Mental Health Exam 2

Which statement of the student nurse indicates effective learning regarding various personality disorders? 1."Paranoid personality disorder is characterized by eccentric behaviors." 2."Avoidant personality disorder is characterized by suspicious behaviors." 3."Borderline personality disorder is characterized by exploitative behaviors." 4."Histrionic personality disorder is characterized by eccentric behaviors."

1."Paranoid personality disorder is characterized by eccentric behaviors."

Which client has a high risk of weight gain and a low risk of extrapyramidal effects? Select all that apply. 1.A client who is on clozapine therapy 2.A client who is on olanzapine therapy 3.A client who is on haloperidol therapy 4.A client who is on fluphenazine therapy 5.A client who is on perphenazine therapy

1.A client who is on clozapine therapy 2.A client who is on olanzapine therapy Weight gain is a side effect associated with histamine blockade. Dopamine blockade results in extrapyramidal side effects. The client who is on clozapine therapy has a high risk of weight gain and a low risk of pyramidal side effects. The client taking olanzapine shows severe weight gain due to histamine blockade and very low extrapyramidal side effects, as it is a weaker dopamine antagonist.

Which daily dose range of haloperidol would a primary health-care provider prescribe to a client with schizophrenia? 1. 1-100 mg 2. 10-30 mg 3. 40-80 mg 4. 40-400 mg

1. 1-100 mg The primary health care provider prescribes 1-100 mg of haloperidol to a client with schizophrenia.

The clinical history of a client who is an alcoholic shows excessive amount of serous fluid accumulation in the abdominal cavity. What is the condition of the client? 1.Ascites 2.Azotemia 3.Somnolence 4.Esophageal varices

1.Ascites Ascites is a complication of cirrhosis in which there is an excessive amount of serous fluid accumulation in the abdominal cavity.

The clinical findings of a client who is an alcoholic indicate the replacement of liver cells with fibrous tissue. Which complications could the nurse expect in this client? Select all that apply. 1.Ascites 2.Gastritis 3.Pancreatitis 4.Esophageal varices 5.Portal hypotension

1.Ascites 4.Esophageal varices

An alcoholic client with Wernicke's encephalopathy recently decided to abstain from alcohol and is receiving thiamine therapy. What health outcome does the nurse expect in the client from the therapy? Select all that apply. 1.Better visual acuity 2.Normalization of blood pressure 3.Normal electrocardiogram (ECG) reading 4.Improved cognitive functioning 5.Removal of excess serous fluid from abdominal cavity

1.Better visual acuity 4.Improved cognitive functioning

Which are the anticholinergic side effects associated with novel antipsychotic medications? 1.Tremors 2.Drowsiness 3.Weight loss 4.Bradycardia

1.Tremors Novel antipsychotic medications may cause tremors as a side effect. This is because of their anticholinergic effect on the motor control of the body.

Which symptoms does a nurse observe in an alcoholic client diagnosed with acute pancreatitis? Select all that apply. 1.Vomiting 2.Weight loss 3.Hemorrhage 4.Severe epigastric pain 5.Abdominal distention

1.Vomiting 4.Severe epigastric pain 5.Abdominal distention

A client attempts suicide following the loss of a relationship due to his alcoholism. Which phase of alcoholism does this indicate? 1.The crucial phase 2.The chronic phase 3.The prealcoholic phase 4.The early alcoholic phase

The chronic phase of alcoholism is characterized by emotional and physical disintegration. The client might be depressed and may attempt suicide.

The nurse is caring for an 8-year-old child with a psychiatric illness. According to Erikson, which behavior indicates maladaptive development in the child? 1. Unable to gain self-confidence 2.Unable to keep up the promises made to peers 3.Unable to integrate the tasks mastered in the previous developmental stages 4.Unable to maintain lasting relationships

1. Unable to gain self-confidence According to Erikson, a child between 6 and 12 years of age achieves a sense of self-confidence by learning, competing, and performing successfully. Therefore, a failure to develop self-confidence indicates developmental delay.

Which personality disorder does the nurse suspect in the client with a psychiatric illness who has made recurrent suicide attempts? 1.Borderline personality disorder 2.Antisocial personality disorder 3.Histrionic personality disorder 4.Avoidant personality disorder

1.Borderline personality disorder Suicidal attempts are common in a client with borderline personality disorder due to feelings of abandonment. At the same time, the client incorporates a measure of safety during these attempts.

Which symptoms does the nurse observe in the client with borderline personality disorder who is diagnosed with complicated grieving? 1.Depression 2.Suicide attempts 3.Manipulation of others 4.Alternating clinging and distancing behaviors

1.Depression The client undergoes depression due to severe sorrow and grieving.

Which is the hypothesized reason that a client with borderline personality disorder does not sense pain after an attempt to cut his or her own wrist? 1.Elevated levels of endorphins 2.Elevated levels of acetylcholine 3.Elevated levels of serotonin 4.Elevated levels of noradrenaline

1.Elevated levels of endorphins Elevated levels of endorphins result in an increase in the threshold for pain. Therefore, pain is not strongly felt when the client cuts his or her wrist.

The nurse is caring for a client with borderline personality disorder who has a history of physical abuse during childhood. The client's caregiver reports that the client is always depressed. Which nursing intervention may lead to regression in the client? 1.Exploring the source of anger with the client 2.Acting as a role model 3.Encouraging the client to take brisk walks 4.Explaining the behaviors associated with depression to the client

1.Exploring the source of anger with the client Exploring the true source of anger with the client is a painful therapy that may lead to regression as the client deals with his or her feelings about the abuse.

Which instructions would the nurse provide to a client who is undergoing antipsychotic therapy to overcome anticholinergic effects? Select all that apply. 1.Have sugarless candies and frequent sips of water 2.Do not drive a vehicle 3.Take medication at bedtime 4.Rise slowly from a lying or sitting position 5.Take calorie-controlled diet and do physical exercise

1.Have sugarless candies and frequent sips of water 2.Do not drive a vehicle Dry mouth is a side effect associated with antipsychotic therapy due to cholinergic blockade. Therefore, the nurse advises the client to have sugarless candies and frequent sips of water to get rid of dry mouth. Blurred vision is a side effect associated with antipsychotic therapy due to cholinergic blockade. Therefore, the nurse advises the client not to drive a vehicle until the vision is clear.

The nurse finds that a client who is on antipsychotic medications is experiencing weight gain and sedation as side effects. What could be the reason for these side effects in this client? 1.Histamine blockade 2.Dopamine blockade 3.Cholinergic system blockade 4.Alpha1-adrenergic receptors blockade

1.Histamine blockade Histamine blockade may cause sedation and weight gain in a client receiving antipsychotic medications.

While assessing a client with a psychiatric disorder, the nurse finds that the client is salivating excessively. The nurse finds clozapine in the client's prescriptions. Which nursing interventions would be beneficial to the client in this situation? Select all that apply. 1.Instruct the client to chew sugar-free gum 2.Administer clonidine, as prescribed 3.Administer benztropine mesylate to the client as prescribed 4.Instruct the client to take frequent sips of water 5.Administer dantrolene to the client as prescribed

1.Instruct the client to chew sugar-free gum 2.Administer clonidine, as prescribed Clozapine (Clozaril) causes hypersalivation as a side effect. Therefore, the nurse instructs the client to chew sugar-free gum to increase the swallowing rate. Clonidine (Kapvay) is an alpha2-adrenoceptor agonist. It helps reduce the salivary production.

While monitoring the blood pressure of a client who is on antipsychotic therapy, the nurse finds that the client has orthostatic hypotension. Which nursing intervention is beneficial for the client in this situation? 1.Instruct the client to rise slowly when going from sitting to standing. 2.Monitor the absolute neutrophil count of the client. 3.Assess the client for symptoms of blood dyscrasias. 4.Check whether the client is taking the medication as prescribed.

1.Instruct the client to rise slowly when going from sitting to standing.

A client whose husband has schizophrenia states, "My husband attacked me last night, and he suspects me of having an extramarital affair." The nurse concludes that the client's husband is exhibiting which type of delusional disorder? 1.Jealous 2.Grandiose 3.Erotomanic 4.Persecutory

1.Jealous

The registered nurse is evaluating a student nurse who is caring for a client with borderline personality disorder. Which action of the student nurse does the registered nurse correct during the evaluation? 1.Leaving the client alone to work out stressful feelings 2.Observing the client's behavior frequently 3.Encouraging the client to talk about his or her feelings 4.Removing dangerous objects from the client's environment

1.Leaving the client alone to work out stressful feelings The client with borderline personality disorder would not be left alone during stressful times because it may cause an acute rise in anxiety and agitation levels.

What general medical conditions may cause psychotic symptoms? Select all that apply. 1.Neurosyphilis 2.Hyperparathyroidism 3.Hyperadrenocorticism 4.Temporal lobe epilepsy 5.Chronic intermittent porphyria

1.Neurosyphilis 2.Hyperparathyroidism 4.Temporal lobe epilepsy

A client in a psychiatric ward has severe psychotic episodes and talks to self. On assessing the behavior of the client, the nurse talks to the client about place, time, and current activity. What is the nurse trying to do by implementing this intervention? 1.Orienting the client toward reality 2.Distracting the client from hallucinations 3.Assessing the client's level of cognitive impairment 4.Facilitating trust and understanding with the client

1.Orienting the client toward reality Talking to the client about place, time, and current activity reminds the client about reality. The nurse is trying to orient the client toward reality by differentiating between what is real and not real.

Which symptom does the nurse notice in a client with paranoid personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)? 1.Persistent grudges 2.Emotional coldness 3.Eccentricities of behavior 4.Exaggerated expression of emotions

1.Persistent grudges Clients with paranoid personality disorder do not forgive others who have insulted or injured them. They persistently hold grudges.

While caring for a client with schizophrenia, the client says to the nurse, "Will you come every day to feed me because I don't know how to eat?" What does this behavior indicate? 1.Regression 2.Anhedonia 3.Perseveration 4.Waxy flexibility

1.Regression The client is assuming that he or she cannot eat by himself or herself, which indicates regression. Regression is one of the primary defense mechanisms of schizophrenia, in which the client assumes earlier levels of development.

The nurse is caring for a client with antisocial personality disorder who is experiencing anxiety and agitation. On assessment, the nurse finds that the client's condition has not improved by "talking down." Which intervention should the nurse implement in this situation? 1.Restrain the client and observe every 15 minutes. 2.Stop involving the client in group activities. 3.Note the signs of aggression in the client. 4.Administer lorazepam to the client as prescribed.

1.Restrain the client and observe every 15 minutes. If the client is not calmed by "talking down," the use of mechanical restraints may be necessary. The restraint would be checked every 15 minutes to ensure that circulation to the extremities is not compromised.

Which personality disorders fall under cluster A according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)? Select all that apply. 1.Schizoid personality disorder 2.Paranoid personality disorder 3.Antisocial personality disorder 4.Borderline personality disorder 5.Schizotypal personality disorder

1.Schizoid personality disorder 2.Paranoid personality disorder 5.Schizotypal personality disorder

The nurse is conducting a session with a group of clients diagnosed with personality disorders. Which nursing interventions provide the clients with alternative ways to deal with frustration? Select all that apply. 1.Social skills training 2.Group skills training 3.Assertiveness training 4.Individual psychotherapy 5.Psychoanalytical psychotherapy

1.Social skills training 3.Assertiveness training

What risk factors can the nurse suspect in a client who has been withdrawn from therapy of central nervous system (CNS) depressants? Select all that apply. 1.Tachycardia 2.Hypertension 3.Hallucinations 4.Suicidal ideation 5.Intense feeling of lassitude

1.Tachycardia 2.Hypertension 3.Hallucinations Withdrawal from CNS depressant therapy may result in tachycardia due to rebound effect on the CNS. Withdrawal from CNS depressant therapy will affect the brain center that controls blood pressure. This results in increased blood pressure. CNS agitations resulting from withdrawal of CNS depressant therapy will induce hallucinations in the client.

The nurse is caring for a client who always wants to be alone due to a lack of trust in other individuals. While caring for the client, the nurse plans to recognize and encourage the client's voluntary interaction with others. What outcome does the nurse expect out of this intervention? 1.The client develops self-esteem. 2.The client experiences emotional security. 3.The client will have decreased suspiciousness. 4.The client learns to interrupt the episodes of anxiety.

1.The client develops self-esteem. A client who experiences social isolation may not trust other individuals. Recognizing and encouraging the client's voluntary interactions with others will help the client develop self-esteem. This in turn helps reduce the symptoms of social isolation in the client.

The nurse is caring for a client with schizophrenia who reports auditory hallucinations. The nurse teaches the client to say "Leave me alone" whenever the voices are speaking. What is the specific outcome of this nursing intervention? 1.The client gains conscious control over the hallucinations. 2.The client demonstrates trust over the surrounding environment. 3.The client perceives fewer hallucinations and involves himself or herself in interpersonal activities. 4.The client will show interest in discussing the content of hallucinations.

1.The client gains conscious control over the hallucinations. The nurse is performing the intervention known as voice dismissal with the client who reports auditory hallucinations. This helps the client dismiss and gain control over the hallucinations.

After assessing the behaviors of a client with psychiatric illness, the nurse suspects the client has borderline personality disorder with impaired social interaction. Which findings would support the nurse's suspicion? Select all that apply. 1.The client splits on staff members. 2.The client manipulates staff members. 3.The client displays disorganized thinking. 4.The client misinterprets the environment. 5.The client alternates between clinging and distancing behaviors.

1.The client splits on staff members. 2.The client manipulates staff members. 5.The client alternates between clinging and distancing behaviors. The client will try to play one staff member against another. The client has impressions of others as good or bad. The client creating interpersonal conflicts indicates impaired social interaction. The client will try to manipulate other staff members due to the fear of abandonment. The client with borderline personality disorder exhibits patterns of interaction with others characterized by alternating clinging and distancing behaviors.

Question 2. While caring for a client with paranoia, the nurse implements the family-style serving of food to the client. What does the nurse expect out of this intervention? 1.The client will have decreased suspiciousness. 2.The client will have improved self-esteem. 3.The client will have improved concrete thinking. 4.The client will have an improved functional communication pattern.

1.The client will have decreased suspiciousness. A client with paranoia may believe that the food or medication provided is being poisoned. A creative approach such as the family-style serving may help in developing trust in the client, and thereby help decrease the suspiciousness.

After assessing a client with schizophrenia, the nurse concludes that the client is experiencing emotional ambivalence. Which behaviors of the client support the nurse's assessment? 1.The client's inability to make a simple decision 2.The client's inability to position body parts in a comfortable position 3.The client's inability to carry out daily living activities 4.The client's inability to know the ego boundaries of the self

1.The client's inability to make a simple decision The client's inability to make a simple decision—for example, whether to have a coffee or tea after lunch—indicates that the client is experiencing emotional ambivalence.

Which symptoms in a client indicate the persecutory type of delusional disorder? Select all that apply. 1.The feeling of being spied on 2.The feeling of being poisoned 3.The feeling of being plotted against 4.The feeling of a famous person being in love with him or her 5.The feeling of being in a relationship with a religious leader

1.The feeling of being spied on 2.The feeling of being poisoned 3.The feeling of being plotted against

Which personality disorders are characterized by exploitative behaviors? Select all that apply. 1. Schizoid personality disorder 2. Antisocial personality disorder 3. Borderline personality disorder 4. Schizotypal personality disorder 5. Narcissistic personality disorder

2. Antisocial personality disorder 5. Narcissistic personality disorder The client with antisocial personality disorder is socially irresponsible, exploitative, and guiltless. They have a general disregard for the rights of others.The client with narcissistic personality disorder is overly self-centered and exploits others to fulfill his or her own desires.

Which nursing intervention requires correction while providing dialectical behavior therapy (DBT) to a client with borderline personality disorder? 1.Including emotional modulation skills in group skills training 2.Conducting monthly sessions for individual psychotherapy 3.Providing help and support to the client by telephone on a 24-hour basis 4.Organizing therapists' meetings regularly to review the work with clients

2. Conducting monthly sessions for individual psychotherapy The nurse would conduct individual psychotherapy sessions once every week. Therefore, this nursing intervention requires correction.

Which medication would the nurse prepare to administer to reverse extrapyramidal effects associated with antipsychotic therapy? 1.Warfarin 2.Amantadine/Benztropine 3.Epinephrine 4.Haloperidol

2.Amantadine/Benztropine Amantadine is a dopamine agonist that helps treat the extrapyramidal effects in clients with psychotic disorders.

Which personality disorder may be caused by predisposing factors such as an absence of parental discipline and having impulsive, inconstant parents? 1.Histrionic 2.Antisocial 3.Borderline 4.Narcissistic

2.Antisocial Antisocial personality disorder is more likely to develop in children who have chaotic home environments. Having impulsive parents who do not provide discipline or consistency is a sign of a chaotic home environment, which is a predisposing factor for antisocial personality disorder.

While communicating with a 20-year-old client, the nurse finds that the client has deceitful, guiltless, and belligerent behavior. On reviewing the client's medical history, the nurse finds behaviors of the client include bullying or intimidating others, initiating physical fights, and cruelty to animals in childhood. Which disorder does the nurse suspect in this client? 1.Avoidant personality disorder 2.Antisocial personality disorder 3.Borderline personality disorder 4.Dependent personality disorder

2.Antisocial personality disorder The client would be at least 18 years of age to predict antisocial behavior. Deceitfulness and guiltless and belligerent behaviors are common in the client with antisocial behavior. The predisposing factor for antisocial personality disorder is conduct disorder.

Which intervention of the nurse needs correction while caring for a client with borderline personality disorder who has a nursing diagnosis of complicated grieving? 1.Exploring the true source of anger with the client 2.Decreasing attention when the client is acting out 3.Avoiding the counter-transfer of the negative feelings onto the client 4.Encouraging the client to participate in large motor activities

2.Decreasing attention when the client is acting out The nurse would set limits on acting-out behaviors of the client and would be attentive while caring for the client. Decreasing attention toward the client may elicit dangerous consequences because the client might become violent toward self or others.

The medical history of a client with alcoholic intoxication shows congestive heart failure. Which medication is contraindicated for this client? 1.Oxazepam 2.Disulfiram 3.Desipramine 4.Chlordiazepoxide

2.Disulfiram Disulfiram is a drug which is contraindicated in clients with psychotic disorders and severe cardiac, renal, or hepatic disease. Thus, disulfiram is contraindicated in the client with congestive heart failure.

Which anticholinergic effects may occur in a client who is on risperidone therapy? Select all that apply. 1.Diarrhea 2.Dry mouth 3.Arrhythmias 4.Blurred vision 5.Urinary retention

2.Dry mouth 4.Blurred vision 5.Urinary retention Antipsychotics decrease the salivary secretions and cause dry mouth. Antipsychotics decrease the secretions of the lacrimal glands and may also result in blurred vision. Antipsychotics impair the emptying of the bladder, resulting in urinary retention.

While reviewing the laboratory reports of a client with a psychotic disorder, the nurse finds abnormally high levels of prolactin in the blood. Which medication in the client's prescription might be the cause of this finding? 1.Clozapine 2.Haloperidol 3.Lurasidone 4.Risperidone

2.Haloperidol Conventional atypical antipsychotics, such as haloperidol, may cause hyperprolactinemia as a side effect.

A client writes, "My kolege konducts unikornth festewel evry year. I vant this buk for studying." Which symptoms would the nurse document in the client record after reading this writing? Select all that apply. 1.Mutism 2.Neologisms 3.Word salad 4.Clang association 5.Associative looseness

2.Neologisms 5.Associative looseness

Which positive symptoms of schizophrenia affect the content of thoughts in a client? Select all that apply. 1.Anergia 2.Paranoia 3.Echolalia 4.Religiosity 5.Anhedonia

2.Paranoia 4.Religiosity

The nurse observes that a client with osteoarthritis behaves rudely to the staff and refuses treatment. On assessing, the nurse learns that the client thinks that all staff members are planning to harm and deceive him. Which is the client likely to be suffering from? 1.Schizoid personality disorder 2.Paranoid personality disorder 3.Narcissistic personality disorder 4.Obsessive-compulsive personality disorder

2.Paranoid personality disorder Clients with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person and reject the treatment. They behave rudely and develop jealousy toward others.

Which is the psychosocial predisposing factor for paranoid personality disorder? 1.Learning experiences 2.Parental antagonism 3.Parental overindulgence 4.Ungratifying relationships

2.Parental antagonism Parental antagonism and harassment make the child gradually relinquish all hope of affection and approval. Finally, the child develops paranoid personality disorder.

Which therapeutic outcome can be achieved with the help of cannabis? 1.Reduced weight 2.Reduced eye pressure 3.Reduced intractable pain 4.Reduced number of diarrheal episodes

2.Reduced eye pressure

The nurse is preparing the client with schizophrenia for an examination procedure to assess abnormal involuntary movements. Which action of the client needs correction during examination? 1.Removing the shoes and socks 2.Sitting in the chair with legs crossed 3.Keeping the legs slightly apart while sitting 4.Sitting in the chair with both hands on knees

2.Sitting in the chair with legs crossed The client would sit in the chair with his or her feet flat on the floor. Therefore, the nurse corrects this action of the client during examination.

The nurse is teaching parents of an adolescent about the influence of peers on first-time substance abusers. To which sociocultural factor does the nurse refer? 1.Conditioning 2.Social learning 3.Ethical influences 4.Cultural influences

2.Social learning The social learning factor says that children are more likely to use substances if they have parents who provide a model for substance use. Therefore, the nurse is teaching the parents about the social learning factors that contribute to substance abuse by children.

.The client learns to monitor moods and thought processes that lead to substance abuse.What perceptual changes occur in a client with hallucinogen intoxication? Select all that apply. 1.Elation 2.Synesthesia 3.Derealization 4.Depersonalization 5.Anterograde amnesia

2.Synesthesia 3.Derealization 4.Depersonalization

While caring for a client with borderline personality disorder, the nurse finds that the client consumes large amounts of food and self-induces vomiting. The client also reports having an increased libido. Which does the nurse interpret from these findings? 1.The client is exhibiting clinging behavior. 2.The client is experiencing impulsive behavior. 3.The client is exhibiting splitting behavior. 4.The client is exhibiting distancing behavior.

2.The client is experiencing impulsive behavior. The impulsive behaviors associated with borderline personality disorder include promiscuity, binging, and purging, such as in the client who consumes large amounts of food and self-induces vomiting. The client's urges to have sex with different partners frequently indicates promiscuity.

The nurse is caring for a client who self-mutilates. On assessment, the primary health-care provider concludes that the client has borderline personality disorder and instructs the nurse to encourage the client to verbalize fears after providing treatment. Which positive outcome does the nurse expect to see in the client? 1.The client needs personal progression through this process. 2.The client seeks out staff when the desire for self-mutilation occurs. 3.The client gains sufficient self-control to limit maladaptive behaviors. 4.The client completes activities of daily living independently.

2.The client seeks out staff when the desire for self-mutilation occurs. The client with borderline personality disorder performs self-destructive behaviors due to poor impulse control. The primary health-care provider instructs the nurse to encourage verbalization of fears in a nonthreatening manner so that the client orients to the reality and seeks out staff when the desire for self-mutilation occurs.

Which are the functions of dialectical behavioral therapy (DBT)? Select all that apply. 1.To provide alternate ways of dealing with frustration 2.To enhance the behavioral capabilities of the client 3.To structure the treatment environment 4.To enhance therapist capabilities and motivation 5.To help the client recognize and correct inaccurate mental schemata

2.To enhance the behavioral capabilities of the client 3.To structure the treatment environment 4.To enhance therapist capabilities and motivation

While caring for a client with schizophrenia, the nurse finds that the client has aggressive body language, catatonic excitement, and command hallucinations. Which interventions would the nurse implement to ensure the safety of this client? Select all that apply. 1.Restrain and monitor the client closely 2.Use a calm attitude with the client 3.Engage the client in activities like punching a bag 4.Maintain a low level of lighting and simple decor in the client's room 5.Assess the client's understanding about the content of hallucinations

2.Use a calm attitude with the client 3.Engage the client in activities like punching a bag 4.Maintain a low level of lighting and simple decor in the client's room Restraints are applied only when the client cannot be controlled with "talking down." The client's understanding about the content of hallucinations does not help minimize the risk of self-directed violence in the client.

Which medications are the most potent antagonists of the serotonin-type 2A receptors? Select all that apply. 1.Loxapine 2.Ziprasidone 3.Risperidone 4.Aripiprazole 5.Fluphenazine

2.Ziprasidone 3.Risperidone 4.Aripiprazole

While taking the blood pressure of a client with schizophrenia, the nurse positions the client's arm outward. After 2 hours, the nurse finds that the client is still sitting in the same position with the arm extended. What does this behavior indicate? 1.Tangentiality 2.Perseveration 3.Waxy flexibility 4.Depersonalization

3. Waxy flexibility Rationale: If a client with schizophrenia allows body parts to be placed in bizarre or uncomfortable positions for long periods, it may indicate waxy flexibility behavior in the client. Tangentiality is the condition in which the client speaks about unrelated topics, and the focus of original discussion is lost. Perseveration is the condition in which the client persistently repeats the same word or idea in response to different questions. Depersonalization is the state in which the client feels that either he or she or the outside world is unreal.

Which statement of the registered nurse describes the predisposing factor for antisocial personality disorder? 1."Children who receive parental pampering are at high risk for antisocial personality disorder." 2."Children who are more attached to their single parent are at high risk for antisocial personality disorder." 3."Children who are exposed to sexual and physical abuse are at high risk for antisocial personality disorder." 4."Children who are belittled and abandoned are at high risk for antisocial personality disorder."

3."Children who are exposed to sexual and physical abuse are at high risk for antisocial personality disorder."

After assessing a client with a psychiatric illness, the nurse concludes that the client is experiencing paranoia. Which client response is most consistent with paranoia? 1."It is raining cats and dogs." 2."The world no longer exists." 3."I won't eat this food. I know it is poisoned." 4."It snowed last night because I wished very, very hard that it would."

3."I won't eat this food. I know it is poisoned."

Which statement of the spouse makes the nurse suspect that the client is in the crucial phase of alcohol addiction? 1."My partner consumes alcohol to relieve tensions and everyday stress." 2."My partner consumes alcohol secretly." 3."My partner is willing to risk anything for alcohol." 4."My partner is emotionally and physically disturbed."

3."My partner is willing to risk anything for alcohol." In the crucial phase, the client has no control and is willing to risk anything for alcohol consumption.

Which does the catatonia specifier stupor indicate? 1.Absence of verbal response 2.No response to external stimuli 3.Absence of psychomotor activity 4.No influence of external stimuli

3.Absence of psychomotor activity The absence of psychomotor activity indicates stupor.

The registered nurse is evaluating the performance of the student nurse who is caring for a client with behaviors such as an inability to form satisfactory, enduring, and intimate relationships with others and frequent lack of success in life. Which interventions included in the care plan needs correction? 1.Conveying an accepting attitude toward the client 2.Maintaining a low level of stimuli in the client's environment 3.Administering chlordiazepoxide to the client 4.Encouraging the client to verbalize hostile feelings

3.Administering chlordiazepoxide to the client An inability to form satisfactory, enduring, intimate relationships and frequent lack of success in life indicates that the client has antisocial personality disorder. Administering antianxiety agents such as chlordiazepoxide requires correction because the client with antisocial personality has strong susceptibility to addictions.

Which behaviors are present in a client with borderline personality disorder? Select all that apply. 1.Suspicious behavior 2.Exploitative behavior 3.Manipulative behavior 4.Splitting behavior 5.Self-destructive behavior

3.Manipulative behavior 4.Splitting behavior 5.Self-destructive behavior A client with borderline personality disorder is a master of manipulation. The nurse would be aware of this behavior of the client to prevent staff splitting. A client with borderline personality disorder causes staff splitting due to the fear of abandonment. Repetitive self-mutilating behaviors are classic manifestations of a client with borderline personality disorder.

Which intervention would the nurse perform while caring for a client with a psychiatric illness who is reluctant to be with friends and expresses a fear of rejection? 1.Observe the client by leaving him or her alone 2.Limit interaction with the client 3.Offer to remain with the client during activities 4.Ensure a low light and calm environment for the client

3.Offer to remain with the client during activities The client with low self-esteem has a fear of rejection and is reluctant to be with friends. Therefore, the nurse would offer to remain with the client to provide emotional security to the client.

Which factor results in delayed absorption of alcohol? 1.Rapid drinking of alcohol 2.Drinking distilled beverages 3.Presence of food in the stomach 4.Decreased levels of digestive enzymes

3.Presence of food in the stomach

A client with a psychiatric illness tells the nurse, "It is very cold. I am cold and bold. The gold has been sold." Which intervention would the nurse implement in this situation? 1.Observe the client by leaving him or her alone 2.Ignore the client's statements 3.Seek clarification from the client 4.Notify the primary health-care provider

3.Seek clarification from the client The nurse would try to decode the client's statement and seek clarification and validation from the client.

Which interventions would the nurse implement while caring for a client with altered thought process? Select all that apply. 1.Sharing the beliefs of the client 2.Denying the beliefs of the client 3.Serving family-style servings of food to the client 4.Performing mouth checks on the client when necessary 5.Being friendly with the client with an overly cheerful attitude

3.Serving family-style servings of food to the client 4.Performing mouth checks on the client when necessary The nurse would not deny or argue over the beliefs of the client, as this may impede the development of a trusting relationship. Clients with disturbed thought processes may be suspicious. Therefore, the nurse can use various creative approaches such as family-style serving. Clients with disturbed thought processes believe that they are being poisoned and may discard their medications. Therefore, the nurse would perform mouth checks on the client following medication administration.

Which action is most attributable to caffeine? 1.Stimulation of norepinephrine release 2.Stimulation of ganglionic synapses 3.Stimulation of cellular metabolism 4.Stimulation of nerve impulse transmission at cholinergic synapses

3.Stimulation of cellular metabolism Inhibition of the enzyme phosphodiesterase by caffeine causes increased levels of 3', 5'-cyclic adenosine monophosphate (cAMP) that in turn stimulates cellular metabolism.

Which finding in the client in the psychiatric ward enables the nurse to reach the conclusion that the client is in the premorbid phase of schizophrenia? 1.The client is anxious and irritable. 2.The client has disorganized speech. 3.The client is very shy and withdrawn. 4.The client has diminished emotional expression.

3.The client is very shy and withdrawn. The client in the premorbid phase of schizophrenia exhibits symptoms such as being very shy and withdrawn.

Which outcome is desired for the client undergoing the second stage of treatment for codependency? 1.The client must avoid denial of problems. 2.The client should exhibit willingness to change. 3.The client should take responsibility for his dysfunctional behavior. 4.The client must face the fact that relationships cannot be managed by force.

3.The client should take responsibility for his dysfunctional behavior. The second stage is the reidentification stage, in which the client should take responsibility for his or her dysfunctional behavior. It helps the client accept his or her limitations and be ready to face the issues of codependency.

What is a drawback associated with Assertive Community Treatment (ACT)? 1.The treatment is less effective for inpatients. 2.The treatment requires longer hospital stays for the client. 3.The treatment does not help with homelessness and substance abuse problems in the client. 4.The treatment does not enable the client to generalize the learning procedure.

3.The treatment does not help with homelessness and substance abuse problems in the client. Clients in ACT often face coexisting problems such as homelessness and substance abuse.

Which client is at a high risk for death due to antipsychotic therapy? 1. A 25-year-old client with schizophrenia 2. A 30-year-old client with bipolar disorder 3. A 40-year-old client with delusional disorder 4. A 68-year-old client with neurocognitive disorder (NCD)

4. A 68-year-old client with neurocognitive disorder (NCD) Antipsychotics may cause cardiac complications such as arrhythmias and congestive heart failure. Elderly clients are at a high risk for these complications. Therefore, a 68-year-old client may have a high risk of death due to antipsychotic therapy.

Which statement from an alcoholic client indicates the chronic phase of alcoholism? 1."I am not able to sleep at nights without drinking alcohol." 2."I usually drink alcohol only to relax from daily tensions." 3."I am unable to decide whether to stop drinking alcohol or not." 4."I feel sorry for myself because I cannot get rid of this addiction."

4."I feel sorry for myself because I cannot get rid of this addiction." When the client express feelings related to self-pity and hopelessness, it indicates the final stage of alcoholism, called the chronic phase.

The nurse asks a client with schizophrenia, "When was your left leg amputated?" Which response by the client indicates a somatic delusion? 1."No, it was not removed; I never had a left leg." 2."My physician removed it last month because he wants to kill me." 3."It was removed last month, but I don't need legs because I have super powers." 4."It was removed last month, but it is growing again and I will be walking shortly."

4."It was removed last month, but it is growing again and I will be walking shortly." The client with somatic delusions may have false ideas about the body's functioning. In this case, the client is feeling that the removed or amputated leg can grow back.

Which statement by the nurse will most likely be effective while caring for a client with antisocial personality disorder who is diagnosed with defensive coping? 1."You should eat at 11 a.m. daily." 2."You should not wander in the corridor." 3."Don't go outside without my permission." 4."You are expected to be friendly with the nursing staff."

4."You are expected to be friendly with the nursing staff." The usage of words such as "you will be expected to ..." will develop a positive impression of the nurse. Thus, the client may cooperate with the nurse during the treatment.

A client says, "Although I sleep well at night, I have uncontrollable urges to sleep during the daytime." Which central nervous system (CNS) medication is preferred for this client? 1.Phenobarbital 2.Caffeine 3.Chlordiazepoxide 4.Amphetamine

4.Amphetamine Amphetamine is a CNS stimulant that is used to treat narcolepsy, while caffeine is not.

Which can be used as a form of self-medication to alleviate depression? 1.Phenobarbital 2.Chlordiazepoxide 3.Desipramine 4.Amphetamine

4.Amphetamine Amphetamines alleviate depression by increasing the levels of the stimulatory neurotransmitters dopamine, and norepinephrine in the brain.

Which therapy helps manage the suspicious nature of a client with schizophrenia? 1.Milieu therapy 2.Family therapy 3.Group therapy 4.Behavior therapy

4.Behavior therapy Behavior therapy involves interventions such as praising the acceptable behaviors of the client. Therefore, this therapy helps manage the highly suspicious nature of a client with schizophrenia.

While communicating with a client who has schizophrenia, the nurse is making numerous interruptions to keep the client involved in the conversation. Which symptom of the client is the basis for the nurse's intervention? 1.Echolalia 2.Tangentiality 3.Magical thinking 4.Circumstantiality

4.Circumstantiality Rationale: Circumstantiality refers to the delay in reaching the point of the communication due to the insertion of unnecessary details. The nurse, while communicating with a client who shows circumstantiality, would make numerous interruptions to keep him or her within the point of communication.

A client who is diagnosed with schizophrenia is receiving clozapine therapy. After 1 week of the treatment, the white blood cell count of the client is 3600/mm3 and the absolute neutrophil count (ANC) is 2100/mm3. Which interventions are beneficial for this client? 1.Notify the primary health-care provider 2.Dispense only a 2-week supply of clozapine as prescribed 3.Instruct the client to discontinue the medication 4.Continue to check the white blood cell count every week

4.Continue to check the white blood cell count every week Rationale: A WBC count and an ANC must be taken weekly for the first 6 months of clozapine treatment.

Which finding in a client acts as a diagnostic criterion for schizophrenia? 1.Bipolar disorder 2.Autism spectrum disorder 3.Catatonic behavior for 1 month 4.Continuous signs of disturbance for 7 months

4.Continuous signs of disturbance for 7 months Disturbances in work, interpersonal skills, or self-care for at least 6 months is indicative of schizophrenia.

A client tells the nurse, "I can be active only when this tube light is switched on, and I must sleep whenever the tube light is switched off." Which type of delusion does this behavior of the client indicate? 1.Somatic delusion 2.Delusion of grandeur 3.Delusion of persecution 4.Delusion of control or influence

4.Delusion of control or influence The client with delusions of control or influence believes that certain objects or persons have control over his or her behavior.

A client with a punitive superego turned to alcohol to diminish unconscious anxiety. Which risk factors would predispose this client to a substance abuse disorder? 1.Genetic factors 2.Personality factors 3.Biochemical factors 4.Developmental influences

4.Developmental influences Developmental influences focus on a punitive superego and fixation at the oral stage of psychosexual development. This will predispose the client to a substance abuse disorder.

A client with a severe anxiety disorder is prescribed a barbiturate. Which physiological effects should the nurse look for during low-dose barbiturate therapy? Select all that apply. 1.Decreased urine output 2.Decreased body temperature 3.Vivid and excessive dreaming 4.Drowsiness 5.Slight decrease in blood pressure

4.Drowsiness 5.Slight decrease in blood pressure Barbiturates cause relaxation in addition to drowsiness A slight decrease in blood pressure occurs due to the action of barbiturates on the vasomotor center in the brain.

The client is unable to meet his or her role expectations due to alcohol abuse. Which nursing intervention would help the client? 1.Reviewing family history of the client 2.Monitoring protein intake of the client 3.Conveying an attitude of acceptance to the client 4.Encouraging the client to express feelings of fear and anxiety

4.Encouraging the client to express feelings of fear and anxiety Inability to meet role expectations indicates the client has ineffective coping. Encouraging the client to express feelings of fear and anxiety may help the client come to terms with long-unresolved issues.

A client with alcohol addiction says, "My spouse and children think that I am an alcoholic. I do not have a drinking problem. I can quit drinking any time." What is the first step in decreasing the use of denial in the client? 1.Confronting the client's statement 2.Offering immediate positive recognition of client's expression 3.Promoting feelings of dignity and self-worth 4.Explaining the relationship between substance abuse and personal problems

4.Explaining the relationship between substance abuse and personal problems The first step in decreasing denial in the client is to explain the relationship between substance abuse and personal problems by identifying maladaptive behaviors or situations that have occurred in the client's life.

Which traits does the nurse expect in a client diagnosed with paranoid personality disorder? 1.Fear of abandonment 2.Lack of guilt for wrongdoing 3.Intense episodes of dysphoria 4.Extremely tense and irritable

4.Extremely tense and irritable A client with paranoid personality disorder appears to be extremely tense and irritable.

Which drugs produce anterograde amnesia in a client with sedative intoxication? Select all that apply. 1.Diazepam 2.Oxazepam 3.Lorazepam 4.Flunitrazepam 5.Gamma hydroxybutyric acid

4.Flunitrazepam 5.Gamma hydroxybutyric acid

A client with schizophrenia says, "Something is always crawling inside my wrist. Can you please take it out?" Which symptom does this behavior of the client indicate? 1.Illusions 2.Paranoia 3.Anhedonia 4.Hallucinations

4.Hallucinations A client with schizophrenia may have different types of hallucinations. Tactile hallucinations are one of the types of hallucinations in which the client may complain about something crawling on or under the skin.

A client has severe anhedonia and regression. Which medication aggravates the condition of the client? 1.Clozapine 2.Quetiapine 3.Olanzapine 4.Haloperidol

4.Haloperidol Haloperidol is a typical antipsychotic that improves the positive symptoms and worsens the negative symptoms. Therefore, haloperidol aggravates anhedonia and regression in the client.

Which receptor is activated by the neurotransmitter glycine? 1.Dopamine 2.Cholinergic 3.Alpha-adrenergic 4.N-methyl-D-aspartate(NMDA)

4.N-methyl-D-aspartate(NMDA)

Which side effect associated with antipsychotics occurs due to the blockade of alpha1-adrenergic receptors? 1.Dry mouth 2.Constipation 3.Urinary retention 4.Orthostatic hypotension

4.Orthostatic hypotension Antipsychotics may cause orthostatic hypotension due to their inhibitory effect on alpha1-adrenergic receptors.

While assessing a client with psychiatric illness, the nurse finds that the client is unable to work and build relationships with friends. The nurse also finds that the client has a very weak emotional tone and is expressionless. Which phase of schizophrenia is the client experiencing? 1.Phase I 2.Phase II 3.Phase III 4.Phase IV

4.Phase IV The client's inability to work and build relationships indicates impairment in role functioning. The client's inability to exhibit emotions indicates the flat affect. Impairment in role functioning and flat affect are commonly seen during the residual phase of schizophrenia.

Which symptom indicates that the client has antisocial personality disorder with defensive coping? 1.Cruelty to animals 2.Overt aggressiveness 3.Dysfunctional interaction with others 4.Projection of blame and responsibility

4.Projection of blame and responsibility Projection of blame and responsibility on others indicates that the client has antisocial personality disorder with defensive coping.

A chronic alcoholic client has elevated levels of muscle enzymes and symptoms of decreased exercise tolerance, dyspnea, edema, and palpitations. As directed by the primary health-care provider, the nurse restrains the client from alcohol use and initiates therapy with digitalis and diuretics. What outcome will the nurse expect in the client? 1.The client will not express reddish tinge during urination. 2.The client verbalizes no pain or burning sensation in the extremities. 3.The client will be able to recollect recent memory and maintain orientation. 4.The chest x-ray of the client will show a proper functioning of the heart.

4.The chest x-ray of the client will show a proper functioning of the heart. Abstinence from alcohol and therapy with digitalis and diuretics will improve the functioning of the heart in clients with alcoholic cardiomyopathy. This will improve the cardiac functioning in the client as evident from the chest x-ray.

A client with a psychiatric illness is on pimozide (Orap) therapy. On assessment of the client after a few weeks, the primary health-care provider instructs the nurse to stop administering the drug. What could be the reason for withdrawing the drug? 1.The client has gained weight. 2.The client has extreme salivation. 3.The client has difficulty in urinating. 4.The client has vermiform tongue movements.

4.The client has vermiform tongue movements. The client, who is on typical antipsychotic therapy, such as pimozide (Orap), may develop tardive dyskinesia. The drug would be withdrawn if the client shows vermiform movements of the tongue.

While caring for a client with a psychotic disorder, the nurse finds that the client has severe delusions, hallucinations, and frequent derailment. What does the nurse infer from these findings? 1.The client is in the residual phase. 2.The client is in the premorbid phase. 3.The client is in the prodromal phase. 4.The client is in the active psychotic phase.

4.The client is in the active psychotic phase. Rationale: Delusions, hallucinations, and disorganized speech, such as frequent derailment or incoherence, and catatonic behavior are the common symptoms present in the client who is in the active psychotic phase.

A client with substance intoxication and mental illness is scheduled for cognitive therapy. Which client outcome would indicate effective therapy? 1.The client can achieve and maintain sobriety. 2.The client learns more adaptive ways of coping. 3.The client knows how psychiatric disorders and substance abuse reinforce each other. 4.The client learns to monitor moods and thought processes that lead to substance abuse.

4.The client learns to monitor moods and thought processes that lead to substance abuse. The presence of substance intoxication and mental illness is termed as a dual diagnosis. Cognitive therapy will help the client with substance intoxication and mental illness in monitoring moods and thought processes that lead to substance abuse.

A chronic alcoholic client tells the nurse, "No matter how much I drink, I can drive just fine." In a caring tone, the nurse responds, "The lab report shows that you were under the influence of alcohol when you had the accident." What is the rationale for this nursing intervention? 1.To make the client understand the relationship between substance abuse and personal problems 2.To develop a trusting relationship with the client 3.To make the client verbalize feelings related to dignity and self-worth 4.To interfere with the client's ability to deny and to prevent him or her from becoming defensive without affecting his or her self-esteem.

4.To interfere with the client's ability to deny and to prevent him or her from becoming defensive without affecting his or her self-esteem. The response of the nurse reflects a caring confrontational statement that interferes with the client's ability to deny and prevents him or her from becoming defensive about the situation. The caring nature of the nurse will preserve the self-esteem of the client.

The nurse observes that a client with osteoarthritis exploits other group members during group activities. On further interaction, the nurse learns that the client thinks that all the staff members are planning to harm him. Which phase of schizophrenia does this behavior of the client indicate? Phase I Phase II Phase III Phase IV

Phase II Rationale: The client in the prodromal phase or phase II experiences nonspecific symptoms such as social withdrawal and positive symptoms such as suspiciousness. Therefore, the client exploiting the group members during any group activities indicates that the client is in phase II of schizophrenia. The client in the premorbid phase or phase I experiences schizoid or schizotypal personalities, which are characterized as quiet, passive, and introverted. The client in the active psychotic phase or phase III experiences prominent psychotic symptoms such as delusions and hallucinations. The client in the residual phase or phase IV experiences periods of remission or exacerbation.