Psych Final

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

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

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

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

A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit ìcold turkey.î What would be the best response by the nurse? A) It is not safe to stop drinking suddenly without medicine. B) You sound really motivated. Come in and we will help you find a treatment center. C) After a few days of rest, you should feel much better as long as you do not drink anything. D) You will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest, and come in if they do not get better in 3 to 5 days.

Ans: A Feedback: Because alcohol withdrawal can be life threatening, detoxification needs to be accomplished under medical supervision. If the client's withdrawal symptoms are mild and he or she can abstain from alcohol, he or she can be treated safely at home. For more severe withdrawal or for clients who cannot abstain during detoxification, a short admission of 3 to 5 days is the most common setting. Some psychiatric units also admit clients for detoxification, but this is less common.

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

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

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

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

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

Ans: A Feedback: CBT has been found to be the most effective treatment for bulimia. This outpatient approach often requires a detailed manual to guide treatment. Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept.

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

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

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

Ans: A Feedback: Dysfunctional relationships with significant others often are a primary issue for clients with eating disorders. In addition, support groups in the community or via the internet can offer support, education, and resources to clients and their families or significant others.

Which patient is most likely suffering from dementia? A) A 90-year-old male who has experienced progressive mental decline that started with forgetfulness B) An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff C) A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes D) A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is

Ans: A Feedback: Memory impairment is the prominent early sign of dementia. The course of dementia is usually progressive. A 90-year-old gentleman who has experienced progressive mental decline that started with forgetfulness is most likely suffering from dementia. An 80- year-old lady who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection is likely experiencing delirium. Delirium almost always results from an identifiable physiologic, metabolic, or cerebral disturbance or from drug intoxication or withdrawal. The 6-year-old who has just been administered conscious sedation is likely delirious. A 22-year-old male who was involved in a motorcycle crash without wearing a helmet and now cannot remember where he is likely experiencing an amnestic disorder.

A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on? A) Aripiprazole (Abilify) B) Risperidone (Risperdal Consta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac)

Ans: A Feedback: New-generation antipsychotics are preferred over conventional antipsychotics because they control symptoms without some of the side effects. Injectable antipsychotics, such as Risperdal Consta, are indicated after the client's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms.

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

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

Which of the following statements by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that she had arrived at the scene of an automobileñpedestrian accident and unsuccessfully performed CPR on a victim 3 days ago? The nurse and her colleague are sitting in the break room and no one else is present. A) Tell me what you saw. B) That is horrible! C) Why did you perform CPR? D) I know how you feel; the same thing happened to me several years ago and I never recovered.

Ans: A Feedback: One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs. Describing what the colleague saw may be very helpful to him or her. ìThat is horrible,î is a judgment and is not likely to be helpful. ìWhy did you perform CPR,î might make the colleague feel defensive. ìI know how you feel; the same thing happened to me several years ago and I never recovered,î is nonsupportive and robs the colleague of any hope that he or she will recover.

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

Ans: A Feedback: Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.

Which of the following disorders involves problems with forming sounds associated with speech? A) Phonologic disorder B) Mixed receptiveñexpressive language disorder C) Expressive language disorder D) Stuttering

Ans: A Feedback: Phonologic disorder involves problems with articulation. Mixed receptiveñexpressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language. Stuttering is a disturbance of the normal fluency and time patterning of speech.

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

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

A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon? A) Increased impulsivity or hyperactive behavior B) Lack of appetite for lunch C) Sleepiness or drowsiness D) Social isolation from peers

Ans: A Feedback: Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. Giving stimulants during daytime hours usually effectively combats insomnia.

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

Ans: A Feedback: Self-monitoring is a cognitiveñbehavioral technique designed to help clients with bulimia. The nurse encourages clients to keep a diary of all food eaten throughout the day, including binges, and to record moods, emotions, thoughts, circumstances, and interactions surrounding eating and binging or purging episodes. In this way, clients begin to see connections between emotions and situations and eating behaviors. The nurse can then help clients to develop ways to manage emotions such as anxiety by using relaxation techniques or distraction with music or another activity.

A client is admitted for major depression. What should the nurse expect to find during assessment? A) Anhedonia, feelings of worthlessness, and difficulty focusing B) Depressed mood, guilt, and pressured speech C) Changes in sleep pattern, tired, and grandiose mood D) Difficulty focusing, feelings of helplessness, and flight of ideas

Ans: A Feedback: Symptoms of major depressive disorder include depressed mood; anhedonism (decreased attention to and enjoyment from previously pleasurable activities); unintentional weight change of 5% or more in a month; change in sleep pattern; agitation or psychomotor retardation; tiredness; worthlessness or guilt inappropriate to the situation (possibly delusional); difficulty thinking, focusing, or making decisions; or hopelessness, helplessness, and/or suicidal ideation. Grandiose mood, pressured speech, and flight of ideas are associated with mania.

A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client? A) Tacrine (Cognex) B) Memantine (Namenda) C) Donepezil (Aricept) D) Rivastigmine (Exelon)

Ans: A Feedback: Tacrine (Cognex) is a cholinesterase inhibitor; however, it elevates liver enzymes in about 50% of clients using it. Lab tests to assess liver function are necessary every 1 to 2 weeks; therefore, tacrine is rarely prescribed. Memantine (Namenda) is an NMDA receptor antagonist that can slow the progression of Alzheimer's in the moderate or severe stages. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) are cholinesterase inhibitors and have shown modest therapeutic effects and temporarily slow the progress of dementia.

The police find a woman wandering around a parking lot, singing very loudly. They bring her to the hospital; she has no knowledge of what she has been doing for the past 12 hours and is dressed in unfamiliar clothing. This is an example of A) dissociation. B) manipulation. C) psychosis. D) regression.

Ans: A Feedback: The client experienced a temporary alteration in conscious awareness. This situation is not an example of manipulation. The woman is not experiencing psychosis. Regression occurs when there is a retreat to an earlier stage of development and comfort.

A concerned family member tells the nurse, ìI am concerned about my brother. He has been acting very different lately.î Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder? A) Taking unnecessary risks B) Sleeping more C) Intense focus D) Showing low self-esteem

Ans: A Feedback: The diagnosis of a manic episode or mania requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments.

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

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

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

Ans: A Feedback: The nurse must set limits on unacceptable behavior at the beginning of treatment. Limit setting involves three steps: (1) informing clients of the rule or limit; (2)explaining the consequences if clients exceed the limit; and (3) stating expected behavior.

A client who is manic states, ìWhat time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?î Which would be the most appropriate response by the nurse? A) ìPlease slow down. I'm not sure what you need first.î B) ìYou will have to be quiet and have breakfast after the doctor comes.î C) ìAre you hungry?î D) ìYour thoughts seem to be racing this morning.î

Ans: A Feedback: The speech of manic clients may be pressured: rapid, circumstantial, rhyming, noisy, or intrusive with flights of ideas. The nurse must keep channels of communication open with clients, regardless of speech patterns. The nurse can say, ìPlease speak more slowly. I'm having trouble following you.î This puts the responsibility for the communication difficulty on the nurse rather than on the client.

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

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

Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide? A) The relative's suicide offers a sense of ìpermissionî or acceptance of suicide as a method of escaping a difficult situation. B) Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation. C) Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation. D) The relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.

Ans: A Feedback: Those with a relative who committed suicide are at increased risk for suicide: the closer the relationship, the greater the risk. One possible explanation is that the relative's suicide offers a sense of ìpermissionî or acceptance of suicide as a method of escaping a difficult situation. Treatment with antidepressants and spring increase in sunlight and energy may give a person with suicidal ideation the energy to act on it. If a relative commits suicide, the family members may recognize that suicide is emotionally harmful to the ones left behind and vow not to consider suicideóthis does not increase the risk of suicide.

The nurse is identifying outcomes for a client with a somatic symptom illness. Which is an appropriate outcome to include in the plan of care? A) The client will verbally express his or her emotions. B) The client will be free from stress. C) The client will demonstrate alternative ways to avoid stressful situations. D) The client will verbalize acceptance of physical symptoms.

Ans: A Feedback: Treatment outcomes for clients with a somatic symptom illness may include the following: the client will identify the relationship between stress and physical symptoms; the client will verbally express emotional feelings; the client will follow an established daily routine; the client will demonstrate alternative ways to deal with stress, anxiety, and other feelings; the client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake. It is unrealistic for the client to be free from stress or avoid stressful situations.

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which of the following is typical of these symptoms? A) Alcohol withdrawal syndrome B) Continuing intoxication C) Delirium tremens D) WernickeñKorsakoff syndrome

Ans: A Feedback: Withdrawal from alcohol produces shakiness, weakness, diaphoresis, and GI symptoms. These are not symptoms of continuing intoxication. Delirium tremens produce hypertension, delusions, hallucinations, and agitated behavior. Wernicke-Korsakoff syndrome is a type of dementia caused by long-term, excessive alcohol intake that results in a chronic thiamine or vitamin B6 deficiency.

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, ìI had a stomachache and felt like vomiting. I couldn't help it. I was just so mad at my dad.î Which would be the most appropriate response by the nurse? A) I can see that you're angry. Let's look at better ways to express it. B) I can understand your anger, but you can't disrupt the classroom. C) If you can get rid of your anger, perhaps your stomachache will go away. D) Perhaps it would be helpful if you let your dad know you're angry.

Ans: A Feedback:A child at this age may have difficulty expressing negative or intense emotions verbally; the nurse's response helps teach the child appropriate expressions of anger.

The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment? A) Plan for the same caregivers to provide care to individuals as much as possible. B) Open the windows and doors to allow fresh air to circulate through the environment. C) Provide a buffet-style menu with many food choices. D) Assign peer-led exercise activates on a daily basis.

Ans: A Feedback:A structured environment and established routines can reassure clients with dementia. Familiar surroundings and routines help to eliminate some confusion and frustration from memory loss. Providing the same caregiver establishes familiarity and routine. Safety considerations involve protecting against injury, meeting physiologic needs, and managing risks posed by the environment. Open doors pose a safety risk of wandering away. Buffet-style meals require the client to make too many choices, thus adding to frustration. The nurse encourages clients to engage in physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

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

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

A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. Which would this be a symptom of? A) Agnosia B) Amnesia C) Apraxia D) Aphasia

Ans: A Feedback:Agnosia is the inability to recognize familiar objects. Amnesia is failure to remember past events. Apraxia is impairment in the ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function.

The nurse is discussing the principles of 12-step programs for recovery with a client. Which statement is consistent with the principles of 12-step programs? A) The client will need to abstain from all substances for successful recovery. B) Once sober, the person can safely return to life as it was before becoming addicted. C) The prognosis for recovery is enhanced with the aid of maintenance medications. D) Recovery requires adherence to a plan of achieving long-term goals.

Ans: A Feedback:Alcoholics Anonymous (AA) developed the 12-step program model for recovery, which is based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety. Key slogans reflect the ideas in the 12 steps, such as ìone day at a timeî (approach sobriety one day at a time), ìeasy does itî (don't get frenzied about daily life and problems), and ìlet go and let Godî (turn your life over to a higher power).

Which is believed to be a risk factor specific to the development of delirium? A) Increased severity of physical illness B) Older age C) Baseline cognitive impairment D) Gradual decline in functioning

Ans: A Feedback:An estimated 10% to 15% of people in the hospital for general medical conditions are delirious at any given time. Onset is sudden. Delirium is common in older, acutely ill clients. Risk factors for delirium include increased severity of physical illness, older age, and baseline cognitive impairment such as that seen in dementia. Children may be more susceptible to delirium, especially that related to a febrile illness or certain medications such as anticholinergics. Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of a day. Prevalence of dementia also rises with age, and progression is gradual.

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

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

A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.

Ans: A Feedback:By the time the child starts school, symptoms of ADHD begin to interfere significantly with behavior and performance. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed. Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets homework assignments, and fails to follow directions. Socially, peers may ostracize or even ridicule the child for his or her behavior. The child often loses necessary things.

A client yells at the nurse, ìYou are all quacks! Can't you see I am sick?î Which knowledge would help the nurse to work most effectively with this client? A) Client progress is expected to be very slow B) Physical illness is the root of the client's problems. C) The client will never be free of somatic symptoms. D) The nurse has done everything possible to treat the client.

Ans: A Feedback:Clients who cope through physical symptoms can be frustrating for the nurse. Initially, they are unwilling to consider that anything other than major physical illness is the root of all their problems. The client's progress is slow and painstaking, if any change happens at all. The nurse should be realistic about the small successes that can be achieved in any given period. To enhance the ongoing relationship, the nurse must be able to accept the client and his or her continued complaints and criticisms while remaining nonjudgmental.

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

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

Which of the following medications rarely causes extrapyramidal side effects (EPS)? A) Ziprasidone (Geodon) B) Chlorpromazine (Thorazine) C) Haloperidol (Haldol) D) Fluphenazine (Prolixin)

Ans: A Feedback:First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs.

Which individual is at highest risk for committing suicide? A) A 71-year-old male, alcohol user, independent minded B) A 16-year-old female, diabetic, two best friends C) A 47-year-old male, schizophrenic, unemployed D) A 57-year-old female, depression, active in church

Ans: A Feedback:In the United States, men commit approximately 72% of suicides, which is roughly three times the rate of women, although women are four times more likely than men to attempt suicide. Adults older than age 65 years compose 10% of the population but account for 25% of suicides. Suicide is the second leading cause of death (after accidents) among people 15 to 24 years of age. Clients with psychiatric disorders, especially depression, bipolar disorder, schizophrenia, substance abuse, posttraumatic stress disorder, and borderline personality disorder, are at increased risk for suicide. Chronic medical illnesses associated with increased risk for suicide include cancer, HIV or AIDS, diabetes, cerebrovascular accidents, and head and spinal cord injury. Environmental factors that increase suicide risk include isolation, recent loss, lack of social support, unemployment, critical life events, and family history of depression or suicide.

For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders? A) It is much more difficult to diagnose psychiatric disorders in children and adolescents. B) It is not necessary because psychiatric disorders do not occur in children and adolescents. C) Children and adolescents experience some of the same mental health problems as adults. D) Psychiatric disorders in children manifest themselves very quickly.

Ans: A Feedback:It is much more difficult to diagnose psychiatric disorders in children and adolescents. Many of the same psychiatric disorders that affect adults also occur in children and adolescents, but because psychiatric disorders in children are difficult to diagnose, they do not manifest themselves very quickly.

A middle-aged client goes to the physician falsely complaining of hip pain. The client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis? A) Malingering B) Hypochondriasis C) Factitious disorder D) Munchausen's syndrome by proxy

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

A client is readmitted to the detox unit for the fourth time in 3 years. The nurse states in the morning report, ìNot again! Why should we keep trying to help this guy? He obviously doesn't want it.î What does this statement reflect? A) The nurse lacks the self-awareness to work effectively with this addicted client. B) The nurse understands the cycle of remission and relapse characteristic of addiction. C) The nurse has repressed negative emotions from past experiences with addiction. D) The nurse is trying to conceal his or her own addictions.

Ans: A Feedback:Many clients experience periodic relapses. For some, being sober is a lifelong struggle. The nurse may become cynical or pessimistic when clients return for multiple attempts at substance use treatment. Such thoughts as ìhe deserves health problems if he keeps drinkingî or ìshe should expect to get hepatitis or HIV infection if she keeps doing intravenous drugsî are signs that the nurse has some self-awareness problems that prevent him or her from working effectively with clients and their families. It is not appropriate to assume that the nurse is trying to conceal his or her own addictions.

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

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

A newly graduated nurse is scheduled to take the NCLEX-RN examination in 3 days. On awakening today, the graduate cannot see anything at all but tells fellow classmates, ìOh, don't worry; it will all work out.î Which might this statement result from? A) La belle indifference B) Regression C) Malingering D) Undoing

Ans: A Feedback:People with a conversion disorder may be seemed to lack concern or distress about the functional loss. This is called la belle indifference. Regression would be when the person reverted to a previous level of functioning. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. This is not an example of undoing.

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

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

Which of the following groups could benefit most from prevention programs? A) Children, prior to first use B) Adults who have already engaged in substance abuse C) Older adults D) Infants

Ans: A Feedback:Poor outcomes have been associated with an earlier age at onset and longer periods of substance use. Children who have not yet used substances may be easily influenced because of their age and the fact that they have not already become addicted. Adults who have already engaged in substance abuse will not benefit as greatly from prevention programs as will children. Older adults will not benefit as greatly from prevention programs as will children. Infants will not benefit from prevention programs as they do not have self-efficacy.

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time? A) Accompany the client to his or her room to get dressed. B) Put the client in seclusion for his or her own protection. C) Tell other clients to ignore the behavior because it is harmless. D) Tell the client that the behaviors have to stop right now.

Ans: A Feedback:Redirecting the client to appropriate behavior without confrontation is most effective. Seclusion is not an appropriate intervention for this situation. Ignoring the behavior is not indicated. The client is in the manic phase; telling him or her to stop the behavior may make the behaviors escalate.

The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. Which best describes the usefulness of viewing photos when caring for the dementia client? A) Viewing photos is a form of reminiscence therapy for the client. B) Sharing photos will encourage interaction with other clients. C) This can help the children to correctly identify old photographs. D) Talking about the photos will encourage the client to live in the past.

Ans: A Feedback:Reminiscence therapy (thinking about or relating personally significant past experiences) is an effective intervention for clients with dementia. Rather than lamenting that the client is ìliving in the past,î this therapy encourages family and caregivers also to reminisce with the client. Reminiscing uses the client's remote memory, which is not affected as severely or quickly as recent or immediate memory. Photo albums may be useful in stimulating remote memory, and they provide a focus on the client's past.

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching? A) We'll have him do his homework at the kitchen table with his brothers and sisters. B) We'll make sure he completes one task before going on to another. C) We'll set up rules with specific times for eating, sleeping, and playing. D) We'll use simple, clear directions and instructions.

Ans: A Feedback:The child with ADHD cannot accomplish complex tasks, such as homework, in a noisy or chaotic setting where there are a lot of distractions. The other choices do not indicate the need for further teaching.

A client who is depressed states, ìI think my family would be better off without me. They don't need to worry.î Which would be the most appropriate response by the nurse? A) ìAre you planning to commit suicide?î B) ìWhat do you think they are worried about?î C) ìWhere are you going?î D) ìYou don't mean that. Your family loves you.î

Ans: A Feedback:The nurse never ignores any hint of suicidal ideation regardless of how trivial or subtle it seems and the client's intent or emotional status. Asking clients directly about thoughts of suicide is important.

The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristics would the nurse identify as a significant risk factor? A) One parent who is an alcoholic B) Parents who practiced strict discipline C) Overprotective parents D) Being raised in an urban area

Ans: A Feedback:The strongest indication of risk factors comes from studies that indicate children of alcoholic parents are four times as likely to develop alcoholism that of nonalcoholic parents. Some theorists also believe that inconsistency in the parent's behavior, poor role modeling, and lack of nurturing pave the way for the child to adopt a similar style of maladaptive coping, stormy relationships, and substance abuse. Others hypothesize that even children who abhorred their family lives are likely to abuse substances as adults because they lack adaptive coping skills and cannot form successful relationships. Urban areas where drugs and alcohol are readily available also have high crime rates, high unemployment, and substandard school systems that contribute to high rates of cocaine and opioid use and low rates of recovery.

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

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

The client with mania attempts to hit the nurse. Which is the best response by the nurse? A) ìDo not swing at me again. If you cannot control yourself, we will help you.î B) ìIf you do that one more time, you will be put in seclusion immediately.î C) ìStop that. I didn't do anything to provoke an attack.î D) ìWhy do you continue that kind of behavior? You know I won't let you do it.î

Ans: A Feedback:This response firmly states behavioral expectations and lets the client know his behavior will be safely controlled if he is unable to do so. The other choices are not appropriate responses to this situation.

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first? A) Decrease the client's environmental stimuli. B) Give the client feedback about his behavior. C) Introduce the client to other staff on the unit. D) Tell the client about hospital rules and policies.

Ans: A Feedback:When the client is agitated, decreasing stimuli is the priority. Answer choices A, B, and C are not priority interventions.

The nurse is coleading a family therapy group with a client addicted to alcohol. Which statement made by the wife indicates the need for additional education regarding alcoholism as a family illness? A) I have to call in sick for my husband when he is too hung over to go to work. B) The Last time he got arrested, I just let him sit in jail. C) We have separated our finances so that I will not go broke. D) I take my kids with me to Al-anon meetings every week.

Ans: A Feedback: Alcoholism (and other substance abuse) often is called a family illness. One type of codependent behavior is called enabling, which is a behavior that seems helpful on the surface but actually perpetuates the substance use. Family members should be referred to Al-anon 12-step self-help groups.

Which of the following is true about the use of touch with a client with dissociative identity disorder? A) It is best not to touch the client without his or her permission. B) Make sure the client knows the touch is friendly and supportive. C) Touch the client only if you are in his or her direct line of vision. D) Touching will convey a sense of security to the client.

Ans: A Feedback: Clients interpret touch differently, so it is important to assess each client's comfort with being touched; these clients often have a history of abuse, so permission should be given before touch is used.

When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods

Ans: A Feedback: Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine- containing foods.

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

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

Which of the following should be an action of a nurse who is having feelings of judgment regarding a client's contributory behavior to an automobile accident that resulted in deaths? A) Discussing the nurse's personal feelings with a peer or a counselor B) Acknowledging the judgment regarding the client's contributory behavior to the client C) Sharing the client's horror and encouraging him or her to avoid thinking about it D) Letting the client know that he or she is now traumatized beyond repair

Ans: A Feedback: When the traumatized client causes a car accident that injured or killed others, it may be more challenging to provide unconditional support and withhold judgment of the client's contributory behavior. Remaining nonjudgmental of the client is important, but does not happen automatically. The nurse may need to deal with personal feelings by talking to a peer or counselor. If the nurse is overwhelmed by the violence or death in a situation, the client's feelings of being victimized to traumatized beyond repair are confirmed. Conveying empathy and validating client's feelings and experiences in a calm, yet caring professional, manner are more helpful than sharing the client's horror.

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

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

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

Ans: A, B, C Feedback: Limit setting is an effective technique that involves three steps:1. Stating the behavioral limit (describing the unacceptable behavior)2. Identifying the consequences if the limit is exceeded3. Identifying the expected or desired behaviorProviding choices and allowing flexibility would be counterproductive as the expectations must be consistent.

Which are actions of the parents of a child with conduct disorders that may contribute to the problems of the child? Select all that apply. A) The parents may not behave appropriately themselves because of a lack of knowledge. B) The parents blame the school when the child causes a disturbance in school and receives detention. C) The parents engage in yelling at, hitting, or simply ignoring the behavior of their child. D) The parents make reasonable curfews that are appropriate for the age of the client. E) The parents establish household responsibilities that are appropriate for the age of the client.

Ans: A, B, C Feedback: Parents may also need help in learning social skills, solving problems, and behaving appropriately. Often, parents have their own problems, and they have had difficulties with the client for a long time before treatment was instituted. Parents need to replace old patterns such as yelling, hitting, or simply ignoring behavior with more effective strategies. The nurse can teach parents age-appropriate activities and expectations for clients such as reasonable curfews, household responsibilities, and acceptable behavior at home. Some parents may need to let clients experience the consequences of their behavior rather than rescuing them.

For which reasons is it more difficult to diagnose psychiatric disorders in children than in adults? Select all that apply. A) Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. B) Because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. C) Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level. D) Sometimes, children ìoutgrowî psychiatric disorders. E) Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults.

Ans: A, B, C Feedback: Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. Because they are constantly changing and developing, children have limited sense of a stable, normal self to allow them to discriminate unusual or unwanted symptoms from normal feelings and sensations. Additionally, behaviors that are normal in a child of one age may indicate problems in a child of another age. Sometimes the manifestations of psychiatric disorders in adults are less of a problem than they were for the child at a younger age, but this does not make it more difficult to diagnose psychiatric disorders in children than in adults. Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults, but this does not make it more difficult for children to be diagnosed.

A fireman survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which of the following as positive outcomes for this client? Which will the nurse evaluate as positive outcomes for this client? Select all that apply. A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community. D) The client will report nightmares and flashbacks of the fire.

Ans: A, B, C Feedback: Treatment outcomes for clients who have survived trauma or abuse may include verbalizing feelings, expressing emotions nondestructively, and establishing a social support system in the community. An absence of stress is an unrealistic outcome. Reporting symptoms of PTSD such as nightmares and flashbacks does not indicate positive treatment outcomes.

A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal D) Feeling mildly anxious E) Occurs 2 weeks after the trauma

Ans: A, B, C Feedback:The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. Feeling mildly anxious is not a major element of PTSD as the person is likely to feel very anxious. Occurring 2 weeks after the trauma would likely be acute stress disorder as PTSD symptoms occur 3 months or more after the trauma.

Which are the factors that are currently considered to be possible reasons for the increased incidence of somatization in women? Select all that apply. A) Boys in the United States are taught to be stoic and to take it like a man, causing them to offer fewer physical complaints as adults. B) Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. C) Childhood sexual abuse, which is related to somatization, happens more frequently to girls. D) Women more often receive treatment for psychiatric disorders with strong somatic components such as depression. E) Unexplained female pains result from migration of the uterus throughout the woman's body.

Ans: A, B, C, D Feedback: Somatization is associated most often with women, as evidenced by the old term hysteria (Greek for ìwandering uterusî). Ancient theorists believed that unexplained female pains resulted from migration of the uterus throughout the woman's body. Psychosocial theorists posit that increased incidence of somatization in women may be related to various factors: ï Boys in the United States are taught to be stoic and to ìtake it like a man,î causing them to offer fewer physical complaints as adults.ï Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. ï Childhood sexual abuse, which is related to somatization, happens more frequently to girls.ï Women more often receive treatment for psychiatric disorders with strong somatic components such as depression.

Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply. A) Negative societal view of suicide B) Feeling inadequate and anxious about suicide and/or his or her own mortality C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety D) Being unaware of his or her own feelings and beliefs about suicide E) Implementing nursing interventions to decrease the risk of suicide

Ans: A, B, C, D Feedback: Some health-care professionals consider suicidal people to be failures, immoral, or unworthy of care. These negative attitudes may result from several factors. They may reflect society's negative view of suicide. Health-care professionals may feel inadequate and anxious dealing with suicidal clients, or they may be uncomfortable about their own mortality. Many people have had thoughts about ìending it all,î even if for a fleeting moment when life is not going well. The scariness of remembering such flirtations with suicide causes anxiety. If this anxiety is not resolved, the staff person can demonstrate avoidance, demeaning behavior, and superiority to suicidal clients. Therefore, to be effective, the nurse must be aware of his or her own feelings and beliefs about suicide.

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

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

Which of the following are possible with psychosomatic illness? Select all that apply. A) Real symptoms can begin. B) Real symptoms can continue. C) Real symptoms can worsen. D) Unrelated symptoms can occur. E) Clients can control these symptoms.

Ans: A, B, C, D Feedback: The term psychosomatic is used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness. Essentially, the mind can cause the body to create physical symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a result of emotional factors. Examples include diabetes, hypertension, and colitis, all of which are medical illnesses influenced by stress and emotions. In addition, stress can cause physical symptoms unrelated to a diagnosed medical illness. Clients do not willfully control the physical symptoms.

Which statements are important reasons for why the problem of substance abuse must be addressed? Select all that apply. A) Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. B) Chemical abuse results in increased violence. C) Drug abuse costs business and industry an estimated $102 billion annually. D) Alcohol abuse is a too frequent cause of or contributor to death. E) Substance abuse is decreasing.

Ans: A, B, C, D Feedback:Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. Chemical abuse results in increased violence. Drug abuse costs business and industry an estimated $102 billion annually. Alcohol abuse is a too frequent cause of or contributor to death. Substance use/abuse and related disorders are a national health problem.

Which reasons make it necessary for the nurse to examine his or her beliefs and attitudes about substance abuse? Select all that apply. A) The nurse may be overly harsh and critical of the client. B) The nurse may unknowingly act out old family roles and engage in enabling behavior. C) The nurse or close friends and family of the nurse may abuse substances. D) The nurse may have different attitudes about various substances of abuse. E) The nurse is not likely to have had any experience with substance abuse.

Ans: A, B, C, D Feedback:The nurse must examine his or her beliefs and attitudes about substance abuse. A history of substance abuse in the nurse's family can strongly influence his or her interaction with clients. The nurse may be overly harsh and critical. Conversely, the nurse may unknowingly act out old family roles and engage in enabling behavior. Examining one's own substance use or use by close friends and family may be difficult and unpleasant but is necessary if the nurse is to have therapeutic relationships with clients. The nurse also might have different attitudes about various substances of abuse. Health-care professionals also have higher rates of alcoholism than the general population. With the pervasive nature of substance abuse nationally, odds are great that nurses and other health professionals have been affected by substance abuse in their lives.

Which are general warning signs of substance abuse that a nurse should be alert for in coworkers? Select all that apply. A) Poor work performance B) Frequent absenteeism C) Unusual behavior D) Slurred speech E) Isolation from peers F) Substance abuse is not a problem in health professionals

Ans: A, B, C, D, E Feedback: General warning signs of abuse include poor work performance, frequent absenteeism, unusual behavior, slurred speech, and isolation from peers. Physicians, dentists, and nurses have far higher rates of dependence on controlled substances, than other professionals of comparable educational achievement. One reason is thought to be the ease of obtaining controlled substances. Health-care professionals also have higher rates of alcoholism than the general population.

The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply. A) Recent alcohol use B) Dehydration C) Use of antihistamines D) Sleep disturbances E) Use of megadoses of vitamins F) Exposure to paint or gasoline

Ans: A, B, C, D, F Feedback: Because the causes of delirium are often related to medical illness, alcohol, or other drugs, the nurse obtains a thorough history of these areas. The nurse may need to obtain information from family members if a client's ability to provide accurate data is impaired. Information about drugs should include prescribed medications, alcohol, illicit drugs, and over-the-counter medications. Physiologic or metabolic causes include hypoxemia, electrolyte disturbances, renal or hepatic failure, hypoglycemia or hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances, thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency, cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint solvents, insecticides, and related substances. Infectious processes include sepsis, urinary tract infection, pneumonia, meningitis, encephalitis, HIV, and syphilis.

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

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

Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply. A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually. B) The nurse may get little or no positive response or feedback from clients with dementia. C) It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak. D) It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses. E) The clients may seem not to hear or respond to anything the nurse does.

Ans: A, B, C, E Feedback:Working with and caring for clients with dementia can be exhausting and frustrating for both the nurse and caregiver. Teaching is a fundamental role for nurses, but teaching clients who have dementia can be especially challenging and frustrating. These clients do not retain explanations or instructions, so the nurse must repeat the same things continuously. The nurse may begin to feel that repeating instructions or explanations does not good because clients do not understand or remember them. The nurse may get little or no positive response or feedback from clients with dementia. It can be difficult to deal with feelings about caring for people who will never get better and go home. As dementia progresses, clients may seem not to hear or respond to anything the nurse says or does. Remaining positive and supportive to clients and family can be difficult when the outcome is so bleak. The nurse may need to deal with personal feelings of depression and grief as the dementia progresses; he or she can do so by discussing the situation with colleagues or even a counselor, but this is an intervention instead of a source of frustration for the nurse.

Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women

Ans: A, B, D Feedback: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast tenderness in men and women is also a potential side effect of antipsychotic drugs that cause elevated prolactin levels, but it is not an extrapyramidal symptom.

Which are characteristics of intermittent explosive disorder (IED)? Select all that apply. A) The episode may occur with seemingly no warning. B) They usually last less than 30 minutes. C) Afterward, the person with IED will not have any remorse. D) It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts. E) The intensity of the emotional outburst is usually within proportion to the stressor or situation.

Ans: A, B, D Feedback: Intermittent explosive disorder (IED) involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. During these episodes, there may be physical injury to others, destruction of property, and injury to the individual as well. The intensity of the emotional outburst is grossly out of proportion to the stressor or situation. The episode may occur with seemingly no warning. Afterward, the individual may be embarrassed and feel guilty or remorseful for his or her actions, but that does not prevent future impulsive, aggressive outbursts.

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

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

Which may be concerns that a nurse has when caring for clients who have conduct disorders? Select all that apply. A) Thinking that the client should be able to refrain from hostility and aggression through use of will power. B) Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude. C) Discussing feelings, fears, or frustrations with colleagues. D) Having anxiety and fears for the nurse's personal safety. E) Believing that aggression is the most productive way to deal with aggression.

Ans: A, B, D Feedback:The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse may also have personal feelings about the disruptive and/or aggressive behaviors, such as thinking the client should be able to refrain from hostility and aggression through use of will power. It can be difficult to reconcile holding clients accountable for their behaviors, but avoiding a purely punitive attitude. Working with aggressive clients of any age may provoke anxiety and fears for personal safety in the nurse. It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression.

A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental health crisis unit for further evaluation. Which of the following are the man most likely suffering from? Select all that apply. A) Depersonalization disorder B) Dissociative identity disorder C) Repressed memories D) Dissociative amnesia E) False memory syndrome

Ans: A, B, D Feedback:With dissociative amnesia, the client cannot remember important personal information. With dissociative personality disorder, the client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. With depersonalization disorder, the client has persistent or recurring feeling of being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream-like state where the environment seems foggy or unreal (derealization). The client is not psychotic or out of touch with reality. Repressed memories are when a person is unable to consciously recall memories of childhood abuse. False memory syndrome can occur during psychotherapy when the client is encouraged to imagine false memories of childhood sexual abuse.

Which steps are involved in limit setting? Select all that apply. A) State expected behavior. B) Inform clients or the rule or limit. C) Threaten incarceration. D) Explain the consequences if clients exceed the limit. E) Occasionally limit enforcement.

Ans: A, B, D Feedback: Limit setting involves three steps:1. Inform clients of the rule or limit.2. Explain the consequences if clients exceed the limit.3. State expected behavior.Threatening the client with incarceration is not likely effective. Providing consistent limit enforcement with no exceptions by all members of the health-care team, including parents, is essential.

Which of the following are common coexisting psychiatric disorders for adults with ADHD? Select all that apply. A) Social phobia B) Bipolar disorder C) Obsessiveñcompulsive disorder D) Major depression E) Alcohol dependence

Ans: A, B, D, E Feedback: Approximately 70% to 75% of adults with ADHD have at least one coexisting psychiatric diagnosis, with social phobia, bipolar disorder, major depression, and alcohol dependence being the most common.

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

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

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

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

The nurse is coleading a family therapy group for clients and families of drug-addicted individuals. The family of a cocaine addict is angry and cannot understand why the client cannot just stop using. The nurse guides the group to discuss their understanding of the nature of addiction. Which statements would the nurse identify as an accurate understanding of the nature of addiction? Select all that apply. A) It is a medical illness that is progressive. B) The client will eventually be cured. C) Relapses and remissions are part of the illness. D) Clients can learn to get control over the substance.

Ans: A, C Feedback:Alcoholism (and other substance abuse) often is called a family illness. All those who have a close relationship with a person who abuses substances suffer emotional, social, and sometimes physical anguish. Client and family members need facts about the substance, its effects, and recovery. The nurse must dispel myths and misconceptions such as, ìIt's a matter of will power,î ìI can't be an alcoholic if I only drink beer or if I only drink on weekends,î ìI can learn to use drugs socially,î or ìI'm okay now; I could handle using once in a while.î

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

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

The nurse is assessing a 16-month-old child during a well-baby checkup. Which of the following behaviors would be consistent with autism spectrum disorder? Select all that apply. A) The child displays little eye contact with others. B) The child thrives on changes in routine. C) The child makes few facial expressions toward others. D) The child does not like repetition. E) The child answers questions verbally.

Ans: A, C, D Feedback:Children with autism display little eye contact with and make few facial expressions toward others; they use limited gestures to communicate. They have limited capacity to relate to peers or parents. They lack spontaneous enjoyment, express no moods or emotional affect, and cannot engage in play or make-believe with toys. There is little intelligible speech. These children engage in stereotyped motor behaviors such as hand flapping, body twisting, or head banging.

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

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

Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply. A) After starting antidepressant therapy but not having reached the therapeutic level B) After having reached the therapeutic level of antidepressants and maintained it for several years C) If the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed D) If the client does not adhere to the medication regimen and takes antidepressant medications irregularly E) Prior to initiating antidepressant therapy but before the depression results in lack of energy

Ans: A, C, D, E Feedback: After starting antidepressant therapy but not having reached the therapeutic level, the client is still troubled with depression and may have the energy to execute any suicide ideation. If the client has made the choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed does not adhere to the medication regimen and takes antidepressant medications irregularly, or prior to initiating antidepressant therapy but before the depression results in lack of energy, the client may be motivated to commit suicide because of the depression that is not effectively treated by a therapeutic level of antidepressant medications and yet still have enough energy to execute any suicide ideation. After having reached the therapeutic level of antidepressant medications and having maintained it for several years, the client is not likely at an increased risk for suicide.

Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply. A) Being a survivor of a tsunami that resulted in thousands of deaths B) Being stranded at the office during a typical winter storm that was anticipated C) Being a marine in a combat situation where the entire platoon was wiped out except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11

Ans: A, C, D, E Feedback: Examples of events that may cause PTSD include someone experiencing, witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or an assault. The person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine in a combat situation where the entire platoon was wiped out except for one person, and being hidden in a closet and hearing the entire family murdered by someone who broke into the house would be situations where the person was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror.

Which are most likely included in the history of a child with conduct disorder? Select all that apply. A) Disturbed relationships with peers B) Major antisocial violations C) Aggression toward people or animals D) Destruction of property E) Serious violation of rules

Ans: A, C, D, E Feedback: Children with conduct disorder have a history of disturbed relationships with peers, aggression toward people or animals, destruction of property, deceitfulness or theft, and serious violation of rules (e.g., truancy, running away from home, and staying out all night without permission). Major antisocial violations would be indicative of antisocial behavior.

Which of the following would be important circumstances to gather assessment data for a child with ADHD? Select all that apply. A) Direct observation of the child B) Reviewing the client's record C) Interviewing the client's parents D) Interviewing the client's teachers E) Assessing the client in a group of peers

Ans: A, C, D, E Feedback:During assessment, the nurse gathers information through direct observation and from the child's parents, day care providers (if any), and teachers. Assessing the child in a group of peers is likely to yield useful information because the child's behavior may be subdued or different in a focused one-to-one interaction with the nurse. Reviewing the client's record will not yield much assessment data.

A child has been displaying behaviors associated with conduct disorder. The nurse should further assess for which common risk factors seen in children with conduct disorder. Select all that apply. A) Poor family functioning B) Strict disciplinary practices C) Family history of substance abuse D) Possible child abuse E) Poverty conditions

Ans: A, C, D, E Feedback:Risk factors include poor parenting, low academic achievement, poor peer relationships, low self-esteem, poor family functioning, marital discord, family history of substance abuse and psychiatric problems, child abuse, inconsistent parental responses, exposure to violence in the media, and community socioeconomic disadvantages such as inadequate housing, crowded conditions, and poverty. Protective factors include resilience, family support, positive peer relationships, and good health.

Psychosomatic illness refers to physical symptoms that are either created or worsened by psychic influences. Which conditions are thought to be attributed to the connection between mind and body? Select all that apply. A) Diabetes B) Arthritis C) Hypertension D) Headache E) Colitis

Ans: A, C, D, E Feedback:The term psychosomatic is used to convey the connection between the mind (psyche) and the body (soma) in states of health and illness. Essentially, the mind can cause the body to create physical symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a result of emotional factors. Examples include diabetes, hypertension, and colitis, all of which are medical illnesses influenced by stress and emotions. In addition, stress can cause physical symptoms unrelated to a diagnosed medical illness such as ìtension headaches.î

The parents of a child with ADHD express to the nurse, ìWe get so frustrated when our son never minds us.î Which parenting strategies should the nurse discuss with the parents? Select all that apply. A) Use time-out for behavior control. B) Provide occasional rewards and consequences for behavior. C) Give verbal reprimands for negative behavior. D) Resist giving praise until fully compliant with requests. E) Use a point system for positive and negative behavior.

Ans: A, C, E Feedback: Educating parents and helping them with parenting strategies are crucial components of effective treatment of ADHD. Effective approaches include providing consistent rewards and consequences for behavior, offering consistent praise, using time-out, and giving verbal reprimands. Additional strategies are issuing daily report cards for behavior and using point systems for positive and negative behavior.

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

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

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

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

The nurse is caring for a client with cognitive impairment. To determine whether the client is suffering from delirium or dementia, the nurse reviews the symptoms and course of each disorder. Place the letter ìAî beside terms describing delirium and the letter ìBî beside terms describing dementia. Rapid onset Progressive decline Long-term memory impairment Slurred speech Hallucinations

Ans: A,B,B,A,A Feedback: Onset of delirium is rapid, but of dementia is gradual. Duration of delirium is brief, but of dementia is progressing. Delirium affects only short-term memory. Dementia begins with short-term memory loss and progresses to long-term memory loss. Slurred speech is characteristic of delirium. Speech with dementia is unchanged until the client begins to develop aphasia. Visual and tactile hallucinations are common with delirium, but rarely experienced with dementia.

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

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

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

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

The husband of a client with hypochondriasis has accompanied his wife to the follow-up doctor's visit. While waiting for the doctor, the husband expresses to the nurse his frustration with his wife's obsession about illness. He asks the nurse, ìWhat can I do?î The best response by the nurse would be, A) Try ignoring her complaints, and they should subside. B) Try finding an activity you enjoy doing together to help her feel better overall. C) Try to be the client and understand that she is worried that she is sick. D) Try to give her some sort of reward when she resists complaining about her illnesses.

Ans: B Feedback: Building a trusting relationship with the client, providing empathy and support, and being sensitive to rather than dismissive of complaints are skills that the nurse can use in any setting where clients are seeking assistance. Encouraging clients to find pleasurable activities or hobbies may help to meet their needs for attention and security.

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

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

The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that his relationship with the client was codependent and enabling. Which is an example of codependent behavior? A) The friend called Alcoholics Anonymous when the client expressed a need to stop drinking. B) The friend called the client every night to make sure he got home safely and went looking for him if he was not at home. C) The friend confronted the client on the effect of his drinking on their relationship. D) The friend refused to go out drinking with the client to celebrate the client's birthday.

Ans: B Feedback: Codependent behavior appears helpful on the surface but actually prolongs the drinking behavior. The other choices are not examples of codependent behavior.

An actor has prepared extensively for his first stage production. On the morning of the opening of the play, the actor awakens with laryngitis. From which disorder is the actor most likely suffering? A) Acute upper respiratory infection B) Conversion disorder C) Hysteria D) Somatization disorder

Ans: B Feedback: Conversion disorder, sometimes called conversion reaction, involves unexplained, usually sudden deficits in sensory or motor function (e.g., blindness, paralysis). These deficits suggest a neurologic disorder but are associated with psychological factors. There is usually significant functional impairment. The term hysteria refers to multiple physical complaints with no organic basis; the complaints are usually described dramatically. Somatization disorder is characterized by multiple physical symptoms and includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms.

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

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

A child with ADHD complains to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.

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

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

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

A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include? A) Unlike heroin, methadone is nonaddicting. B) Methadone will meet the physical need for opiates without producing cravings for more. C) Methadone will produce a high similar to heroin. D) People taking methadone run the same risks associated with IV drug use as those taking heroin.

Ans: B Feedback: Methadone, a potent synthetic opiate, is used as a substitute for heroin in some maintenance programs. The client takes one daily dose of methadone, which meets the physical need for opiates but does not produce cravings for more. Methadone does not produce the high associated with heroin. The client has essentially substituted his or her addiction to heroin for an addiction to methadone; however, methadone is safer because it is legal, controlled by a physician, and available in tablet form. The client avoids the risks of intravenous drug use, the high cost of heroin (which often leads to criminal acts), and the questionable content of street drugs.

The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, ìI saw you sitting alone and thought I might keep you company.î The client turns away from the nurse. Which would be the most therapeutic nursing intervention? A) Move to another chair closer to the client and say, ìThe staff is here to help you.î B) Move to a chair a little further away and say, ìWe can just sit together quietly.î C) Remain in place and say, ìHow are you feeling today?î D) Say, ìI'll visit with you a little later,î and leave the client alone for a while.

Ans: B Feedback: Moving away gives the client more personal space; staying with the client indicates acceptance and genuine interest. It is not necessary for the nurse to talk to the client the entire time; rather, silence can convey that clients are worthwhile even if they are not interacting.

Which one of the following statements about educating parents of a child with ADHD is true? A) It is unimportant to educate the family members about ADHD as they already know the problem too well. B) Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. C) It is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents. D) If the child receives special school services under the Individuals with Disabilities Education Act, there is no need for further services.

Ans: B Feedback: Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. Including parents in planning and providing care for the child with ADHD is important. The nurse must listen to the parents' feelings. The education of a child with ADHD is important, but the child is only in school for part of their day. The parents must deal with the child and the other aspects of the child's life at all times.

How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease.

Ans: B Feedback: Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. These conditions previously could be diagnosed only through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests.

Which is the primary gain associated with developing physical symptoms in response to stress? A) Accept dependency B) Decrease anxiety C) Experience attention D) Suppress anger

Ans: B Feedback: Primary gain is always relief of stress, anxiety, or conflicting/unacceptable emotions. They are the direct external benefits that being sick provides, such as relief from anxiety, conflict, or distress.

Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine (Parnate) B) Sertraline (Zoloft) C) Imipramine (Tofranil) D) Phenelzine (Nardil)

Ans: B Feedback: SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound.

A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose

Ans: B Feedback: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause less weight gain than other antidepressants. Dry mouth and nasal passages are common anticholinergic side effects associated with all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychotic medication. Furthermore, sedation is a common side effect of Paxil.

A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, ìI feel like all my work doesn't do them any good.î Which should the nurse's supervisor encourage the nurse to do? A) Cease giving instructions because the clients will not remember them anyway. B) Try to stay supportive and meet the clients' needs at the current moment. C) Seek counseling if personal feelings get in the way of client care. D) Consider transferring to a different client care specialty area.

Ans: B Feedback: Teaching is a fundamental role for nurses, but teaching clients who have dementia can be especially challenging and frustrating. These clients do not retain explanations or instructions, so the nurse must repeat the same things continually.The nurse must be careful not to lose patience and not to give up on these clients. Discussing these frustrations with others can help the nurse to avoid conveying negative feelings to clients and families or experiencing professional and personal burnout. The nurse must remain positive and supportive to clients and family.

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

Ans: B Feedback: Teaching is effective when the client recognizes the need to return to nutritious eating patterns. Answer choices A, C, and D would not be appropriate responses to teaching regarding bulimia nervosa.

The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client? A) A card game with other clients B) An activity with the nurse C) Decorating a bulletin board with the group D) Morning stretch group with music

Ans: B Feedback: The client has to interact only with the nurse, who will behave in a predictable way and will focus on the client's needs, without undue or unexpected disruptions. Group activities do not provide a safe and secure environment like an activity done with the nurse does.

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

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

Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects? A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers

Ans: B Feedback: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.

A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, ìI am so ashamed.î What should the nurse reply? A) I really thought you would make it. B) Tell me what has happened since your last admission. C) You have nothing to be ashamed of. D) Why did you start drinking again?

Ans: B Feedback: This is a therapeutic communication technique designed to help the client talk about himself and his current situation.

The nurse understands that when working with a child with a disruptive behavior disorder, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior. D) Interpret the child's thoughts and feelings to the parent.

Ans: B Feedback: Working with parents is a crucial aspect of dealing with children with these disorders. Parents often have the most influence on how these children learn to cope with their disorders. The nurse can teach parents age-appropriate activities and expectations for clients.

The nurse understands that when working with a child with a mental health problem, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior D) Interpret the child's thoughts and feelings to the parent.

Which client would have an increased risk for delirium? A) An elderly woman with abdominal pain B) A 3-year-old child with a temperature of 103.2F C) A middle-aged woman newly diagnosed with multiple sclerosis D) A young adult male with gastroenteritis and dehydration

Ans: B Feedback: Young children with high fever are at risk for delirium. The other choices would not be the most likely candidates for increased risk for delirium.

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

Ans: B Feedback:Admitting her fears is an initial step in recovery. Accepting herself as having value and worth, following a nutritionally balanced diet, and identifying problems and potential alternative coping strategies are examples of long-term outcomes.

Which characteristic of the 12-step program distinguishes it from other programs? A) The philosophy that it is possible to reduce the use of substances without abstaining. B) It is a self-help group that does not necessarily use health professionals as leaders. C) Persons who use this program are independent in their sobriety. D) Infrequent attendance is usually successful.

Ans: B Feedback:Alcoholics Anonymous (AA) was founded in the 1930s by alcoholics. This self-help group developed the 12-step program model for recovery, which is based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety. Regular attendance at meetings is emphasized.

The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which is the best action for the nurse to take? A) Ask other nurses if they have noticed anything unusual. B) Call the manager and report the observations. C) Observe the nurse as injections are prepared and administered. D) Tell the nurse, I know you've been stealing Valium.

Ans: B Feedback:Any suspicions should be communicated to someone in a supervisory position so that effective action can be taken.

A client who has been discharged home on Celexa (citalopram) calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions? A) Make an appointment to change to a different medication. B) Take the medication at night. C) Be patient while this early side effect subsides. D) Skip a dose if drowsiness is excessive.

Ans: B Feedback:Citalopram (Celexa) causes drowsiness, sedation, insomnia, nausea, vomiting, weight gain, constipation, and diarrhea. Nursing implications for drowsiness and sedation include instructing the client to administer the dose at 6 PM or later.

A peer reports for work looking unkempt and disheveled. Her movements are uncoordinated, and her breath smells like mouthwash. Another nurse suspects this peer is intoxicated. What should be the action of the nurse who suspects that a peer is intoxicated? A) Immediately call the supervisor to report the peer's behavior. B) Ask the peer if she feels alright and express concern. C) Give the peer some information about the hospital's employee assistance program. D) Ignore the situation until someone else validates the observations.

Ans: B Feedback:Client safety is a priority; the impaired nurse should not be caring for clients. After client safety is ensured, the nurse should call the supervisor to handle the situation. It is not the nurse's responsibility to give out information on the hospital's employee assistance program. It is not appropriate to ignore the situation.

A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention? A) Stating, ìThe effects of medications will not last forever. You will need to eventually learn to function without them.î B) Stating, ìMedications help your brain function better, but the therapy helps you achieve lasting behavior change.î C) Stating, ìBoth are recommended. Since your insurance covers both, that is the best plan for you.î D) Asking, ìDo you have reservations about going to therapy?î

Ans: B Feedback:Clients and family should know that treatment outcomes are best when psychotherapy and antidepressants are combined. Psychotherapy helps clients to explore anger, dependence, guilt, hopelessness, helplessness, object loss, interpersonal issues, and irrational beliefs. The goal is to reverse negative views of the future, improve self- image, and help clients gain competence and self-mastery

The husband of a woman with a somatic symptom illness asks the nurse why the doctors cannot find anything wrong with her. Which would be the appropriate explanation for the nurse to offer? A) ìShe is not really experiencing the symptoms. She is making them up to get attention. B) ìThere is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it. C) ìShe controls the symptoms when she isn't feeling much stress. It is hard to diagnose when the symptoms are intermittent. D) ìThere is a physical cause. It just has not been detected yet.

Ans: B Feedback:Clients are convinced they harbor serious physical problems despite negative results during diagnostic testing. They actually experience these physical symptoms as well as the accompanying pain, distress, and functional limitations such symptoms induce. Clients do not willfully control the physical symptoms. Nurses must remember that these clients really experience the symptoms they describe and cannot voluntarily control them.

A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse? A) I am going to take up a new hobby. It's time to start something new. B) I can still hang out with my old friends. I am just not going to use. C) I'm not very comfortable with being alone yet. D) Shooting baskets helps me not think about getting high.

Ans: B Feedback:Clients are likely to have exercised poor judgment. They may still believe they can control the substance use. The nurse can help clients to find ways to relieve stress or anxiety that do not involve substance use. Relaxing, exercising, listening to music, or engaging in activities may be effective. Clients also may need to develop new social activities or leisure pursuits if most of their friends or habits of socializing involved the use of substances. Acknowledging difficulties shows insight into the changes needed for recovery. Assuming that old friends will not be a relapse trigger shows a lack of understanding of the relapse dynamics associated with former leisure activities.

A client is seeking relief for undiagnosed pain. There is no history of significant physical illness. The history reveals that the client was laid off 4 months ago from her job. Which statement made by the client would most strongly suggest a somatoform disorder? A) I have been having a hard time lately. It's hard not working like I'm used to. B) I seem to have more pain now that I got laid off. C) I probably just overexerted myself working around the house. It's hard to slow down. D) I'm sure they will figure out what is wrong with me.

Ans: B Feedback:Clients are unlikely to be able to think about or to respond to questions about emotional feelings. They will answer questions about how they feel in terms of physical health or sensations. For example, the nurse may ask, ìHow did you feel about having to quit your job?î The client might respond, ìWell, I thought I'd feel better with the extra rest, but my back pain was just as bad as ever.î Recognizing the emotional difficulties of a lifestyle change or feeling relaxed about symptoms is not expected for a client with a somatic symptom illness.

Which statement would indicate to the nurse that the client has understood somatic symptom illness? A) As soon as my symptoms go away, I'll be my old self again. B) How I handle stress and emotions can affect my physical health. C) I have to avoid stress all my life to avoid getting sick again. D) Taking medication won't help my pain since it's caused by stress.

Ans: B Feedback:Clients who come to understand that how they cope with stress affects their physical health demonstrate an understanding of somatization disorder. Clients with somatization disorder eventually may be treated in mental health settings. It is an unreality to avoid all stress in one's life.

The client asks the nurse, ìWhat does having psychosomatic symptoms mean?î What should the nurse reply? A) It means you're not physically sick. B) It means that stress and/or emotions are causing your symptoms. C) It means that you'll be well when you get your life in order. D) It means that your symptoms are a product of your imagination.

Ans: B Feedback:Clients who do not cope well with stress or emotions develop physical symptoms that are real as a means of coping. Answer choices A, C, and D are inappropriate responses.

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

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

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

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

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

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

Which is the most effective intervention for clients with delirium? A) Giving detailed explanations B) Managing environmental stimuli C) Promoting rest with PRN medications D) Providing activities for distraction

Ans: B Feedback:Clients with delirium become overstimulated easily; their ability to process environmental stimuli is impaired.

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

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

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

Ans: B Feedback:Cognitiveñbehavioral therapy has been found to be the most effective treatment for bulimia. Strategies designed to change the client's thinking (cognition) and actions (behavior) about food focus on interrupting the cycle of dieting, binging, and purging and altering dysfunctional thoughts and beliefs about food, weight, body image, and overall self-concept. All of the other statements are factors that may reinforce the continuing cycle of an eating disorder.

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

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

A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? A) The clients should be able to ask us for items they need. B) The clients may not recognize their family when they come to visit. C) The clients who are ambulatory can still carry out activities of daily living independently. D) The clients should know when to come to the dining room for meals.

Ans: B Feedback:Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory impairment, and at least one of the following cognitive disturbances: (1) aphasia, which is deterioration of language function; (2) apraxia, which is impaired ability to execute motor functions despite intact motor abilities; (3) agnosia, which is inability to recognize or name objects despite intact sensory abilities; and (4) disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.

When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication.

Ans: B Feedback:Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are not mild side effects because these are very uncomfortable symptoms. These symptoms would not be an idiosyncratic reaction because this is the expected reaction. These symptoms are not indicative of a severe allergy to the medication.

A client who is depressed begins to cry and states, ìI'm just really sick of feeling this way. Nothing ever seems to go right in my life.î Which would be the most appropriate response by the nurse? A) ìDon't cry. Try to look at the positive side of things.î B) ìYou are feeling really sad right now. It's a hard time.î C) ìHang in there. Your medication will start helping in a few days.î D) ìNothing ever goes right?î

Ans: B Feedback:Do not cut off interactions with cheerful remarks or platitudes. Do not belittle the client's feelings. Accept the client's verbalizations of feelings as real, and give support for expressions of emotions, especially those that may be difficult for the client (like anger). Allow (and encourage) the client to cry. It is important that the nurse does not attempt to ìfixî the client's difficulties

Which of the following statements about posttraumatic stress disorder is accurate? A) Estimates are that the disorder is very rare. B) Estimates are that up to 60% of people at risk develop PTSD. C) Only 20% of victims of rape develop PTSD. D) PTSD symptoms usually begin at the time of the trauma

Ans: B Feedback:Estimates are that up to 60% of people at risk develop PTSD.

A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at his time? A) Confiscate the soda can as a restricted item. B) Pour the soda into a plastic cup. C) Ask the visitor to place the soda can at the nurse's desk until he or she leaves. D) Ask the visitor not to bring outside items on the unit in the future.

Ans: B Feedback:For clients who are suicidal, staff members remove any item they can use to commit suicide, such as sharp objects, shoelaces, belts, lighters, matches, pencils, pens, and even clothing with drawstrings. The client could access the soda can and commit self-harm.

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

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

A community health nurse is planning a substance abuse prevention program. Which group would be the best target audience for the nurse to plan a program? A) Teenagers in a high school health class B) School-age children in an after-school program C) Parents attending a parentñteacher association meeting D) Elementary school teachers and counselors

Ans: B Feedback:Forty-three percent of all Americans have been exposed to alcoholism in their families. Children of alcoholics are four times more likely than the general population to develop problems with alcohol. Many adult people in treatment programs as adults report having had their first drink of alcohol as a young child, when they were younger than age 10. With the increasing rates of use being reported among young people today, this problem could spiral out of control unless great strides can be made through programs for prevention, early detection, and effective treatment.

Which of the following is an inhibitory neurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine

Ans: B Feedback:GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.

The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer? A) Ask her to explain what she did at work today that kept her busy. B) Go along with her thought of it having been a busy day, but do not refer to her work. C) Reorient her that she is at home and did not go to work. D) Give her 5 to 10 minutes of rest, and she will have no memory of the incident.

Ans: B Feedback:Going along means providing emotional reassurance to clients without correcting their misperception or delusion. The nurse does not engage in delusional ideas or reinforce them, but he or she does not deny or confront their existence. For example, a client is fretful, repeatedly saying, ìI'm so worried about the children. I hope they're okayî and speaking as though his adult children were small and needed protection. The nurse could reassure the client by saying, ìThere's no need to worry; the children are just fineî (going along). Time away is an effective technique for aggression.

An 8-year-old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. Which should be the nurse's first step? A) I need to talk to you. B) Stop that right now. C) You are going to hurt yourself. D) Why are you jumping off the bed?

Ans: B Feedback:If the child is engaged in a potentially dangerous activity, the first step is to stop the behavior. Attempting to talk to or reason with a child engaged in a dangerous activity is unlikely to succeed because his or her ability to pay attention and to listen is limited.

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

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

Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? A) OpisthotonusB) Oculogyric crisis C) TorticollisD) Pseudoparkinsonism

Ans: B Feedback:Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects.

A nurse is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications. The best response is, A) When studies are published they can be trusted to be accurate. B) We need to look at the research very closely to see how reliable the studies are. C) Your prescribed medication is the best for your condition, so you should not read those studies. D) Switching medications will alter the course of your illness. It is not advised.

Ans: B Feedback:Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their families to understand. The nurse must ensure that clients and families are well informed about progress in these areas and must also help them to distinguish between facts and hypotheses. The nurse can explain if or how new research may affect a client's treatment or prognosis. The nurse is a good resource for providing information and answering questions.

Which of the following terms describes the repeating of one's own words or sounds? A) Coprolalia B) Palilalia C) Echolalia D) None of the above

Ans: B Feedback:Palilalia is the repeating of one's own words or sounds. Coprolalia is the use of socially unacceptable words, which are frequently obscene. Echolalia is the repeating of the last heard sound, word, or phrase.

A client with alcohol dependence is admitted to the hospital with pancreatitis. Which intervention should be included in the client's plan of care? A) Fluid restriction of 1000 mL per 24 hours B) Glucometer checks b.i.d. C) High-protein diet D) Protective isolation precautions

Ans: B Feedback:Pancreatitis can cause elevated serum glucose levels. The other choices are not necessarily appropriate.

The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. The nurse would be most therapeutic by saying which of the following? A) Your son is a cute child, but he needs to calm down. B) It must be difficult to handle your son at home. C) You need to take a firmer approach with your son. D) Your son sure is active.

Ans: B Feedback:Parents find themselves chronically exhausted mentally and physically. Parents need support and reassurance, and making a statement about the difficulties of handling the child at home validates the mother's feelings. It is not appropriate to say, ìYour son is a cute child, but he needs to calm down.î It may make the parents defensive to say, ìYou need to take a firmer approach with your son.î ìYour son sure is activeî is not a therapeutic response.

Which of the following statements regarding the individual responses to trauma and stressors is a positive outcome? A) Many individuals are unable to cope with the event, manage their stress and emotions, or resume the daily activities of their lives. B) Some individuals may develop enhanced coping as a result of dealing with the stressor. C) These events are only significant in individuals who have risk for or actual mental health problems or issues. D) Large numbers or groups of people may be affected by a traumatic event.

Ans: B Feedback:People may experience events in their lives that are extraordinary in intensity or severity, well beyond the stress of daily life. These traumatic events or stressors would be expected to disrupt the life of anyone who experienced them, not just individuals at risk for mental health problems or issues. These events and stressors may affect individuals or large numbers and groups of people. While all persons experiencing events such as these manifest anxiety, insomnia, difficulty coping, grief, or any variety of responses, most work through the experience and return to their usual level of coping and equilibriumóperhaps even enhanced coping as a result of dealing with the event.

A 14-year-old girl is being treated for conduct disorder. She refuses to attend class today, stating that yesterday the other nurse told her she did not have to go to class if she did not want to. Which would be the best response by the nurse? A) Fine, but you're confined to your room. B) Missing class is against the rules. C) You and I both know you're lying. D) Why do you keep fighting the system?

Ans: B Feedback:Reinforcing rules avoids a power struggle; the nurse must set limits on the unacceptable behavior of missing class. The nurse can negotiate with a client a behavioral contract outlining expected behaviors, limits, and rewards to increase treatment compliance.

When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic? A) This is a good medication! It will be effective within 20 minutes of the first dose. B) You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication. C) It will probably take months for the medication to work. In the meantime, you should work on improving your attitude. D) If you believe it will work, then it will. You have to have faith!

Ans: B Feedback:SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these drugs are an ìinitiating eventî and that eventual therapeutic effectiveness results when neurons respond more slowly, making serotonin available at the synapses. The medication will not be effective within 20 minutes of the first dose, and it will not likely take months for the medication. Attitude and faith will improve with the medication's effectiveness.

Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance

Ans: B Feedback:Safety of the child and others is always a priority. The other nursing interventions are appropriate for a child with ADHD, but the priority is safety.

When interviewing the family members of a client being treated for substance abuse problems, which behavior would alert the nurse to the possibility of codependency? A)Being Flexible but angry B) Blaming themselves for the family's problems C) Expressing thoughts and feeling openly D)Taking pleasure in self-accomplishments

Ans: B Feedback:Self-blame is an example of maladaptive coping or codependent behavior. The other choices do not correlate with codependency behaviors.

The nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. Which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal? A) ìI just don't understand why anyone would want to kill themselves.î B) ìI think suicide is wrong and selfish.î C) ìI get frustrated when my client negates all the positives I try to point out.î D) ìI can see how much my client is hurting inside.î

Ans: B Feedback:Some health-care professionals consider suicidal people to be failures, immoral, or unworthy of care. These negative attitudes may result from several factors. They may reflect society's negative view of suicide: many states still have laws against suicide, although they rarely enforce these laws. If this anxiety is not resolved, the staff person can demonstrate avoidance, demeaning behavior, and superiority to suicidal clients. Therefore, to be effective, the nurse must be aware of his or her own feelings and beliefs about suicide.

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

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

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

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

Which is the most commonly used treatment for oppositional defiant disorder? A) Pharmacologic treatment B) Parent training models of behavioral interventions C) Individual therapy D) ìBoot campî

Ans: B Feedback:Treatment for ODD is based on parent management training models of behavioral interventions. These programs are based on the idea that ODD problem behaviors are learned and inadvertently reinforced in the home and school. Older children may also benefit from individual therapy in addition to the behavioral program. There is little evidence that medications help ODD behaviors; however, successful pharmacologic treatment of comorbid disorders such as ADHD may also decrease the severity of ODD symptoms. Dramatic interventions, such as ìboot campî or incarceration, have not proved effective and may even worsen the situation.

A nurse suspects a coworker is signing out narcotics for clients and is using them herself. Which action should be taken by the nurse who has these suspicions? A) Ignore suspicions and leave it to the supervisor to intervene. B) Report the observations to the supervisor. C) Follow behind the coworker to ensure client comfort and safety. D) Confront the coworker about suspicions.

Ans: B Feedback: Nurses have an ethical responsibility to report suspicious behavior to a supervisor and, in some states, a legal obligation as defined in the state's nurse practice act. Nurses should not try to handle such situations alone by warning the coworker; this often just allows the coworker to continue to abuse the substance without suffering any repercussions.

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

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

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale? A) As soon as lunch is over, the client will calm down. B) Other clients need to be protected from the intrusive behavior. C) The client's behavior is not an imminent threat to anyone's physical safety. D) The client needs food and fluids in any way possible.

Ans: B Feedback: The nurse must set limits on this intrusive behavior because other clients have the right to be protected. The client is in the manic phase; the client may not calm down after lunch. The behavior could be an imminent threat to individual safety for many reasons, infection control included. The client's need for food and fluids does not supersede any of the other clients' needs for food and fluids.

A nurse is providing education to a group of parents who have children with ADHD. Which of the following statements would be accurate and should be included in the education? Select all that apply. A) Medication alone will adequately treat children with ADHD. B) It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem. C) Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. D) ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help. E) Children with ADHD do not qualify for special school services under the Individuals with Disabilities Education Act.

Ans: B, C, D Feedback: Although medication can help reduce hyperactivity and inattention and allow the child to focus during school, it is by no means a cure-all. The child needs strategies and practice to improve social skills and academic performance. Because these children are often not diagnosed until the second or third grade, they may have missed much basic learning for reading and math. Parents should know that it takes time for them to catch up with other children of the same age. Most of these children have low self-esteem because they have been labeled as having behavior problems and have been corrected continually by parents and teachers for not listening, not paying attention, and misbehaving. Parents must understand how to help rebuild their child's self-esteem. Parents should give positive comments as much as possible to encourage the child and acknowledge his or her strengths. One technique to help parents to achieve a good balance is to ask them to count the number of times they praise or criticize their child each day for several days. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help. Children with ADHD do qualify for special school services under the Individuals with Disabilities Education Act.

A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply. A) Weigh self weekly at the same time of day. B) Drink a 2-L bottle of decaffeinated fluid daily. C) Do not alter dietary salt intake. D) See the doctor if you get the flu. E) Restrict involvement in intense exercise.

Ans: B, C, D Feedback:Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so the lithium level will be too low. If there is too much water, lithium is diluted, and the lithium level will be too low to be therapeutic. Drinking too little water or losing fluid through excessive sweating, vomiting, or diarrhea increases the lithium level, which may result in toxicity. Monitoring daily weights and the balance between intake and output and checking for dependent edema can be helpful in monitoring fluid balance. The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration.

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

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

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

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

Which of the following might the nurse recognize as longer-term responses to trauma and stress? Select all that apply.A) Acute stress disorderB) Posttraumatic stress disorder C) Adjustment disorderD) Reactive attachment disorderE) Dissociative disorder

Ans: B, C, D, E Feedback:Acute stress disorder usually occurs from 2 days to 4 weeks after a trauma. Posttraumatic stress disorder usually begins 3 months after the trauma. All of the rest of these are longer-term responses to trauma and stress.

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

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

The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time.

Ans: B, C, E Feedback:Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stool softeners are permissible, but the client should avoid laxatives. The use of sunscreen is recommended because photosensitivity can cause the client to sunburn easily. If the client forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose.

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

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

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

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

Which variables represent the highest risk for developing major depressive disorder? Select all that apply. A) Male gender B) Mood disorder in first-degree relatives C) Substance abuse D) Divorced E) Older adult

Ans: B, D Feedback: Major depression is twice as common in women and has a 1.5 to 3 times greater incidence in first-degree relatives than in the general population. Incidence of depression decreases with age in women and increases with age in men. Single and divorced people have the highest incidence. Depression in prepubertal boys and girls occurs at an equal rate.

Which of the following outcomes would take priority for a client who has survived trauma or abuse? Select all that apply. A) The client will demonstrate healthy, effective ways of dealing with the stress. B) The client will be physically safe. C) The client will establish a social support system in the community. D) The client will distinguish between ideas of self-harm and taking action on those ideas. E) The client will express emotions nondestructively.

Ans: B, D Feedback:It is the highest priority that the client be physically safe. Because persons who have survived trauma or abuse may have thoughts of self-harm, it is also critical that the client will distinguish between ideas of self-harm and taking action on those ideas. The other objectives are not as high a priority as safety and ideas of self-harm.

Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply. A) Norepinephrine levels may be increased in mania. B) Manic episodes are a ìdefenseî against underlying depression. C) Acetylcholine seems to be implicated in mania. D) The id takes over the ego and acts as an undisciplined hedonistic being (child).

Ans: B, D Feedback:Most psychoanalytic theories of mania view manic episodes as a ìdefenseî against underlying depression, with the id taking over the ego and acting as an undisciplined hedonistic being (child). Norepinephrine levels may be increased in mania, and acetylcholine seems to be implicated in mania, but these are neurochemical theories.

Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness? Select all that apply. A) The client will assume responsibility for self-care activities. B) The client will identify the relationship between stress and physical symptoms. C) The client will learn to vary his or her schedule. D) The client will verbally express emotional feelings. E) The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings.

Ans: B, D, E Feedback: Somatic symptom illnesses are chronic or recurrent, so changes are likely to occur slowly. If treatment is effective, the client should make fewer visits to the physician as a result of physical complaints, use less medication and more positive coping techniques, and increased functional abilities. Improved family and social relationships are also a positive outcome that may follow improvements in the client's coping abilities. Treatment outcomes for clients with a somatic symptom illness may include the following:ï The client will identify the relationship between stress and physical symptoms.ï The client will verbally express emotional feelings.ï The client will follow an established daily routine.ï The client will develop alternative ways to deal with stress, anxiety, and other feelings. ï The client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake.

Which of the following symptoms are characteristic of ADHD? Select all that apply. A) Enuresis B) Inattentiveness C) Encopresis D) Overactivity E) Impulsiveness

Ans: B, D, E Feedback:ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Encopresis is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally. Encopresis and enuresis are elimination disorders that are unrelated to ADHD.

Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? Select all that apply. A) Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods. B) Remember to focus on the client's strengths and assets, as well as their problems. C) Transient conduct disorders are common in all children. D) Avoid a ìblamingî attitude toward clients and/or families. E) Focus on positive actions to improve situations and/or behaviors.

Ans: B, D, E Feedback:Points to consider when working with clients with disruptive behavior disorders and their families include the following:ï Remember to focus on the client's strengths and assets, as well as their problems.ï Avoid a blaming attitude toward clients and/or families; rather focus on positive actions to improve situations and/or behaviors.There is a familial tendency for behavior disorders, but that is not the only cause for behavior disorders. Conduct disorders are not common in all children, but it can be difficult to distinguish normal child behavior from conduct disorders at times.

Which of the following would the nurse know are the major elements of posttraumatic stress disorder (PTSD)? Select all that apply. A) Trying to avoid any places or people or situations that may trigger memories of the trauma B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts C) Becoming increasingly more isolated D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal

Ans: B, D, E Feedback:The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. The client may also experience a numbing of general responsiveness and may try to avoid any places or people or situations that may trigger memories of the trauma, but these are not the major elements of PTSD.

Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy

Ans: B, E Feedback:Lethargy and weight gain are difficult to manage or minimize and frequently lead to noncompliance.

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? A) How would you feel if someone yelled at you like that? B) What's the matter with you? Don't you know any better? C) Yelling at others is unacceptable. You need to let staff know you're upset. D) You're still having problems controlling your anger.

Ans: C Feedback: The nurse must show acceptance of clients as worthwhile persons even if their behavior is unacceptable. This means that the nurse must be matter of fact about setting limits and must not make judgmental statements about clients. He or she must focus only on the behavior.

When presenting information about conduct disorders to a community group, the nurse is asked, ìwhich is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?î Which would be the most appropriate reply by the nurse? A) The acute care setting B) School C) Residential treatment settings D) Jail-diversion program

Ans: C Feedback:Group homes, halfway houses, and residential treatment settings are designed to provide safe, structured environments and adequate supervision if that cannot be provided at home. Clients with conduct disorder are seen in acute care settings only when their behavior is severe and only for short periods of stabilization. Clients with legal issues may be placed in detention facilities, jails, or jail-diversion programs.

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

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

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

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

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

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

The nurse is teaching a 70-year-old man about his depression. Which statement by the client would indicate that teaching has been effective? A) ìAll old people get depressed at times. B) ìI'm glad I'll feel better in 2 or 3 days.î C) ìI never knew depression could just happen for no specific reason. D) ìWhen I reduce the stress in my life, the depression will go away.î

Ans: C Feedback: Depression can be endogenous, with no external cause or event. Clients must understand that depression is an illness, not a lack of willpower or motivation. Major depression typically involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression.

The nurse is planning care for a client with major depression. Which is an appropriate expected outcome? A) The client will avoid causing harm to others. B) The client will be free from stress. C) The client will independently carry out activities of daily living. D) The client will not experience agitation.

Ans: C Feedback: Expected outcomes for the depressed client include the following: ï The client will not injure himself or herself.ï The client will independently carry out activities of daily living (showering, changing clothing, grooming). ï The client will establish a balance of rest, sleep, and activity.ï The client will establish a balance of adequate nutrition, hydration, and elimination. ï The client will evaluate self-attributes realistically. ï The client will socialize with staff, peers, and family/friends. ï The client will return to occupation or school activities. ï The client will comply with the antidepressant regimen. ï The client will verbalize symptoms of a recurrence.Avoiding agitation and harm to others are outcomes more appropriate for a client with mania. It is unrealistic to be completely free from stress.

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

Ans: C Feedback: Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Clients usually seek treatment for depression, unexplained physical problems, and difficulties in relationships. Obsessiveñcompulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.

Which of the following accurately describes how somatic symptoms are distinguished from factitious disorders and malingering? A) Munchausen's syndrome cannot be controlled by persons who have it. B) Persons who experience somatic disorders intentionally produce symptoms for some external purpose or gain. C) In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. D) People who experience somatic symptom illnesses can stop the physical symptoms as soon as they have gained what they wanted.

Ans: C Feedback: In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. Munchausen's disorder is the common term for factitious disorder, imposed on self and occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. People with factitious disorders may even inflict injury on themselves to receive attention. Persons who experience somatic disorders are unable to control their symptoms. People who experience somatic symptom illnesses cannot stop their physical symptoms. However, people who malinger can stop the physical symptoms as soon as they have gained what they wanted.

Which is the most important reason for the nurse who cares for children with conduct disorders to discuss feelings, fears, or frustrations with colleagues? A) To make the nurse feel better and avoid burnout. B) To encourage camaraderie between colleagues. C) To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. D) To ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders.

Ans: C Feedback: It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. It may also make the nurse feel better and avoid burnout, but that is not the most important reason to do so. It may encourage camaraderie between colleagues, but that is not the most important reason for the nurse to do so. It will not be possible to ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders, but they must be consistent with limit setting, irrespective of their own attitudes and beliefs.

Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders? A) Somatization B) Identification C) Internalization D) Repression

Ans: C Feedback: Psychosocial theorists believe that people with somatic symptom illnesses keep stress, anxiety, or frustration inside rather than expressing them outwardly. This is called internalization. Clients express these internalized feelings and stress through physical symptoms (somatization). Both internalization and somatization are unconscious defense mechanisms. Identification is trying to ease distress by emulating others whom one admires. Repression is the unconscious exclusion of distressing situations from one's memory.

During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse? A) ìDo you think you could sit still for a few minutes so we can talk?î B) ìHow are you ever going to get any rest if you keep that music on?î C) ìLet's go to the conference room and talk for a while.î D) ìTurn the radio down so we can hear ourselves talk.î

Ans: C Feedback: Redirecting the client to a quieter, smaller room will decrease external stimuli and promote calmness, so the client will eventually rest and sleep.

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

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

The nurse is planning care for a client with somatic symptom illness disorder. Which should the nurse plan to reassess on a daily basis? A) Sensory deficits experienced by the client B) Character of pain reported by the client C) Frequency of generalized somatic complaints D) Signs of possible neurologic disorders

Ans: C Feedback: Somatic symptom illness is characterized by multiple physical symptoms. The frequency of generalized somatic complaints will give the nurse information about the current status of the disorder. Conversion disorder involves unexplained, usually sudden deficits in sensory or neurologic motor function and might be manifested by sensory deficits being experienced by the client. Pain disorder has the primary physical symptom of pain and would be reassessed with the description of the character of any pain reported by the client. If the nurse would reassess for signs of possible neurologic disorders, it may serve to reinforce to the client that there might be something wrong.

A nurse is providing education about trauma and its effects to a community group in a community that has just been hit by a devastating tornado. One of the participants asked about what kind of support a survivor of the tornado will need. Which would be the best response of the nurse? A) If a person is willing to share his or her feelings about what has happened, he or she is not dealing with their feelings effectively. B) It is counterproductive for people to share what has happened to them and their feelings about it as there is nothing more to be done. C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD. D) It is best to wait until a survivor's life has returned to normal before dealing with the trauma.

Ans: C Feedback: Some people more easily express their feelings and talk about stressful, upsetting, or overwhelming events. They may do so with family, friends, or professionals. Others are more reluctant to open up and disclose their personal feelings. They are more likely to ignore the feelings, deny their importance, or insist ìI'm fine, I'm over it.î By doing that, they increase the risk for future problems such as PTSD. One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs.

A client will be taking disulfiram (Antabuse) after discharge from an alcohol treatment program. Which statement would indicate that teaching has been effective? A) Antabuse is safe to take with any over-the-counter cold medication. B) Antabuse will block my cravings for alcohol, so I'll have less desire to drink. C) Drinking alcohol while taking Antabuse can cause dangerous symptoms. D) If I drink while taking Antabuse, it will make me vomit before the alcohol affects me.

Ans: C Feedback: Taking alcohol in any form while taking Antabuse causes a severe adverse reaction. Antabuse is not safe to take with OTC medications. It does not block cravings for alcohol. Antabuse does not restrict the effect of alcohol on the body.

A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is, A) It is recommended that you wait until the child is older to vaccinate. B) There are safer alternative immunizations available now. C) There has been no research to establish a relationship between vaccines and autism. D) The risks do not outweigh the benefits of immunization against childhood diseases.

Ans: C Feedback: The National Institute of Child Health and Human Development, Centers for Disease control (CDC) and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between vaccines and autism and that the MMR vaccine is safe.

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

Ans: C Feedback: The client may attempt to bend the rules ìjust this onceî with numerous excuses and justifications. The nurse's refusal to be manipulated or charmed will help decrease manipulative behavior. Avoid any discussion about why requirements exist. State the

At 1 AM, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response? A) ìGo to the day room and wait while I call your psychiatrist. B) ìDon't be unreasonable. I can't call the psychiatrist at this time of night. C) I can't call the psychiatrist now, but you and I can talk about your request for a pass. D) You must really be upset to want a pass immediately; I'll give you some medication.î

Ans: C Feedback: This response states a limit on an unreasonable request while providing the opportunity to discuss the request. Answer choices A, B, and D are not therapeutic.

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

Ans: C Feedback: When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image.

A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, ìThat just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach.î Which is the nurse's best response? A) To give the client some privacy and time to calm down B) To say nothing and sit quietly with the client C) The pain in your head is very real. D) Well, that's not what your doctor thinks.

Ans: C Feedback: When the nurse says, ìThe pain in your head is very real,î the nurse is validating the client's pain as real. The client is asking for some type of validation. In the situation presented, the client's headaches are very real to him or her. The client needs to talk out the feelings regarding what the physician has told him or her. It would be inappropriate for the nurse to say nothing. To give the client some privacy and time to calm down is not indicated. ìWell, that's not what your doctor thinks,î would put the client on the defensive.

Which of the following terms are applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a ìheroî for saving the victim? A) Malingering B) Factitious disorder C) Munchausen's syndrome by proxy D) Induced illness

Ans: C Feedback:A variation of factitious disorder, imposed on others, is commonly called Munchausen's syndrome by proxy and occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a ìheroî for saving the victim. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms; it is motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. Factitious disorder, imposed on self, occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Induced illness is another name for factitious disorder.

The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention? A) Decrease environmental misinterpretation B) Improve memory retention C) Increase frustration D) Slow the progress of the disease

Ans: C Feedback:Alzheimer's disease is progressive; clients do not learn new information, and they become frustrated when asked to perform tasks they are not capable of doing.

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

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

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

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

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

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

Which best explains the neurochemical processes responsible for depression? A) Increased activity of dopamine B) Decreased glucocorticoid activity C) Decreased serotonin and norepinephrine activity D) Potentiating of the kindling process

Ans: C Feedback:Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid, or 5-HIAA) of serotonin found in the blood or cerebrospinal fluid occur in people with depression. Norepinephrine levels may be deficient in depression and increased in mania. Elevated glucocorticoid activity is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression. Kindling is the process by which seizure activity in a specific area of the brain is initially stimulated.

Which of the following increases the risk for neuroleptic malignant syndrome (NMS)? A) Overhydration B) Intake of vitamins C) Dehydration D) Vegetarian diet

Ans: C Feedback:Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritional status. Vegetarian diet would not relate to NMS.

Which distinguishes delirium from dementia? A) Delirium has an acute onset and is progressive in course. B) Delirium has a gradual onset and can be resolved. C) Dementia has a gradual onset and is progressive in course. D) Dementia has an acute onset and can be resolved.

Ans: C Feedback:Delirium has a sudden onset, and the underlying cause is treatable; by contrast, dementia has a gradual onset and is progressive rather than treatable.

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

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

A nurse is working with a couple seeking counseling for marital discord. The history indicates the husband was treated for substance abuse 4 years ago and attends AA meetings occasionally. Which statement made by the recovering husband should alert the nurse for the need for further education? A) I still need to go to AA meetings even though I have been sober for years. B) After all these years, I just don't have the will power to stop if I started using again. C) She gets upset when I hang out with my old buddies on the weekends. D) I wish I could be able to handle just one beer with dinner.

Ans: C Feedback:Family members and friends should be aware that clients who begin to revert to old behaviors, return to substance-using acquaintances, or believe they can ìhandle myself nowî are at high risk for relapse, and loved ones need to take action. The nurse must dispel myths and misconceptions such as, ìIt's a matter of will power,î ìI can't be an alcoholic if I only drink beer or if I only drink on weekends,î ìI can learn to use drugs socially,î or ìI'm okay now; I could handle using once in a while.î

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? A) Peanut butter sandwich, chips, cola B) Fried chicken, mashed potatoes, milk C) Ham sandwich, cheese slices, milk D) Spaghetti, garlic bread, salad, tea

Ans: C Feedback:Finger foods, or things clients can eat while moving around, are the best options to improve nutrition. Such foods should be as high in calories and protein as possible.

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

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

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

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

A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports A) feeling sleepy and less energetic. B) weight gain of 7 pounds in the last 6 months. C) minimal mood swings. D) increased feelings of self-worth.

Ans: C Feedback:Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment.

Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders? A) Administering medications B) Avoiding setting limits C) Group-based parenting classes D) Being overprotective of the child

Ans: C Feedback:Parental behavior profoundly influences children's behavior. Group-based parenting classes are effective to deal with problem behaviors in children and prevent later development of conduct disorders.

A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The patient is symptom-free and therefore does not need to adhere to the medication regimen. B) The patient cannot clearly see the instructions written on the prescription bottle. C) The patient dislikes the weight gain associated with antipsychotic therapy. D) The patient sells the antipsychotics to addicts in the neighborhood

Ans: C Feedback:Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally balanced diets; this pattern decreases the likelihood that they can minimize potential weight gain or lose excess weight. Antipsychotics should be taken regularly and not omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do they have addictive potential.

The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements? A) I'm glad I can eat pizza since it's my favorite food. B) I must follow this diet or I will have severe vomiting. C) It will be difficult for me to avoid pepperoni. D) None of the foods that are restricted are part of a regular daily diet.

Ans: C Feedback:Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular concern to this client is the potential life-threatening hypertensive crisis if the client ingests food that contains tyramine. Answer choices A, B, and D are inappropriate statements toward effective teaching for the client receiving a monoamine oxidase inhibitor.

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

Ans: C Feedback:Physiologic safety and homeostasis are the priority concerns. Changing of thought pattern, establishing a target weight, and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa.

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

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

A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see? A) Constipation and postural hypotension B) Fever, muscle rigidity, and disorientation C) Nausea, diarrhea, and confusion D) None; the serum level is in therapeutic range

Ans: C Feedback:Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.

The nurse is assessing the drinking history of a client being admitted for alcohol abuse. Which statement would the nurse expect the client to make? A) I really need some help. My drinking is tearing my family apart. B) I have tried so many times to stop drinking. It is so hard. C) I don't really have a problem with alcohol. I've just been having a streak of bad luck lately. D) I have no intention to stop drinking. I like the way it makes me feel.

Ans: C Feedback:Substance use typically includes the use of defense mechanisms, especially denial. Clients may deny directly having any problems or may minimize the extent of problems or actual substance use. During assessment of thought process and content, clients are likely to minimize their substance use, blame others for their problems, and rationalize their behavior. They may believe that they could quit ìon their ownî if they wanted to, and they continue to deny or minimize the extent of the problem. Upon admission, the nurse would not expect the client have the insight to know how badly help is needed, or to express powerlessness over alcohol. The client would have some motivation for treatment if admission was underway. Often the motivation is external, such as pressure from family or employers.

Which of the following is the primary consideration with clients taking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep

Ans: C Feedback:Suicide is always a primary consideration when treating clients with depression.

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

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

A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially? A) Instruct the client to stop the medication for a few days to see if the nausea goes away. B) Reassure the client that this is an expected side effect that will improve with time. C) Suggest that the client take the medication with food. D) Tell the client to contact the physician for a change in medication.

Ans: C Feedback:Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The client should not stop taking the drug. It would be appropriate to reassure the client that this is an expected side effect that will improve with time, but that would not be done initially. A change in medication may be indicated if the nausea is intolerable or persistent, but that would not be done initially.

One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of A) acute dystonic reaction. B) extrapyramidal side effects. C) neuroleptic malignant syndrome. D) tardive dyskinesia.

Ans: C Feedback:The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing.

A client states, ìI am dead. I have come back from the dead.î An appropriate response by the nurse is, A) ìWhat is it like to feel dead? B) ìNo you did not die. People don't come back from the dead. C) ìShow me what you did in art therapy this morning. D) ìI'll get your medicine and you'll feel better.

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

A client is being discharged on disulfiram (Antabuse). Which instruction for Antabuse should the client receive? A) Take disulfiram with food to avoid stomach upset. B) Skip the daily dose of disulfiram on days when consumption of alcoholic beverages is likely. C) Read products labels carefully to avoid all products containing alcohol. D) Disulfiram will prevent the desire to drink alcoholic beverages.

Ans: C Feedback:The client must avoid a wide variety of products that contain alcohol such as cough syrup, lotions, mouthwash, perfume, aftershave, vinegar, and vanilla and other extracts. The client must read product labels carefully, because any product containing alcohol can produce symptoms. Ingestion of alcohol may cause unpleasant symptoms for 1 to 2 weeks after the last dose of disulfiram.

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

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

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

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

The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation? A) Show an instructional video just prior to the activity. B) Describe the exercise immediately before performing it. C) Demonstrate the exercises while clients simultaneously perform them. D) Perform the same routine daily to avoid the need for repeated instruction.

Ans: C Feedback:The nurse encourages clients to engage in physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, ìI wish I could, but I feel so terrible.î Which of the following approaches should the nurse suggest to encourage activity? A) What does your pain feel like right now? B) You are fine, the doctor said so. Let's go. C) I know this is difficult, but exercise is important. It will be a short walk. D) I'll let you rest. Let me know when you feel better.

Ans: C Feedback:The nurse must help the client and family learn how to establish a daily routine that includes improved health behaviors. Family members should expect resistance, including protests from the client that she or he does not feel well enough to do these things. The challenge is to validate the client's feelings while encouraging her or him to participate in activities.

The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child.

Ans: C Feedback:The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Caring for a child as a nurse is very different from being responsible around the clock. The parents likely have other obstacles to carrying out effective discipline. Teaching again is not likely to effect change. Given their own skills and problems, parents often give their best efforts. Given the opportunity, resources, support, and education, many parents can improve their parenting. It is premature to refer to family therapy or remove the child from the home. Emotional barriers to effective parenting should be explored first.

The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response by the nurse? A) ìYou sound like you aren't ready for her to be dependent on caregivers.î B) ìHer confusion is a temporary complication of her physical illness and should subside when the illness gets better.î C) ìSymptoms of dementia gradually get worse. Unfortunately she will not be independent again.î D) ìWith early treatment, mild dementia can be reversed. It may be possible.î

Ans: C Feedback:The prognosis for dementia involves progressive deterioration of physical and mental abilities until death. Typically, in the later stages, clients have minimal cognitive and motor function, are totally dependent on caregivers, and are unaware of their surroundings or people in the environment. They may be totally uncommunicative or make unintelligible sounds or attempts to verbalize. Delirium secondary to physical illness will subside with physical recovery.

The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation? A) It would be best if you just took your shower now. B) You seem anxious and upset. C) You have plenty of time to shower before it's time to go home. D) Why are you thinking you're going home?

Ans: C Feedback:This is an example of going along with, rather than correcting, the client's misperception so that she can get on with her daily activities and not focus on being upset about not going home. The other choices are not the best responses in this situation.

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

Ans: C Feedback:This statement reflects the nurse's expectation that the client will eat, yet the nurse still will provide adequate supervision. The other choices are not appropriate means of assuming a positive expectation of the client.

A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior? A) The nurse was unsure of how to calm the client. B) The nurse was frustrated and needed to take a ìtime-out.î C) The nurse gave the client a chance to calm down before resuming the meal. D) The nurse stepped away to verify the safety of other clients.

Ans: C Feedback:Time away involves leaving clients for a short period and then returning to them to reengage in interaction. For example, the client may get angry and yell at the nurse for no discernible reason. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on his or her return.

Which one of the following drugs should the nurse expect the patient to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac

Ans: C Feedback:Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. For clients taking lithium and the anticonvulsants, monitoring blood levels periodically is important.

Which client is at highest risk for carrying out a suicide plan? A) A client who plans to take a bottle of sleeping pills. B) A client who says, ìMy life is over.î C) A client who has a private gun collection. D) A client who says, ìI'm going to jump off the next bridge I see.î

Ans: C Feedback:When a client admits to having suicidal thoughts, the next step is to determine potential lethality, including a specific plan and lethality of means. Specific and positive answers to lethality assessment questions increase the client's likelihood of committing suicide.

A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse? A) It's distressing when my mother forgets my name B) I wish my sister would come to visit more often C) Mother won't let anyone else do anything for her D) Taking care of my mother is a big responsibility

Ans: C Feedback:When the caregiver feels as though no one else can provide care, the risk for role strain is markedly increased. The other choices do not require intervention by the nurse.

When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents? A) Continue to remind the child and parents that the prognosis for improvement is very poor. B) Encourage the parents to believe that the child will recover spontaneously. C) Assist the child and the parents to develop coping mechanisms. D) Focus on their problems instead of their strengths and assets.

Ans: C Feedback:Working with children and adolescents can be both rewarding and difficult. Many disorders of childhood such as severe developmental disorders severely limit the child's abilities. It may be difficult for the nurse to remain positive with the child and parents when the prognosis for improvement is poor. Even in overwhelming and depressing situations, the nurse has an opportunity to positively influence children and adolescents, who are still in crucial phases of development. The nurse often can help these clients to develop coping mechanisms they will use through adulthood. It is important to remember to focus on the client's and parents' strengths and assets, not just their problems.

A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least six drinks with every episode in order to ìhave a good time.î Which term would best describe this phenomenon? A) Dependence B) Intoxication C) Tolerance D) Withdrawal

Ans: C Feedback: As the person continues to drink, he or she often develops a tolerance for alcohol; that is, he or she needs more alcohol to produce the same effect. Intoxication is use of a substance that results in maladaptive behavior. Withdrawal syndrome refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases. Substance dependence also includes problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance.

The client states, ìI can't go to group today. I have a very upset stomach this morning.î Which would be the nurse's most appropriate response? A) You have to go to group. The doctor has ordered it.î B) Okay, you can miss this time. C) I know you don't feel well, but it's important for you to participate in therapy. D) You aren't really feeling nauseous. It is part of your illness.

Ans: C Feedback: The challenge for the nurse is to validate the client's feelings while encouraging her or him to participate in activities. The nurse should not strip clients of their somatizing defenses until adequate assessment data are collected and other coping mechanisms are learned. The nurse should not attempt to confront clients about somatic symptoms or attempt to tell them that these symptoms are not ìreal.î They are very real to clients who actually experience the symptoms and associated distress.

The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning? A) Orientation B) Food preferences C) Recent memory D) Remote memory

Ans: C Feedback: The initial sign of dementia is memory loss for recent events that exceeds normal forgetfulness. Asking what the client ate for breakfast is not determining orientation, food preferences, or remote memory.

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

Ans: C Feedback:Many clients with anorexia also have purging behavior; even those who have not purged previously may begin to do so when they are unable to restrict their eating. Answer choices A, B, and D do not promote healthy eating behaviors.

The nurse has been working with the family of a small child with oppositional defiant disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best nursing action at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child.

Ans: C Feedback:The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Caring for a child as a nurse is very different from being responsible around the clock. The parents likely have other obstacles in carrying out effective discipline. Teaching again is not likely to effect change. It is premature to refer to family therapy or remove the child from the home. Emotional barriers to effective parenting should be explored first.

Which of the following was the first nonstimulant medication specifically designed and tested for ADHD? A) Methylphenidate (Ritalin) B) Amphetamine (Adderall) C) Atomoxetine (Strattera) D) Pemoline (Cylert)

Ans: C Feedback: Strattera was the first non-stimulant medication specifically designed and tested for ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin), amphetamine (Adderall), and pemoline (Cylert).

Which slogans would be used in a 12-step program? Select all that apply. A) Pull yourself together. B) Get control of your problem. C) One day at a time. D) Easy does it. E) Let go and let God.

Ans: C, D, E Feedback:Before the illness of addiction was fully understood, most of the society and even the medical community viewed chemical dependency as a personal problem; the user was advised to ìpull yourself togetherî and ìget control of your problem.î Key slogans in AA reflect the ideas in the 12 steps, such as ìOne day at a timeî (approach sobriety one day at a time), ìeasy does itî (don't get frenzied about daily life and problems, and ìlet go and let Godî (turn your life over to a higher power).

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

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

The parents of an autistic child ask the nurse, ìWill my child ever be normal?î Which would be the most appropriate response by the nurse? A) You seem worried about your child's future. B) Autistic children can fully recover with the right treatment and education. C) Your child should outgrow autistic traits by adolescence D) Your child will probably always have some autistic traits.

Ans: D Feedback: Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others. Manifestations vary from little speech and poor daily living skills throughout life to adequate social skills that allow relatively independent functioning. Social skills rarely improve enough to permit marriage and child rearing.

The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements? A) I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate. B) Certain foods will cause me to have sexual dysfunction when I take this medication. C) Foods that are high in tyramine will reduce the medication's effectiveness. D) I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels.

Ans: D Feedback: Because the enzyme MAO is necessary to break down the tyramine in certain foods, its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias. Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common side effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness.

The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, ìAt times it is so overwhelming! I feel I do not have a life anymore!î Which is the most helpful response by the nurse? A) Are you saying you don't want to care for your mother anymore? B) I know it is really hard. It takes a lot of work and you are doing such a good job. C) Your mother really appreciates what you do for her. You are the best one to care for her. D) Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?

Ans: D Feedback: Caregivers need outlets for dealing with their own feelings. Support groups can help them to express frustration, sadness, anger, guilt, or ambivalence; all these feelings are common. Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. The client's physician can provide information about support groups, and the local chapter of the National Alzheimer's Disease Association is listed in the phone book. Area hospitals and public health agencies also can help caregivers to locate community resources. The nurse should understand that the caregiver is asking for help when expressing frustration. The nurse should not dismiss the caregiver's feelings or in any way induce additional guilt.

Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia? A) Most people seek help when they really need it. B) What is wrong with your family? Can't they see you need help?î C) You should be grateful that you still have your family member around. D) Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.î

Ans: D Feedback: Caregivers need support to maintain personal lives. They need to continue to socialize with friends and to engage in leisure activities or hobbies rather than focus solely on the client's care. Caregivers who are rested, are happy, and have met their own needs are better prepared to manage the rigorous demands of the caregiver role. Most caregivers need to be reminded to take care of themselves; this act is not selfish but really is in the client's best long-term interests. Many times caregivers will say they will seek help when they really need it. However, they must maintain their own well-being and not wait until they are exhausted before seeking relief. The primary caregiver may believe other family members should volunteer to help without being asked, but other family members may believe that the primary caregiver chose to take on the responsibility and do not feel obligated to help out regularly. It is important for the family to express their feelings and ideas and to participate in caregiving according to their own expectations. Many families need assistance to reach this type of compromise. Asking the caregiver what is wrong with his or her family and pointing out that the caregiver needs help are not helpful to the caregiver. It would be better for the nurse to encourage family members to share their feelings and to compromise for the best interests of the client. Telling the caregiver that he or she should be grateful will only increase the caregiver's sense of guilt, which is not productive.

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

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

A client in treatment for drug abuse makes the statement, ìI am a winner. You all are the losers because you can't beat this on your own.î What common characteristic of persons addicted to drugs is revealed in this statement? A) Realistic understanding of successful recovery of drug addiction B) Indication of an underlying personality disorder C) Brain damages resulting from chronic drug use D) Defending against a negative self-concept

Ans: D Feedback: Clients generally have low self-esteem, which they may express directly or to cover with grandiose behavior. They do not feel adequate to cope with life and stress without the substance and often are uncomfortable around others when not using. They often have difficulty identifying and expressing true feelings.

The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake? A) Sit with the client as long as necessary to complete the meal. B) Provide entertainment during meals such as television or music. C) Avoid between-meal snacks to encourage appetite. D) Serve meals in small, bite-size pieces.

Ans: D Feedback: Clients may eat poorly because of limited appetite or distraction at mealtimes. The nurse addresses this problem by providing foods clients like, sitting with clients at meals to provide cues to continue eating, having nutritious snacks available whenever clients are hungry, and minimizing noise and undue distraction at mealtimes. Clients who have difficulty manipulating utensils may be unable to cut meat or other foods into bite-sized pieces. The food should be cut up when it is prepared, not in front of clients, to deflect attention from their inability to do so. Food that can be eaten without utensils, or finger foods such as sandwiches and fresh fruits, may be best.

A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't want to be sick.î The nurse would best respond with, A) People who develop mental illnesses often had very traumatic childhood experiences. B) There is some evidence that contracting a virus during childhood can lead to mental disorders. C) Sometimes people with mental illness have an overactive immune system. D) We don't fully understand the cause, but mental illnesses do seem to run in families.

Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervous system may contribute to mental illness.

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? A) Unable to identify a water pitcher B) Unable to transfer to sitting position C) Difficulty with verbal expression D) Disoriented to person

Ans: D Feedback: Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day. Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. Dementia symptoms include aphasia (deterioration of language function), apraxia (impaired ability to execute motor functions despite intact motor abilities), and agnosia (inability to recognize or name objects despite intact sensory abilities).

The client asks the nurse, ìWhat will happen if I drink while taking Antabuse?î What should be the nurse's reply? A) You will not want to drink while taking Antabuse. It reduces the cravings. B) You will not get any effect from the alcohol you drink. C) Antabuse will reverse the effects of alcohol. D) You will experience a severe reaction, including a throbbing headache and vomiting.

Ans: D Feedback: Disulfiram (Antabuse) may be prescribed to help deter clients from drinking. If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result.

A nurse asks an assigned client, ìHow are you doing today?î The client responds with ìdoing today, doing today, doing today.î Which speech pattern disturbance is this an example of? A) Reactive attachment disorder B) Stereotypic movement disorder C) Selective mutism D) Echolalia

Ans: D Feedback: Echolalia is repeating the last heard sound, word, or phrase. Stereotypic movement disorders include waving, rocking, twirling objects, biting fingernails, handing the head, biting or hitting oneself, or picking at the skin or body orifices. Selective mutism is characterized by persistent failure to speak in social situations where speaking is expected.

Which disorder is exemplified by vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity? A) Intermittent explosive disorder B) Mild conduct disorder C) Oppositional defiance Disorder D) Moderate conduct disorder

Ans: D Feedback: Examples of moderate conduct disorder include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Intermittent explosive disorder (IED) involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. In mild conduct disorder, the child has some conduct problems that cause relatively minor harm to others. Examples include repeated lying, truancy, minor shoplifting, and staying out late without permission. Oppositional defiant disorder (ODD) consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations.

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

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

What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder? A) In acute stress disorder, the client is likely to develop exacerbation of symptoms. B) In PTSD, the recovery rate is 80% within 3 months. C) The severity and duration of the trauma are the most important variables in acute stress disorder.D) In PTSD, the symptoms occur 3 months or more after the trauma.

Ans: D Feedback: In acute stress disorder, the symptoms occur 2 days to 4 weeks after a traumatic event and are resolved within 3 months of the event. In PTSD, the symptoms occur 3 months or more after the trauma. In PTSD, the client is likely to develop exacerbation of symptoms. The severity and duration of the trauma and the proximity of the person to the event are the most important factors affecting the likelihood of developing PTSD. In PTSD, complete recovery occurs within 3 months for about 50% of people.

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

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

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

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

Which of the following neurochemical influences is a probable cause of substance abuse? A) Imbalances of serotonin and norepinephrine in the brain B) Inhibition of GABA in the brain C) Excessive serotonin activity in the CNS D) Stimulation of dopamine pathways in the brain

Ans: D Feedback: Neurochemical influences on substance use patterns have been studied primarily in animal research (Jaffe & Anthony, 2005). The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a ìhighî that is a reinforcing, or positive, experience.

Which of the following interventions would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse? A) To identify a list of support people or activities in the community B) To remind them to calm down when they appear to be experiencing a flashback C) To encourage them to tell their story repeatedly to everyone they meet D) To help them to refocus their view of themselves from being victims to being survivors

Ans: D Feedback: Often it is useful to view the client as a survivor of trauma or abuse rather than as a victim. For these clients, who believe they are worthless and have no power over the situation, it helps to refocus their view of themselves from being victims to being survivors. Defining themselves as survivors allows them to see themselves as strong enough to survive their ordeal. It is a more empowering image than seeing oneself as a victim. It would be beneficial for the client to identify a list of support people or activities in the community, but this would be to establish social support and not promote their self-esteem. It would not be helpful for anyone to tell the client to calm down when he or she appears to be experiencing a flashback or to encourage him or her to tell his or her story repeatedly.

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

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

A client with somatic symptom illness tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth. Which is this evidence of? A) Dysfunctional family unit B) Primary gain C) Role reversal D) Secondary gain

Ans: D Feedback: Secondary gains involve increased attention and relief from normal responsibilities and expectations when clients are ill. This is not an example of a dysfunctional family unit or role reversal. A primary gain is the direct external benefits that being sick provides.

A client with a somatic symptom illness asks what is causing her physical symptoms. Which would be the appropriate explanation for the nurse to offer? A) Physical symptoms can be attributed to an organic cause. B) Physical symptoms are deliberately expressed in order to benefit in some way. C) Physical symptoms are independent of the amount of the client's psychic distress. D) Physical symptoms are an involuntary way of dealing with psychic conflict.

Ans: D Feedback: Somatic symptom illnesses can be characterized as the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for them. The three central features of somatic symptom are as follows: physical complaints suggest major medical illness, but have no demonstrable organic basis; psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms; and symptoms or magnified health concerns are not under the client's conscious control.

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

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

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first? A) Administer an antianxiety drug such as lorazepam (Ativan) at these times. B) Explain the unit routine and the reasons for increased activity to the client. C) Keep unit activity to a minimum. D) Move the client to a quieter area during these times.

Ans: D Feedback: The nurse must alter the environment because the client will not learn new coping skills for frustrating or overly stimulating situations. Administering an antianxiety agent or explaining the routine of the unit and reasons for increased activity to the client may be done but would not be the initial intervention. The unit activity does not need to be kept to a minimum.

The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient, A) Have you ever had an allergic reaction to radioactive dye? B) Have you had anything to eat in the last 24 hours? C) Does your insurance cover the cost of this scan? D) Are you anxious about being in tight spaces?

Ans: D Feedback: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans require radioactive substances to be injected into the bloodstream. A patient is not required to fast before brain imaging studies. Verifying insurance benefits is not a primary role of the nurse.

Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection? A) You are likely to become progressively more confused now. B) This should be just a temporary situation. C) Don't worry about it; everyone is confused when they are in the hospital. D) I know things are upsetting and confusing right now, but your confusion should clear as you get better.

Ans: D Feedback: ìI know things are upsetting and confusing right now, but your confusion should clear as you get better,î would be validating and giving information and would provide realistic reassurance to the client who has delirium as this is often an acute and temporary situation in elderly people who are acutely ill and have other risk factors such as medications and illness and age. ìYou are likely to become progressively more confused now,î is inaccurate as the person likely has delirium, and this will be an acute and temporary situation. ìThis should be just a temporary situationî provides some reassurance but no validation. ìDon't worry about it; everyone is confused when they are in the hospitalî is inaccurate.

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

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

A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following? A) Tardive dyskinesia B) Neuroleptic malignant syndrome C) Dystonia D) Akathisia

Ans: D Feedback:Akathisia is reported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.

Which is the primary gain for a client with conversion disorder? A) Emotional detachment B) Emotional support from family C) Identification of anxious feelings D) Relief from emotional conflict

Ans: D Feedback:An emotional conflict precedes the development of conversion disorder; the conversion disorder relieves that specific emotional conflict. Emotional detachment and emotional support from the family or identification of anxious feelings are not examples of primary gain in clients diagnosed with conversion disorder. Secondary gains are the internal or personal benefits received from others because one is sick, such as attention from family members.

Which drug classification is the primary medication treatment for schizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics

Ans: D Feedback:Antipsychotic drugs are the primary medical treatment for clients diagnosed with schizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis.

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

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

Which of the following would not be included as a symptom of drug-induced Parkinsonism? A) Stooped posture B) Cogwheel rigidity C) Drooling D) Tachycardia

Ans: D Feedback:Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse pill-rolling movements of the thumb and fingers while at rest.

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

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

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

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

For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivity reaction D) Sore throat and malaise

Ans: D Feedback:Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects.

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

Ans: D Feedback:Conduct disorder is characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas. Behavioral symptoms include physical fights, destruction of property, vandalism, and serious violation of rules among others. ODD consists of an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures without major antisocial violations. Asperger's disorder is a pervasive developmental disorder characterized by the same impairments of social interaction and restricted stereotyped behaviors seen in autistic disorder, but there are no language or cognitive delays. Attention deficit hyperactivity disorder (ADHD) is characterized by inattentiveness, overactivity, and impulsiveness.

In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose

Ans: D Feedback:Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision. More severe anticholinergic effects such as agitation, delirium, and ileus may occur, particularly in older adults. Other common side effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients may develop tolerance to anticholinergic effects (such as orthostatic hypotension and worsening of narrow-angle glaucoma, but these side effects are common reasons that clients discontinue drug therapy. The risk of seizures is increased by bupropion, which is a different type of antidepressant.

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

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

The nurse is working with the client to develop emotion-focused coping strategies. Which should the nurse include as an emotion-focused coping strategy? A) Problem solving B) Assertiveness techniques C) Role-playing D) Deep breathing techniques

Ans: D Feedback:Emotion-focused coping strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities. Problem-focused coping strategies include learning problem-solving methods, applying the process to identified problems, and role-playing interactions with others.

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

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

The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of her husband. The nurse suggests the wife implement the limit- setting skills she has learned in family therapy. In this instance, the nurse's action would be considered A) inappropriate; the nurse should not give advice to the wife. B) inappropriate; the husband has the legal right to spend personal money. C) appropriate; the wife is responsible for the husband's actions since he has a mental illness. D) appropriate; the wife needs support in setting boundaries.

Ans: D Feedback:Family members often say they know clients have stopped taking their medication when, for example, clients become more argumentative, talk about buying expensive items that they cannot afford, hotly deny anything is wrong, or demonstrate any other signs of escalating mania. People sometimes need permission to act on their observations.

28. The wife of a client who is alcoholic asks the nurse how to respond to him in a helpful way when he is disruptive in family life. Which is the nurse's best response? A) Help him avoid embarrassment by supporting him when he makes excuses for failing to meet obligations. B) Include him in family outings even when he is drinking.î C) Search the house regularly for alcohol. D) Try to maintain a normal home environment for yourself and the children.

Ans: D Feedback:Focusing on self and family members is the first step in breaking codependent behavior. Answer choices A, B, and C would not be the best response.

Which is a freudian explanation of the etiology of depression? A) Depression is a reaction to a distressing life experience. B) Depression results from being raised by rejecting or unloving parents. C) Depression results from cognitive distortions. D) Depression is anger turned inward.

Ans: D Feedback:Freud looked at the self-depreciation of people with depression and attributed that self- reproach to anger turned inward related to either a real or perceived loss. Meyer viewed depression as a reaction to a distressing life experience such as an event with psychic causality. Horney believed that children raised by rejecting or unloving parents were prone to feelings of insecurity and loneliness. Beck saw depression as resulting from specific cognitive distortions in susceptible people.

A client is seen in the primary care clinic complaining of headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which diagnosis is most probable for this client? A) Conversion disorder B) Pain disorder C) Brain cancer D) Hypochondriasis

Ans: D Feedback:Hypochondriasis is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions. Conversion disorder, sometimes called conversion reaction, involves unexplained, usually sudden deficits in sensory or motor function. Pain disorder has the primary physical symptom of pain, which generally is unrelieved by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance.

An unconscious client is admitted to the emergency department after a motor vehicle accident. The client's blood alcohol level upon admission was 1.7. The client's family soon arrives, reporting that the client is an uncle who is visiting from out of town. They cannot give much more history other than that he is a ìsocial drinker.î After being transported to the unit, the client starts sweating and has elevated vital signs. What information should the nurse request of the family? A) Who is the next of kin? B) For what occasion is the uncle visiting from out of town? C) Does the uncle have a history of any sort of anxiety disorder? D) Are there other indications that the client may be a heavy drinker?

Ans: D Feedback:It is important to assess the situation thoroughly and since the client is unconscious, he cannot communicate what is happening to the staff. The best chance for the staff to understand what is going on would be to inquire further of the relatives. If the client is experiencing withdrawal, detoxification needs to be initiated immediately under medical supervision. Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake. Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or deliriumócalled delirium tremens (DTs). Alcohol withdrawal usually peaks on the second day and is over in about 5 days.

The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets ìa big insurance settlement.î What condition might the nurse suspect? A) Hypochondriasis B) La belle indifference C) Conversion Reaction D) Malingering

Ans: D Feedback:Malingering is suspected when the client is exaggerating physical complaints for some type of material gain. Hypochondriasis is a preoccupation with the fear that one has a serious disease. La belle indifference is a seeming lack of concern or distress about a functional loss. A conversion reaction involves unexplained, usually sudden, deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly.

Which is likely to be most effective for adolescents with conduct disorder? A) Involvement with the legal system B) Focusing on the parenting education C) Incarceration D) Early intervention

Ans: D Feedback:Many treatments have been used for conduct disorder with only modest effectiveness. Early intervention is more effective, and prevention is more effective than treatment. Dramatic interventions, such as ìboot campî or incarceration, have not proved effective and may even worsen the situation. Treatment must be geared toward the client's developmental age. For school-aged children with conduct disorder, the child, family, and school environment are the focus of treatment. Adolescents rely less on their parents and more on peers, so treatment for this age group includes individual therapy. Many adolescent clients have some involvement with the legal system as a result of criminal behavior, but this is a consequence of and not a treatment for conduct disorder.

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

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

A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm? A) Immediately after a family visit B) On the anniversary of significant life events in the client's life C) During the first few days after admission D) Approximately 2 weeks after starting antidepressant medication

Ans: D Feedback:Observe the client closely for suicide potential, especially after antidepressant medication begins to raise the client's mood. Risk for suicide increases as the client's energy level is increased by medication. The other choices are not significantly associated with increased risk for suicide.

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

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

A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include as a measure most likely to prevent Alzheimer's disease and other dementias? A) Crafts B) Cooking C) Watching television D) Reading

Ans: D Feedback:People who regularly participate in brain-stimulating activities such as reading books and newspapers or doing crossword puzzles are less likely to develop Alzheimer's disease than those who do not. Engaging in leisure-time physical activity during midlife and having a large social network are associated with a decreased risk for Alzheimer's disease in later life.

A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums.

Ans: D Feedback:Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol) or risperidone (Risperdal), may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors.

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority? A) Hopelessness related to recent divorce B) Ineffective coping related to inadequate stress management C) Spiritual distress related to conflicting thoughts about suicide and sin D) Risk for suicide related to a highly lethal plan

Ans: D Feedback:Safety is the priority. The overall goal for the client who is suicidal is to first keep the client safe and later to help him or her to develop new coping skills that do not involve self-harm. The other choices would not be the highest priority diagnosis for this client.

Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? A) We'll teach him the proper way to take the medication, so he can manage it independently. B) We'll be sure he takes Ritalin at the same time every day, just before bedtime. C) We're so glad that Ritalin will eliminate the problems of ADHD. D) We'll be sure to record his weight on a weekly basis.

Ans: D Feedback:Stimulant medications used to treat ADHD can suppress appetite, and the child may lose or fail to gain weight properly. The client is too young to manage his medications independently. Ritalin should be given in divided doses. Ritalin reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately.

The nurse has encouraged the client with a somatic symptom illness to keep a journal. Which treatment outcome might be met by journaling? A) The nurse will control external stressors that trigger the patient's physical symptoms. B) The nurse will assess the onset of physical symptoms. C) The client will express emotions privately. D) The client will identify the occurrence of physical symptoms when stressed.

Ans: D Feedback:Teaching about the relationship between stress and physical symptoms is a useful way to help clients begin to see the mindñbody relationship. 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. The journal may help clients to see when physical symptoms seemed worse or better and what other factors may have affected that perception.

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to A) get a stat. order for a serum drug level. B) hold the client's medication until the symptoms subside. C) place an urgent call to the client's physician. D) give a PRN dose of benztropine (Cogentin) IM.

Ans: D Feedback:The client is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.

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

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

A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate? A) Allowing the client to direct her participation at her own pace B) Giving the client several choices of projects, so she can choose her favorite C) Staying away from the client during the session to encourage free expression D) Structuring the activity to facilitate completion of one specific task

Ans: D Feedback:The client needs to experience success in the group but is unlikely to do that independently. The other choices would not be appropriate actions for the client who is lethargic and apathetic.

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of A) extrapyramidal side effects B) loss of voluntary muscle control C) posturing D) tardive dyskinesia

Ans: D Feedback:The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the long- term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing.

A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time.

Ans: D Feedback:The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic. Answers A, B, and C are not appropriate interventions for the given lithium level.

A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be A) increasing the amount of serotonin and norepinephrine in the brain. B) decreasing the amount of an enzyme that breaks down neurotransmitters. C) normalizing the levels of serotonin, norepinephrine, and dopamine. D) blocking dopamine receptors in the brain.

Ans: D Feedback:The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.

The nurse performs a thorough physical examination for a client being admitted for a somatic symptom illness. Which of the following is the best rationale for the physical exam? A) Ease the client's mind that the nurse is looking for physical illness. B) Physical disorders underlie somatic disorders. C) Physical exams are reimbursed by third-party payers. D) Underlying pathology should be ruled out.

Ans: D Feedback:The nurse must investigate physical health status thoroughly to ensure that there is no underlying organic pathology requiring treatment. When a client has been diagnosed with a somatic symptom illness, it is important not to dismiss all future complaints because at any time the client could develop a physical condition that would require medical attention.

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, ìI'm going to take walk outside. I'll be back in about 10 minutes.î Which is the most appropriate nursing action? A) Further assess the client's motives for wanting to walk. B) Give the client permission to go on a walk on the grounds. C) Tell the client the walk is not allowed and restrict him to the unit. D) Designate a staff member to accompany the client on the walk.

Ans: D Feedback:The nurse teaches clients to request assistance for activities such as getting out of bed or going to the bathroom. If clients cannot request assistance, they require close supervision to prevent them from attempting activities they cannot perform safely alone. The nurse responds promptly to calls from clients for assistance and checks clients at frequent intervals.

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

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

A client has been admitted to the inpatient unit after using inhalants recently. Which is an antidote to treat inhalant toxicity? A) Ativan B) Narcan C) Antabuse D) There is no antidote

Ans: D Feedback:There is no antidote or specific medication to treat inhalant toxicity. Ativan, Narcan, and Antabuse are not used to treat inhalant toxicity.

Which is true of the time-out strategy that may be used for persons with conduct disorder? A) It is a punishment. B) It should only be used as a last resort. C) Eventually, the goal is for the client to avoid time-out. D) Time-out is retreat to a neutral place, so clients can regain self-control.

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

A client is admitted for a drug overdose with a Barbiturate? Which is the priority nursing action when planning care for this client? A) Check the client's belongings for additional drugs. B) Pad the side rails of the bed because seizures are likely. C) Prepare a dose of ipecac, an emetic. D) Monitor respiratory function.

Ans: D Feedback: CNS depressants depress respiratory functioning. Answer choices A, B, and C would not be priority nursing actions in this situation.

Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors.

Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studies involving viral theories have focused on schizophrenia, but so far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specific stressor with a specific disease have been unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common.

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

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

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

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

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior? A) Administering a sedative that has been prescribed to be used PRN. B) Insisting the client take a ìtime-outî in his room C) Clearing the area of all other clients D) Setting limits on aggressive and intimidating behavior

Ans: DFeedback:Because of the safety risks that clients in the manic phase take, safety plays a primary role in care, followed by issues related to self-esteem and socialization. It is necessary to set limits when they cannot set limits on themselves. Giving the client the opportunity to exercise self-control is most therapeutic. If the client cannot control his or her behavior, then more restrictive measures can be taken, such as room restriction or sedation. Clearing the area is not necessary during limit setting and may cause excessive panic on the part of other clients. When setting limits, it is important to clearly identify the unacceptable behavior and the expected, appropriate behavior. All staff must consistently set and enforce limits for those limits to be effective.

The mother of a 15-year-old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. She asks if it is healthy for a 15-year-old to be so independent. Which is valid information for the nurse to offer the mother? A) His behavior reflect normal growth and development B) He is overly independent C) It sounds like he is trying to avoid her D) She should observe for signs of substance abuse

Ans:A Feedback:The behaviors described by the mother are typical in terms of growth and development for a 15-year-old. The other choices are not found to give valid information to the mother regarding increased adolescent independence.

Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed where the patient who had the same diagnosis as her father had and saw her father's facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing? A) A flashback B) Emotional numbing C) Hyperarousal D) A dream

Ans:A Feedback:This nurse was experiencing a flashback where similar circumstances triggered a sensation that the stressful experience were happening again.

The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique? A) Let's look at what is on television. B) If you stop yelling, I will get your dessert. C) Don't you want to finish your meal? D) I don't understand what you are saying.

Answer: A Feedback:Distraction involves shifting the client's attention and energy to a more neutral topic. For example, the client may display a catastrophic reaction to the current situation, such as jumping up from dinner and saying, My food tastes like poison! The nurse might intervene with distraction by saying, Can you come to the kitchen with me and find something you'd like to eat? or You can leave that food. Can you come and help me find a good program on television? (redirection/distraction). Influencing behavior with a reward is a behavioral technique. Asking a direct question is ineffective. Clarification is used to try to determine meaning behind the client's message.

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