clients have had some therapeutic effect from their medication, they report resolution of many of these complaints and exhibit an improvement in their appearance. Options 1, 2, and 4 identify continued depression.

A nurse is planning a staff education program on substance use in older adults. Which of the following information should the nurse include in the presentation? 1. Older adults require higher doses of a substance to achieve a desired effect. 2. Older adults commonly use rationalization to cope with a substance use disorder. 3. Older adults are at an increased risk for substance use following retirement. 4. Older adults develop substance use to mask manifestations of dementia.

Answer: 3 Rationale: Retirement and other life change stressors increase the risk for substance use in older adults, especially if there is a prior history of substance use.

A client arrives at the mental health clinic for the first time. The client is overly friendly and flirtatious, very dramatic, and attention-seeking. Which of the following personality disorders does the nurse suspect the client is experiencing? 1. Histrionic personality disorder 2. Borderline personality disorder 3. Avoidant personality disorder 4. Obsessive compulsive disorder

Answer: 1 Rationale: A client who is overly friendly and flirtatious, very dramatic, and attention-seeking is exhibiting histrionic personality disorder. Histrionic personality disorder is a mental disorder that causes a person to think, perceive, and relate to others differently. It is thought to be genetic. If a child has been abused or had an unstable childhood, the person is at high risk of developing a histrionic personality disorder. A histrionic client seeks attention, overly friendly, wants to be noticed, and emotions change rapidly. Traits of a histrionic client may include one who is overly flirtatious; demands gratification; strives to be the center of attention; seeks approval of others for self-esteem; and behaves dramatically and/or unbecoming to seek attention.

The nurse determines that the spouse of an alcoholic client is benefiting from attending an Al-Anon group if the nurse hears the spouse make which statement? 1. "I no longer feel that I deserve the beatings my partner inflicts on me." 2. "My attendance at the meetings has helped me to see that I provoke my partner's violence." 3. "I enjoy attending the meetings because they get me out of the house and away from my partner." 4. "I can tolerate my partner's destructive behaviors now that I know they are common among alcoholics."

Answer: 1 Rationale: Al-Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain excellent pointers about successful behavioral changes. The correct option is the healthiest response because it exemplifies an understanding that the alcoholic partner is responsible for their own behavior and cannot be allowed to blame family members for loss of control. Option 2 is incorrect because the nonalcoholic partner should not feel responsible when the spouse loses control. Option 3 indicates that the group is viewed as an escape, not as a place to work on issues. Option 4 indicates that the nonalcoholic partner remains codependent.

A client taking lithium reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L (2.5 mmol/L). The nurse plans care based on which representation of this level? 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

Answer: 1 Rationale: Maintenance serum levels of lithium are 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). Symptoms of toxicity begin to appear at levels of 1.5 mEq/L (1.5 mmol/L). Lithium toxicity requires immediate medical attention and the primary health care provider is notified if symptoms of toxicity occur.

A hospitalized client with a history of alcohol use disorder tells the nurse: "I am leaving now. I must go. I do not want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action would the nurse take? 1. Call the nursing supervisor. 2. Call security to block all exit areas. 3. Restrain the client until the primary health care provider (PHCP) can be reached. 4. Tell the client that the client cannot return to this hospital again if the client leaves now.

Answer: 1 Rationale: Most health care facilities have documents that the client is asked to sign relating to the client's responsibilities when the client leaves against medical advice. The client would be asked to wait to speak to the PHCP before leaving and to sign the "against medical advice" document before leaving. If the client refuses to do so, the nurse cannot hold the client against the client's will. Therefore, in this situation, the nurse would call the nursing supervisor. The nurse can be charged with false imprisonment if clients are made to believe wrongfully that they cannot leave the hospital. Restraining the client and calling security to block exits constitutes false imprisonment. All clients have a right to health care and cannot be told otherwise.

A client is unwilling to go to church because the ex-spouse goes there and the client feels that the ex-spouse will laugh at the client. Because of this hypersensitivity to a reaction from the spouse, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? 1. Avoidant 2. Borderline 3. Schizotypal 4. Obsessive-compulsive

Answer: 1 Rationale: The avoidant personality disorder is characterized by social withdrawal and extreme sensitivity to potential rejection. The person retreats to social isolation. Borderline personality disorder is characterized by unstable mood and self-image and impulsive and unpredictable behavior. Schizotypal personality disorder is characterized by the display of abnormal thoughts, perceptions, speech, and behaviors. Obsessive-compulsive personality disorder is characterized by perfectionism, the need to control others, and a devotion to work.

A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? 1. Life isn't worth living if I gain weight. 2. Don't pretend like you don't know how fat I am. 3. If I could be skinny, I know I'd be popular. 4. When I look in the mirror, I see myself as obese.

Answer: 1 Rationale: This statement reflects the cognitive distortion of catastrophizing because the client's perception of their appearance or situation is much worse than their current condition.

Which of the following are taught as recovery coping skills for a recovering alcoholic? Select all that apply. 1. Expressing accountability 2. Joining Alcoholics Anonymous meetings. 3. Seeking out a sponsor. 4. Setting realistic goals. 5. Stopping after the first drink.

Answer: 1, 2, 3, 4 Rationale: The first step to a life of sobriety is admitting the alcoholic has a problem. Recovery teachings include expressed accountability or taking responsibility for one's own actions and acknowledging what was done. Joining and participating in Alcoholics Anonymous (AA) meetings helps the alcoholic have accountability and gives them coping skills. Asking for a sponsor to help when the need arises or the urge to drink becomes increasingly difficult. Setting goals and atoning for one's behavior is part of the process of recovery. Joining a 12-step program and attaining each step helps to reduce the urge to drink and prolong sobriety.

A client is admitted to the mental health inpatient hospital with histrionic personality disorder. Which of the following goals should be implemented by the nurse? Select all that apply. 1. To prevent self-harm 2. To keep the client safe and secure 3. To set rules and boundaries. 4. To keep the client away from others. 5. To encourage psychotherapy.

Answer: 1, 2, 3, 5 Rationale: The goals for a histrionic personality disorder client may include to prevent self-harm; to keep the client safe and secure; to set rules and boundaries; and to encourage psychotherapy. A client who is overly friendly and flirtatious, very dramatic, and attention-seeking is exhibiting histrionic personality disorder. Histrionic personality disorder is a mental disorder that causes a person to think, perceive, and relate to others differently. It is thought to be genetic. If a child has been abused or had an unstable childhood, the person is at high risk of developing a histrionic personality disorder. A histrionic client seeks attention, overly friendly, wants to be noticed, and emotions change rapidly. Traits of a histrionic client may include one who is overly flirtatious; demands gratification; strives to be the center of attention; seeks approval of others for self-esteem; and behaves dramatically and/or unbecoming to seek attention.

Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply. 1. Monitor vital signs. 2. Provide a safe environment. 3. Address hallucinations therapeutically. 4. Provide stimulation in the environment. 5. Provide reality orientation as appropriate

Answer: 1, 2, 3, 5 Rationale: When the client is experiencing withdrawal from alcohol, the priority for care is to prevent the client from harming self or others. The nurse would monitor the vital signs closely and report abnormal findings. The nurse would provide a low-stimulation environment to maintain the client in as calm a state as possible. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake needs to be maintained.

A nurse is obtaining a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (Select all that apply.) 1. What is your relationship like with your family? 2. Why do you want to lose weight? 3. Would you describe your current eating habits? 4. At what weight do you believe you will look better? 5. Can you discuss your feelings about your appearance?

Answer: 1, 3 Rationale: 1- A nursing history of a client who has anorexia nervosa should include an assessment of family and interpersonal relationships. 2- Asking a "why" question promotes a defensive client response and is therefore nontherapeutic. 3- A nursing history of a client who has anorexia nervosa should include an assessment of the client's current eating habits. 4- This question promotes cognitive distortion, places the focus on weight, and implies that the client;s current appearance is not acceptable. 5- A nursing history of a client who has anorexia nervosa should include an assessment of the client's perception of the issue.

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings would the nurse expect to note? Select all that apply. 1. Dental decay 2. Moist, oily skin 3. Loss of tooth enamel 4. Electrolyte imbalances 5. Body weight well below ideal range

Answer: 1, 3, 4 Rationale: Clients with bulimia nervosa initially may not appear to be physically or emotionally ill. They are often at or slightly below ideal body weight. On further inspection, a client exhibits dental decay and loss of tooth enamel if the client has been inducing vomiting. Electrolyte imbalances are present. Dry, scaly skin (rather than moist, oily skin) is present.

A charge nurse preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply) 1. Difficulty in getting along with other members of a group. 2. Belief in the ability to become invisible during times of stress. 3. Display of defense mechanisms when routines are changed. 4. Claiming to be more important than other persons 5. Difficulty understanding why it is inappropriate to have a personal relationship with staff.

Answer: 1, 3, 5 Rationale: Difficulty getting along with other members of a group; displaying of defense mechanisms when routines are changed; and difficulty understanding why it is inappropriate to have a personal relationship with staff, are all characteristics seen in personality disorders. Belief in the ability to become invisible in during times of stress and claiming to be more important than other persons are manifestations of schizophrenia.

Which of the following clients have obsessive compulsive disorder? Select all that apply. 1. A client who washes his hands 20 times a day. 2. A client who washes his car once a month. 3. A client who cleans her bathroom every weekend. 4. A client who cleans her kitchen for 8 hours every day. 5. A client who arranges the pictures in her home every day until the pictures are just right.

Answer: 1, 4, 5 Rationale: The clients with obsessive compulsive disorder may include the client who washes his hands 20 times a day; a client who cleans her kitchen for 8 hours every day; and a client who arranges the pictures in her home every day until the pictures are just right. Obsessions are excessive thoughts and impulses that cause anxiety which leads to compulsive repetitive ritualistic behaviors. Rituals are time consuming and wasteful. They know it's irrational, but cannot stop. The clients have a tendency to be excessively orderly, perfectionistic, and pay extreme recognition to detail. Examples are a fear of germs, and arranging objects in order. OCD is used to decrease anxiety to a tolerable level.

A nurse is performing an admission assessment of a client who has bullimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply.) 1. Amenorrhea 2. Hypokalemia 3. Yellowing of the skin 4. Slightly elevated body weight 5. Presence of lanugo on the face

Answer: 2 Rationale: 1- Amenorrhea is an expected finding of anorexia nervosa rather than bullimia nervosa. 2- Hypokalemia is an expected finding of purging-type bullimia nervosa. 3- Yellowing of the skin is an expected finding in anorexia nervosa rather than bullimia nervosa 4- Most clients who have bullimia nervosa maintain a weight within normal range or slightly higher. 5- Lanugo is an expected finding of anorexia nervosa rather than bullimia nervosa.

A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching? 1. Rape is a crime of passion. 2. Acquaintance rape often involves alcohol. 3. Young adults are the typical victims of sexual assault. 4. The majority of rapists are unknown to the victims.

Answer: 2 Rationale: Alcohol and other substances are often associated with date or acquaintance rape

The nurse is describing the medication side and adverse effects to a client who is taking amitriptyline. Which information would the nurse incorporate in the discussion? 1. Consume a low-fiber diet. 2. Increase fluids and bulk in the diet. 3. Rest if the heart begins to beat rapidly. 4. Walk if you have difficulty urinating because this is a normal side effect.

Answer: 2 Rationale: Amitriptyline causes constipation, and the client is instructed to increase fluid intake and bulk (high fiber) in the diet. If the heart begins to beat fast, the primary health care provider (PHCP) is notified, because this could indicate an adverse effect. Difficulty urinating is an adverse effect and indicates urinary retention; this should also be reported.

A client who has been taking buspirone for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred? 1. Paranoid thought process 2. Rapid heartbeat or anxiety 3. Alcohol withdrawal symptoms 4. Thought broadcasting or delusions

Answer: 2 Rationale: Buspirone is not recommended for the treatment of paranoid thought disorders, drug or alcohol withdrawal, or schizophrenia. Buspirone most often is indicated for the treatment of anxiety.

A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes an interest in buying new clothes, but expresses that money is limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced personal caloric intake to 800 calories daily. How would the nurse evaluate this behavior? 1. Normal behavior 2. Evidence of the client's disturbed body image 3. Regression as the client is moving toward the community 4. Indicative of the client's ambivalence about hospital discharge

Answer: 2 Rationale: Disturbed body image is a concern with clients with anorexia nervosa. Although the client may struggle with ambivalence and show regressed behavior, the client's coping pattern relates to the basic issue of disturbed body image. The nurse should address this need in the support group.

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? 1. Orient the client frequently to time, place, and person. 2. Offer fluids and nourishing diet as tolerated. 3. Implement seizure precautions. 4. Encourage participation in group therapy sessions.

Answer: 3 Rationale: The greatest risk to the client is injury. Implementing seizure precautions is the priority intervention.

The nurse is caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention would the nurse include? 1. Increase socialization of the client with peers. 2. Avoid using a whisper voice in front of the client. 3. Begin to educate the client about social supports in the community. 4. Have the client sign a release of information to appropriate parties for assessment purposes.

Answer: 2 Rationale: Disturbed thought process related to paranoid personality disorder is the client's problem, and the plan of care must address this problem. The client is distrustful and suspicious of others. The members of the health care team need to establish a rapport and trust with the client. Laughing or whispering in front of the client would be counterproductive. The remaining options ask the client to trust on a multitude of levels. These options are actions that are too intrusive for a client with this disorder.

When planning the discharge of a client with chronic anxiety, which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continuing contact with a crisis counselor 4. Eliminating all anxiety from daily situations

Answer: 2 Rationale: Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations, and this option does not encourage the development of internal strengths. Suppressing feelings will not resolve anxiety. Elimination of all anxiety from life is impossible.

The 16 year old client hospitalized with acute issues related to anorexia nervosa, will have a care plan that includes which of the following? 1. An 1800 calorie diet 2. Nutritional rehabilitation 3. Strenuous exercise program 4. Bowel and bladder training

Answer: 2 Rationale: Restoring the weight and nutritional status of the anorexia nervosa client is the main goal. The caloric intake needs to be 3,000-5,000 calories.

A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how would the nurse administer the dose? 1. On an empty stomach 2. At the same time each evening 3. Evenly spaced around the clock 4. As needed when the client complains of depression

Answer: 2 Rationale: Sertraline is classified as an antidepressant. Sertraline generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline is not prescribed for use as needed.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding specific side and adverse effects of the medication? 1. Renal dysfunctions 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

Answer: 2 Rationale: Specific side and adverse effects related to fluoxetine include central nervous system and gastrointestinal system dysfunction. Fluoxetine affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Renal dysfunctions, dry mouth, and excessive sweating are not side and adverse effects associated with this medication.

A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? 1. Regression 2. Splitting 3. Undoing 4. Identification

Answer: 2 Rationale: Splitting occurs when a person is unable to see both positive and negative qualities at the same time. The client who has borderline personality disorder tends to see a person as all bad one time and all good another time.

A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a two-bed room. A newly admitted client will be assigned to this client's room. Which client would be the best choice as a roommate for the client with anorexia nervosa? 1. A client with pneumonia 2. A client undergoing diagnostic tests 3. A client who thrives on managing others 4. A client who could benefit from the client's assistance at mealtime

Answer: 2 Rationale: The client undergoing diagnostic tests is an acceptable roommate. The client with anorexia nervosa is most likely experiencing hematological complications, such as leukopenia. Having a roommate with pneumonia would place the client with anorexia nervosa at risk for infection. The client with anorexia nervosa should not be put in a situation in which the client can focus on the nutritional needs of others or be managed by others because this may contribute to sublimation and suppression of personal hunger.

The nurse is teaching a client who is being started on imipramine about the medication. The nurse would inform the client to expect maximum desired effects at which time period following initiation of the medication? 1. In 2 months 2. In 2 to 3 weeks 3. During the first week 4. During the sixth week of administration

Answer: 2 Rationale: The maximum therapeutic effects of imipramine may not occur for 2 to 3 weeks after antidepressant therapy has been initiated. Options 1, 3, and 4 are incorrect time periods.

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I need to get out of this bad situation." Which is the most helpful response by the nurse? 1. "Why don't you tell your spouse about this?" 2. "What do you find difficult about this situation?" 3. "This is not the best time to make that decision." 4. "I agree with you. You should get out of this situation."

Answer: 2 Rationale: The most helpful response is one that encourages the client to solve problems. Giving advice implies that the nurse knows what is best and can foster dependency. The nurse would not agree with the client, and the nurse would not request that the client provide explanations.

The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action would the nurse take to plan appropriate nursing care? 1. Ask the client why they started taking illegal drugs. 2. Ask the client about the amount of drug use and its effect. 3. Ask the client how long they thought that they could take drugs without someone finding out. 4. Not ask any questions for fear that the client is in denial and will throw the nurse out of the home.

Answer: 2 Rationale: Whenever the nurse carries out an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. Option 1 is incorrect because it is judgmental and off-focus, and reflects the nurse's bias. Option 3 is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. Option 4 is incorrect because it indicates passivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention.

After establishing rapport and trust with the client that has sustained a dislocated shoulder, which question will the registered nurse (RN) ask to help identify the presence of intimate partner abuse? Select all that apply. 1. Do you aggravate your partner to the point of anger? 2. Do you feel safe in your home with your partner? 3. Is anyone in your home or life hurting you? 4. Has anyone threatened you with physical harm? 5. Has anyone verbally threatened you in the last weeks?

Answer: 2, 3, 4, 5 Rationale: Intimate partner abuse (violence) occurs between two people that reside in the same dwelling. The abuse can be physical, emotional, verbal, psychological, sexual, or financial in nature. It is necessary for the RN to establish trust and rapport prior to asking personal type questions. The client needs to feel safe if information related to abuse is to be obtained. Implementing non-accusatory type questions can be helpful in obtaining information.

A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? (Select all that apply.) 1. We need to understand that our sibling is responsible for their disorder. 2. Eliminating codependent behavior will promote recovery. 3. Our sibling should participate in an Al-Anon group to assist with recovery. 4. The primary goal of treatment is abstinence from substance use. 5. Our sibling needs to discuss personal feelings about substance use to help with recovery.

Answer: 2, 4 Rationale: Families should be aware of codependent behavior (enabling) that can promote substance use rather than recovery. Abstinence is the primary treatment goal fro a client who has a substance use disorder. Clients are not responsible for their disease but are responsible for their recovery. Al-Anon is a recovery group for the family of a client, rather than the client who has a substance use disorder. Clients must acknowledge their feelings about substance use as part of a substance use recovery program.

A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) 1. Bradycardia 2. Find tremors of both hands 3. Hypotension 4. Vomiting 5. Restlessness

Answer: 2, 4, 5 Rationale: Fine tremors of both hands, vomiting, and restlessness are all expected findings of alcohol withdrawal. The patient would tachycardia and hypertension rather than bradycardia and hypotension.

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition? 1. Psychosis 2. Repression 3. Conversion disorder 4. Dissociative disorder

Answer: 3 Rationale: A conversion disorder is the alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. A conversion disorder is thought to be an expression of a psychological need or conflict. In this situation, the client witnessed an accident that was so psychologically painful that the client became blind. Psychosis is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, interfering with the person's ability to deal with life's demands. Repression is a coping mechanism in which unacceptable feelings are kept out of awareness. A dissociative disorder is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness.

Which of the following actions by the borderline personality disorder client shows that the client is improving with therapy? 1. Laughs when making demands 2. Writes checks for all the client's bills for the months. 3. Easily talks about anger issues and demands 4. Tells the nurse never to engage in flattering behaviors.

Answer: 3 Rationale: Borderline personality disorder is a mental condition characterized by emotional instability, unstable behaviors, insecure, impulsive, no restraint, depressed, poor self-image, grandiose, narcissistic, mood swings, and sadness. These clients are hostile, compulsive, irritable, and self-destructive. Their primary coping style is manipulation. They use self-harm to draw attention to themselves. Borderline clients have a high risk of suicide. Borderline personality disorder characteristics may include a fear of being abandoned; manipulative behaviors; uses self-harm to draw attention; has damaged social relationships; and feel worthless to others. The actual cause of borderline personality disorder is unknown. Borderline personality disorder is usually diagnosed by the signs and symptoms the client is exhibiting. When a borderline personality disorder client begins easily talking about anger issues and demands, this reveals that the client is improving with therapy.

A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? 1. I can promote my client's sense of control by establishing a schedule. 2. I should encourage clients who have a schizoid personality disorder to increase socialization. 3. I should practice limit-setting to help prevent client manipulation. 4. I should implement assertiveness training with clients who have antisocial personality disorder.

Answer: 3 Rationale: When caring for a client who has a personality disorder, limit-setting is appropriate to help prevent client manipulation.

While providing care to a client diagnosed with dissociative identity disorder (DID), the registered nurse (RN) anticipates what clinical manifestation for this disorder? Select all that apply. 1. Long periods of narcolepsy. 2. Being keenly aware of the other personalities. 3. Lack of awareness of the personalities. 4. Appearance of 2 or more personalities. 5. Recurrent episodes of amnesia

Answer: 3, 4, 5 Rationale: Dissociative identity disorder (DID) is a form of dissociative disorder. This disorder is characterized by recurrent episodes of amnesia and the presence of two or more personalities. The individual experiences memory problems, depersonalization, and loss of time. The individual does not have conscious control of this condition. The amnesia events and multiple personalities assist the individual in surviving traumatic memories.

A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply) 1. Demonstrates extreme anxiety when placed in a social situation 2. Often engages in magical thinking 3. Attempts to convince other clients to relinquish their belongings. 4. Becomes agitated if personal area is not neat and orderly. 5. Blames others for personal past and current problems.

Answer: 3, 5 Rationale: Exploitation and manipulation of others is an expected finding of antisocial personality disorder. Failure to accept personal responsibility is an expected finding of clients who have antisocial personality disorder.

The registered nurse (RN) realizes that the victim is at greatest risk for injury from the partner at what point in the relationship? 1. At the beginning of the relationship 2. After several years of the abusive relationship. 3. As the victim becomes more submissive to the abuser. 4. When the victim moves towards independence from the abuser.

Answer: 4 Intimate partner abuse (violence) occurs between two people that reside in the same dwelling. The abuse can be physical, emotional, verbal, psychological, sexual, or financial in nature. It is not easy for the victim partner to make the move towards independence due to the abuse. Once the victim partner does decide to leave (which demonstrates independence), this is when the partner is at greatest risk for increased abuse. A safe exit plan must be established so that the move occurs quickly to decrease the risk for the victim partner.

While working with a client that has sustained a dislocated shoulder, the registered nurse (RN) becomes concerned about intimate partner abuse based on what personality trait is noted in the partner who remains at the client's bedside? 1. Kind, caring, and attentive to the client 2. Concerned for the client's comfort 3. Helpful and encouraging to the client 4. Controlling and not allowing the client to speak.

Answer: 4 Intimate partner abuse (violence) occurs between two people that reside in the same dwelling. The abuse can be physical, emotional, verbal, psychological, sexual, or financial in nature. The abusive partner displays characteristics of jealousy and possessiveness. The abusive partner implements various techniques to control the thoughts and actions of the victim partner. Because the abusive partner's actions of abuse are unpredictable, the victim partner lives in constant fear.

A client with agoraphobia watches the neighbors through the windows. A therapist works with the client two days a week via the computer. The client sees a neighbor fall down the stairs and is lying a few feet from the front door. Which of the following options shows that the client's agoraphobia has improved? 1. The client notifies 911 and stays in the house watching the neighbor from the window. 2. The client opens the front door and yells, "Help, help, the neighbor has fallen down the stairs." 3. The client is too frightened to do anything to help the neighbor. 4. The client notifies 911 and opens the front door to stay with the neighbor until the ambulance arrives.

Answer: 4 Rationale: A client with agoraphobia is afraid to leave the comfortable environment around him/her. The client feels safe in the environment and has anxiety/fear about leaving. The client may not leave the safe environment for weeks, months, and even years. The client may fear being trapped, helpless, and embarrassed. Treatment for agoraphobia may include lifestyle changes, therapy, as well as medications. A therapist may assist the client to work through his/her fears regarding the phobia. Cognitive behavioral therapy may be implemented to help the client recognize thought patterns that cause anxiety.

A client has a fear of death with chest pain, heart palpitations, profuse sweating, and hot flashes. This client is experiencing signs of which of the following? 1. Mild anxiety 2. Moderate anxiety 3. Severe anxiety 4. Panic attack

Answer: 4 Rationale: Anxiety is an emotion of uneasiness, fear, or dread. Anxiety may cause physical symptoms such as sweating, restlessness, tenseness, and tachycardia. When a client experiences stress, anxiety may be a normal reaction. There are 4 classifications of anxiety: mild, moderate, severe, and panic attack. With mild anxiety, the client may experience restlessness and irritability. With moderate anxiety, the client may pace back and forth, have difficulty concentrating, and have increased respiratory rate and heart rate. With severe anxiety, the client may experience hyperventilation with increased respiratory rate and a pounding high heart rate. The client may experience a feeling of impending doom and does not have the ability to respond to directions. A client who has a panic attack may have a fear of death and an impending doom, hallucinations, chest pain with heart palpitations, trembling, numbness, sweating, hot flashes, nausea, and a choking sensation.

The nurse is caring for a client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? 1. Allow the client to complete the exercise program. 2. Interrupt the client and weigh the client immediately. 3. Tell the client that exercising rigorously is not allowed. 4. Interrupt the client and offer to take the client for a walk.

Answer: 4 Rationale: Clients with anorexia nervosa frequently are preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise and place limits on rigorous activities. The correct option stops the harmful behavior yet provides the client with an activity to decrease anxiety that is not harmful. Weighing the client immediately reinforces the client's preoccupation with weight. Allowing the client to complete the exercise program can be harmful to the client. Telling the client that completing the exercise is not allowed will increase the client's anxiety.

A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following actions should the nurse include in the client's plan of care? 1. Allow the client to select preferred meal times. 2. Establish consequences for purging behavior. 3. Provide the client with a high-fat diet at the start of treatment. 4. Implement one-to-one observation during meal times.

Answer: 4 Rationale: Closely monitor the client during and after meals to prevent purging.

What explanation will the registered nurse (RN) provide when discussing the technique of systematic desensitization as the client learns to deal with the aerophobia? 1. This technique states that the best way to deal with this fear is to book the longest flight possible and just learn to deal with it. 2. This technique states that the best way to deal with this fear is to completely avoid any exposure to planes or flying, even on television. 3. This technique states that the best way to deal with this fear is to identify alternatives to traveling instead of flying or planes. 4. This technique states that the best way to deal with this fear is to slowly expose yourself to the thought of flying and slowly move towards viewing pictures and videos of flying.

Answer: 4 Rationale: For a client diagnosed with a phobia, psychotherapy is the most common treatment method. A type of psychotherapy is exposure therapy. With this type of therapy, the client has slow, gradual exposure to the object or situation related to the phobia. This is referred to as systematic desensitization. As the client continues to slowly become more comfortable in exposure to the object or situation, self observation is evidenced by the client's insight about the anxiety and feelings related to the phobia. The final goal of exposure therapy is the client's ability to implement self distraction, which involves focusing on something other than the phobia.

While working with a client that has sustained a dislocated shoulder, the registered nurse (RN) becomes concerned about intimate partner abuse and implements what priority intervention? 1. Ask the partner to explain what occurred while providing care for the client. 2. Ask the client what occurred while providing care and with the partner at bedside. 3. Call security to remove the partner to a holding room while providing client care. 4. Instruct the partner to wait outside the room prior to asking any questions of the client.

Answer: 4 Rationale: Intimate partner abuse (violence) occurs between two people that reside in the same dwelling. The abuse can be physical, emotional, verbal, psychological, sexual, or financial in nature. The abusive partner will use various techniques to maintain control of the victim partner. If information of abuse is to be obtained, it is necessary to provide the victim partner privacy and safety. This can only be accomplished if the abusive partner is not in the room with the client.

What priority intervention will the registered nurse (RN) implement for the client that demands to go home with the partner after admitting that there is physical abuse in the home setting? 1. Physically restrain the client while the partner is arrested for suspicion of abuse. 2. Explain to the client that the RN will not be legally responsible if further injury occurs. 3. Provide discharge education for management of injury during the healing process. 4. Provide the client with contact information for the National Domestic Violence Hotline.

Answer: 4 Rationale: Intimate partner abuse (violence) occurs between two people that reside in the same dwelling. The abuse can be physical, emotional, verbal, psychological, sexual, or financial in nature. There are many reasons the victim partner remains with the abusive partner. These reasons include financial, religious, fear, feeling alone, believing the abusive partner will change, or love for the abusive partner. It is the RN's responsibility to provide the victim partner with information regarding resources available if the victim partner decides to remain in the relationship/dwelling. This information can be for the national hotline as well as local shelters and organizations.

A client is scheduled for discharge and will be taking phenobarbital for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety? 1. Take the medication only with meals. 2. Take the medication at the same time each day. 3. Use a dose container to help prevent missed doses. 4. Avoid drinking alcohol while taking this medication.

Answer: 4 Rationale: Phenobarbital is an anticonvulsant and hypnotic agent. The client should avoid taking any other central nervous system depressants such as alcohol while taking this medication. The medication may be given without regard to meals. Taking the medication at the same time each day enhances compliance and maintains more stable blood levels of the medication. Using a dose container or "pillbox" may be helpful for some clients.

A client arrives at the outpatient mental health clinic. The client is withdrawn, odd, and eccentric. The client stated, "I can read other people's minds. Do you want to know what you are thinking?" What disorder is the client's behavior exhibiting to the nurse? 1. Avoidant personality disorder. 2. Obsessive compulsive disorder. 3. Histrionic personality disorder. 4. Schizotypal personality disorder

Answer: 4 Rationale: Schizotypal personality disorder is a mental and behavioral disorder where the client is withdrawn, odd, eccentric, and believes he has the ability to read other people's minds (telepathy). Schizotypal clients have few close relationships, are detached, withdrawn, and prefer to be alone. Schizotypal clients do not enjoy close relationships with others and do not understand what it takes to create a close relationship. These clients tend to misinterpret the real world and reality. These clients think they have magical thinking and special powers. Avoidant personality disorder is a mental disorder where the client is extremely shy, feels ridiculed, and overly concerned with feeling foolish. Obsessive compulsive disorder is when a client strives for perfection and the client spends too much time on tasks yet never completes the tasks. Histrionic personality disorder is a mental disorder where the client seeks approval of others to achieve self-esteem. The client behaves dramatically to get attention.

What action will the registered nurse (RN) implement during the care of the client diagnosed with somatic symptom disorder who is experiencing continued abdominal pain? 1. Explain to the client that the abdominal pain is all in their head 2. Advocate for the healthcare provider to provide pain medication 3. Advocate for the healthcare provider to perform further testing. 4. Limit the time that the client spends discussing the abdominal pain

Answer: 4 Rationale: Somatic symptom disorder is characterized by multiple, recurrent medical symptoms. The client tends to be extremely focused and concerned about their symptoms. The overconcern of the symptoms control the client's life, impairing daily functions. Psychotherapy, including cognitive behavioral therapy is part of the treatment plan. Therapy interventions include limiting the client's focus on the symptoms. This can be accomplished by limiting the amount of time the client discusses the symptoms. Promoting self observation can assist the client in identifying the extreme stressors that cause the symptoms to appear or worsen. Educating the client to implement coping mechanisms can be beneficial to decrease the stressors.

The registered nurse (RN) realizes that what specific cause can be linked to the development of somatic symptom disorder in a client? 1. Environment change 2. Advanced aging 3. Personality change 4. Extreme stress

Answer: 4 Rationale: Somatic symptom disorder is characterized by multiple, recurrent medical symptoms. These symptoms do not have an explanation. There is no evidence of a medical condition that causes these symptoms. The client will seek multiple healthcare providers to obtain a diagnosis for the symptoms. The client tends to be extremely focused and concerned about their symptoms. Extreme stressors and traumatic events have been identified as the cause of somatic symptom disorder.

The nurse is assessing a client who was admitted 24 hours ago for a fractured humerus. Which findings would alert the nurse to the potential for alcohol withdrawal delirium? 1. Hypotension, ataxia, hunger 2. Stupor, lethargy, muscular rigidity 3. Hypotension, coarse hand tremors, lethargy 4. Hypertension, changes in level of consciousness, hallucinations

Answer: 4 Rationale: Symptoms associated with alcohol withdrawal delirium typically include hypertension, tachycardia, nausea and vomiting, tremors (especially in the hand), sweating, anxiety, agitation, tactile disturbances, hallucinations such as auditory or visual disturbances, headache, and disorientation.

A client gives the home health nurse a bottle of clomipramine. The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication? 1. Complaints of insomnia 2. Complaints of hunger and fatigue 3. A pulse rate of less than 60 beats per minute 4. Frequent handwashing with hot, soapy water

Answer: 4 Rationale: Clomipramine is a tricyclic antidepressant used to treat obsessive-compulsive disorder. Sedation sometimes occurs. Insomnia seldom is a side effect. Weight gain and tachycardia are side and adverse effects of this medication.

A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape-trauma syndrome? (Select all that apply.) 1. Genitourinary soreness 2. Difficulties with low self-esteem 3. Sleep disturbances 4. Emotional outbursts 5. Difficulty making decisions.

Answer: 4, 5 1- Genitourinary soreness indicates a somatic reaction 2- Difficulties with low self-esteem are an indication of a sustained and maladaptive emotional response beyond the initial reaction 3- Sleep disturbances indicates a somatic reaction 4- Emotional outbursts indicate an expressed initial reaction of rape-trauma syndrome. 5- Difficulty making decisions indicates a controlled initial reaction of rape-trauma syndrome.

Situation: In a home visit done by the nurse, she suspects that the wife and her child are victims of abuse. Which of the following is the most appropriate for the nurse to ask? A. "Are you being threatened or hurt by your partner?" B. "Are you frightened of your partner?" C. "Is something bothering you?" D. "What happens when you and your partner argue?"

Correct Answer: A. "Are you being threatened or hurt by your partner? The nurse validates her observation by asking simple, direct questions. This also shows empathy. Some survivors may be hesitant to discuss certain aspects of their experience, while others may be more willing to share. Let the survivor share their story in their own words. While paraphrasing may be a helpful technique to understand the interviewee, it runs the risk of generalizing their experience. Option B: Try not to make assumptions. Recognize that every survivor has had a different experience, and may be at different points in their healing process. Try not to assume something has already taken place, such as reporting to law enforcement, or that the survivor may feel a certain way. Option C: Ask for additional input. Ask the survivor if there is anything else they would like to share with you. Some aspects of their experience might not have been addressed as a direct answer to your questions. Give the survivor the opportunity to share any additional information. Option D: Be mindful and respect boundaries. Ask if there is anything the survivor would prefer not to discuss. Let the survivor know that it's OK if they don't want to answer every question you ask. Avoid giving advice. It's natural to try to give people solutions, especially if you have dealt with a similar situation. Keep in mind that survivors may have already taken action, or may not be looking for another solution. Instead of saying, "You should report," or "You should find a therapist," take a more supportive approach by asking, "Would you be interested in resources that may help with healing and recovery?"

What would be the best approach for a wife who is still living with her abusive husband? A. "Here's the number of a crisis center that you can call for help ." B. "It's best to leave your husband." C. "Did you discuss this with your family?" D. " Why do you allow yourself to be treated this way."

Correct Answer: A. "Here's the number of a crisis center that you can call for help ." Protection is a priority concern in abuse. Help the victim to develop a plan to ensure safety. The world for many domestic abuse victims can be lonely, isolated, and filled with fear. Sometimes reaching out and letting them know that someone is there for them can provide tremendous relief. Option B: Do not give advice to leave the abuser. Making decisions for the victim further erodes her esteem. However, discuss options available. If you want to help, it is important that you validate her feelings by letting her know that having these conflicting thoughts is normal. But it is also important that you confirm that violence is not okay, and it isn't normal to live in fear of being physically attacked. Option C: The victim tends to isolate from friends and family. Help the victim find support and resources. Look up telephone numbers for shelters, social services, attorneys, counselors, or support groups. If available, offer brochures or pamphlets about domestic violence. Option D: This is judgmental. Avoid in any way implying that she is at fault. If the person does decide to talk, listen to the story without being judgmental, offering advice, or suggesting solutions. Chances are if you actively listen, the person will tell you exactly what they need. Just give the person the full opportunity to talk. You can ask clarifying questions, but mainly just let the person vent their feelings and fears. You may be the first person in which the victim has confided.

What would be the best response to the client's repeated complaints of pain: A. "I know the feeling is real, but tests revealed negative results." B. "I think you're exaggerating things a little bit." C. "Try to forget this feeling and have activities to take it off your mind." D. "So tell me more about the pain."

Correct Answer: A. "I know the feeling is real, but tests revealed negative results." Shows empathy and offers information. Provide accommodation for the client and make them more comfortable (ie., pillows, temperature, positioning, etc.) This can help the client feel accepted and develop rapport and trust. This can allow the client to feel more comfortable and express their feelings and emotions more readily to the healthcare team. Option B: This is a demeaning statement. Encourage behavior modification such as praising the client and offering more attention when symptoms improve. Change the focus from what's wrong to what's right. Helps the client feel accomplished and more positive about improvements in health condition instead of focusing on the symptoms. Option C: This belittles the client's feelings. Provide education about fears or actual medical conditions. Helps the client understand the condition in a more realistic light and helps alleviate fear and anxiety about a particular health concern. Option D: Giving undue attention to the physical symptom reinforces the complaint. Discuss symptoms with the client and when they began, what makes them better or worse and how they have been managing these symptoms. This helps make a more definitive diagnosis and helps determine how to best treat the client. Helping the client determine the etiology of symptoms helps them to recognize and avoid situations that make symptoms worse.

Mr. Johnson was recently admitted to a psychiatric unit because of severe obsessive-compulsive behavior. Which initial response by the nurse would be most therapeutic for him? A. Accepting the client's ritualistic behaviors. B. Challenging the client's need for rituals. C. Expressing concern about the harmfulness of the client's rituals. D. Limiting the client's rituals that are excessive.

Correct Answer: A. Accepting the client's ritualistic behaviors It is important to accept the client's need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client. Initially meet the client's dependency needs as necessary. Sudden and complete elimination of avenues for dependency would create anxiety and will burden the client more. Option B: During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. To deny the client this activity can precipitate panic level of anxiety. Encourage independence and give positive reinforcement for independent behaviors. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors. Option C: Support and encourage the client's efforts to explore the meaning and purpose of the behavior. The client may be unaware of the relationship between emotional problems and compulsive behaviors. Recognition and acceptance of problems are important before a change can occur. Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones. Option D: Encourage the recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Recognition of precipitating factors is the first step in teaching the client to interrupt escalation of anxiety. Provide positive reinforcement for non-ritualistic behaviors. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors.

David is preoccupied with numerous bodily complaints even after a careful diagnostic workup reveals no physiologic problems. Which nursing intervention would be therapeutic for him? A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. B. Challenge the physical complaints by confronting the client with the normal diagnostic findings. C. Ignore the client's complaints, but request that the client keeps a list of all symptoms. D. Listen to the client's complaints carefully, and question him about specific symptoms.

Correct Answer: A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. After physical factors are ruled out, somatic complaints are thought to be expressions of anxiety. The complaints are real to the client, but the nurse should not focus on them. Prompting the client about other concerns will encourage the expression of anxiety and dependency needs. The nurse must help the client establish a daily routine that includes improved health behaviors. Provide accommodation for the client and make them more comfortable (ie., pillows, temperature, positioning, etc.). This can help the client feel accepted and develop rapport and trust. This can allow the client to feel more comfortable and express their feelings and emotions more readily to the healthcare team. Option B: Clients may keep a detailed journal of their physical symptoms; the nurse might ask them to describe the situation at the time such as whether they were alone or with others, whether any disagreements were occurring, and so forth. Provide education about feared or actual medical conditions. This can help relieve acute pain and distress that the client may feel, but also helps them learn to control many symptoms through focus and calming the mind. Option C: Encourage behavior modification such as praising the client and offering more attention when symptoms improve. Change the focus from what's wrong to what's right. Helps the client feel accomplished and more positive about improvements in health condition instead of focusing on the symptoms. Encourage the client to keep a journal of symptoms and the events or factors that lead up to the development of symptoms and their resolution. This is a technique of cognitive behavior therapy that helps the client understand what factors (usually stress) that prompt the onset of symptoms. It can also help the client determine a pattern of emotions surrounding the symptoms. Option D: Discuss symptoms with the client and when they began, what makes them better or worse and how they have been managing these symptoms. Teach coping strategies. Emotion-focused strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities; problem-focused coping strategies include problem-solving methods, applying the process to identified problems, and role-playing interactions with others.

Genevieve only attends social events when a family member is also present. She exhibits behavior typical of which anxiety disorder? A. Agoraphobia B. Generalized anxiety disorder C. Obsessive-compulsive disorder D. Post-traumatic stress disorder

Correct Answer: A. Agoraphobia Agoraphobia is a disorder characterized by avoidance of situations in which escape may not be possible or help may be unavailable. Agoraphobia is the anxiety that occurs when one is in a public or crowded place, from which a potential escape is difficult, or help may not be readily available. It is characterized by the fear that a panic attack or panic-like symptoms may occur in these situations. Individuals with agoraphobia, therefore, strive to avoid such situations or locations. Option B: Generalized anxiety disorder is one of the most common mental disorders. Up to 20% of adults are affected by anxiety disorders each year. Generalized anxiety disorder produces fear, worry, and a constant feeling of being overwhelmed. Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive worry is the central feature of generalized anxiety disorder. Option C: Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others to participate; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function. Option D: Posttraumatic stress disorder (PTSD) is a syndrome that results from exposure to real or threatened death, serious injury, or sexual assault. Following the traumatic event, PTSD is common and is one of the serious health concerns that is associated with comorbidity, functional impairment, and increased mortality with suicidal ideations and attempts. The Diagnostic and Statistical Manual of Mental Disorders(DSM-5) has included PTSD in the new category of Trauma- and Stress-related Disorders.

Which outcome is most appropriate for Francis who has a dissociative disorder? A. Francis will deal with uncomfortable emotions on a conscious level. B. Francis will modify stress with the use of relaxation techniques. C. Francis will identify his anxiety responses. D. Francis will use problem-solving strategies when feeling stressed.

Correct Answer: A. Francis will deal with uncomfortable emotions on a conscious level. Dissociative disorders occur when traumatic events are beyond an individual's recall because these memories have been "blocked" from conscious awareness. Bringing the feelings associated with these events into conscious awareness and coping with these feelings will decrease the need for dissociation. Explore client's feelings. Explore feelings that client experienced in response to the stressor; help client understand that the disequilibrium felt is acceptable-indeed, even expected-in times of severe stress. Option B: Assess for stressors. Identify stressor that precipitated severe anxiety; this information is necessary to the development of an effective plan of client care and problem resolution. Encourage methods for coping. Have the client identify methods of coping with stress in the past and determine whether the response was adaptive or maladaptive. Option C: Identify behavioral limits and behaviors that are expected. Client needs a clear structure. Expect frequent testing of limits initially. Maintaining limits can enhance feelings of safety in the client. Identify what the client sees as the behaviors and circumstances that lead to the hospitalization. Ascertain client's understanding of behaviors and responsibility for own actions. Option D: Ascertain from family/friends how the person interacts with significant people. Is the client always withdrawn, distrustful, hostile, and have continuous physical complaints? Identifying baseline behaviors helps with setting goals. When the client is ready and interested, teach client coping skills to help defuse tension and trouble feelings (e.g., anxiety reduction, assertiveness skills). Increasing skills helps the client use healthier ways to defuse tensions and get needs met.

The wife admits that she is a victim of abuse and opens up about her persistent distaste for sex. This sexual disorder is: A. Sexual desire disorder B. Sexual arousal disorder C. Orgasm disorder D. Sexual Pain Disorder

Correct Answer: A. Sexual desire disorder Has little or no sexual desire or has a distaste for sex. Hypoactive sexual desire disorder (HSDD) and sexual aversion disorder (SAD) are an under-diagnosed group of disorders that affect men and women. Despite their prevalence, these two disorders are often not addressed by healthcare providers and patients due their private and awkward nature. Option B: Failure to maintain the physiologic requirements for sexual intercourse. Sexual arousal disorder is characterized by a lack or absence of sexual fantasies and desire for sexual activity in a situation that would normally produce sexual arousal, or the inability to attain or maintain typical responses to sexual arousal. The disorder is found in the DSM-IV. Option C: Persistent and recurrent inability to achieve an orgasm. Orgasmic disorder is the lack of or delay in sexual climax (orgasm) even though sexual stimulation is sufficient and the woman is sexually aroused mentally and emotionally. Women may not have an orgasm if love-making ends too soon, there is not enough foreplay, or they are afraid of losing control or letting go. Option D: Also called dyspareunia. Individuals with this disorder suffer genital pain before, during and after sexual intercourse. Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many women have painful intercourse at some point in their lives. The medical term for painful intercourse is dyspareunia, defined as persistent or recurrent genital pain that occurs just before, during, or after intercourse.

A group of community nurses sees and plans care for various clients with different types of problems. Which of the following clients would they consider the most vulnerable to post-traumatic stress disorder? A. An eight (8)-year-old boy with asthma who has recently failed a grade in school. B. A 20-year-old college student with DM who experienced date rape. C. A 40-year-old widower who has recently lost his wife to cancer. D. A wife of an individual with a severe substance abuse problem.

Correct Answer: B. A 20-year-old college student with DM who experienced date rape Post-traumatic stress disorder is caused by the experience of severe, specific trauma. Rape is a severely traumatic event. Posttraumatic stress disorder (PTSD) is a syndrome that results from exposure to real or threatened death, serious injury, or sexual assault. Following the traumatic event, PTSD is common and is one of the serious health concerns that is associated with comorbidity, functional impairment, and increased mortality with suicidal ideations and attempts. Option A: The development of posttraumatic stress disorder in individuals is linked to a large number of factors. These include experiencing a traumatic event such as a severe threat or a physical injury, a near-death experience, combat-related trauma, sexual assault, interpersonal conflicts, child abuse, or after a medical illness. Chronic PTSD occurs in patients who are unable to recover from the trauma due to maladaptive responses. Option C: The risk factors for the development of PTSD include biological and psychological factors such as gender (more prevalent in women), childhood adversities, pre-existing mental illness, low socioeconomic status, less education, lack of social support. Nature and the severity of the trauma are also accountable while determining the risk factors for PTSD. Option D: Although this situation is certainly stressful, they are not at the level of severe trauma. The symptoms of PTSD include persistently re-experiencing the traumatic event, intrusive thoughts, nightmares, flashbacks, dissociation(detachment from oneself or reality), and intense negative emotional (sadness, guilt) and physiological reaction on being exposed to the traumatic reminder.[1] Furthermore, problems with sleep and concentration, irritability, increased reactivity, increased startle response, hypervigilance, avoidance of traumatic triggers also occur.

The psychoanalytic theory explains the etiology of anorexia nervosa as: A. The achievement of secondary gain through control of eating. B. A conflict between mother and child over separation and individualization. C. Family dynamics that lead to enmeshment of members. D. The incorporation of thinness as an ideal body image.

Correct Answer: B. A conflict between mother and child over separation and individualization. According to psychoanalytic theory, early mother-child dynamics lead to difficulty with a child establishing a sense of separateness from the mother. Control of eating becomes one area in which the child establishes a sense of independence. Anorexia nervosa is an expression of ego-defective development arising from varying degrees of failure to resolve the process of developing a sense of individuality. There result primitive aggression, archaic guilt, and great difficulties in establishing an integrated sense of sexual identity. Option A: This is the behavioral view of anorexia nervosa. For disorders that belong in the Behavioral Perspective, the behavior shown by the patient is the cardinal abnormality, whether it is the behavior of self-starving, purging, alcohol consumption, dysfunctional sexual behavior, or other actions. A psychiatrically abnormal behavior is required. Absent the behavior, absent the disorder. Option C: This reflects the family theory view of anorexia nervosa, which deals with the issue of lack of generational boundaries. Family systems theory views anorexia nervosa not only as a product of dysfunctional transactional patterns within a family, but also as a crucial stabilizing element within the family. With regard to family factors, recent studies have found associations between the difficulties of adolescents with EDs and family functioning, but no study, to our best knowledge, has investigated the impact of family psychopathological profiles on the adolescents' psychopathological symptoms, differentiating for different types of EDs, during adolescence. Option D: This characterizes the sociocultural view of anorexia nervosa, which identifies thinness as being a culturally determined ideal. According to the sociocultural model, internalization of the thin ideal leads to body dissatisfaction and subsequent negative affect and dieting behaviors which increase the risk for eating disorder development.

Nurse Gina understands that her client Glenda who is bulimic feels shame and guilt over binge eating and purging. This disorder is therefore considered: A. Ego-distorting B. Ego-dystonic C. Ego-enhancing D. Ego-syntonic

Correct Answer: B. Ego-dystonic An ego-dystonic disorder is one in which the client views behaviors or symptoms as incongruent with self-image and therefore feels guilt, shame, and distress about the symptoms. Ego-dystonic refers to thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept. Option A: To say that the ego is distorted is simply to say that the mental apparatus is in a state of disordered function, and we cannot pursue this matter fruitfully unless we know exactly what part or layer of the ego is distorted and how and when and why, and with what other psychic reactions the ego-distortion is associated. Option C: Ego enhancement has been offered as the psychological mechanism that drives differences in judgments about effects on self and others. Findings indicate that although ego enhancement does not appear to directly influence either third-person perception or its relationship to support for government control, it does play a moderating role in regulating the relationship between perceived effects and support for controls, especially in the case of perceived effects on others. Option D: An ego-syntonic disorder is one which the client views behaviors as congruent with her self-image (as in anorexia nervosa). Ego-syntonic refers to instincts or ideas that are acceptable to the self; that are compatible with one's values and ways of thinking. They are consistent with one's fundamental personality and beliefs.

Nurse Martha is teaching her students about anxiety medications; she explains that benzodiazepines affect which brain chemical? A. Acetylcholine B. Gamma-aminobutyric acid (GABA) C. Norepinephrine D. Serotonin

Correct Answer: B. Gamma-aminobutyric acid (GABA) Anti Anxiety medications stimulate the neurotransmitter GABA, which is a chemical associated with relaxation. The other options are not affected by benzodiazepines. Benzodiazepines are a class of drugs that act upon benzodiazepine receptors (BZ-R) in the central nervous system (CNS). The receptor is a protein composed of five transmembrane subunits that form a chloride channel in the center, i.e., GABA-A receptor. The five subunits consist of two alpha, two beta, and one gamma subunit. The extracellular portions of the alpha and beta subunit proteins form a receptor site for gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Option A: The extracellular portions of the alpha and gamma subunit proteins form a binding site for benzodiazepines. Activation of the BZ-R causes a conformational change to a central pore, which allows the entrance of chloride ions into the neuron. The influx of the chloride anion hyperpolarizes the neuron, resulting in the decreased firing of action potentials of that neuron. Option C: Flumazenil is a GABA-A receptor antagonist, acting to reverse the sedative effects of benzodiazepines. Flumazenil functions through competitive inhibition of the alpha-gamma subunit of the GABA-A receptor. Administration of flumazenil should be carried out judiciously, as it may precipitate withdrawal seizures. Of note, one multi-center trial found that patients with excessive benzodiazepine ingestion could become "re-sedated" after flumazenil began to wear off. Option D: Benzodiazepine administration can be performed by providing small doses of the medication until the desired effect (i.e., sedation, cessation of seizure activity, anxiolysis) has been achieved. It should be noted that with intravenous administration, it may take 3 to 5 minutes to achieve a CNS drug concentration adequate to produce the desired effect. Therefore, the adequate time between doses should be allowed to prevent oversedation of the patient.

Chuck is a 20-year-old student diagnosed with obsessive-compulsive behavior. A psychiatrist prescribes clomipramine (Anafranil) to treat his condition. Nurse Nicolette understands the rationale for this treatment is that the clomipramine: A. Increases dopamine levels B. Increases serotonin levels C. Decreases norepinephrine levels D. Decreases GABA levels

Correct Answer: B. Increases serotonin levels According to the psychobiological theory, dysregulation of the neurotransmitter serotonin is thought to contribute to obsessive-compulsive behavior. Clomipramine (Anafranil) is used to increase serotonin levels, thereby decreasing the need for obsessive-compulsive behaviors. The only FDA-approved use for clomipramine is for the treatment of the obsessive-compulsive disorder (OCD) in ages 10 and older. Clomipramine was the first FDA-approved medication for OCD in 1989. For the treatment of OCD, a meta-analysis found clomipramine was more effective than sertraline, fluoxetine, and fluvoxamine.

A nurse at Nurseslabs Medical Center is developing a care plan for a female client with post-traumatic stress disorder. Which of the following would she do initially? A. Instruct the client to use distraction techniques to cope with flashbacks. B. Encourage the client to put the past in proper perspective. C. Encourage the client to verbalize thoughts and feelings about the trauma. D. Avoid discussing the traumatic event with the client.

Correct Answer: C. Encourage the client to verbalize thoughts and feelings about the trauma. Planning care for a client with post-traumatic stress disorder would involve helping the client to verbalize thoughts and feelings about the trauma. This will help the client work through the strong emotions connected with the trauma and, therefore foster the belief that she is able to cope. Maintain a calm, non-threatening manner while working with the client. Anxiety is contagious and may be transferred from health care provider to client or vice versa. The client develops a feeling of security in presence of a calm staff person. Option A: Encourage the client's participation in relaxation exercises such as deep breathing, progressive muscle. Relaxation exercises are effective nonchemical ways to reduce anxiety. relaxation, guided imagery, meditation and so forth. Maintain calmness in your approach to the client. The client will feel more secure if you are calm and if the client feels you are in control of the situation. Option B: This may be possible later after the client is able to verbalize strong emotions. Present and discuss the reality of the situation with client in order to recognize aspects that can be changed and those that cannot. The client must accept the reality of the situation before the work of reducing the fear can progress. Option D: Avoiding discussion would be inappropriate. Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help the client to understand how facing these feelings, rather than suppressing them, can result in more adaptive coping abilities. Verbalization of feelings in a non-threatening environment may help the client come to terms with unresolved issues.

Which of the following statements describe somatoform disorders: A. Physical symptoms are explained by organic causes. B. It is a voluntary expression of psychological conflicts. C. Expression of conflicts through bodily symptoms. D. Management entails a specific medical treatment.

Correct Answer: C. Expression of conflicts through bodily symptoms Bodily symptoms are used to handle conflicts. Up to 50 percent of primary care patients present with physical symptoms that cannot be explained by a general medical condition. Some of these patients meet criteria for somatoform disorders. Although most do not meet the strict psychiatric diagnostic criteria for one of the somatoform disorders, they can be referred to as having "somatic preoccupation," a subthreshold presentation of somatoform disorders that can also cause patients distress and require intervention. Option A: Manifestations do not have an organic basis. The unexplained symptoms of somatoform disorders often lead to general health anxiety; frequent or recurrent and excessive preoccupation with unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic symptoms; difficult encounters with the health care system; disproportionate disability; displays of strong, often negative emotions toward the physician or office staff; unrealistic expectations; and, occasionally, resistance to or noncompliance with diagnostic or treatment efforts. Option B: This occurs unconsciously. There are three required clinical criteria common to each of the somatoform disorders: The physical symptoms (1) cannot be fully explained by a general medical condition, another mental disorder, or the effects of a substance; (2) are not the result of factitious disorder or malingering; and (3) cause significant impairment in social, occupational, or other functioning. Option D: Medical treatment is not used because the disorder does not have a structural or organic basis. Patients who experience unexplained physical symptoms often strongly maintain the belief that their symptoms have a physical cause despite evidence to the contrary. These beliefs are based on a false interpretation of symptoms. Additionally, patients may minimize the involvement of psychiatric factors in the initiation, maintenance, or exacerbation of their physical symptoms.

Marty is pacing and complains of racing thoughts. Nurse Lally asks the client if something upsetting happened, and Marty's response is vague and not focused on the question. Nurse Lally assess Marty's level of anxiety as: A. Mild B. Moderate C. Severe D. Panic

Correct Answer: C. Severe When the client has difficulty focusing and exhibits excessive motor activity, the level of anxiety is severe. Severe anxiety is intensely debilitating, and symptoms of severe anxiety meet key diagnostic criteria for clinically-significant anxiety disorder. People with severe anxiety typically score higher on scales of distress and lower on functioning. Severe anxiety symptoms also frequently co-occur with major depression, which can contribute to greater disability. Option A: Mild anxiety is characterized by increased alertness and problem-solving ability. Although often described as sub-clinical or clinically non-significant, mild anxiety can impact emotional, social, and professional functioning. Mild anxiety symptoms may present as social anxiety or shyness and can be experienced in early childhood through to adulthood. If left unaddressed, mild anxiety can lead to maladaptive coping strategies or more severe mental conditions. Option B: Moderate anxiety is characterized by the ability to focus on central concerns but the inability to problem-solve without assistance. People with moderate levels of anxiety have more frequent or persistent symptoms than those with mild anxiety, but still have better daily functioning than someone with severe anxiety or panic disorder. For example, people with moderate anxiety may report experiencing symptoms such as feeling on edge, being unable to control their worrying or being unable to relax several days or the majority of days in a week, but not every day. Although moderate anxiety symptoms are disruptive, people with moderate anxiety may have success in managing their anxiety with the help of a doctor or self-help strategies. Option D: Panic level of anxiety is characterized by complete inability to focus and reduced perceptions. Panic level anxiety, or panic disorder, is characterized by frequent, recurring and unexpected panic attacks. Panic attacks usually last around 10 minutes. The triggers for panic attacks vary from person to person, and the cause of an attack may be familiar to a person or unknown.

Marlyn is diagnosed with anorexia nervosa and is admitted to the special eating disorder unit. The initial treatment priority for her is: A. To determine her current body image. B. To identify family interaction patterns. C. To initiate a refeeding program. D. To promote the client's independence.

Correct Answer: C. To initiate a refeeding program. The physical need to reestablish near-normal weight takes priority because of the physiologic, life-threatening consequences of anorexia. Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results; provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Option A: Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision-making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work. Weigh with back to scale (depending on program protocols). Although some programs prefer the patient to see the results of the weighing, this can force the issue of trust in the patient who usually does not trust others. Option B: Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain. Option D: Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games.

Nurse Kerrick observes Toni who is hospitalized on an eating disorder unit during mealtimes and for 1 hour after eating. An explanation for this intervention is: A. To develop a trusting relationship. B. To maintain focus on the importance of nutrition. C. To prevent purging behaviors. D. To reinforce the behavioral contact.

Correct Answer: C. To prevent purging behaviors. Toni may experience increased anxiety during treatment and, therefore, may resume behaviors designed to prevent weight gain, such as vomiting or excessive exercise. Supervise the patient during mealtimes and for a specified period after meals (usually one hour). This prevents vomiting during or after eating. Avoid room checks and other control devices whenever possible. External control reinforces feelings of powerlessness and therefore is usually not helpful. Option A: Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games. Option B: Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision-making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Option D: Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results. Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight. Weigh with back to scale (depending on program protocols). Although some programs prefer the patient to see the results of the weighing, this can force the issue of trust in the patient who usually does not trust others.

Nurse Wayne is planning a psychoeducational discussion for a group of adolescent clients with anorexia nervosa. Which of the following topics would Nurse Wayne select to enhance understanding about central issues in this disorder? A. Anger management B. Parental expectations C. Peer pressure and substance abuse D. Self-control and self-esteem

Correct Answer: D. Self-control and self-esteem Self-control and self-esteem are central issues for clients with eating disorders. Such clients feel a loss of self-control over their life and experience diminished self-esteem and severe doubts about their self-worth. The individual tries to gain a sense of self-control through food and exercise since this is the one and only aspect of their life they are able to control. Choosing to engage in binging, extreme dieting, purging and other obsessive behaviors relating to body image and weight loss are attempts to "self-treat" their lack of control in other aspects of their life where they have no control. Option A: The American Psychological Association (APA) has shown that past abuse or trauma, low-self esteem, bullying, poor parental relationships, borderline personality disorder, substance abuse, non-suicidal self-injury disorder (NSSI), a perfectionistic personality, difficulty communicating negative emotions, difficulty resolving conflict, and genetics are known underlying triggers that contribute to the development of an eating disorder. Option B: Maternal psychopathology such as negative expressed emotion, the thrive for perfectionism, and maternal encouragement of weight loss can lead to the development of eating disorders in children and teenagers. The obsessions of binging and purging are brought on by low-self esteem, fear, and anxiety and therefore an individual will binge, purge or exercise excessively to only be relieved of these unhealthy emotions and feelings temporarily until feelings of self-blame and guilt follow. Option C: The first-line treatment for all eating disorders is psychotherapy, which encompasses a broad range of therapy approaches such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) which aim to recognize and reduce the harmful thoughts and emotions associated with the eating disorder and works to develop productive coping mechanisms and tools to help the individual engage in positive thoughts, emotions, and behaviors in order to overcome their past traumas and low-self esteem.

Situation: A 30-year-old male employee frequently complains of low back pain that leads to frequent absences from work. Consultation and tests reveal negative results. The client has which somatoform disorder? A. Somatization Disorder B. Hypochondriasis C. Conversion Disorder D. Somatoform Pain Disorder

Correct Answer: D. Somatoform Pain Disorder This is characterized by severe and prolonged pain that causes significant distress. Pain disorder is fairly common. Although the pain is associated with psychological factors at its onset (e.g., unexplained chronic headache that began after a significant stressful life event), its onset, severity, exacerbation, or maintenance may also be associated with a general medical condition. Pain is the focus of the disorder, but psychological factors are believed to play the primary role in the perception of pain. Option A: This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. Somatization disorder is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version of DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. Option B: This is an unrealistic preoccupation with a fear of having a serious illness. Illness anxiety disorder (IAD) is a recent term for what used to be diagnosed as hypochondriasis, or hypochondria. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms. Yet IAD patients' concerns are to them very real. Even if they go to doctors and no illnesses are found, they are generally not reassured and their obsessive worry continues. Option C: Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict. Conversion disorder is a mental condition in which a person has blindness, paralysis, or other central nervous system (neurologic) symptoms that cannot be explained by medical evaluation. People who have conversion disorder are not making up their symptoms in order to obtain shelter, for example (malingering). They are also not intentionally injuring themselves or lying about their symptoms just to become a patient (factitious disorder). Some health care providers falsely believe that conversion disorder is not a real condition and may tell people that the problem is all in their head. But this condition is real. It causes distress and cannot be turned on and off at will.