Psych Test #8

A class of medications commonly prescribed for somatic disorders is A mood stabilizers. B antidepressants. C anxiolytics. D antipsychotics.

C anxiolytics. Primary care providers prescribe anxiolytic agents for patients who seem highly anxious and concerned about their symptoms. Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety or to induce sleep. REF: 333

The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has A paranoid personality disorder and is suspicious of his neighbors. B narcissistic personality disorder and is highly self-important. C borderline personality disorder and is impulsive. D dependent personality disorder and clings to her husband.

C borderline personality disorder and is impulsive. Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times. REF: 470-471

A child who was physically and sexually abused is at great risk for A depression. B suicide attempts. C bullying and abusing others. D becoming active in a gang.

C bullying and abusing others. Children who have been abused are at risk for abusing others, as well as for developing dysfunctional patterns in close interpersonal relationships. REF: 305-306

Emily asks you what kind of therapy will help her. Your best response, based on current knowledge, is: A "A combination of antianxiety and antidepressant therapy is the most effective therapy." B "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." C "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." D "Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders."

D "Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders." Cognitive behavioral therapy (CBT) is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder. Text page: 336

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? A "I feel less anxiety than before." B "My memory is better than it was a month ago." C "I take my medications just as the physician prescribed." D "I don't think about my symptoms all the time as I used to."

D "I don't think about my symptoms all the time as I used to." This statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome. REF: Page 329

Which child is at greatest risk for developing attachment problems as a result of a neurobiological development? A A 13-year-old male B A 10-year-old female C A 7-year-old male D A 4-year-old female

D A 4-year-old female The developing brain is particularly vulnerable to adverse events because the most rapid brain development occurs in the first five years of life. The right hemisphere is involved in processing social-emotional information, promoting attachment functions, regulating body functions, and in supporting the individual in survival and in coping with stress. Since the right brain develops first and is involved with developing templates for relationships and regulation of emotion and bodily function, early attachment relationships are particularly important for healthy development and life-long health. REF: Page 316

Which statement about somatoform disorders is true? A An organic basis exists for each group of disorders. B Nurses perceive clients with these disorders as easy to care for. C No relation exists between these disorders and early childhood loss or trauma. D Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

D Clients lack awareness of the relations among symptoms, anxiety, and conflicts. Somatization disorders are believed to be responses to psychosocial stress, although the patient often shows no insight into the potential stressors. REF: Page 339-340

Which medication is FDA approved for treatment of anxiety in children? A Lorazepam (benzodiazepine) B Fluoxetine (selective serotonin reuptake inhibitor) C Clomipramine (tricyclic antidepressant) D None of the above

D None of the above There are no medications with FDA approval for children with anxiety disorders; however, medications approved for other age groups are often prescribed. None of the other options are FDA approved to treat anxiety in children (see the previous sentence). Text page: 296

Which behavior by a client would not support a diagnosis of somatoform disorder? A Attention seeking from significant others B Acquiring financial gain from a disability plan C Avoidance of certain unpleasant activities D Performing activities of daily living unassisted

D Performing activities of daily living unassisted Correct Somatic symptoms are reinforced by situations in which there is some sort of "payoff" for the client, such as attention, financial gain, avoidance of unpleasant situations, or getting dependent needs met. Performing activities of daily living unassisted would have no payoff of the sort mentioned. REF: Page 328

Which behavior would be characteristic of an individual who is displacing anger? A Lying B Stealing C Slapping D Procrastinating

D Procrastinating A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance. REF: 283; Table 15-2

Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder? A Express mild amusement over symptoms. B Arrange for client to spend time away from others. C Advise client to minimize exercise to conserve endorphins. D Reinforce use of positive self-talk to change negative assumptions.

D Reinforce use of positive self-talk to change negative assumptions. This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try." REF: Page 300-301

When discussing the symptoms of PTSD, the nurse correctly states A "The symptoms can occur almost immediately or can take years to manifest." B "PTSD causes agitation and hypervigilance but rarely chronic depression." C "When experiencing a flashback, the client generally experiences a slowing of responses." D "PTSD is an emotional response that does not cause significant changes in brain chemistry."

A "The symptoms can occur almost immediately or can take years to manifest." Correct B "PTSD causes agitation and hypervigilance but rarely chronic depression." C "When experiencing a flashback, the client generally experiences a slowing of responses." D "PTSD is an emotional response that does not cause significant changes in brain chemistry." The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon. REF: 310

A physician describes a client as "malingering." The nurse knows this means that the client A is falsely claiming to have symptoms. B experiences symptoms that cannot be explained medically. C experiences symptoms that have a physiological basis. D is seeking medication to ease pain of psychological origin.

A is falsely claiming to have symptoms. Malingering is a consciously motivated act to deceive based on the desire for material gain. REF: 337

Generally, ego defense mechanisms A often involve some degree of self-deception. B are rarely used by mentally healthy people. C seldom make the person more comfortable. D are usually effective in resolving conflicts.

A often involve some degree of self-deception. Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. REF: 290-291

Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of A panic attacks with agoraphobia. B obsessive-compulsive disorder. C posttraumatic stress response. D generalized anxiety disorder.

A panic attacks with agoraphobia. Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. REF: 291-292

Use of dissociation most closely resembles A performing mundane tasks on autopilot. B developing a headache to avoid an unpleasant task. C feeling angry with a co-worker who shirks work. D finding a socially acceptable reason to meet a need.

A performing mundane tasks on autopilot. Mild, fleeting dissociative experiences are relatively common to all of us; for example, we say we are on "automatic pilot" when we drive home from work and cannot recall the last 15 minutes before reaching the house. REF: 315

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff will A regularly discuss their feelings about the client during the unit's interprofessional care meetings. B be required to attend in-services that focus on the various aspects of somatic disorders. C rotate care of the client among the entire nursing department staff to minimize the frustration. D provide a unified approach to the client's behavior so as to manage and lessen the barrier itself.

A regularly discuss their feelings about the client during the unit's interprofessional care meetings. It is helpful for health care workers, no matter the setting, to discuss responses to these patients in conferences with other health care members to allow for expression of feelings and, ultimately, to provide for consistent care. REF: Page 331-332

An important question to ask during the assessment of a client diagnosed with anxiety disorder is A "How often do you hear voices?" B "Have you ever considered suicide?" C "How long has your memory been bad?" D "Do your thoughts always seem jumbled?"

B "Have you ever considered suicide?" The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any client with higher levels of anxiety. REF: 291

Emily is a veteran returning from Iraq. Ever since Emily participated in a village raid where explosives were used, she has been unable to walk. All diagnostic testing has been negative for any physical abnormalities, and she was diagnosed with conversion disorder. She asks you what that means. Your best response would be: A "Your legs don't work because your brain is screwed up." B "Your emotional distress is being expressed as a physical symptom." C "You are making up your symptoms as a cry for help." D "You are overly anxious about having a severe illness."

B "Your emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder. Text page: 325-326

The most likely client to initially demonstrate behaviors suggesting a somatic disorder is a A 13-year-old male B 23-year-old female C 33-year-old male D 43-year-old female

B 23-year-old female The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals. REF: 325

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports A that his symptoms started right after he was robbed at gunpoint. B being so worried he hasn't been able to work for the last 12 months. C that eating in public makes him extremely uncomfortable. D repeatedly verbalizing his prayers helps him feel relaxed.

B being so worried he hasn't been able to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer. REF: Page 286

Therapeutic intervention for a client with a somatoform disorder would include A steering conversation away from the client's feelings. B conveying an interest in the client rather than in the symptoms. C encouraging the client to use benzodiazepines liberally. D encouraging the client to rely on the nurse to meet the client's needs.

B conveying an interest in the client rather than in the symptoms. When the nurse focuses on the client rather than on the symptoms, the client's self-worth and coping skills are enhanced. REF: 337; Table 17-4

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of A altruism. B denial. C undoing. D suppression.

B denial. Denial involves escaping unpleasant reality by ignoring its existence. REF: 283; Table 15-2

The primary difference between a factitious disorder and other somatic disorders is that factitious disorders A respond well to confrontation as a primary therapeutic technique. B have a symptomatology that is actually controlled by the client. C have their origins in depression and anxiety. D are always self-directed.

B have a symptomatology that is actually controlled by the client. Factitious disorders, in contrast to other somatic disorders, are under conscious control. REF: Page 331-332

Research has indicated that the antisocial personality may be characterized by A social isolation. B lack of remorse. C learning difficulties. D difficulty with reality testing.

B lack of remorse. Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. REF: 465-466

Empathic listening is therapeutic because it focuses on A enhancing self-esteem. B lessening feelings of isolation. C reducing anxiety. D encouraging resilience.

B lessening feelings of isolation. Empathic listening can be healing because it can help minimize feelings of isolation. REF: 320; Table 16-2

Selective inattention is first noted when experiencing anxiety that is A mild. B moderate. C severe. D panic.

B moderate. When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events. REF: 279

A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds, A "You need to calm yourself." B "What is it that you would like me to do to help you?" C "Can you tell me what you were feeling just before your attack?" D "I will get you some medication to help calm you."

C "Can you tell me what you were feeling just before your attack?" A response that helps the client identify the precipitant stressor is most therapeutic. REF: Page 284-285

Which statement made by a client would support the diagnosis of hypochondriasis? A "I feel confused and disoriented." B "I feel as though I'm outside my body watching what is happening." C "I know I have cancer, but the doctors just cannot find it." D "I woke up one morning, and my left leg was paralyzed from the knee down."

C "I know I have cancer, but the doctors just cannot find it." Hypochondriasis is characterized by the persistent belief that one has a serious medical condition despite lack of evidence to prove this. REF: Page 325

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? A Potential for violence B Level of confusion C Dependence on medication D Personal identity disturbance

C Dependence on medication Many clients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the client has taken, but also for amounts and length of time over which the drugs have been prescribed. REF: Page 336

What would be an appropriate expected outcome of Emily's treatment plan? A Emily will walk unassisted within 1 week. B Emily will return to a pre-illness level of functioning within 2 weeks. C Emily will be able to state two new effective coping skills within 2 weeks. D Emily will assume full self-care within 3 weeks.

C Emily will be able to state two new effective coping skills within 2 weeks. An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic. Text page: 331

Hallie's father, Brent, has now been diagnosed with PTSD as well as Hallie. Which of the following symptoms would lead a provider to suspect PTSD? (select all that apply): A Visiting the scene of the accident over and over B Talking with strangers about the events of the accident C Flashbacks of the accident Correct D Hypervigilance E Irritability F Difficulty concentrating G Mania

C Flashbacks of the accident D Hypervigilance E Irritability F Difficulty concentrating All these symptoms are signs of PTSD. The other options are not associated with signs of PTSD. Text page: 305

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? A Somatic disorder B Factitious disorder C Illness anxiety disorder D Conversion disorder

C Illness anxiety disorder Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic. REF: 325

Which nursing diagnosis should be investigated for clients with somatoform disorders? A Deficient fluid volume B Self-care deficit C Ineffective coping D Delayed growth and development

C Ineffective coping Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms. REF: 324, 333

Which nursing diagnosis would be most useful for clients with anxiety disorders? A Excess fluid volume B Disturbed body image C Ineffective role performance D Disturbed personal identity

C Ineffective role performance Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting.REF: Page 287

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? A Having the client repeatedly touch "dirty" objects B Not allowing the client to seek reassurance from staff C Not allowing the client to wash hands after touching a "dirty" object D Telling the client that he or she must relax whenever tension mounts

C Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. REF: Page 300

Which disorder places the client at highest risk for developing a coexisting substance abuse disorder? A Conversion disorder B Factitious disorder C Somatoform pain disorder D Illness anxiety disorder

C Somatoform pain disorder Clients with pain disorder may use alcohol or other central nervous system depressants or anxiolytic drugs to self-medicate. REF: Page 16-17

The symptoms of an adjustment disorder can include (Select all that apply.) A Guilt Correct B Social withdrawal Correct C Overachieving D Anger Correct E Depression

E Depression In contrast to acute stress disorder responses, which are quite severe and include anxiety and fear, symptoms of an adjustment disorder can run the gamut of all forms of distress including guilt, depression, and anger. These feelings may be combined with other manifestations of distress, including physical complaints, social withdrawal, or work or academic inhibition. REF: Page 310-311

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." A helpful response for the nurse to make would be A "What things have you done in the past that helped you feel more comfortable?" B "Let's try to focus on that adorable little granddaughter of yours." C "Why don't you sit down over there and work on that jigsaw puzzle?" D "Try not to think about the feelings and sensations you're experiencing."

A "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. REF: Page 286-287

A possible outcome criterion for a client diagnosed with anxiety disorder is A Client demonstrates effective coping strategies. B Client reports reduced hallucinations. C Client reports feelings of tension and fatigue. D Client demonstrates persistent avoidance behaviors.

A Client demonstrates effective coping strategies. Option A is the only desirable outcome listed. REF: 281-282

What information should the nurse give to the family of a client who has had a dissociative episode? A Dissociation is a method for coping with severe stress. B Dissociation suggests the possibility of early dementia. C Brief periods of psychotic behavior may occur. D Ways to intervene to prevent self-mutilation and suicide attempts.

A Dissociation is a method for coping with severe stress. Childhood physical, sexual, or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms. REF: 316

Shane, aged 23 years, is admitted to your medical-surgical unit with complaints of abdominal pain, dizziness, and headaches. Results of a physical workup have been negative so far. Today Shane tells you, "Now I am having back pain." Which of the following in Shane's medical record may alert you to the possibility of malingering? (select all that apply): A Shane has a court date this week for drunk driving. B Shane was adopted at the age of 5 years. C Shane has a history of physical abuse by his stepfather. D Shane has a history of oppositional-defiant disorder. E Shane was raised primarily by his mother.

A Shane has a court date this week for drunk driving. C Shane has a history of physical abuse by his stepfather. Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home or by a primarily female influence is not known to be a causative factor in malingering. Text page: 337

Which statement is descriptive of clients with a personality disorder? A They are resistant to behavioral change. B They have an ability to tolerate frustration and pain. C They usually seek help to change maladaptive behaviors. D They have little difficulty forming satisfying and intimate relationships.

A They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly. REF: 461-462

Which item of data routinely gathered during assessment of a client with dissociative disorder would be of least relevance to planning? A Voluntary control of symptoms B Ability to remember C Level of anxiety D Evidence of disorientation

A Voluntary control of symptoms Clients with dissociative disorders do not have voluntary control of symptoms. Voluntary control of symptoms has greater relevance when the nurse is assessing clients with somatoform disorders. REF: Page 315

Characteristics the nurse will assess in the client diagnosed with antisocial personality disorder are A deceitfulness, impulsiveness, and lack of empathy. B perfectionism, preoccupation with detail, and verbosity. C avoidance of interpersonal contact and preoccupation with being criticized. D a need for others to assume responsibility for decision making and seeking nurture.

A deceitfulness, impulsiveness, and lack of empathy. Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others. REF: 465

A potential problem for a client diagnosed with severe obsessive-compulsive disorder is A sleep disturbance. B excessive socialization. C command hallucinations. D altered state of consciousness.

A sleep disturbance. Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep. REF: 286

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to A suddenly tremble severely. B exhibit stoic behavior. C report both nausea and vomiting. D laugh inappropriately.

A suddenly tremble severely. Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity. REF: Page 291

A client is experiencing a panic attack. The nurse can be most therapeutic by A telling the client to take slow, deep breaths. Correct B verbalizing mild disapproval of the anxious behavior. C asking the client what he means when he says "I am dying." D offering an explanation about why the symptoms are occurring

A telling the client to take slow, deep breaths. Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. REF: Page 284 (Table 15-3)

The primary goal of milieu therapy for clients diagnosed with personality disorders is A to manage the effect the behavior has on the entire group. B to provide one-on-one therapy for each member of the milieu. C to help the client remain uninvolved with other patients. D to promote a laissez-faire attitude among the staff members.

A to manage the effect the behavior has on the entire group. The primary goal of milieu therapy is affect management in a group context. REF: 470-471

The initial nursing action for a newly admitted anxious client is to A assess the client's use of defense mechanisms. B assess the client's level of anxiety. C limit environmental stimuli. D provide antianxiety medication.

B assess the client's level of anxiety. The priority nursing action is the assessment of the client's anxiety level. REF: 279-280

It can be said that the onset of most anxiety disorders occurs A before the age of 20 years. B before the age of 40 years. C after the age of 40 years. D scattered throughout the life span.

B before the age of 40 years. Epidemiology reports indicate that the onset of most anxiety disorders occurs before age 40 years. REF: 289

What can be said about the comorbidity of anxiety disorders? A Anxiety disorders generally exist alone. B A second anxiety disorder may coexist with the first. C Anxiety disorders virtually never coexist with mood disorders. D Substance abuse disorders rarely coexist with anxiety disorders.

B A second anxiety disorder may coexist with the first. In many instances, when one anxiety disorder is present, a second one coexists. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment. REF: 290-291

Which of the following statements about dissociative disorders is true? A Dissociative symptoms are under the person's conscious control. B Dissociative symptoms are not under the person's conscious control. C Dissociative symptoms are usually a cry for attention. D Dissociative symptoms are always negative.

B Dissociative symptoms are not under the person's conscious control. Dissociation is involuntary and results in failure of the normal control over a person's mental processes and normal integration of conscious awareness. The other responses are untrue. Text page: 315

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? A Overeating B Hypervigilance C A drive to be perfect D Passivity

B Hypervigilance PTSD in preschool children may manifest as irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, and hypervigilance. REF: 310

Studies of clients diagnosed with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal? A Brainstem B Hypothalamus-pituitary-adrenal system C Frontal lobe D Limbic system

B Hypothalamus-pituitary-adrenal system Studies of clients with posttraumatic stress disorder suggest that the stress response of the hypothalamus-pituitary-adrenal system is abnormal. REF: 290

Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because: A Jerry may become addicted faster than younger patients. B Jerry is at risk for falls. C Jerry has a history of nonadherence with medications. D Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

B Jerry is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels. Text page: 296-297

Which therapeutic intervention can the nurse implement personally to help a client diagnosed with a mild anxiety disorder regain control? A Flooding B Modeling C Thought stopping D Systematic desensitization

B Modeling Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used. The other options require agreement of the treatment team. REF: Page 290-291

The symptom the nurse can expect a client with depersonalization disorder to manifest is A aimless wandering with confusion and disorientation. B a feeling of detachment from one's body or mental processes. C existence of two or more personalities that take control of behavior. D worry about having a serious disease based on symptom misinterpretation.

B a feeling of detachment from one's body or mental processes. Depersonalization is characterized by a sense of unreality or self-estrangement. REF: Page 317

An obsession is defined as A thinking of an action and immediately taking the action. B a recurrent, persistent thought or impulse. C an intense irrational fear of an object or situation. D a recurrent behavior performed in the same manner.

B a recurrent, persistent thought or impulse. Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. REF: 287-288

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal A a history of childhood trauma. B a sibling with the disorder. C an eating disorder. D a phobia as well.

B a sibling with the disorder. Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population. REF: Page 290

Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." You suspect: A panic disorder. B adult separation anxiety disorder. C agoraphobia. D social anxiety disorder.

B adult separation anxiety disorder. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. Text page: 282-283

The defense mechanisms that can only be used in healthy ways include A suppression and humor. B altruism and sublimation. C idealization and splitting. D reaction formation and denial.

B altruism and sublimation. Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. REF: 281-282

When a toddler's mother is hospitalized for several months, the nursing diagnosis Risk for impaired parent/child attachment related to: prolonged separation has been included into a child's plan of care. The most appropriate outcome would be that A the mother is discharged and returned home as soon as possible. B mother and child show signs of healthy bonding. C the father is able to assume the mother's role in her absence. D the child is able to transfer nuturing needs to another available adult.

B mother and child show signs of healthy bonding. An overall attachment outcome would be for the parent and infant/child to demonstrate an enduring affectionate bond. REF: Page 308-309

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of A a rude awakening. B normal anxiety. C trait anxiety. D altruism.

B normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. REF: Page 279-280

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is A projection. B repression. C displacement. D reaction formation.

B repression. Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. REF: 283; Table 15-2

A child who is able to regain mental stability after a traumatic event is said to be A autonomous. B resilient. C mature. D independent.

B resilient. The term resilience refers to positive adaptation, or the ability to maintain or regain mental health despite adversity. REF: Page 307

When discussing somatic disorders from a cultural perspective, it is true that A somatic disorders are rarely observed in males. B somatic symptoms vary widely from culture to culture. C underdeveloped countries rarely tolerate somatic disorders. D secondary gain is seldom a factor in somatic disorders.

B somatic symptoms vary widely from culture to culture. The type and frequency of somatic symptoms vary across cultures. REF: 328

A child reared in a minority culture is at greatest risk for A eating- and sleep-related disorders. B traumatic experiences in early childhood. C bullying. D homicidal thoughts.

B traumatic experiences in early childhood. Poverty, parental substance abuse, and exposure to violence have received increasing attention and place minority children at greater risk for trauma and stress. REF: Page 307-308

Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, "I feel so anxious! Something is wrong!" Your best action is to: A reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her. B use the call light to inquire whether Lana has any prn anxiety medication. C call for help and assess Lana's vital signs. D tell Lana you will stay with her until the anxiety subsides.

C call for help and assess Lana's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety. Text page: 287

According to the Attachment Theory, relationship disorders are related to trauma associated with A insufficient food and/or shelter. B siblings and/or strangers. C caregivers and/or parents. D culture and/or religion.

C caregivers and/or parents. Attachment patterns or schemas are formed early in life through interaction and experiences with caregivers, and this relationship is embedded in implicit emotional and somatic memories. REF: Page 307-308

An example of a somatoform disorder is A depersonalization. B dissociative fugue. C conversion disorder. D dissociative identity disorder.

C conversion disorder. Somatic disorders include conversion disorders that are functional neurological disorders. REF: 325-326

Syndromes seen in other cultures but not seen in our own, such as piblokto, Navajo frenzy witchcraft, and amok should be considered: A dissociative disorders such as dissociative identify disorders. B physical disorders, not mental disorders. C culture-bound syndromes that are not dissociative disorders. D myths, or rumors, because they have not been sufficiently studied to be classified as real.

C culture-bound syndromes that are not dissociative disorders. Certain culture-bound disorders exist in which there is a high level of activity, a trancelike state, and running or fleeing, followed by exhaustion, sleep, and amnesia regarding the episode. These syndromes, if observed in individuals native to the corresponding geographical areas, should be differentiated from dissociative disorders. The other responses are incorrect. Text page: 316

A Gulf War veteran is entering treatment for post-traumatic stress disorder. An important facet of assessment is to A ascertain how long ago the trauma occurred. B find out if the client uses acting-out behavior. C determine use of chemical substances for anxiety relief. D establish whether the client has chronic hypertension related to high anxiety.

C determine use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms. REF: Page 286-287

An appropriate intervention for stage 2 of the staged model of trauma treatment is A re-enforcing social skills training. B providing a predictable environment. C engaging in memory work. D role-modeling problem-solving skills.

C engaging in memory work. Appropriate interventions for stage 2 of the staged model of trauma treatment include reducing arousal and regulating emotion through symptom reduction; engaging in memory work while reducing arousal; finding comfort from others; tolerating affect; integrating disavowed emotions and accepting ambivalence, overcoming avoidance; improving attention and decreasing dissociation; working with memories; and transforming memories. REF: 309

Panic attacks in Latin American individuals often involve A repetitive involuntary actions. B blushing. C fear of dying. D offensive vebalizations.

C fear of dying. Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying. REF: Page 291

Characteristic behaviors the nurse will assess in the narcissistic client are A dramatic expression of emotion, being easily led. B perfectionism and preoccupation with detail. C grandiose, exploitive, and rage-filled behavior. D angry, highly suspicious, aloof, withdrawn behavior.

C grandiose, exploitive, and rage-filled behavior. Correct D angry, highly suspicious, aloof, withdrawn behavior. Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem. REF: 460-461

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit A frequent episodes of psychosis. B constant involvement with the needs of significant others. C inflexible and maladaptive responses to stress. D abnormal ego functioning.

C inflexible and maladaptive responses to stress. Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.REF: 462

If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to A make jokes to relieve tension. B miss appointments. C justify illogical ideas and feelings. D behave in ways that are the opposite of his or her feelings.

C justify illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. REF: Page 283 (Table 15-2)

A woman suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of A regression. B depersonalization. C la belle indifference. D dissociative amnesia.

C la belle indifference. La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety. REF: Page 325-326

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing A denial. B compensation. C normal anxiety. D selective inattention.

C normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. REF: Page 279-280

Hallie, 4 years old, is referred to the outpatient mental health clinic after being in a severe car accident during which her father was driving and her mother died. Her father states she is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again when playing. Hallie states to you, "It's my fault because I'm bad." You suspect: A adjustment disorder. B dissociative identity disorder. C posttraumatic stress disorder (PTSD). D acute stress disorder (ASD).

C posttraumatic stress disorder (PTSD). PTSD in preschool children may manifest as repetitive play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion. Children may blame themselves for the traumatic event and manifest persistent negative thoughts about themselves. Unlike PTSD, adjustment disorder may be diagnosed immediately or within 3 months of exposure. Responses to the stressful event may include combinations of depression, anxiety, and conduct disturbances. Dissociative identity disorder includes the presence of "alters" or other personalities that take over in times of stress. As compared with PTSD that occurs a month after the trauma, ASD occurs from 3 days and up to 1 month after exposure to a highly traumatic event. Individuals with ASD experience three or more dissociative symptoms either during or after the traumatic event, including the following: a sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization (a sense of unreality related to the environment); depersonalization (experience of a sense of unreality or self-estrangement); or dissociative amnesia (loss of memory). Text page: 305

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating A projection. B rationalization. C reaction formation. D undoing.

C reaction formation. Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. REF: 283; Table 15-2

The wife of a client diagnosed with hypochondriasis tells the nurse, "It is so difficult! Whenever we make plans my husband says he is too ill to go. I don't know how much longer I can take it." On the basis of this report, the nurse may wish to explore the nursing diagnosis of A interrupted family processes. B decisional conflict. C risk for caregiver role strain. D impaired home maintenance.

C risk for caregiver role strain. Caregiver role strain is defined as caregiver's felt or expressed difficulty in performing the family caregiver role. The statements "It is so difficult" and "I don't know how much longer I can take it" are the clues. REF: Page 333 (Table 17-3)

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as A mild. B moderate. C severe. D panic.

C severe. Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. REF: Page 279-280

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should A question the physician's order because the dose is excessive. B explain the long-term nature of benzodiazepine therapy. C teach the client to limit caffeine intake. D tell the client to expect mild insomnia.

C teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication. REF: Page 296-297

Dissociative identity disorder is characterized by A the inability to recall important information. B sudden, unexpected travel away from home and inability to remember the past. C the existence of two or more subpersonalities, each with its own patterns of thinking. D recurring feelings of detachment from one's body or mental processes.

C the existence of two or more subpersonalities, each with its own patterns of thinking. The essential feature of dissociative identity disorder is the presence of two or more distinct personality states that recurrently take control of behavior. Each alternate personality (alter) has its own pattern of perceiving, relating to, and thinking about the self and the environment. It is believed that severe sexual, physical, or psychological trauma in childhood predisposes an individual to the development of dissociative identity disorder. REF: 317

A client diagnosed with PTSD shows little symptom improvement after being prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse expects that the next medication to be prescribed will be a A beta blocker. B barbiturate. C tricyclic antidepressant (TCA). D sedative.

C tricyclic antidepressant (TCA). TCAs or mirtazapine (Remeron) maybe be prescribed if SSRIs or SNRIs are not tolerated or do not work. REF: 313-314

Which statement about structural dissociation of the personality is true? A An organic basis exists for this type of disorder. B Nurses perceive clients with this disorder as easy to care for. C No known link exists between this disorder and early childhood loss or trauma. D This disorder results in a split in the personality causing a lack of integration.

D This disorder results in a split in the personality causing a lack of integration. The theory of structural dissociation of the personality proposes that patients with complex trauma have different parts of their personality, the apparently normal part and the emotional part, that are not fully integrated with each other. Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors. These different parts may not be aware of each other, with only one dominant personality operating depending on the situation and circumstance of the moment. REF: Page 316-317

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of A standard antipsychotic medication. B tricyclic antidepressant medication. C anticholinergic medication. D a short-acting benzodiazepine medication.

D a short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects. REF: Page 296

Studies have shown a correlation between mental disorders and medical conditions such as A psoriasis. B asthma. C renal failure. D cancer.

D cancer. Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions such as cardiovascular disease and cancer. REF: 326

Working to help the client view an occurrence in a more positive light is called A flooding. B desensitization. C response prevention. D cognitive restructuring.

D cognitive restructuring. The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. REF: 299-300

In somatization disorders, it is important for the nurse to employ holistic strategies. This can be defined as: A utilizing many different therapeutic strategies or modalities for enhanced coping. B involving every member of the family as well as the patient in treatment. C incorporating spirituality and religion into treatment. D considering all dimensions of the patient, including biological, psychological, and sociocultural.

D considering all dimensions of the patient, including biological, psychological, and sociocultural. It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care. Text page: 325

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to A protect the nurse legally. B establish the nursing diagnoses of priority. C obtain information about the client's psychosocial background. D determine whether the anxiety is primary or secondary in origin.

D determine whether the anxiety is primary or secondary in origin. The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause. REF: 291-292

A symptom commonly associated with panic attacks is A obsessions. B apathy. C fever. D fear of impending doom.

D fear of impending doom. The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. REF: 282-283

When caring for a client demonstrating the inability to provide effective self-care, the nurse A identifies the level of self-care the client is willing to perform and sets expectations accordingly. B initially sets only minimal self-care expectations for the client. C attends to all self-care needs until the client indicates a willingness to perform care independently. D identifies the client's highest level of self-care and states reasonable expectations to the client.

D identifies the client's highest level of self-care and states reasonable expectations to the client. In general, interventions involve the use of a matter-of-fact approach to support the highest level of self-care the client can perform. For clients manifesting paralysis, blindness, or severe fatigue, an effective nursing approach is to support the client while expecting the individual to feed, bathe, or groom himself or herself. REF: 335

The major distinction between fear and anxiety is that fear A is a universal experience; anxiety is neurotic. B enables constructive action; anxiety is dysfunctional. C is a psychological experience; anxiety is a physiological experience. D is a response to a specific danger; anxiety is a response to an unknown danger.

D is a response to a specific danger; anxiety is a response to an unknown danger. Fear is a response to an objective danger; anxiety is a response to a subjective danger. REF: 279

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to: A reinforce the preoperative teaching by restating it slowly. B have Lana read the teaching materials instead of verbal instruction. C have a family member read the preoperative materials to Lana. D not attempt any teaching at this time.

D not attempt any teaching at this time. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety. Text page: 279

A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as A mild. B moderate. C severe. D panic.

D panic. Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety. REF: Page 293-294

Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. The nurse explains that A children this age usually have imaginary friends. B it is nothing to worry about unless the child starts to socially isolate. C the child needs more of their one-on-one attention. D the imaginary friend is a coping mechanism the child is using.

D the imaginary friend is a coping mechanism the child is using. Often traumatized children feel responsible for what happened to them and are frightened by flashbacks, amnesia, or hallucinations that may be due to trauma. For example, a child may use imaginary friends as a coping mechanism. REF: Page 309-310