Mental Health

A nurse is caring for a client diagnosed with body dysmorphic disorder and perceives to have a disturbed body image due to a reddened face. Which is a long-term outcome for this client?

The client will verbalize acceptance of the reddened face by the three month follow-up appointment.

A client's prognosis is said to be good due to a high degree of self-efficacy. Which of the following is evidence of a high degree of self-efficacy? A) The client is self-motivated and asks for help when needed. B) The client is able to resist illness when under stress. C) The client responds well in stressful situations. D) The client uses good problem-solving abilities.

Ans: A Feedback: People with high self-efficacy set personal goals, are self-motivated, cope effectively with stress, and request support from others when needed. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problem solving abilities and believing that one can cope with adverse or novel situations.

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

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

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

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

A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, I am so ashamed. What should the nurse reply? A) I really thought you would make it. B) Tell me what has happened since your last admission. C) You have nothing to be ashamed of. D) Why did you start drinking again? Ans: B Feedback: This is a therapeutic communication technique designed to help the client talk about himself and his current situation.

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

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

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

A client asks how his prescribed alprazolam (Xanax) helps his anxiety disorder. The nurse explains that antianxiety medications such as alprazolam affect the function of which neurotransmitter is believed to be dysfunctional in anxiety disorders. A) Serotonin B) Norepinephrine C) GABA D) Dopamine

Ans: C Feedback: Gamma-aminobutyric acid (GABA) is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA reduces anxiety, and norepinephrine increases it; researchers believe that a problem with the regulation of these neurotransmitters occurs in anxiety disorders. Serotonin is usually implicated in psychosis and mood disorders. Dopamine is indicated in psychosis.

The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders?

Body dysmorphic disorder

The nurse correctly identifies that which of a client with OCD's self-soothing behaviors may involve self-destruction of the body? Select all that apply.

Dermatillomania Trichotillomania Onychophagia

When working with a client diagnosed with a narcissistic personality disorder, the Registered Nurse (RN) would use which approach? Friendly Supportive Matter-of-fact Cheerful

Matter-of-fact

Registered Nurse (RN) determines that teaching about drug use and pregnancy has been effective when the client makes which statement? "Right after birth, I will give the baby up for adoption." "It's scary to think the baby may have Down Syndrome." "I will help the baby get through the withdrawal period." "I do not want the baby to have withdrawal symptoms."

"I do not want the baby to have withdrawal symptoms."

A client with somatic symptom disorder has been attending group therapy. Which statement indicates therapy is having a positive outcome for this client? "The other people in this group have emotional problems." "I should not complain too much; my problems are not as bad as others." "I have not said much, but I get a lot from listening to others." "I feel better physically just from getting a chance to talk."

"I feel better physically just from getting a chance to talk."

Parents of a client diagnosed with anorexia nervosa ask the Registered Nurse (RN) for information about the risk factors for this disorder. The RN determines understanding of this information when the parents make which statement? "Risk factors include a lack of life experience and no opportunities to learn skills." "Risk factors include low self-esteem and problems with family relationships." "Risk factors include the inability to be still and emotional lability." "Risk factors include a high level of anxiety and disorganized behavior."

"Risk factors include low self-esteem and problems with family relationships."

Which statement made by a client with paranoid personality disorder shows that teaching about social relationships is effective? "Sometimes, I can see what causes relationship." "As long as I live, I would not abide by social rules." "I will find out what problems others have so I would not repeat them." "I do not have problems in social relationships; I never really

"Sometimes, I can see what causes relationship problems."

Which statement made by a client with paranoid personality disorder shows that teaching about social relationships is effective? "Sometimes, I can see what causes relationship." "As long as I live, I would not abide by social rules." "I will find out what problems others have so I would not repeat them." "I do not have problems in social relationships; I never really did

"Sometimes, I can see what causes relationship."

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

A. Risk for injury R/T central nervous system stimulation

Which conditions would the Registered Nurse (RN) recognize as signs of alcohol withdrawal? Select all that apply. Tremors Elevated blood pressure Diaphoresis Anxiety

ALL OF THEM!!!

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

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

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

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

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is which of the following? A) Neglect B) Physical abuse C) Sexual abuse D) Emotional abuse

Ans: A Feedback: Sixty-four percent of child maltreatment victims suffered neglect; 16% were physically abused; 8.8% were sexually abused; 6.6% were psychologically or emotionally abused; and 2.2% were medically neglected. Also, 15% suffered ìotherî types of maltreatment such as abandonment, physical threats, and congenital drug addiction.

The client stated, I was so upset about my sister ignoring me when I was talking about being ashamed. Which nontherapeutic communication technique would the nurse be using if the nurse would state, How are your stress reduction classes going? A) Changing the subject B) Offering advice C) Challenging D) Disapproving

Ans: A Feedback: The nurse did not respond to the client's statement and instead introduced an unrelated topic. Advising would be telling the client what to do. Challenging would be demanding proof from the client. Disapproving would be denouncing the client's behavior or ideas.

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

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

The nurse is working with a patient who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the patient, the nurse shows positive regard through which statement? A) How is not working right now affecting you? B) How do you expect your kids to be provided for? C) You need to somehow find a way to support your children. D) Can the children's mother can get by for a while until you get better?

Ans: A Feedback: The nurse who appreciates the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. The nurse maintains attention on the client and avoids communicating negative opinions or value judgments about the client's behavior. In using positive regard, the nurse avoids value judgments and shifting of the focus away from the patient

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

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

The patient states that he is 14 trillion years old and created the world. The nurse documents this statement as an example of which type of thinking displayed by the patient? A) Delusional thinking B) Ideas of reference C) Word salad D) Hallucination

Ans: A Feedback: A delusion is a fixed false belief not based in reality. Ideas of reference are client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning. Word salad is flow of unconnected words that convey no meaning to the listener. Hallucinations are false sensory perceptions or perceptual experiences that do not really exist.

Which of the following interventions are most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply. A) Planning group activities such as playing games B) Scheduling one-to-one interactions with the client C) Providing structure and consistency in the unit D) Avoiding discussions among clients on the unit E) Discouraging clients from negotiating solutions

Ans: A, B, C Feedback: Group and planned activities such as playing card games, watching and discussing movies, or participating in informal discussions give the clients the opportunity to talk about events or issues when they are calm. Scheduling one-to-one interactions with clients indicates the nurse's genuine interest in the client and a willingness to listen to the client's concerns, thoughts, and feelings. Knowing what to expect enhances the client's feelings of security. Avoiding discussions does not give clients the opportunity to talk about events or issues when they are calm. If clients have a conflict or dispute with one another, the nurse can offer the opportunity for problem solving or conflict resolution. Expressing angry feelings appropriately, using assertive communication statements, and negotiating a solution are important skills clients can practice. These skills will be useful for the client when he or she returns to the community.

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

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

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

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

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

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

Which of the following are common reasons why abused women remain with the abusive partner? Select all that apply. A) The abused person is personally and financially dependent on the abuser. B) The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work. C) The abused person is convinced that she has been abusive toward the abuser at some point and that the abuse is her fault. D) The abused person believes that she is unable to function without her husband. E) The abused person is afraid that the abuser will kill her if she tries to leave.

Ans: A, B, D, E Feedback: Dependency is the trait most commonly found in abused wives who stay with their husbands. Women often cite personal and financial dependency as a reason why they find leaving an abusive relationship extremely difficult. The victim may suffer from low self-esteem and defines her success as a person by her ability to remain loyal to her marriage and ìmake it work.î Some women internalize the criticism they receive and mistakenly believe they are to blame. Women also fear their abuser will kill them if they try to leave. An abuser often has feelings of low self-esteem and poor problem-solving and social skills and may interpret any attempts at defense or any behavior of the abused person as abuse of the perpetrator.

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

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

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

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

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

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

The school nurse is teaching a health class about recognizing the signs of abusive relationships. The nurse describes the cycle of violence. The nurse would document effective teaching if the students identify the cycle of violence to be which of the following patterns? Select the order in which the events occur. A. Tension building B. Honeymoon period C. Violent behavior D. Period of remorse

Ans: A, C, D, B Feedback: The tension-building phase begins; there may be arguments, stony silence, or complaints from the husband. The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. This cycle continually repeats itself. Each time, the victim keeps hoping the violence will stop

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

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

Which of the following personal characteristics influence a client's response to stressors? Select all that apply. A) Self-efficacy B) Sense of belonging C) Spirituality D) Hardiness E) Resilience F) Resourcefulness

Ans: A, C, D, E, F Feedback: Personal characteristics that influence a client's response to stressors include self efficacy, spirituality, hardiness, resilience, and resourcefulness. Sense of belonging is an interpersonal factor that can influence a client's response to stressors.

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

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

A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including A) providing clinical supervision. B) using effective communication skills. C) adjusting client medications. D) directing program development. Ans: B Feedback: Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision.

Ans: B Feedback: Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision.

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

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

What is the primary difference between anorexia nervosa and bulimia nervosa? A) Anorexia has a psychological basis, whereas the cause of bulimia is biologic. B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. C) Bulimia can be life threatening, whereas anorexia is seldom so. D) There is no real difference between these two types of disorders. Ans: B Feedback: Clients with bulimia know their behavior is pathologic and are ashamed of it; clients with anorexia think they are fine and see no problem with their weight-control efforts. Anorexia nervosa is a life-threatening eating disorder. Studies of anorexia nervosa and bulimia nervosa have shown that these disorders tend to run in families.

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

The patient expresses frustration that the doctor does not spend enough time with the patient when making rounds. The nurse replies The doctors are very busy. What can I help you with? The nurse incorporated which nontherapeutic technique in this response? A) Belittling B) Defending C) Disagreeing D) Introducing an unrelated topic

Ans: B Feedback: Defending attempts to protect someone or something from verbal attack. This implies that the client has no right to express impressions, opinions, or feelings. Belittling is misjudging the degree of the client's discomfort, which implies that the discomfort is temporary, mild, self-limiting, or not very important. Disagreeing is opposing the client's ideas, which may cause the client to feel defensive about his or her point of view or ideas. Introducing an unrelated topic is evidenced when the nurse changes the subject. This takes away the initiative for the client to interact.

A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health-care need? A) Influencing schizophrenic patients to adhere to medication regimens B) Assisting high school students to effectively manage stress C) Coaching patients with depression to obtain employment D) Teaching parents the early signs of attention deficit disorder in children

Ans: B Feedback: Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill

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

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

When is a nurse legally obligated to breach confidentiality? A) At any time a client is threatening B) If threats are made to an identifiable third party C) Whenever the client becomes aggressive D) When the client violates the nurse's boundaries

Ans: B Feedback: The duty to warn a third party exists when a client threatens harm to that identifiable third party; the client's confidentiality is overridden. Answer choices A, C, and D are not situations in which confidentiality may be breached. Decisions about the duty to warn third parties usually are made by psychiatrists or by qualified mental health therapists in outpatient settings. It is not permissible for a nurse to breach confidentiality at any time a client is threatening, or becomes aggressive or violates the nurse's boundaries.

Which of the following distance zones is acceptable for people who mutually desire personal contact? A) Social B) Intimate C) Personal D) Public

Ans: B Feedback: The intimate zone is the amount of space that is comfortable for parents with young children and those who desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The personal zone is comfortable between family and friends who are talking. The public zone is an acceptable distance between a speaker and an audience.

A nurse has invited a patient to sit down and have a conversation. The patient takes the first seat. The nurse pulls up another chair to sit with the patient. Approximately how far from the patient should the nurse place her chair? A) 1 to 2 feet B) 3 to 4 feet C) 6 to 8 feet D) 8 to 10 feet

Ans: B Feedback: The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings.

Before eating a meal, a client with obsessiveñcompulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. When evaluating the progress of the client, what is the most important treatment objective for this client? A) Allow ample time for completion of all rituals before each meal. B) Gradually decrease the amount of time spent for performing rituals. C) Increase the client's acceptance of the need for medication to control rituals. D) Omit one ritualistic behavior every 4 days until all rituals are eliminated.

Ans: B Feedback: Treatment has been effective when OCD symptoms no longer interfere with the client's ability to carry out responsibilities. When obsessions occur, the client manages resulting anxiety without engaging in complicated or time-consuming rituals. He or she reports regained control over his or her life and the ability to tolerate and manage anxiety with minimal disruption. Ritualistic behaviors may be decreased gradually over time.

A nurse is working with a client to develop assertive communication skills. The nurse documents achievement of treatment outcomes when the client makes a statement such as, A) I'm sorry. I'm not picking this up very quickly. B) I feel upset when you interrupt me. C) You are pushing me too hard. D) I'm not going to let people push me around anymore.

Ans: B Feedback: Assertiveness training helps the person take more control over life situations. Techniques help the person negotiate interpersonal situations and foster self- assurance. They involve using ìIî statements to identify feelings and to communicate concerns or needs to others

A young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. Which of the following should be a consideration in providing care for this client? A) Most views regarding domestic violence are universal across cultures. B) She may fear deportation if she seeks public assistance. C) Immigrants have expedited access to public legal services. D) The nurse should ignore the details and focus on treatment.

Ans: B Feedback: Battered immigrant women face legal, social, and economic problems different from US citizens who are battered and from people of other cultural, racial, and ethnic origins who are not battered: The battered woman may come from a culture that accepts domestic violence. She may believe she has less access to legal and social services than do US citizens. If she is not a citizen, she may be forced to leave the United States if she seeks legal sanctions against her husband or attempts to leave him. She is isolated by cultural dynamics that do not permit her to leave her husband; economically, she may be unable to gather the resources to leave, work, or go to school. Language barriers may interfere with her ability to call 911, learn about her rights or legal options, and obtain shelter, financial assistance, or food. The nurse must treat the whole person and encourage the client to share the details in order to protect the client's safety and wellbeing.

Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error? A) Confidentiality allows for the disclosure of information under specific circumstances. B) If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights. C) Privileged communication does not apply to medical records, and they can be used in court. D) Clients can never be held against their will.

Ans: B Feedback: Being committed and/or incompetent does not negate the Patient's Bill of Rights. However, if a guardian is appointed, the client loses the right to enter into legal contracts or agreements that require a signature. Confidentiality does allow for the disclosure of information under specific circumstances such as to another health-care provider who has a need to know or if the client specifically consents that information be shared with persons of his or her choice and also the duty to warn if the client threatens to harm others. Privileged communication relates to the privacy of what was discussed during therapy sessions and this can be documented in medical records. Clients may be held against their will if they are committed to a facility for psychiatric care until they no longer pose a danger to themselves or to anyone else.

A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at and listening to the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly. The professor understands that the student is likely experiencing which level of stress? A) Mild B) Moderate C) Severe D) Panic

Ans: B Feedback: Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. As the person progresses to severe anxiety and panic, more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning.

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

Ans: B Feedback: The four temperament traits are harm avoidance, novelty seeking, reward dependence, and persistence. People with high harm avoidance exhibit fear of uncertainty, social inhibition, shyness with strangers, rapid fatigability, and pessimistic worry in anticipation of problems. Avoidant personalities are individuals who appear anxious or fearful. Schizoid personality disorder is a related disorder that is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of othersóand with the central characteristics of deceit and manipulation. 9. Which of the following is a psychoso

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history? A) Headaches B) Insomnia C) Weight loss D) GI upset

Ans: B Feedback: Those grieving may complain of insomnia, headaches, impaired appetite, weight loss, lack of energy, palpitations, indigestion, and changes in the immune and endocrine systems. Sleep disturbances are among the most frequent and persistent bereavement-associated symptoms.

Which of the following behaviors by the nurse demonstrates positive regard? Select all that apply. A) Communicating judgments about the client's behavior B) Calling the client by name C) Spending time with the client D) Responding openly E) Considering the client's ideas and preferences when planning care

Ans: B, C, D, E Feedback: Calling the client by name, spending time with the client, and listening and responding openly are measures by which the nurse conveys respect and positive regard to the client. The nurse also conveys positive regard by considering the client's ideas and preferences when planning care. The nurse maintains attention on the client and avoids communicating negative opinions or value judgments about the client's behavior.

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

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

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

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

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

Ans: C Feedback: Taking alcohol in any form while taking Antabuse causes a severe adverse reaction. Antabuse is not safe to take with OTC medications. It does not block cravings for alcohol. Antabuse does not restrict the effect of alcohol on the body. Disulfiram (Antabuse) may be prescribed to help deter clients from drinking. If a client taking disulfiram drinks alcohol, a severe adverse reaction occurs with flushing, a throbbing headache, sweating, nausea, and vomiting. In severe cases, severe hypotension, confusion, coma, and even death may result.

A married man expresses to the nurse that his wife's frequent nagging angers him. The nurse role-plays assertive communication techniques with the husband. Which of the following indicates the husband understands how to use assertive techniques effectively? A) I really wish you would stop nagging me. B) You are not perfect either. C) I feel unappreciated when you criticize me. D) Are you telling me you want me to change?

Ans: C Feedback: The nurse can help clients express anger appropriately by serving as a model and by role-playing assertive communication techniques. Assertive communication uses ìIî statements that express feelings and are specific to the situation; for example, ìI feel angry when you interrupt me,î or ìI am angry that you changed the work schedule without talking to me.î Statements such as these allow appropriate expression of anger and can lead to productive problem-solving discussions and reduced anger.

A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. Which would be the best approach for the nurse to use? A) Have a sense of humor to show a lack of fear. B) Provide close contact to increase the client's sense of safety. C) Use brief statements and questions to obtain information. D) Use open-ended questions, so the client can elaborate.

Ans: C Feedback: Following an aggressive episode, clients may have difficulty expressing themselves; short, concise statements and questions will get needed information. Humor or openended questions may be frustrating or annoying for the client. It is not safe for the nurse to provide close contact under these circumsta

A client says to the nurse, ìI just can't talk in front of the group. I feel like I'm going to pass out.î The nurse assesses the client's anxiety to be at which level? A) Mild B) Moderate C) Severe D) Panic

Ans: C Feedback: Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain.

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

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

Throughout the assessment, the client displays disorganized thinking, jumping from one idea to another with no clear relationship between the thoughts. The nurse would assess the client as having which of the following? A) Tangential thinking B) Ideas of reference C) Loose associations D) Word salad

Ans: C Feedback: The client displayed ideas that were loosely associated to one another. Tangential thinking is manifested by wandering off the topic and never providing the information requested. Ideas of reference are the client's inaccurate interpretation that general events are personally directed to him or her. Word salad is a flow of unconnected words that convey no meaning to the listener.

A teenage patient defies the nurse's repeated requests to turn off the video game and go to sleep. The teen says angrily, You sound just like my mother at home! and continues to play the video game. The nurse understands that this statement likely indicates A) the need of stricter discipline at home. B) early signs of oppositional defiant disorder. C) viewing the nurse as her mother. D) expression of developing autonomy.

Ans: C Feedback: Transference occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships. Transference patterns are automatic and unconscious in the therapeutic relationship. The occurrence of transference does not indicate ineffective parenting or disciplinary practices, nor is it indicative of a disorder. Autonomy is developed much earlier in the toddler years.

The nurse is working with a client who has a history of inflicting spousal abuse. Although the nurse does not condone domestic violence, the nurse treats the client with unconditional positive regard through which of the following? A) The nurse tries to understand the feelings that might have led to violent behavior. B) The nurse uses the honest emotional expression in relating to a client. C) The client is still viewed as someone worthy of respect and assistance. D) The nurse relates to the client as if he were her own spouse.

Ans: C Feedback: Unconditional positive regard involves nonjudgmental caring for the client that is not dependent on the client's behavior. Genuineness is a realness or congruence between what the therapist feels and what he or she says to the client. Empathetic understanding is when the therapist senses the feelings and personal meaning from the client and communicates this understanding to the client.

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

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

After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which of the following is the most helpful response to the client at this time? A) We will have to talk about this later. B) You really scared me. I'm glad you are okay. C) What happened that got you so upset? D) What can you do differently next time you get angry?

Ans: C Feedback: As the client regains control (recovery phase), he or she is encouraged to talk about the situation or triggers that led to the aggressive behavior. The nurse should help the client relax, perhaps sleep, and return to a calmer state. Talking about the event at a later time does let the client rest, but it does less to address the client's feelings associated with the angry outburst. It is too early postcrisis to discuss behavior change for the future as the client needs to recover from intense emotions first

What would the nurse expect to assess in a client with narcissistic personality disorder? A) Genuine concern for others B) Mistrust of others C) Grandiose and superior self-concept D) Dependence on others for decision making Ans: C Feedback: Clients with narcissistic personality disorder believe themselves superior to others and expect to be treated as such.

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

Which distinguishes delirium from dementia? A) Delirium has an acute onset and is progressive in course. B) Delirium has a gradual onset and can be resolved. C) Dementia has a gradual onset and is progressive in course. D) Dementia has an acute onset and can be resolved. Ans: C Feedback: Delirium has a sudden onset, and the underlying cause is treatable; by contrast, dementia has a gradual onset and is progressive rather than treatable.

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

Which of the following are nontherapeutic techniques? Select all that apply. A) Silence B) Voicing doubt C) Agreeing D) Challenging E) Giving approval F) Accepting

Ans: C, D, E

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

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

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

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

A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss

Ans: D Feedback: Safety loss is the loss of a safe environment. That feeling of safety is shattered when public violence occurs. Examples of physiologic loss include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility. A loss of self-esteem includes any change in how a person is valued at work or in relationships or by himself or herself can threaten self-esteem. Loss related to self-actualization includes an external or internal crisis that blocks or inhibits strivings toward fulfillment that may threaten personal goals and individual potential

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

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

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

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

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

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

A patient shows no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which of the following terms when documenting the patient's affect? A) Blunt affect B) Restricted affect C) Broad affect D) Flat affect

Ans: D Feedback: Common terms used in assessing affect include blunted affect: showing little or a slow to-respond facial expression; broad affect: displaying a full range of emotional expressions; flat affect: showing no facial expression; inappropriate affect: displaying a facial expression that is incongruent with mood or situation, often silly or giddy regardless of circumstances; restricted affect: displaying one type of expression, usually serious or somber.

The most commonly supported neuroanatomic theory of schizophrenia suggests which etiology? A) Excessive amounts of dopamine and serotonin in the brain B) Ineffective ability of the brain to use dopamine and serotonin C) Insufficient amounts of dopamine in the brain D) Decreased brain tissue in the frontal and temporal regions of the brain Ans: D Feedback: Decreased brain tissue in the frontal and temporal regions of the brain is the most commonly supported neuroanatomic theory that suggests the etiology of schizophrenia. The other theories are neurochemical

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

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

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

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

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

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

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

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

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

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

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

Knowing that relationships with others are significant to mental health, the nurse effectively assesses a patient's family relationships through which of the following? A) Do you feel your family helps you? B) How many people are in your family? C) Whom are you closest to in your family? D) Describe your relationships with your family.

Ans: D Feedback: The nurse must assess the relationships in the client's life, the client's satisfaction with those relationships, or any loss of relationships. Open-ended questions and statements elicit more descriptive responses from the patient than direct questions.

The client tells the nurse, ìI don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her.î The nurse should recognize this as A) confrontation. B) countertransference. C) incongruence. D) transference.

Ans: D Feedback: Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others. Confrontation is a technique used to highlight the incongruence between a person's verbalizations and actual behavior. Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. Incongruence occurs when the communication content and process disagree.

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

Ans: D Feedback: (don't know why not C) When a client admits to having suicidal thoughts, the next step is to determine potential lethality, including a specific plan and lethality of means. Specific and positive answers to lethality assessment questions increase the client's likelihood of committing suicide.

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

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

Which of the following is most important to maintain therapeutic boundaries when working with aggressive clients? A) Encourage clients to express how the nurse can avoid causing emotional irritation. B) Discuss difficult patient care situations with a supervisor. C) Reflect on your actions that may have instigated the client's anger, D) Do not personalize a client's anger

Ans: D Feedback: Do not take the client's anger or aggressive behavior personally or as a measure of your effectiveness as a nurse. The client's aggressive behavior, however, does not necessarily reflect the nurse's skills and abilities. Clients should not dictate nurses' behaviors. The nurse is not responsible for angering the client. Individuals are responsible for their own emotional control. If the nurse cannot maintain boundaries, assistance should be sought form a supervisor.

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

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

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states ìHe is so jealous and overprotective; he wants to know where I am and who I'm with every minute.î Which of the following is most likely true of the situation? A) The student is overreacting. B) This is a situation requiring a restraining order. C) The student's boyfriend is simply insecure and needs reassurance. D) This is characteristic of the tension-building phase of the violence cycle.

Ans: D Feedback: In tension building, the abuser attempts to establish complete control over all the person's actions. It is more appropriate for the nurse to listen to the client, rather than to judge whether the client is overreacting. This may or may not require a restraining order. The student's boyfriend is insecure and needs reassurance, but that is not the only concern.

The nurse is working with a client at the battered women's shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, ìWhat do you think about that? Which is the best response by the nurse? A) Batterers never change, so it would be best for you to leave. B) If you don't leave, he'll think you're going to continue to endure his abuse.îC) If you leave, maybe he'll see that he has to change his behavior. D) You may be in more physical danger after you leave him.

Ans: D Feedback: Statistics indicate that violence increases when the victim attempts to leave or end the relationship. It is not appropriate for the nurse to offer advice such as this. It is not the victim's fault whether the victim stays or not. If you leave, maybe he'll see that he has to change his behavior, which is not appropriate as it minimizes the situation.

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

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

Which of the following nursing diagnoses would be appropriate for a client with an avoidant personality disorder? Anxiety related to fear of criticism, disapproval, and rejection. Risk for self-mutilation related to a desperate need for attention. Ineffective coping related to negative attitudes toward health behavior. Risk for injury related to uncontrolled anger and hostility towards others

Anxiety related to fear of criticism, disapproval, and rejection.

A Registered Nurse (RN) doing an assessment with a client diagnosed with anorexia nervosa would expect which finding? Select all that apply. Belief that dieting behavior is not a problem. Strong desire to get treatment. History of dieting at a young age. View of self as overweight or obese.

Belief that dieting behavior is not a problem. History of dieting at a young age. View of self as overweight or obese.

A nurse is caring for a client who believes her feet are enormous compared with the rest of her body. She has visited an orthopedic surgeon to see if surgery is possible. She spends hours trying to buy shoes that make her feet look smaller, and she prefers social interactions where she can sit with her feet concealed under a table. The nurse assesses that the client's symptoms are consistent with which disorder?

Body dysmorphic disorder

The Registered Nurse (RN) is assessing an adult client diagnosed with ADHD. The RN expects which to be present? Falling asleep at work. Difficulty remembering appointments. Problems getting started on a project. Lack of motivation to do tasks.

Difficulty remembering appointments.

Monoamine oxidase inhibitors (MAOIs) have been prescribed for a client with bulimia nervosa. What is the most important information for the Registered Nurse (RN) to give to the client? "Do not eat foods that contain tyramine, such as cheese, cottage cheese, pickled herring, and salami." "Watch for bleeding and bruising." "Drink several glasses of water with each dose." " Eat whatever you want"

Do not eat foods that contain tyramine, such as cheese, cottage cheese, pickled herring, and salami."

The RN would assess for which characteristics in a client diagnosed with narcissistic personality disorder? Suspiciousness Entitlement Hypersensitivity Fear of abandonment

Entitlement

A Registered Nurse (RN) is assessing a client with bulimia nervosa for possible substance abuse. What is the most important question for the RN to ask the client?" "Where would you go to buy drugs?" "At what age did you start drinking?" "Have you ever used diet pills?" "Do your peers ever offer you drugs?"

Have you ever used diet pills?

The Registered Nurse (RN) would expect to see all the following symptoms in a child diagnosed with ADHD, except the following: Moody, sullen, slow and pouting behavior. Interrupting others and inability to take turns. Distractibility and forgetfulness. Excessive running, climbing, and fidgeting.

Moody, sullen, slow and pouting behavior.

Paroxetine (Paxil) has been prescribed for a client with a somatic illness. The Registered Nurse (RN) instructs the client to watch out for which side effect?

Nausea

The Registered Nurse (RN) anticipates that which therapeutic modality will be used to treat an individual diagnosed with hypochondriasis? Electroconvulsive therapy (ECT) Aversion therapy Relaxation exercises Suicide precautions

Relaxation exercises

What is the most appropriate goal for a client with antisocial personality disorder with a high risk for violence directed at others? The client will understand the difference between anger and physical symptoms. The client will discuss the desire to hurt others rather than act. The client will develop a list of resources to use when anger escalates. The client will be given something to destroy to displace the anger.

The client will discuss the desire to hurt others rather than act

Client doesn't understand the purpose of going to AA meeting. what does the nurse say? What do you want to get out of the AA meetings?" "When do you think you will stop going to the meetings?" "Do you think you can control what happens in a meeting?"

What do you want to get out of the AA meetings?"

A client diagnosed with an antisocial personality disorder is trying to convince a Registered Nurse (RN) that they deserve special privileges and that an exception to the rules should be made for them. What is the best response by the RN? "Do not you know better than to try to bend the rules?" "I believe we need to sit down and talk about this." "Why do not you bring this request to the community meeting?" "What you are asking me to do for you is unacceptable."

What you are asking me to do for you is unacceptable."

Which question is most useful in assessing the self-esteem of a client with anorexia nervosa? a. "How would you describe yourself to others?" b. "What activities do you enjoy doing with your friends?" c. "Do you play any sports at school or in your community?" d. "How do you decide how to spend your free time?"

a. "How would you describe yourself to others?

A nurse should be alert for which findings in a client with bulimia nervosa? Select all that apply: a. Severe electrolyte imbalances b. Damaged teeth due to the eroding effects of gastric acids on tooth enamel c. Pneumonia from aspirated stomach contents d. Cessation of menses e. Esophageal tears and gastric rupture f. Intestinal inflammation

a. Severe electrolyte imbalances b. Damaged teeth due to the eroding effects of gastric acids on tooth enamel d. Cessation of mensese. Esophageal tears and gastric rupture

A nurse doing an assessment with a client with bulimia would expect which findings? a.Compensatory behaviors limited to purging. b.Dissatisfaction with body shape and size c.Feelings of guilt and shame about eating behavior. d.Near-normal body weight for height and age. e. Performance of rituals or compulsive behavior f.Strong desire to please others

b.Dissatisfaction with body shape and size c.Feelings of guilt and shame about eating behavior d.Near-normal body weight for height and age f.Strong desire to please others

A female client with bulimia nervosa tells a nurse her major problem is eating too much food in a short period of time and then vomiting. Which short-term goal is the most important? a. Help the client to understand every person has a satiety level. b. Encourage the client to verbalize fears and concerns about food. c. Determine the amount of food the client will eat without purging. d. Obtain a therapy appointment to look at the emotional causes of bulimia nervosa.

c. Determine the amount of food the client will eat without purging.

Xanax (alprazolam)

•Side effects: Dizziness, clumsiness, sedation, headache, fatigue, sexual dysfunction, blurred vision, dry throat and mouth, constipation, high potential for abuse and dependence