Psych W5 Questions

A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to support which electrolyte imbalance? A. Hypernatremia B. Hypokalemia C. Hypercalcemia D. Hypolipidemia

B. Hypokalemia Vomiting causes loss of potassium, leading to hypokalemia. Vomiting is not the trigger for any of the other options presented.

A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." What response should the nurse provide to address the client's comment? A. "I will be continuing to follow the established care plan for the patient." B. "I see you are trying to control that patient's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "That patient's care is really of no concern to you or to other clients."

A. "I will be continuing to follow the established care plan for the patient." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.

A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder? A. Antisocial personality disorder B. Borderline personality disorder C. Schizotypal personality disorder D. Narcissistic personality disorder

A. Antisocial personality disorder Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts. The description provided is not associated with any of the other suggested options.

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which of the client's classic characteristics? A. Mood shifts, impulsivity, and splitting B. Grief, anger, and social isolation C. Altered sensory perceptions and suspicion D. Perfectionism and preoccupation with detail

A. Mood shifts, impulsivity, and splitting Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings. The remaining options suggest characteristics not associated with this disorder.

Which remark would signal to the nurse that there is a teaching need for the family of a client diagnosed with schizophrenia? A. "We always reprimand him whenever his behavior is bothersome." B. "We watch him closely for signs of illness associated with relapse." C. "We have taught him to use the bus so we do not have to drive him everywhere." D. "We give positive recognition to him whenever he does even simple things well."

A. "We always reprimand him whenever his behavior is bothersome." An important need of families caring for the severely and persistently mentally ill is psychoeducation to help them understand the disease process. Families need to be prepared to meet the many concerns related to safety, communication, medication compliance, and symptom management. Family interventions are now considered an evidence-based practice, with research showing improved outcomes of decreased relapses and rehospitalizations for clients whose families participate. The only negative approach to the client and his/her needs is reflected in the option that suggests reprimanding when bothersome.

Which statement is true of the eating disorder referred to as bulimia? A. Patients with bulimia often appear at a normal weight. B. Patients with bulimia binge eat but do not engage in compensatory measures. C. Patients with bulimia severely restrict their food intake. D. One sign of bulimia is lanugo.

A. Patients with bulimia often appear at a normal weight. Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. The other options do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

Serious mental illness (SMI) affects how many adults in the United States? A. 11 million B. 8 million C. 4 million D. 1 million

A. 11 million SMI affects about 11.4 million adults in the United States. The other options are incorrect percentages.

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A. A court date this week for drunk driving B. Was adopted at the age of 5 years C. A history of physical abuse by his stepfather D. A history of oppositional-defiant disorder

A. A court date this week for drunk driving 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.

The term dual diagnosis refers to having a severe mental illness and what other dysfunctional behavior? A. A substance abuse problem B. Medication noncompliance C. A personality disorder D. HIV infection

A. A substance abuse problem Dual diagnosis is the term used to identify a client with severe mental illness and a substance abuse problem. Both problems must be treated if the client is to be successfully rehabilitated. None of the other options reflect an accurate description of the term dual diagnosis.

An older adult client tells the nurse that he prefers not to attend senior citizens meetings because "they are all old fuddy duddies who talk subjects to death but never take action." The nurse can hypothesize that the client is demonstrating which type of reaction? A. Ageism B. Paranoid thinking C. Projection of personal weaknesses D. Poor social skills

A. Ageism Ageism, a form of discrimination, is often exhibited by the elderly themselves. Proximity raises feelings of vulnerability. None of the other options appropriately identifies this reaction.

A 20-year-old Amish client was diagnosed with paranoid schizophrenia 1 year ago who lives with his parents. When the nurse attempts to educate him about his diagnosis and the need for medication, the client persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to describe this response? A. Anosognosia B. Resistance C. Apathy D. Religiosity

A. Anosognosia Anosognosia is the inability to recognize one's deficits as a result of one's illness. In serious mental illnesses (SMIs), the brain, the organ one needs to have insight and make good decisions, is the organ that is diseased. An illness that makes one unable to recognize that illness can understandably cause one to be resistant to treatment. Although the patient may be resistive to treatment, it does not best describe the patient's denial of the illness. Apathy is lack of caring. Nothing in the scenario depicts the patient being preoccupied with religion at this time.

Which statement is true of pharmacological therapies associated with the treatment of personality disorders? A. Clients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. B. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. C. Clients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. D. Clients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these clients.

A. Clients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off-label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although clients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.

Which characteristics will the nurse assess in the client diagnosed with antisocial personality? 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. Characteristics presented in the other options are not associated with this disorder.

A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating which defense mechanism? A. Denial B. Projection Rationalization Reaction formation

A. Denial Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence). No other options are associated with the client's statement. Reaction formation is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior. (Ch. 15) Adaptive use: A recovering alcoholic constantly talks about the evils of drinking. Maladaptive use: A woman who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development.

Which coping mechanism is used excessively by clients diagnosed with bulimia nervosa to cope with their obsession with their body image? A. Denial B. Humor C. Altruism D. Projection

A. Denial Denial of incongruence between body reality, body ideal, and body presentation is the mainstay of the client diagnosed with bulimia nervosa. None of the other mechanisms are as vital to their coping technique.

Which psychosocial disorder is more often initially seen in late life? (Select all that apply.) A. Depression B. Bipolar disorder C. Schizophrenia D. Dissociative disorder E. Anxiety

A. Depression E. Anxiety Depression, risk for suicide, alcohol abuse, and anxiety are all disorders seen in mental illnesses in late life. Although it may be possible to experience these other disorders in older age, they are not usually first diagnosed in this age group; clients diagnosed with these disorders earlier in life may in fact have some symptom remission as they age.

What is the initial task of an outpatient clinic nurse who is working with a client experiencing a sexual disorder? A. Establish trust with the client B. Assess the client's physical health C. Explain that the nurse is a therapeutic agent D. Orient the client to the clinic's programs, use as part of therapy

A. Establish trust with the client The initial task in working with any client is to establish trust. While the other options are appropriate, the basis of facilitating openness and cooperation is an effective, mutually respective relationship between client and nurse.

The client who will most likely respond well to drug therapy for the management of compulsive deviant sexual behavior is one with which diagnosis? A. Exhibitionism B. Antisocial personality disorder C. Low sexual drive D. Fetishism

A. Exhibitionism Libido and compulsive deviant sexual behavior is best managed pharmacologically in individuals with high sexual drive such as exhibitionists. This is not true of the other options.

A primary health provider describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? A. Falsely claiming to have symptoms. B. Experiencing symptoms that cannot be explained medically. C. Experiencing symptoms that have a physiological basis. D. Seeking medication to ease pain of psychological origin.

A. Falsely claiming to have symptoms. Malingering is a consciously motivated act to deceive based on the desire for material gain. The symptoms described are nonexisting and so none of the other options are correct statements of behavior.

The treatment team meets to discuss a client's plan of care. Which of the following factors will be priorities when planning interventions? A. Readiness to change behaviors B. Current college performance C. Financial ability D. Availability of immediate family to come to meetings

A. Readiness to change behaviors The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital.

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested what substance? (Select all that apply.) A. Flunitrazepam B. Gamma-hydroxybutyrate (GHB) C. ReVia D. Clonidine E. Ayahuasca

A. Flunitrazepam B. Gamma-hydroxybutyrate (GHB) The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies"), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. The description is not associated with any of the other suggested drugs. Naltrexone (ReVia) is an opioid antagonist used to block the opioid receptors and prevent opioids from activating feelings of euphoria. Clonidine is an alpha2-adrenergic agonist. It is used to decrease HR and BP. (Catapres), an alpha agonist antihypertensive, is often used to reduce the symptoms of opioid withdrawal. By blocking neurotransmitters that trigger sympathetic nervous system activity, clonidine eases sweating, hot flashes, watery eyes, and restlessness. This drug also decreases anxiety and may even shorten the detox process. Ayahuasca is a commonly misused drug. It is a DMT-containing plant that produces strong hallucinations, altered vision and auditory perceptions, increased BP, V/D.

A client hospitalized with anorexia nervosa has a weight that is 65% of normal. For this client, what is a realistic short-term goal for the first week of hospitalization regarding the physical impact of his/her weight? A. Gain a maximum of 3 lb. B. Develop a pattern of normal eating behavior. C. Discuss fears and feelings about gaining weight. D. Verbalize awareness of the sensation of hunger.

A. Gain a maximum of 3 lb. The critical outcome during hospitalization for anorexia nervosa is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. Too-rapid weight gain can cause pulmonary edema. While all the remaining goals are appropriate, none have the physical focus that is the initial priority. Healthy weight gain of 1-2 pounds per week can be expected when reasonably increasing energy intake. It takes an excess of about 2,000 to 2,500 calories per week to support the gain of a pound of lean muscle and about 3,500 calories per week to gain a pound of fat.

The mother of a client with severe, persistent schizophrenia tells the nurse, "My child has slipped so far away from me over the past few years. We really don't have a relationship anymore. I miss my child terribly." The nursing diagnosis that best describes the mother's feelings using which term? A. Grieving B. Powerlessness C. Caregiver role strain D. Ineffective coping

A. Grieving The mother is mourning the loss of her son as she formerly knew him. Grief is a common experience for families with mentally ill members. The statement does not support any of the other options.

Clients diagnosed with borderline personality disorder (BPD) exhibit negative effect, which includes rapidly moving from one emotional extreme to another. What term is used to describe this characteristic? A. Lability B. Impulsivity C. Splitting D. Denial

A. Lability One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Clients exhibiting this trait are often documented as being labile. None of the other options is used to describe this characteristic.

Which signs and symptoms are associated with opioid withdrawal? A. Lacrimation, rhinorrhea, dilated pupils, and muscle aches. B. Illusions, disorientation, tachycardia, and tremors. C. Fatigue, lethargy, sleepiness, and convulsions. D. Synesthesia, depersonalization, and hallucinations.

A. Lacrimation, rhinorrhea, dilated pupils, and muscle aches. Symptoms of opioid withdrawal resemble the "flu"; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever. None of the other options are generally related to opioid withdrawal.

The client experiencing bulimia differs from the client diagnosed with anorexia nervosa by exhibiting which characteristic? A. Maintaining a normal weight B. Holding a distorted body image C. Doing more rigorous exercising D. Purging to keep weight down

A. Maintaining a normal weight Many bulimics are at or near normal weight, whereas clients with anorexia nervosa are underweight. The other characteristics are commonly shared among persons with either disorder.

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 should implement which personal intervention? A. Regularly discuss their feelings about the client during the unit's interprofessional care meetings. B. 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. While the other options are appropriate, none are as staff oriented as the correct option. When a healthcare worker is experiencing frustration as a result of a patient with a somatization disorder, the best intervention for the worker is to discuss their feelings. Attending in-services will only expand on their clinical knowledge, but it will not promote self-care.

Which statement accurately applies to exhibitionism? A. Seldom a precursor to sexual assault or rape. B. Generally viewed as a victimless crime. C. Rarely prosecuted. D. Generally viewed as an illness by the courts.

A. Seldom a precursor to sexual assault or rape. Exhibitionism is generally done more for shock value, and actual physical contact is rarely sought. None of the other options are accurate statements regarding this disorder.

A client confides to the nurse that she is sexually excited by dominating her partner and achieves orgasm only when she humiliates her partner. This admission supports which sexual disorder? A. Sexual sadism B. Orgasmic disorder C. Sexual pain disorder D. Immature sexual gratification

A. Sexual sadism Sexual sadism involves the need to give psychological or physical pain to achieve sexual gratification. No other option is supported by the statement.

The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by implementing which intervention? A. Teaching the family about the disorder and the client's behaviors B. Stressing the need to suppress overt conflict within the family C. Urging the family to demonstrate greater caring for the client D. Encouraging the family to use their usual social behaviors at meals

A. Teaching the family about the disorder and the client's behaviors Families need information about specific eating disorders and the behaviors often seen in clients with these disorders. This information can serve as a basis for additional learning about how to support the family member. While the other options may be appropriate for specific client families, they are not as fundamental as the correct option.

When attempting to determine the cause of low sexual drive in either a male or female client, the nurse can expect evaluation of the client's serum level of which hormone? A. Testosterone B. Estrogen C. Thyroxin D. Insulin

A. Testosterone Testosterone, present in both males and females, appears to be essential to sexual desire in both men and women. This is not true of any of the other options.

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 with cognitive functioning.

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. None of the other options are generally associated with this disorder.

Which statement about the adequacy of pain management in the elderly is supported by current research? A. They receive less analgesia than younger adults, which makes pain relief inadequate. B. They need smaller doses of pain medication to achieve adequate pain relief. They excrete analgesics more rapidly and therefore need more frequent doses. They respond better to meperidine than to morphine sulfate when opiates are necessary.

A. They receive less analgesia than younger adults, which makes pain relief inadequate. It is true that the older adult receives pain medication less frequently than younger adults resulting in ineffective pain management. None of the other statements are accurate.

Nursing assessment of an alcohol-dependent client 6 to 8 hours after the last drink would most likely reveal the presence of which early sign of alcohol withdrawal? A. Tremors B. Seizures C. Blackouts D. Hallucinations

A. Tremors Tremors are an early sign of alcohol withdrawal. The remaining options are not events considered early signs of alcohol withdrawal. Hallucinations are seen in the 2nd part of untreated alcoholic withdrawals. They are often auditory hallucinations and are paired with psychomotor agitation (movements with no purpose -- pacing, rapid talking, tapping toes). Seizures are seen in the 3rd part of untreated alcoholic withdrawals: alcohol withdrawal delirium (Delirium Tremens).

After stabilization of symptoms, what is the primary focus of treatment for a client diagnosed with anorexia nervosa? A. Weight restoration B. Improving interpersonal skills C. Learning effective coping methods D. Changing family interaction patterns

A. Weight restoration Weight restoration is the priority goal of treatment for the client with anorexia nervosa because health is seriously threatened by the underweight status. The other options are addressed are secondary to the physiological goal of weight restoration. For AN, weight restoration takes priority over learning effective coping methods because low body weight is a medical problem.

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which behaviors? 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. The other options present behaviors not necessarily associated with this disorder.

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. This is not an accurate description of any of the other options.

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? 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. The discussion related to client feelings is a major focus of therapy. Neither of the remaining options serves to help the client identify the causes of the illness and so would not serve as effective interventions.

Which statement by a young client diagnosed with a severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention? A. "I like to watch cartoons every morning." B. "I hear that marijuana helps calm you down." C. "I am looking for a job washing dishes at a diner." D. "I hate having my thoughts so messed up all the time."

B. "I hear that marijuana helps calm you down." Clients with mental illness should receive information about the dangerous negative impact of using illegal drugs. None of the other options suggest situations that are unsafe for the client.

A 24-year-old client diagnosed with borderline personality disorder (BPD) is admitted to the inclient psychiatric unit following a suicide attempt. Which client statements illustrate a primary coping style of persons with BPD? A. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" B. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." C. "I will never again speak to any of my messed up family members. I know that this will help me to be more functional." D. "I promise I am not feeling suicidal. I won't hurt myself."

B. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." A primary coping style used by clients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The other options do not describe splitting, which is a primary coping style of clients with BPD.

The role of a case manager working with severely and persistently mentally ill clients who are homeless would include which intervention? A. Administer medication B. Coordinate needed services C. Ensure that the clients are not re-hospitalized D. Teach the clients to function independently

B. Coordinate needed services Community mental health services are designed to provide outreach and case management for severely mentally ill persons who are homeless. A team approach is used to gain access to clients and connect them with the various services available to meet their needs. The role of the outreach worker is to be an advocate in all areas of client need and to foster client self-care. The role of the case manager does not include any of the other options.

A client has been diagnosed with gender identity disorder. The nurse can expect that the client will evidence which characteristic? A. Intense sexual urges focused on an object B. Discomfort with biological gender C. Self-humiliation during the sexual act D. Inability to maintain sexual arousal

B. Discomfort with biological gender Gender identity disorder involves the lack of a match between biological gender and psychological gender anxiety. The client will state that he is a woman who was mistakenly given a man's body. None of the other options are associated with this disorder.

A client diagnosed with bulimia nervosa uses enemas and laxatives to purge to maintain weight. What is the likely physiological outcome of this practice? A. Increase in the red blood cell count B. Disruption of the fluid and electrolyte balance C. Elevated serum potassium level D. Elevated serum sodium level

B. Disruption of the fluid and electrolyte balance Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. There would be a decrease in potassium and sodium levels while the concentration of, but not actual red cell count would be affected.

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

B. Factitious disorders have a symptomatology that is actually controlled by the client. Factitious disorders, in contrast to other somatic disorders, are under conscious control. None of the other statements accurately describe these disorders.

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" 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.

Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder? 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.

The nurse admitting an older, Hispanic, adult for a possible urinary tract infection is overheard stating, "I probably won't be able to get accurate information until the client's family comes in and can answer my questions." The nurse is exhibiting which bias? A. Gender bias B. Ageism C. Racism D. Cultural bias

B. Ageism The nurse appears to be demonstrating discrimination against ageism by assuming she is confused or demented because of her age and will not be able to provide accurate information. Ageism has been defined as a bias against older people based on advanced age. Ageism differs from other forms of discrimination in that it cuts across gender, race, religion, and socioeconomic status to reach the majority of persons who are more than 65 years old. Gender is not a factor in this scenario. Neither race nor culture tends to be factors in this behavior.

A 68-year-old recently retired client is referred to the mental health clinic for symptoms of depression, social isolation, and irritability. The client's son states, "My dad never used to be like this. My mom's been gone for 10 years and he has been doing fine." When the nurse asks the client directly about alcohol intake, he becomes defensive and refuses to discuss the issue. The nurse's response should be guided by what knowledge? (Select all that apply.): A. Older men are more likely to abuse substances other than alcohol. B. Alcohol abuse often goes undetected in older adults. C. The client is exhibiting dysfunctional grieving. D. The client is most likely reacting to his retirement. E. Depression plays a role in increased drinking. F. Being single is a risk factor for alcohol abuse.

B. Alcohol abuse often goes undetected in older adults. E. Depression plays a role in increased drinking. F. Being single is a risk factor for alcohol abuse. The risk factors for heavy drinking in older adults are being male and single, having less than a high school education, low income, and smoking. Additionally, depression often plays a role in increased alcohol consumption in the elderly. Identifying alcohol and substance abuse is often difficult because the accompanying personality and behavioral changes associated with alcohol abuse frequently go unrecognized in older adults. Alcohol abuse is more common than is abuse of other substances. The client's wife died 10 years ago, and there is nothing in the scenario to indicate dysfunctional grieving. Although depression may be a factor, the reasons for depression are not the priority assessment at this time.

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? A. Mood stabilizers B. Antidepressants C. Anxiolytics D. Atypical antipsychotics

B. Antidepressants The antidepressant fluoxetine has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders.

A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for this client's treatment plan while in the hospital? A. Client will return to a pre-drug level of functioning within 1 week. B. Client will be medically stabilized while in the hospital. C. Client will state within 3 days that they will totally abstain from drugs and alcohol. D. Client will take a leave of absence from college to alleviate stress.

B. Client will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely.

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? A. It will reduce the need for cognitive therapy. B. It will be prescribed at a higher than typical dose. C. There are a variety of medications to prescribe if fluoxetine proves to be ineffective. D. Long-term management of symptoms is best achieved with tricyclic antidepressants.

B. It will be prescribed at a higher than typical dose. Research has shown that antidepressant medication together with cognitive-behavioral therapy brings about improvement in bulimic symptoms. Fluoxetine (Prozac), an Selective serotonin reuptake inhibitors (SSRI) antidepressant, has FDA approval for acute and maintenance treatment of bulimia nervosa in adult patients. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression. Although no other drugs have FDA approval for this disorder, tricyclic antidepressants helped reduce binge eating and vomiting over short terms. Fluoxetine (Prozac) is the only FDA-approved medication for bulimia nervosa. That is why C is incorrect: there are not other meds that are *proven* to be effective.

Research has indicated that the antisocial personality may be characterized by what behavior? 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. This disorder is not associated with any other behaviors suggested by the remaining options.

A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive. What nursing intervention should be implemented to best assure the safety of the client and the milieu? (Select all that apply.) A. Taking him to the gym on the psychiatric unit B. Obtaining an order for seclusion and close observation C. Assigning a psychiatric technician to "talk him down" D. Administering naltrexone as needed per hospital protocol E. Obtaining a prescription for a benzodiazepine

B. Obtaining an order for seclusion and close observation E. Obtaining a prescription for a benzodiazepine Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off as well as the calming effect of a benzodiazepine. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist. Option C is used for hallucinogen toxicity. Option D is used for opioid withdrawals. Naltrexone is an opioid antagonist. Option E is used for PCP intoxication because benzos are a type of calming medication.

Disorders that involve sexual behaviors associated with nonhuman objects are identified by which term? A. Pedophilias B. Paraphilias C. Frotteurism D. Sadomasochism

B. Paraphilias The essential features of paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving inanimate objects, the suffering or humiliation of oneself or a partner, or the use of children or other nonconsenting persons. This description does not accurate relate to any of the other options. Rubbing or touching a nonconsenting person characterizes frotteuristic disorder.

Institutionalization leads to what specific type of behaviors in adults old enough to have been confined to institutions before deinstitutionalization? A. Anger and aggression B. Passivity and dependence C. Assertiveness and candor D. Fearfulness and paranoia

B. Passivity and dependence Medical paternalism, in which the health care provider made all decisions for patients with serious mental illnesses (SMIs), was pervasive at the time of common institutionalization for mental illness. As a result, patients became dependent on the services and structure of institutions and unable to function independently outside such institutions. It was difficult to distinguish whether behaviors such as regression were the result of the illness or institutionalization. The other options are incorrect regarding the common resulting behavior of institutionalized patients.

A 31-year-old patient who has been referred to the sexual disorders clinic by a primary care provider. The client describing his problem states, "I can have an orgasm, no problem. It just happens way too soon." This description support what form of sexual dysfunction? A. Erectile disorder B. Premature ejaculation C. Delayed ejaculation D. Male hypoactive sexual desire disorder

B. Premature ejaculation In premature ejaculation, a man persistently or recurrently achieves orgasm and ejaculation before he wishes to. Erectile disorder (also called erectile dysfunction and impotence) refers to failure to obtain and maintain an erection sufficient for sexual activity. In delayed ejaculation, a man achieves ejaculation during coitus only with great difficulty. Male hypoactive sexual desire disorder is characterized by a deficiency or absence of sexual fantasies or desire for sexual activity.

What is the most beneficial nursing intervention directed toward minimizing the discomfort associated with conducting a sexually focused assessment? A. Assure the client that the responses will be kept confidential. B. Provide the client with a rationale for asking the questions. C. Begin with the most relevant, non-personal question. D. Project a relaxed, causal demeanor when questioning the client.

B. Provide the client with a rationale for asking the questions. Letting the client know why the questions are being asked increases openness and cooperation. While the other options are appropriate, the basis of facilitating openness and cooperation is an exchange of information between client and nurse. Providing rationales helps establish trust with the patient. which is the initial task.

Under the Patient Self-Determination Act of 1990, what is the nurse's responsibility when a client is admitted to a long-term care facility? A. Explain advance directives and the agency expectation that the client will formulate such directives within 24 hours after admission. B. Provide written materials concerning the client's rights to make decisions about medical care and to formulate advance directives and also ask whether the client has an advance directive. C. Offer to act as the client's health care proxy for as long as he or she is a resident at the facility. D. Ask the client to explain the end-of-life choices he or she has made and document these in the nursing progress notes.

B. Provide written materials concerning the client's rights to make decisions about medical care and to formulate advance directives and also ask whether the client has an advance directive. Any agency serving Medicare and Medicaid clients is obligated to provide written materials to all clients concerning their rights under state law to make decisions about medical care, including the right to accept or refuse surgical or medical care and to formulate advance directives. The nurse is required to ask whether the client has executed advance directives and to document it. This act does not address the actions identified in any of the remaining options.

The nurse working with a client diagnosed with severe and persistent mental illness will implement rehabilitation principles by concentrating on which intervention? A. Assessment on the client's deficits B. Reinforcing the client's strengths C. Reviewing earlier treatment plans for errors D. Considering the need to lower expectations periodically

B. Reinforcing the client's strengths Although deficits are assessed and addressed, implementation of rehabilitation is dependent on reinforcement of identified client strengths. None of the remaining options is fundamental to the rehab process.

A newly admitted client has a diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be directed toward which classic client need? A. Set firm limits on behavior. B. Respect need for social isolation. C. Encourage expression of feelings. D. Involve in milieu and group activities.

B. Respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.

A client diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around others in the group home. It's better when I just stay by myself." The nurse should consider which nursing diagnosis to address the client's concerns? A. Acute confusion B. Social isolation C. Risk for activity intolerance D. Impaired comfort

B. Social isolation Social isolation is aloneness experienced by the individual and perceived as imposed by others. None of the other options would be supported by the information provided in the question.

When discussing somatic disorders from a cultural perspective, which statement is true? 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. Currently, none of the other options have been supported by research.

A client who lives with an adult child is quite self-sufficient but tells the community health nurse that "it gets lonely being by myself so much of the time with only the television set for company." What suggestion should the nurse make to address the client's need for socialization? A. Have the neighborhood watch visit once daily. B. Spend time at the local senior's center three times a week. C. Attend an adult day health program daily. D. Attend a maintenance day care program daily.

B. Spend time at the local senior's center three times a week. A social day care gives the participants the opportunity for recreation and social interaction. Nursing, medical, or rehabilitative care is usually not provided. The client needs socialization but does not require other facets of care. The other options provide services that this client does not require.

Playing one staff member against another is an example of what defense mechanism? A. Devaluation B. Splitting C. Impulsiveness D. Social ineptitude

B. Splitting Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases. The example provided does not effectively describe any of the other options.

Cocaine exerts which of the following effects on a client? A. Stimulation after 15 to 20 minutes B. Stimulation and euphoria C. Immediate imbalance of emotions D. Paranoia

B. Stimulation and euphoria Cocaine exerts two main effects on the body, both anesthetic and stimulant. None of the other options are associated with the effects of cocaine.

A student nurse in the emergency department is assigned to care for a client convicted of the sexual abuse of a child. The student is repulsed by the client because of the nature of his crime and doesn't know how to care for the client under these circumstances. What action should the student nurse take? A. Refuse the assignment because personal feelings will prevent the student from providing good care. B. Talk with a faculty member or an experienced nurse in the emergency department. C. Perform the activities of care but not engage in conversation with the client. D. Suggest to the client that he request a different nurse.

B. Talk with a faculty member or an experienced nurse in the emergency department. Nurses may experience distress when providing care for someone who engages in what they view as objectionable, or even reprehensible, acts. This is sometimes compounded by knowing someone who was a victim or having been victimized ourselves. Talking with a faculty member, a nurse mentor, or someone at a mental health clinic can be helpful and important and may even result in better personal understanding and coping. Refusing an assignment is not an option. Performing the activities of care but not engaging in conversation does not appropriately or fully care for the patient. Telling the patient how she feels would be unprofessional and inappropriate and is putting the burden of our own feelings onto the patient.

A 26-year-old patient who abuses heroin states, "I've been using more heroin lately because I've begun to need more to feel the effect I want." What effect does this statement describe? A. Intoxication B. Tolerance C. Withdrawal D. Addiction

B. Tolerance Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.

Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa? A. Weigh 2 times daily first week, then three times weekly. B. Weigh fully clothed before breakfast. C. Do not reweigh client when client requests. D. Permit no oral intake before weighing.

B. Weigh fully clothed before breakfast. Clients should be weighed daily first week, then three times weekly wearing only bra and panties or underwear before ingesting any food or fluids in the morning. Reweighing is not a request that should be afforded to the client. If the patient asks to be reweighed, do not reweigh them.

Ali is a 17-year-old patient diagnosed with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? A. "I purge only once a day now instead of twice." B. "I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." C. "I am a hard worker and I am very compassionate toward others." D. "I always purge when I'm alone so that I'm not a bad role model for my younger sister."

C. "I am a hard worker and I am very compassionate toward others." An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is incorrect because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging.

Which statement made by a client would support the diagnosis of Illness anxiety disorder? 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." Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. People experience extreme worry and fear about the possibility of having a disease. None of the other statements accurately support this illogical fear of illness.

The clinical nurse specialist should suggest which cognitive intervention initially for a client experiencing auditory hallucinations? A. Seclusion when escalation begins B. Physical restraints when the client is disruptive C. Initiating a distracting technique D. Giving as-needed medication for anxiety

C. Initiating a distracting technique Strategies have been successfully applied to treat hallucinations, delusions, and negative symptoms, making cognitive interventions an evidence-based practice. For example, distraction techniques can be taught when auditory hallucinations occur, such as listening to music or humming. The remaining options should only be considered when less restrictive interventions, like distraction, prove to be ineffective and the client is at risk for injury to self or to others.

A cognitively impaired resident living at a long-term care unit has become unsteady when walking alone. The family is concerned about the potential for serious injury from falls and suggests that restraints be used. What is the nurse's best response to the family's request? A. "You will need to make your request to the physician at the planning meeting." B. "The federal government forbids the use of restraints on elderly residents." C. "Using restraints puts the resident at higher risk for serious injury, even death." D. "Immobilization will cause constipation and necessitates the use of enemas."

C. "Using restraints puts the resident at higher risk for serious injury, even death." This response would open the door to being able to explain the hazards of restraint use compared with the minor problems incurred when the client is unrestrained. None of the other options provides appropriate information regarding the use of restraints in this situation.

Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. Which nursing diagnosis best addresses this sort of interpersonal dysfunction? A. Spiritual distress B. Defensive coping C. Impaired social interaction D. Disturbed sensory perception

C. Impaired social interaction For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used. None of the other options appropriately deals with this type of dysfunctional behavior. Since the pt has a near-normal ego functioning, it means they have the awareness to see their defensive coping mechanisms. While these copping mechanisms are still a problem, the more prominent issue for this pt includes interpersonal (people) problems.

What is an appropriate long-term client-centered goal/outcome for a recovering substance abuser? A. Ability to discuss the addiction with significant others. B. State an intention to stop using illegal substances. C. Abstain from the use of mood-altering substances. D. Substitute a less addicting drug for the present drug.

C. Abstain from the use of mood-altering substances. Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. The remaining options would be considered short-term goals.

A client diagnosed with osteoarthritis says she is unable to sleep because of aching in her hips and shoulders. Which medication would be appropriate in this situation? A. Aspirin B. Meperidine C. Acetaminophen D. A sedative-hypnotic

C. Acetaminophen Acetaminophen is an effective analgesic in the elderly. It does not produce the gastrointestinal bleeding seen with aspirin and nonsteroidal anti-inflammatory drugs. Meperidine, an opiate with metabolites that stimulate the central nervous system, may produce confusion. A sedative-hypnotic may produce daytime sedation or confusion.

What is the priority nursing intervention for a client diagnosed with borderline personality disorder? A. Protect other clients from manipulation. B. Respect the client's need for attention. C. Assess for suicidal and self-mutilating behaviors. D. Provide clear, consistent limits and boundaries.

C. Assess for suicidal and self-mutilating behaviors. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress. While the other options may be appropriate, none have the priority of safety.

A client with paraphilia tendencies tells the nurse that "I'm disgusted with my lifestyle." What is the nurse's initial intervention? A. Assuring the client that this condition responds well to treatment. B. Telling the client that the first step to managing this behavior is recognizing it as unhealthy. C. Assessing the client for the existence of suicidal ideations. D. Recommending inpatient behavioral modification therapy.

C. Assessing the client for the existence of suicidal ideations. Such clients may be severely depressed and have suicidal ideations that must be recognized immediately. The priority intervention is to address client safety.

Which client, diagnosed with which personality disorder, will most likely require admission to a psychiatric unit as a result of developing a psychosis? A. Paranoid personality disorder B. Narcissistic personality disorder C. Borderline personality disorder D. Dependent personality disorder

C. Borderline personality disorder Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times. Psychosis is not generally associated with the other options.

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? A. Client will walk unassisted within 1 week. B. Client will return to a pre-illness level of functioning within 2 weeks. C. Client will be able to state two new effective coping skills within 2 weeks. D. Client will assume full self-care within 3 weeks.

C. Client 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.

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. This information supports that clients generally demonstrate ineffecting coping of anxiety, loneliness, and risk of suicide. None of the other options are associated with somatoform disorders.

Which statement is true regarding substance addiction and medical comorbidity? A. Most substance abusers do not have medical comorbidities. B. There has been little research done regarding substance addiction disorders and medical comorbidity. C. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. D. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.

C. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden.

The nurse feels uncomfortable talking with a young male client about his sexual problem. Which action should the nurse take? A. Ask another nurse to take over the interview, so you don't project your feelings onto the patient. B. Pause the interview and take time to gather your thoughts and do positive self-talk. C. Continue the interview using an appropriate professional tone and matter-of-fact approach. D. Ask Lance whether he would feel more comfortable speaking with a physician about his problem.

C. Continue the interview using an appropriate professional tone and matter-of-fact approach. Remembering your position as a professional and addressing the topics in a tone and manner appropriate of a professional will increase your comfort, along with the patient's. The response in the first option would be confusing to the patient and does not address your feelings or work to resolve them. Pausing the interview would not be appropriate because self-assessment is best done before patient interaction. Asking the patient whether he would feel more comfortable speaking with a physician projects your feelings of being uncomfortable onto the patient and does not carry out your professional role and responsibility.

Which mental health disorder is an example of a somatoform disorder? 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. None of the other options are associated with this classification of mental health disorders.

The goal of a nurse working in psychiatric rehabilitation would be to help clients in the community achieve which outcome? A. Complete mental health B. Live comfortably in a psychiatric treatment facility C. Cope more effectively with their symptoms D. Learn to live with dependency

C. Cope more effectively with their symptoms The long-term outcomes of rehabilitation for severely mentally ill clients include the concepts of illness management and recovery. Illness management refers to the focus in the early stage of treatment that assists the client to gain control over symptoms. Clients are taught to collaborate with professionals in mental health treatment, reduce susceptibility to relapse, and cope more effectively with symptoms. Complete mental health is not always achievable.

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. None of the other options are routinely associated with somatoform disorders. Somatic Symptom Disorders 1. Assess for nature, location, onset, characteristics, and duration of the symptom(s). 2. Explore past history of ACEs. 3. Identify symptoms of anxiety, depression, and past trauma that may be contributing to somatic symptoms and the ability to meet basic physical and safety/security needs. 4. Determine current quality of life, social support, and coping skills, including spirituality. 5. Identify any secondary gain that the patient is experiencing from symptom(s). 6. Explore the patient's cognitive style and ability to communicate feelings and needs. 7. Assess current psychosocial and biological needs. 8. *Screen for misuse of prescribed medication and substance use.*

According to current theory, which statement regarding eating disorders is accurate? A. Eating disorders are psychotic disorders in which patients experience body dysmorphic disorder. B. Eating disorders are frequently misdiagnosed. C. Eating disorders are possibly influenced by sociocultural factors. D. Eating disorders are rarely comorbid with other mental health disorders.

C. Eating disorders are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders.

What characteristic behaviors will the nurse assess in the narcissistic client? 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 Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem. None of the other options provide a description associated with narcissism.

A usually quiet resident in a long-term care facility has become confused and has shouted out a number of times during the night. What is the nurse's initial action? A. Obtain an order for an as-needed dose of a sedative for the client. B. Encourage the client to be quiet and go back to sleep. C. Investigate the reason for the client's behavioral change. D. Place the client in a geriatric chair near the nurse's station.

C. Investigate the reason for the client's behavioral change. New-onset confusion and behavior change should not be treated with sedation, but rather should be investigated for the cause. Finding the cause and addressing it is more appropriate than using chemical restraint. Neither of the other options addresses the cause of the behavior.

A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of what process? 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. Such indifference is not observed in any of the other options.

Which statement is true of the relationship between serious mental illnesses (SMIs) and substance abuse? A. Substance abuse rarely occurs within this population. B. Substance abuse occurs at approximately the same rate as in the general population. C. Of those diagnosed with SMI, substance abuse is high. D. Smoking has declined in this population at the same rate as the general public.

C. Of those diagnosed with SMI, substance abuse is high. Comorbid substance abuse occurs in 30% of those with SMI. It may be a form of self-medication, countering the dysphoria or other symptoms caused by illness or its treatment (e.g., the sedation caused by one's medications) or a maladaptive response to boredom. Nicotine use has always been higher in the population of those with SMI and is not declining as it has been in the general population. Substance abuse contributes to comorbid physical health problems, reduced quality of life, incarceration, relapse, and reduced effectiveness of medications. Substance abuse in those with SMI is higher than in the general population. Smoking has not declined in this population at the same rate as for the general public.

A 69-year-old client with a recent history of cancer is undergoing workup for memory loss. The client asks the nurse, "Why am I having all these problems now? I thought life would get easier as I got older." The nurse's response should be guided by what knowledge? A. The client is an exception; older people usually have less medical and psychosocial issues than when younger. B. The client is exhibiting signs of acute depression. C. Older adults experience more medical and psychiatric illnesses. D. Older adults usually have a low risk for suicide.

C. Older adults experience more medical and psychiatric illnesses. Aging is accompanied by increased medical and psychiatric illness. This increase is brought about in part by increasingly stressful life events (e.g., the loss of a spouse, family members, and independence) and comorbid illness. Polypharmacy and drug reactions also play a part. There is nothing to indicate that the client is depressed. The elderly population is at high risk for suicide. Here, the patient is curious as to why they are having all of these medical problems as an older adult. This requires education. This situation does not indicate assessing for any mental illnesses. That's why B is incorrect.

The client reveals to the nurse that, "I'm turned on by little girls, not adult women." This statement supports which possible diagnosis? A. Exhibitionism B. Hedonism C. Pedophilia D. Voyeurism

C. Pedophilia Pedophilia involves sexual fantasies, urges, or behaviors with a child aged 13 years or younger. This is not a characteristic of any of the other options.

Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa? A. Disturbed body image B. Chronic low self-esteem C. Risk for injury: electrolyte imbalance D. Ineffective coping: impulsive responses to problems

C. Risk for injury: electrolyte imbalance The client who engages in purging and excessive use of laxatives and enemas is at risk for metabolic acidosis from bicarbonate loss. This electrolyte imbalance is potentially life threatening. While appropriate none of the other options are as likely to risk the client's life.

Biological theorists suggest that the cause of eating disorders may be related to which factor? A. Normal weight phobia B. Body image disturbance C. Serotonin imbalance D. Dopamine excess

C. Serotonin imbalance The selective serotonin reuptake inhibitors have been shown to improve the rate of weight gain and reduce the occurrence of relapse. None of the remaining options are currently supported by any biological theories. D is incorrect because dopamine excess is only seen in one of the neurobiological explanations for why bulimia nervosa occurs.

Which statement provides accurate information regarding transvestic disorder? A. Most people with this disorder are homosexual. B. Only men are diagnosed with transvestic disorder. C. Sexual orientation has no bearing on transvestic disorder. D. Transvestic behavior develops in middle adulthood.

C. Sexual orientation has no bearing on transvestic disorder. Unlike in gender dysphorias, in transvestic disorder there are no sexual orientation issues, and people with transvestic disorder do not desire a sex change. Transvestites are usually heterosexual. Although more common in men, women are also diagnosed with transvestic disorder. Transvestic disorder usually develops early in life.

An issue for severely and persistently mentally ill clients living in the community is inadequate long-term medication monitoring by community mental health workers. What is a remedy for this problem? A. Discontinue antipsychotics that cause untoward side effects. B. Develop tools to predict relapse and assess the potential for violence. C. Shift follow-up from social workers to the ACT model. D. Use client empowerment techniques to increase client autonomy.

C. Shift follow-up from social workers to the ACT model. Adequate monitoring of medication effects by the community-based health care provider is often difficult but more achievable when the client is being monitored by the assertive community treatment (ACT) model. None of the other options present an effective remedy for this problem. ACT provides a comprehensive array of services. While it is important to develop tools to predict relapse and assess the potential for violence, ACT has is more readily available because their treatment model is more aggressive. The emphasis is on treating patients within their own environment.

Ageism is best explained as what? A. A prominent personality disorganization after the age of 65 B. A learned helplessness among elderly clients C. The discrimination against the elderly on the basis of age D. The behaviors of elderly persons that serve as barriers to health

C. The discrimination against the elderly on the basis of age Ageism is a destructive phenomenon, based on negative attitudes toward the elderly, that results in age-related discrimination. None of the other options accurately describe this form of discrimination.

What class of medications is commonly prescribed for somatic disorders? 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.

Effective care of a client suspected of experiencing bulimia nervosa calls for the nurse to perform which assessment? A. a range of motion assessment. B. inspection of body cavities. C. inspection of the oral cavity. D. body fat analysis.

C. inspection of the oral cavity. Repeated vomiting often causes dental erosions and caries. None of the other options represent frequently engaged dysfunctional behaviors.

Hormone therapy for the purpose of surgical gender reassignment is initiated when the client has demonstrated what behavior? A. successfully demonstrated a genuine intent to change genders. B. taken on the dress and manners of the preferred gender. C. successfully lived the cross-gender role in all aspects of life. D. taken all legal steps to change name and legal status.

C. successfully lived the cross-gender role in all aspects of life. After living as a member of the desired gender, if the client still wishes to proceed with gender reassignment, hormone therapy can be initiated. All the other options are secondary to the correct option since none have presented the client with the challenges of this life altering change.

Studies have shown a correlation between mental disorders and which medical condition? A. Psoriasis B. Asthma C. Chronic renal failure D. Cardiovascular disease

D. Cardiovascular disease 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. No such correlation has been proven between medical and any suggest psychiatric conditions.

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. None of the other options accurately describe somatoform disorders.

A client asks the nurse what kind of therapy will help. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? 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 (CBT) has been shown to consistently provide the best outcome for these types of disorders."

D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders." 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. Aversion therapy -- a type of therapy in which the patient gives up an unfavorable habit and replaces it with a favorable habit.

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 be."

D. "I don't think about my symptoms all the time as I used to be." This statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome. Neither medication adherence nor memory loss is associated with this disorder. The client would not acknowledge generalized anxiety as a symptom of their disorder.

A client being prepared for discharge tells the nurse, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? A. "It helps your mood so that you don't feel the need to do drugs." B. "It will keep you from experiencing flashbacks." C. "It is a sedative that will help you sleep at night, so you are more alert and able to make good decisions." D. "It helps prevent relapse by reducing drug cravings."

D. "It helps prevent relapse by reducing drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. None of the other options do not accurately describe the action of naltrexone. Naltrexone (ReVia) is an opioid antagonist. It is used for withdrawal, for preventing relapse, and for decreasing self-injurious behaviors in pts with Borderline Personality Disorder.

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? 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 management to its fullest.

A client who lives with a daughter's family is often left alone during the day and even some evenings. The client has expressed being lonely and socially isolated. Considering the situation, which support option is most appropriate? A. Partial hospitalization B. Nursing home admission C. Home health nursing care D. Adult day care

D. Adult day care In adult day care settings, older adults are cared for during the day and stay in a home environment at night. These programs are meant to provide a safe, supportive, and nonthreatening environment and fulfill a vital function for older adults and their families. The programs allow older adults to continue their present living arrangements and maintain their social ties to the community; they also relieve families of the burden of 24-hour-a-day care for older adult dependents. Partial hospitalization is recommended for ambulatory clients who do not need 24-hour nursing care but require and would benefit from intensive, structured psychiatric treatment. Nothing indicates that the client needs skilled nursing home care at this time. Home health nurses generally visit clients in their home to see to medical needs and treatment. This option would not fulfill the need for social interaction.

A client who has been prescribed an antipsychotic medication comes to the clinic 3 days after a scheduled visit and demonstrates evidence of restlessness and agitation. He states, "My medicine ran out, and I didn't remember where to get more." The client's case manager should initially implement which intervention to support medication adherence? A. Arrange to have the client's nursing care plan reflect the need for a medication change B. Arrange for the client to see his psychiatrist as soon as the psychiatrist has an open appointment. C. Arrange for the client to get to the nearest emergency department for treatment. D. Arrange for a dose of the client's medication immediately.

D. Arrange for a dose of the client's medication immediately. The role of the case manager is to coordinate access to psychiatric treatment, housing, rehabilitation or work setting, socialization, and medical care. The client's immediate need for medication is best addressed by arranging for an immediate dose. None of the other options addresses the client's needs as effectively.

A terminally ill, elderly client wants to ensure that his wishes about end-of-life care are followed and discusses them thoroughly with his daughter. Which action will best guarantee the client's wishes will be achieved? A. Share his wishes with the nurse B. Write a living will C. Issue a directive to his physician D. Execute the signing of advance directives

D. Execute the signing of advance directives With advance directives, an individual states how they want medical decision to be made if they lose the ability to make them for themself. No waiting period is required for the document to take effect. None of the other options would place the end of life care in the control of family as the correct option. A written document stating how you want medical decisions to be made if you lose the ability to make them for yourself is called an advance directive. It may also be called a living will. Signing advance directives finalizes the document whereas writing a living will is still a WIP.

Benzodiazepines are useful for treating alcohol withdrawal because they are associated with which action? A. Blocking cortisol secretion B. Increasing dopamine release C. Decreasing serotonin availability D. Exerting a calming effect

D. Exerting a calming effect Benzodiazepines act by binding to α-aminobutyric acid benzodiazepine receptor sites, producing a calming effect. Benzodiazepines are not associated with any of the other suggested actions.

Which subjective symptom should the nurse expect to note during assessment of a client diagnosed with anorexia nervosa? A. Lanugo B. Hypotension C. 25-lb weight loss D. Fear of gaining weight

D. Fear of gaining weight Fear of weight gain is the only subjective data listed, and it is universally true of clients diagnosed with anorexia nervosa. The remaining options are objective signs.

The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when which assessment data is observed? A. Weighs 10% below ideal body weight. B. Has serum potassium level of 3 mEq/L or greater. C. Has a heart rate less than 60 beats/min. D. Has systolic blood pressure less than 90 mm Hg.

D. Has systolic blood pressure less than 90 mm Hg. Systolic blood pressure of less than 90 mm Hg is one of the established criteria signaling the need for hospitalization of a client with anorexia nervosa. It suggests severe cardiovascular compromise. None of the remaining options represent data aligned with the criteria for hospitalization.

A client, who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds, eats one tiny meal daily and engages in a rigorous exercise program. Which nursing diagnosis addresses this assessment data? A. Death anxiety B. Ineffective denial C. Disturbed sensory perception D. Imbalanced nutrition: less than body requirements

D. Imbalanced nutrition: less than body requirements A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of this diagnosis. There is no support in the data as presented to justify any of the other nursing diagnoses.

Which interventions and/or goals related to planning for discharge of a client diagnosed with a serious mental illness (SMI) would support the recovery model of care? A. Attending groups that teach how to cope with one's present illness. B. The client's parents will receive education on how to manage the patient's deficits. C. Care plan interventions will focus on medication adherence. D. Interventions will focus on the client's stated wish for independent living.

D. Interventions will focus on the client's stated wish for independent living. The recovery model is patient centered, instills hope and empowerment, emphasizes the person and the future, encourages independence and self-determination, and focuses on achieving goals of the patient's choosing and meaningful living. The National Alliance on Mental Illness (NAMI) and the President's New Freedom Commission on Mental Health (2003) both support the recovery model of care rather than the rehabilitation model, which focuses on the illness and the present. The other options all follow the rehabilitation model, focusing on the illness.

A client has a 4-year history of using cocaine intranasally. When brought to the hospital in an unconscious state, what nursing measure should be included in the client's plan of care? A. Induction of vomiting B. Administration of ammonium chloride C. Monitoring of opiate withdrawal symptoms D. Observation for tachycardia and seizures

D. Observation for tachycardia and seizures Tachycardia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose. None of the other options are associated with the nursing care required of cocaine stimulation.

An elderly client is cognitively impaired and terminally ill with breast cancer. When asked if she is in pain, she usually denies it by shaking her head, but the nurses note that she lies rigidly in bed and grimaces when she turns from side to side. In an attempt to obtain a more accurate assessment, the nurses might choose to use which assessment tool? A. Present Pain Intensity Rating Scale. B. McGill Pain Questionnaire (MPQ). C. Wong-Baker FACES Scale. D. Pain Assessment in Advanced Dementia (PAINAD) scale.

D. Pain Assessment in Advanced Dementia (PAINAD) scale. The PAINAD scale is used to evaluate the presence and severity of pain in patients with advanced dementia who no longer have the ability to communicate verbally. The scale evaluates five domains: breathing, negative vocalizations, body language, and consolability. The score guides the caregiver in the appropriate pain intervention. None of the other options would compensate for this client's cognitive status.

Which statement is true regarding antisocial personality disorder (APD)? (Select all that apply.) A. It is the least studied of the personality disorders. B. It is characterized by rigidity and inflexible standards of self and others. C. Persons with APD display magical thinking. D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. F. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. G. Frontal lobe dysfunction is a brain change identified in APD.

D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. G. Frontal lobe dysfunction is a brain change identified in APD. APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes schizotypal personality disorder (STPD). People with APD usually present with depression because of the consequences of their behaviors, not because they care about the effects of their actions on others.

A 37-year-old client, referred to the mental health clinic with a suspected personality disorder, is withdrawn and suspicious and states, "I've always preferred to be alone" and then adds, "I can read your thoughts whenever I want to." This presentation supports which psychiatric diagnosis? A. Obsessive-compulsive personality disorder B. Narcissistic personality disorder C. Avoidant personality disorder D. Schizotypal personality disorder (STPD)

D. Schizotypal personality disorder (STPD) The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence of goals long after they are necessary, even if they are self-defeating or negatively affect relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.

A nurse planning continuing education programs for nursing staff members at a multipurpose senior center will plan programs based on the knowledge that which mental health problem is most common among the elderly? A. Schizophrenia B. Agoraphobia C. Obsessive-compulsive disorder D. Suicidal ideation

D. Suicidal ideation In the United States, the suicide rate among the elderly is the highest for any age group. While present among this population, none of the other options is considered a common disorder.

Severely mentally ill (SMI) clients often express a strong desire to be employed. According to the evidence-based research, what is the most effective model of employment for these clients? A. Vocational rehabilitation B. Productive employment C. A placement program of rehabilitation D. Supported employment

D. Supported employment In the past, vocational rehabilitation programs required extensive evaluation procedures and training before attempting job placement. However, these programs were unsuccessful at helping severely mentally ill clients to maintain jobs. Research efforts have identified a more productive model called supported employment. Vocational rehabilitation is an older model whereas supported employment is a newer model. Supported employments are best at *supporting* ppl with SMIs.

The term tolerance, as it relates to substance abuse, refers to which situation? A. The use of a substance beyond acceptable societal norms B. The additive effects achieved by taking two drugs with similar actions C. The signs and symptoms that occur when an addictive substance is withheld D. The need to take larger amounts of a substance to achieve the same effects

D. The need to take larger amounts of a substance to achieve the same effects With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. This is the only option that describes the effects of tolerance.

A client explains that he is heterosexual but prefers to dress in feminine clothing. This characteristic behavior is suggestive of which sexual disorder? A. Fetishism B. Exhibitionism C. Voyeurism D. Transvestism

D. Transvestism Transvestism is a paraphilia that involves dressing in the clothing of the opposite sex. This behavior is not characteristic of any of the other options.

A client, prescribed which class of antidepressant medication should be monitored for the development of premature ejaculation? A. Monoamine oxidase (MAO) inhibitors B. Tricyclic antidepressants C. Atypical antipsychotics D. selective serotonin reuptake inhibitor (SSRI) antidepressants

D. selective serotonin reuptake inhibitor (SSRI) antidepressants Treatments include antidepressants in the SSRI category. Conversely, pharmacotherapy may cause erectile dysfunction, and medications may need to be evaluated for change or dose reduction. The other options are not used for premature ejaculation.

What term is used to identify a syndrome that occurs after stopping the long-term use of a drug? A. amnesia. B. tolerance. C. enabling. D. withdrawal.

D. withdrawal. Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage.