psych nursing midterm
A client is diagnosed with posttraumatic stress disorder (PTSD). What questions should the nurse ask the client to elicit information about the symptoms? Select all that apply. A. "Do you have recurrent and intrusive thoughts of the trauma?" B. "Do you feel detached from others?" C. "Do you get irritated by trivial issues?" D. "Do you have a past history of any surgery?" E. "Did you have trouble with social relationships as a child?"
A. "Do you have recurrent and intrusive thoughts of the trauma?" B. "Do you feel detached from others?" C. "Do you get irritated by trivial issues?"
When conducting a focused assessment on a newly admitted client who attempted suicide, which question should the nurse include to ensure the client's safety? Select all that apply. A. "Do you still have a plan to harm yourself?" B. "Have you ever tried to hurt yourself before?" C. "Are you willing to tell us if you plan to harm yourself again?" D. "Did you really want to kill yourself?" E. "Is there a history of depression in your family?"
A. "Do you still have a plan to harm yourself?" B. "Have you ever tried to hurt yourself before?" C. "Are you willing to tell us if you plan to harm yourself again?"
A client approaches the nurse and loudly states, "I'm not putting up with this anymore!" The most appropriate response by the nurse would be what? A. "I can see you are angry. Tell me what's going on." B. "You are not allowed to make threats. Please keep your voice down." C. "Why do you say that?" D. "You are here voluntarily. You can leave if you want."
A. "I can see you are angry. Tell me what's going on."
A nurse is meeting with a client prior to discharge from the hospital. The client tells the nurse he is "really worried about returning home." Which response indicates the nurse is employing therapeutic communication? A. "Please share with me what is worrying you right now." B. "Home is a much better place for you." C. "It is best to complete your recovery surrounded by loved ones." D. "Most clients have anxiety before they return home."
A. "Please share with me what is worrying you right now."
A nurse is talking to a provider, who quietly and numbly tells the nurse about arriving at the scene of an automobile-pedestrian accident 3 days ago. The provider performed CPR on a victim, but it was unsuccessful. Which statement by the nurse would be most appropriate? A. "Tell me what you saw." B. "That is horrible!" C. "Why did you perform CPR?" D. "I know how you feel; the same thing happened to me several years ago and I never recovered."
A. "Tell me what you saw."
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 it if you would not do that." D. "Why do you do these things?'
A. "That is not allowed here. You will lose a privilege. You need to stop."
Friends of two teenagers recently killed in a car accident are discussing their sense of loss. Which comment best indicates that the friends are trying to make sense of the loss cognitively? A. "Why did they have to die so young?" B. "They shouldn't have been driving so recklessly." C. "If we had only stayed longer, they would not have been on that road." D. "It took the ambulance too long to get there."
A. "Why did they have to die so young?"
Which clients would be most likely to attempt situational suicidal thoughts? A. A client who has been given a diagnosis of cancer with a poor prognosis B. A client who is asking how painful it is to die of a medication overdose C. A client who is giving away a cherished book D. A client who is writing an angry letter to an ex-spouse
A. A client who has been given a diagnosis of cancer with a poor prognosis
Three years after the nurse's father died in an intensive care unit, the nurse was reviewing a client's chart. The nurse looked at the client, who had the same diagnosis and similar features to the nurse's father. The nurse felt a sense of panic but quickly realized that the client in the bed was not their father. Which of these manifestations of PTSD did this nurse experience? A. A flashback B. Emotional numbing C. Hyperarousal D. A dream
A. A flashback
A nurse is caring for clients who are psychologically abused. Which clients should the nurse screen for psychological abuse? Select all that apply. A. A partner of a client who has destroyed the front door of their home. B. A client whose friend makes a joke about the clothing the client is wearing. C. A client whose partner is monitoring the amount of money spent on food and clothing. D. A partner of client who does not want the client to spend any time with family or friends. E. A parent of a client who is threatening to injure the family's pet.
A. A partner of a client who has destroyed the front door of their home. C. A client whose partner is monitoring the amount of money spent on food and clothing. D. A partner of client who does not want the client to spend any time with family or friends. E. A parent of a client who is threatening to injure the family's pet.
A client is diagnosed with intermittent explosive disorder (IED). What drugs are likely to be prescribed for the client? Select all that apply. A. Antidepressant drugs B. Antipsychotic drugs C. Mood-stabilizing drugs D. Stimulant drugs E. Barbiturates
A. Antidepressant drugs C. Mood-stabilizing drugs
A nurse is working in a psychiatric-mental health facility. The nurse observes a client pacing and punching the wall. Which measure can the nurse take for personal safety? A. Avoid being alone with the client. B. Stand on the client's dominant side. C. Stand with hands behind the back. D. Avoid standing close to a door.
A. Avoid being alone with the client.
A nurse is reviewing the medical records of several clients who have come to the community health center. The nurse would most likely identify a client experiencing which event as being at risk for developing posttraumatic stress disorder (PTSD)? Select all that apply. A. Being a survivor of a tsunami that resulted in thousands of deaths B. Being stranded at the office during a typical winter storm that was anticipated C. Being a marine in a combat situation where the entire platoon was wiped out, except for one person D. Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E. Watching televised segments of the moment when the plane hit the second tower on 9/11
A. Being a survivor of a tsunami that resulted in thousands of deaths C. Being a marine in a combat situation where the entire platoon was wiped out, except for one person D. Being hidden in a closet and hearing the entire family murdered by someone who broke into the home
A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which characteristic would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply. A. Body dissatisfaction B. Feelings of control C. Obsessiveness D. Boundary problems E. Sexuality fears F. Cognitive distortions
A. Body dissatisfaction C. Obsessiveness F. Cognitive distortions
A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? A. Body weight less than normal for age, height, and overall physical health B. Irregular menstrual cycles C. Absence of hunger feelings D. Erosion of dental enamel
A. Body weight less than normal for age, height, and overall physical health
When teaching a client with generalized anxiety disorder, which is the priority for the nurse to teach the client to avoid? A. Caffeine B. High-fat foods C. Refined sugars D. Sodium
A. Caffeine
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 stated, "How are your stress reduction classes going?" A. Changing the subject B. Offering advice C. Challenging D. Disapproving
A. Changing the subject
In observing a client's pattern of development of aggression, which techniques can a nurse teach a client to help with management of anger? Select all that apply. A. Count to the number 10. B. Ignore the increase in anger. C. Use deep breathing exercises. D. Take a time-out from the situation. E. Watch a television show.
A. Count to the number 10. C. Use deep breathing exercises. D. Take a time-out from the situation. E. Watch a television show.
The nurse is caring for a client whose death is imminent and who is therefore receiving hospice care. In preparing the family members for the death of their loved one, the nurse assists the family with which areas, regardless of the family's cultural preferences? Select all that apply. A. Dealing with the shock of losing a loved one B. Burial plans after death has occurred C. Efforts to stay connected to the client after death D. Use of support from family and friends E. Anger at the loss of a loved one
A. Dealing with the shock of losing a loved one C. Efforts to stay connected to the client after death E. Anger at the loss of a loved one
A client is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the client, the client cannot recall the client's name or where the client lives. The responders transport the client to the mental health crisis unit for further evaluation. Which is the client likely potentially suffering from? Select all that apply. A. Depersonalization disorder B. Dissociative identity disorder C. Repressed memories D. Dissociative amnesia E. False memory syndrome
A. Depersonalization disorder B. Dissociative identity disorder D. Dissociative amnesia
The nurse is having feelings of judgement regarding a client's contributory behavior to an automobile accident that resulted in deaths. Which action would the nurse take? A. Discussing the nurse's personal feelings with a peer or a counselor B. Acknowledging to the client the judgment regarding his or her contributory behavior C. Sharing the client's horror and encouraging him or her to avoid thinking about it D. Letting the client know that he or she is now traumatized beyond repair
A. Discussing the nurse's personal feelings with a peer or a counselor
A nurse is assessing a child diagnosed with autism spectrum disorder. When assessing the child's communication, which of the following would the nurse expect to find? Select all that apply. A. Echolalia B. Delayed language skills C. Normal intonation D. Inappropriate use of words E. Abstract interpretation of words
A. Echolalia B. Delayed language skills
During an interview, the nurse has asked a client with depression about any hopes or plans for the future. In response, the client silently made a gesture of drawing the index finger from one side of the client's throat to the other. The nurse has informed the client that this must be communicated to the care team. What is the main rationale for the nurse's action? A. Ensuring the client's safety B. Ensuring continuity of care C. Promoting collaborative practice D. Promoting the client's autonomy
A. Ensuring the client's safety
Initially, the nurse should focus on successfully achieving which goal in order to effectively provide care for a client diagnosed with a mental illness? A. Establishing trust and rapport with the client B. Offering sound advice concerning the client's primary problem C. Setting reasonable limits early in the relationship D. Promoting friendship within the relationship
A. Establishing trust and rapport with the client
The nurse is caring for a client with conversion disorder. The client reports having paralysis of the right side of the body. Which action by the nurse would constitute a secondary gain? A. Feeding the client during mealtime B. Talking about family and friends with the client C. Teaching the client techniques of meditation and relaxation D. Discussing coping strategies that the client used in the past
A. Feeding the client during mealtime
The nurse is working with a client who lost the client's youngest child 2 months ago. When the nurse approaches, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases a response to the client on the understanding of what? A. Hostility is a common behavioral response to grief. B. It is too soon after the loss to empathize with the client. C. Personality traits such as aggressiveness are exaggerated during the grief process. D. The nurse may have nonverbally indicated a judgmental attitude toward the client.
A. Hostility is a common behavioral response to grief.
To care for an acutely suicidal client, which is the most effective initial mode of treatment? A. Inpatient care B. Group therapy C. Behavioral therapy D. Outpatient care
A. Inpatient care
A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which would a nurse most likely find? A. Intentional self-injurious behavior B. Pain to achieve a self-serving goal C. Malingering to avoid work D. Parents who were restrictive
A. Intentional self-injurious behavior
The traumatized client has suddenly changed demeanor and voice pitch. Which is true about the use of touch with a client with dissociative identity disorder? A. It is best not to touch the client without his or her permission. B. Make sure the client knows the touch is friendly and supportive. C. Touch the client only if you are in his or her direct line of vision. D. Touch will convey a sense of security to the client.
A. It is best not to touch the client without his or her permission.
A child has been displaying behaviors associated with conduct disorder. As the nurse evaluates these behaviors, the nurse will 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
A. Poor family functioning C. Family history of substance abuse D. Possible child abuse E. Poverty conditions
Which are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A. Positive reframing B. Decatastrophizing C. Assertiveness training D. Humor E. Unlearning
A. Positive reframing B. Decatastrophizing C. Assertiveness training
In clients who do not completely recover from the trauma of rape, which mental illness is most likely to develop? A. Post-traumatic stress syndrome B. Anxiety disorders C. Borderline personality disorder D. Delirium
A. Post-traumatic stress syndrome
A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A. Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B. Showing emotional numbing such as feeling detached from others C. Being on guard, irritable, or experiencing hyperarousal D. Feeling mildly anxious E. Occuring 2 weeks after the trauma
A. Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B. Showing emotional numbing such as feeling detached from others C. Being on guard, irritable, or experiencing hyperarousal
A client is experiencing a panic attack while in the recreation room. Which intervention would be a priority to promote the client's safety? Select all that apply. A. Remaining with the client to assess needs B. Requesting a prescription for an antianxiety agent C. Offering the client therapy to calm down D. Turning off any televisions or radios in the immediate area E. Engaging the client in recreational activities.
A. Remaining with the client to assess needs D. Turning off any televisions or radios in the immediate area
When providing care for children with psychiatric disorders, which are the priorities for care? Select all that apply. A. Safety B. Self-esteem C. Nutrition D. Ability to function E. Emotional support
A. Safety B. Self-esteem
A client has been diagnosed with somatic symptom disorder. The client's assessment reveals high levels of anxiety. Which would the nurse expect to be prescribed? A. Selective serotonin reuptake inhibitors (SSRIs) B. Antipsychotics C. Tricyclic antidepressants D. Mood stabilizers
A. Selective serotonin reuptake inhibitors (SSRIs)
Which medication classification has been shown to be effective in some cases of somatoform disorders? A. Serotonin reuptake inhibitors (SSRIs) B. Antimanics C. Antipsychotics D. Antibiotics
A. Serotonin reuptake inhibitors (SSRIs)
The nurse reviews the medications prescribed for an individual diagnosed with posttraumatic stress disorder (PTSD). Which medications are effective with managing the symptoms of PTSD? Select all that apply. A. Sertraline B. Paroxetine C. Prazosin D. Risperidone E. Hydromorphone
A. Sertraline B. Paroxetine C. Prazosin
The nurse has used wrist and ankle restraints for a client who was extremely aggressive. What assessments should the nurse perform on a regular basis after restraining the client? Select all that apply. A. Side effects of medication B. Skin condition C. Peripheral circulation D. Emotional well-being E. Memory
A. Side effects of medication B. Skin condition C. Peripheral circulation D. Emotional well-being
A client has lost a job of 20 years. This is an example of which type of crisis? A. Situational B. Maturational C. Developmental D. Adventitious
A. Situational
Which steps are involved in limit setting? Select all that apply. A. State the expected behavior. B. Inform clients of the rule or limit. C. Threaten incarceration. D. Explain the consequences if clients exceed the limit. E. Occasionally limit enforcement.
A. State the expected behavior. B. Inform clients of the rule or limit. D. Explain the consequences if clients exceed the limit.
A nurse is seeing a client prior to discharge after being admitted to hospital for suicidal ideation. As the nurse begins the discharge process, the client closes the eyes and begins rapid, shallow breathing. The client also begins to shake and perspire profusely. Which actions should the nurse take? Select all that apply. A. Talk to the client in a comforting manner. B. Take the client to a quiet space. C. Reassure the client of being safe. D. Ask the client to spend some time alone. E. Assess the client for suicidal ideation.
A. Talk to the client in a comforting manner. B. Take the client to a quiet space. C. Reassure the client of being safe.
A client with obsessive-compulsive disorder (OCD) spends several hours each day cleansing the home and washing the hands. The client tells the nurse, "I don't think you quite realize how many bacteria, viruses, and fungi live around us." What is the nurse's most accurate interpretation of this client's statement? A. The client may lack insight into the OCD. B. The client's OCD is the result of physiologic factors. C. The client is unlikely to respond to conventional treatment for OCD. D. The client may have contacted a severe infection or contamination earlier in life.
A. The client may lack insight into the OCD.
A nurse is caring for a client with posttraumatic stress disorder (PTSD) who is treated with cognitive-behavioral therapy. What changes in behavior should the nurse expect in the client during the four to five days of therapy? Select all that apply. A. The client will have decreased anxiety and fear. B. The client will stop taking alcohol and drugs. C. The client will establish contact with family and friends. D. The client will be able to identify the traumatic event. E. The client will show an increased ability to cope with the stress.
A. The client will have decreased anxiety and fear. D. The client will be able to identify the traumatic event.
A firefighter survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which as positive outcomes for this client? Select all that apply. A. The client will verbalize feelings of stress related to returning to work. B. The client will express guilt openly through nondestructive means. C. The client will identify a social support system within the community. D. The client will report nightmares and flashbacks of the fire.
A. The client will verbalize feelings of stress related to returning to work. B. The client will express guilt openly through nondestructive means. C. The client will identify a social support system within the community.
A client developed conversion blindness after witnessing the death of the client's twin in a car accident. When teaching the client's parent about the client's illness, the nurse explains what? A. The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis. B. The client's blindness results in increased anxiety and attention from family and friends. C. The clients blindness will gradually disappear if proper ophthalmologic care is provided. D. The client's blindness requires a conscious effort to maintain the feigned symptom.
A. The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis.
Which nursing action would be a protective factor in the prevention of suicide for a client who has been identified at risk? A. The nurse facilitates a referral to a drug and alcohol recovery program. B. The nurse emphasizes medical interventions for depression. C. The nurse counsels clients to avoid conflict. D. The nurse encourages clients to spend more time alone.
A. The nurse facilitates a referral to a drug and alcohol recovery program.
It is brought to the nurse administrator's attention that a nurse has developed an intimate relationship with a client. Which behavior indicates the nurse has engaged in an intimate relationship with a client? A. The nurse is having dinner with a client outside the hospital premises. B. The nurse is talking to the spouse of the client regarding the client's condition. C. The nurse examines the genital area of a client diagnosed with a sexually transmitted infection. D. The nurse speaks on topics like sports while performing assessment on the client.
A. The nurse is having dinner with a client outside the hospital premises.
A nurse is assessing several clients who have expereinced loss. Which client would the nurse most likely identify as experiencing complicated grieving? Select all that apply. A. The spouse of a person who died 7 years ago and visits the grave several times a day. B. The grandchild of a soldier killed in war who visits the grave once a year on Memorial Day. C. A driver whose spouse and children all died as a result of his driving drunk. D. An adult who insisted for many years that the adult hated the adult's deceased parent. E. The parent of a child who died after the having left the child in a car on a hot day.
A. The spouse of a person who died 7 years ago and visits the grave several times a day. C. A driver whose spouse and children all died as a result of his driving drunk. D. An adult who insisted for many years that the adult hated the adult's deceased parent. E. The parent of a child who died after the having left the child in a car on a hot day.
The bereaved client has worked through many processes of grief with the nurse. Which are eventual outcomes of the emotional dimension of grieving? Select all that apply. A. The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B. The survivor begins to gain independence and confidence. C. The survivor develops new ways of managing life and new relationships. D. The survivor's life returns to the same state as it was before the loss. E. The survivor forgets about the loss.
A. The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. B. The survivor begins to gain independence and confidence. C. The survivor develops new ways of managing life and new relationships.
Which is one of the most common reasons clients are often concerned about confidentiality of treatment for mental health problems? A. They are worried about the opinions of people who know them outside the hospital, due to shame produced by societal views of mental illness. B. They lack health care coverage for the treatment. C. They do not understand that most people will not know what a mental health problem is. D. They are concerned about receiving their next paycheck when they return to work.
A. They are worried about the opinions of people who know them outside the hospital, due to shame produced by societal views of mental illness.
Which phase of the aggression cycle is defined as occurring when an event or circumstance in the environment initiates the client's response? A. Triggering B. Escalation C. Crisis D. Recovery
A. Triggering
The parents of a child with attention deficit hyperactivity disorder (ADHD) express to the nurse, "We get so frustrated when our child never minds us." Which parenting strategies should the nurse discuss with the parents? Select all that apply. A. Use time-out for behavior control. B. Provide occasional rewards and consequences for behavior. C. Give verbal reprimands for negative behavior. D. Resist giving praise until fully compliant with requests. E. Use a point system for positive and negative behavior.
A. Use time-out for behavior control. C. Give verbal reprimands for negative behavior. E. Use a point system for positive and negative behavior.
A psychiatric-mental health advanced practice nurse is mentoring a newly hired psychiatric-mental health nurse and role modeling therapeutic communication techniques. The advanced practice nurse observes the new nurse and determines the need for additional role modeling when the new nurse uses which technique? Select all that apply. A. advice B. reassurance C. disapproval D. silence E. validation
A. advice B. reassurance C. disapproval
The nurse is developing a plan of care for an elderly client who has experienced the traumatic death of a spouse. Which intervention would the nurse prioritize for the client? A. arrangement for delivery of meals for the client B. discussion regarding the client's level of anxiety C. management of the client's financial needs D. preparation for a visit to a grief counselor
A. arrangement for delivery of meals for the client
When assessing a client's potential for aggression and violence, which would the nurse identify as the most important predictor? A. client's history B. age C. gender D. race
A. client's history
A pre-teen client has been considered a neighborhood bully for several years. Peers avoid him, and the mother says she cannot believe a thing he tells her. Recently, the client was observed shooting at several dogs with a pellet gun and setting fire to a vacant lot for the first time. A nurse would assess these behaviors as being most consistent with which disorder? A. conduct disorder B. oppositional defiant disorder C. pyromania D. defiance of authority
A. conduct disorder
A nurse is seeing a female client who has been mandated to counseling sessions after shoplifting numerous times. Which disruptive behavior disorder is the client most likely experiencing? A. kleptomania B. pyromania C. intermittent explosive disorder D. internalizing behavior
A. kleptomania
When assessing risk of suicide, which are important assessment components? Select all that apply. A. seriousness of suicidal ideation B. degree of hopelessness C. previous attempt D. lethality of method E. Unemployment
A. seriousness of suicidal ideation B. degree of hopelessness C. previous attempt D. lethality of method
The nurse is working with a client who is experiencing a crisis due to a divorce. Which statement would alert the nurse to the client's need for referral for further mental health counseling? A. "I am having a hard time going to work every day as if nothing is happening." B. "I am trying to work through this but have had to cut myself a few times." C. "I have been having a hard time going to sleep at night." D. "I am really angry with my spouse for divorcing me."
B. "I am trying to work through this but have had to cut myself a few times."
During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, "You don't need to follow me into the bathroom. Give me some space." Which response by the nurse is most appropriate? A. "You're right. I don't need to come into the bathroom with you. I will wait outside the door." B. "I must stay with you until we are sure you will not hurt yourself." C. "If you think you are going to be OK, I will check on you in 5 minutes." D. "I can't imagine anything dangerous is in the bathroom. Go ahead. I will wait for you in the hallway."
B. "I must stay with you until we are sure you will not hurt yourself."
The client asks the nurse, "What does having psychosomatic symptoms mean?" What is the nurse's best reply? A. "It means you're not physically sick." B. "It means that stress and/or emotions are causing your symptoms." C. "It means that you'll be well when you get your life in order." D. "It means that your symptoms are a product of your imagination."
B. "It means that stress and/or emotions are causing your symptoms."
A nurse is seeing a client in the outpatient psychiatric clinic. The client reports recent job loss and tells the nurse the client is easily angered. What is the client likely suffering from? A. Acute stress disorder B. Adjustment disorder C. Posttraumatic stress disorder D. Reactive attachment disorder
B. Adjustment disorder
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.
B. Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior.
When working with the family of a client with anorexia nervosa, which issue must be addressed? A. Codependence B. Control C. Self-discipline D. Sexual identity
B. Control
A nurse is assessing a 13-year-old client with intermittent explosive disorder (IED). The nurse suspects that the client has other psychiatric disorders. What findings would lead the nurse to conclude this? Select all that apply. A. Delusions B. Depression C. Drug abuse D. Hyperactivity E. Obsession with cleanliness
B. Depression C. Drug abuse D. Hyperactivity
Which is the most important skill the nurse must bring to the therapeutic nurse-client relationship? A. Confrontation B. Empathy C. Humor D. Reframing
B. Empathy
The nurse is having an initial meeting with a client who has just spontaneously lost an unborn child. After establishing rapport, the priority nursing intervention should focus on what? A. Assessing the client's support system B. Exploring what this loss means for the client C. Discussing helpful ways to cope with the loss D. Assessing what knowledge the client desires about the situation
B. Exploring what this loss means for the client
A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is most likely to cause the client anxiety? A. Having a blood sample drawn and experiencing mild pain B. Going to a crowded, outdoor market independently C. Having the client's work performance closely scrutinized by a supervisor D. Gaining 5 pounds and being unable to exercise vigorously
B. Going to a crowded, outdoor market independently
Before eating a meal, a client with obsessive-compulsive disorder must wash the hands for 14 minutes, comb the 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 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.
B. Gradually decrease the amount of time spent for performing rituals.
A nurse is assessing a child with a diagnosis of autism spectrum disorder. The child has severe uncontrollable temper outbursts and repeatedly bangs the head on the wall or door. When considering medication for treatment, the nurse knows which will be the most effective? A. Pemoline B. Haloperidol C. Methylphenidate D. Imipramine
B. Haloperidol
The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which physical symptom of grief would the nurse most likely expect to detect in the history? A. Hair loss B. Insomnia C. Compulsive behaviors D. Vomiting
B. Insomnia
A client is admitted to the mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what? A. Schizoid personality traits B. Munchausen's syndrome by proxy C. Functional neurologic symptoms D. Borderline personality disorder
B. Munchausen's syndrome by proxy
The nurse is assessing a client with bulimia nervosa. Which symptoms would the nurse expect to find? Select all that apply. A. Cold intolerance B. Normal weight for height C. Dental erosion D. Hypotension E. Metabolic alkalosis
B. Normal weight for height C. Dental erosion E. Metabolic alkalosis
Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? A. Leave the client alone to relax during meals. B. Offer liquid protein supplements if the client is unable to complete a meal. C. Observe the client for 30 minutes after all meals. D. Weigh the client weekly in the same clothing at the same time of day.
B. Offer liquid protein supplements if the client is unable to complete a meal.
Which type of service is provided to medically stable clients who do not require inpatient, residential, or home care environments? A. Crisis Intervention B. Outpatient care C. Detoxification D. Crisis stabilization
B. Outpatient care
A psychiatric-mental health nurse is engaging in active listening with a client. Which technique would the nurse most likely use? Select all that apply. A. Changing the subject to gather more information B. Responding indirectly to statements C. Using open-ended statements D. Concentrating fully on what the client says E. Allowing the client to talk as long as the client wishes
B. Responding indirectly to statements C. Using open-ended statements D. Concentrating fully on what the client says
The ultimate goal of the treatment plan in inpatient care settings is what? A. Focus on compliance with medication B. Stabilize the client C. Initiate physical therapy D. Complete a thorough physical assessment
B. Stabilize the client
A nurse is assessing a 14-year-old adolescent who is known for constantly bullying children. On assessment, the nurse finds that the adolescent had early onset conduct disorder. What other findings during the assessment are suggestive of early onset conduct disorder? Select all that apply. A. The client does not have extremely aggressive behavior. B. The maladaptive behavior started before the age of 10 years. C. The client does not have normal peer relationships. D. The client is susceptible to developing antisocial personality disorder. E. The client has never abused the children physically.
B. The maladaptive behavior started before the age of 10 years. C. The client does not have normal peer relationships.
A nurse observes a middle school student having an angry outburst in the hallway. The nurse is aware that the student has these outbursts frequently. The nurse suspects that the student has intermittent explosive disorder (IED). What other assessment findings would support this conclusion? Select all that apply. A. The student has had an anger episode that lasted more than 30 minutes. B. The student has caused extensive damage to school property. C. The student has experienced anger episodes over very minor events. D. The student has no sense of guilt or remorse after the anger outburst. E. The student has had outbursts of anger without any warning.
B. The student has caused extensive damage to school property. C. The student has experienced anger episodes over very minor events. E. The student has had outbursts of anger without any warning.
What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it a secret that the client plans to kill a family member? A. The student nurse must respect the client's privacy and not tell anyone. B. The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. C. The student nurse must tell the client that the student nurse will keep the secret and then tell the instructor and/or staff members. D. The student nurse must tell the instructor and then ask the instructor to keep it secret.
B. The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members.
A nurse is preparing to assess a middle-aged client who was brought to the emergency department by the client's spouse. The spouse reports that the client has been "extremely depressed lately." When assessing this client, which would be a priority assessment? A. Changes in sleeping patterns B. Thoughts of self-harm C. Appetite changes D. Level of fatigue
B. Thoughts of self-harm
Nurses who work with children should be on alert for which physical signs of child abuse? A. Excessive crying, temper tantrums, and talkativeness B. Unexplained cuts, bruises, burns, and scars C. Poor appetite, hypoactivity, and listlessness D. Stomach aches, skin rashes, and obesity
B. Unexplained cuts, bruises, burns, and scars
The nurse suspects that a client is a victim of intimate partner violence. What should the nurse consider when caring for this client? Select all that apply. A. cost-effective care B. availability of support C. legal counsel is obtained D. family counseling is provided E. support can be accessed safely
B. availability of support E. support can be accessed safely
A client with a specific phobia of spiders is seeing a therapist for the first session of treatment. The therapist hands the client a clear container with a large house spider inside. This activity is repeated continuously until the client's fear subsides. Which strategy is being used to treat the client's specific phobia? A. systematic desensitization B. flooding C. decatastrophizing D. assertiveness training
B. flooding
The nurse learns that a client has been receiving unwanted gifts and visits from someone in the neighborhood. For which unwelcomed behavior should the nurse plan interventions for this client? A. hazing B. stalking C. bullying D. ostracizing
B. stalking
If a client states, "I carry this lucky rabbit's foot for luck, my dad did too, and it really works," which statement by the nurse reflects respect for the client's belief? A. "A rabbit's foot has never brought me luck. I don't know why people carry them." B. "Yes, the rabbit's foot can bring luck to some." C. "I can accept that you feel it is lucky, so let's get to our activities for the day." D. "It is not appropriate to harm small animals for their parts."
C. "I can accept that you feel it is lucky, so let's get to our activities for the day."
The client states, "I can't go to group today. I have a very upset stomach this morning." Which would be the nurse's most appropriate response? A. "You have to go to group. The doctor has ordered it." B. "Okay, you can miss this time." C. "I know you don't feel well, but it's important for you to participate in therapy." D. "You aren't really feeling nauseous. It is part of your illness."
C. "I know you don't feel well, but it's important for you to participate in therapy."
A client comes to the health care provider's office for an annual checkup. During the interview, the nurse learns that the client's spouse died unexpectedly of a heart attack 2 months ago. Which would be the most appropriate response by the nurse? A. "At least you and your spouse enjoyed life right until the end." B. "It's better to go quickly like your spouse did instead of suffering." C. "The loss of your spouse must be very painful for you." D. "You'll feel better after you get over the shock of your spouse's death."
C. "The loss of your spouse must be very painful for you."
A client with pain who has been diagnosed with somatic symptom disorder and depression is prescribed medication therapy to treat both the pain and the symptoms of depression. When educating the client about the medication, which would the nurse emphasize? A. Use of sunscreen when exposed to bright sunlight B. Limiting of the amount of water ingested C. Alcohol should be avoided D. Stopping the medication if there is no change after 1 week
C. Alcohol should be avoided
The nurse is planning care for a client who has been newly diagnosed with a mental illness. Which should be the nurse's first step in managing this client's nursing care? A. Planning B. Evaluation C. Assessment D. Implementation
C. Assessment
A client has just been informed of a diagnosis of terminal cancer. The client states, "God has to have mercy on me because my children need me. He knows I'll change if he gets me through this." The nurse documents that the client is expressing signs of which of Kubler-Ross's stages of grief? A. Denial B. Anger C. Bargaining D. Depression
C. Bargaining
A client tells a nurse about recent episodes of strange behavior that the client cannot recall but has discussed with family. The client reports being told of going out late at night dressed, but not in the usual wardrobe. Upon return, the client cannot recall any of the event. The nurse suspects the client is dealing with which personality disorder? A. Antisocial personality B. Borderline personality C. Dissociative identity disorder D. Body dysmorphic disorder
C. Dissociative identity disorder
A client is being transferred from a group home to an evolving consumer household. The goal of this transition is for the client to eventually do what? A. Meet with a therapist on a weekly basis. B. Resolve crises within a shorter time period. C. Fulfill daily responsibilities without supervision. D. Use the increased emotional support of paid staff.
C. Fulfill daily responsibilities without supervision.
During a session with a client, the client asks the nurse what the client should do about the client's "cheating" spouse. The nurse replies, "You should divorce. You deserve better than that." The nurse used which nontherapeutic communication technique? A. Giving information B. Verbalizing the implied C. Giving advice D. Agreeing
C. Giving advice
Clients with a somatization disorder typically do what? A. Discuss feelings and express needs verbally B. Minimize their medical history C. Have a history of going to many different providers without satisfaction D. Avoid playing the sick role and resist attention from health care providers
C. Have a history of going to many different providers without satisfaction
Which intervention would be appropriate for a client with anorexia nervosa? A. Allowing the client to eat whenever the client feels hungry B. Insisting that the client sit in the dining room until all food is eaten C. Having the client in view of staff for 90 minutes after each meal D. Permitting the client to eat any food the client chooses, as long as the client is eating
C. Having the client in view of staff for 90 minutes after each meal
While conducting a class on anxiety and stress reduction, a nurse describes the symptoms of anxiety (including panic), informing the class that the physical symptoms of a panic attack can mimic what? A. Stroke B. Gastrointestinal flu C. Heart attack D. Appendicitis
C. Heart attack
Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client's distorted body image? A. Amitriptyline B. Cyproheptadine C. Olanzapine D. Fluoxetine
C. Olanzapine
The client is a 32-year-old diagnosed with bipolar disorder. The client attends group therapy for 6 hours a day and then returns home to the client's residence. In which setting would the client receive this type of care? A. Long-term hospitalization B. Acute care hospitalization C. Partial hospitalization program D. Psychiatric specialty unit
C. Partial hospitalization program
When intervening with a suicidal client, the initial goal is to keep the client safe. Measures to optimize safety would include what? A. Avoid asking direct questions B. Do not take threats seriously C. Remove access to the means to attempt suicide D. Intervene less when mood improves
C. Remove access to the means to attempt suicide
Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa? A. Changing the client's irrational thinking about the client's body B. Establishing a target weight to be achieved by discharge C. Restoring nutritional status to normal D. Gaining insight into the effects of anorexia on the client's physical health
C. Restoring nutritional status to normal
Which is the priority for admission to inpatient care? A. Confusion or disorientation B. Need for medication changes C. Safety of self or others D. Withdrawal from alcohol or other drugs
C. Safety of self or others
A nurse is assessing a client and suspects obsessive-compulsive disorder .The nurse understands that to rule a behavior as obsessive-compulsive disorder (OCD), the obsession or compulsion must meet which criteria? A. Be the client's primary thought process throughout the entire day. B. Cause considerable anguish if not performed first thing in the morning. C. Take up more than 1 hour/day and cause stress to the client. D. Convince the client that the obsessive thoughts are true.
C. Take up more than 1 hour/day and cause stress to the client.
A client with obsessive-compulsive disorder describes all doorknobs as being contaminated with a variety of viruses. The client cleans each knob three times with paper towels before use. Such behavior allows the client to do what? A. Punish the self for past infractions B. Receive needed attention from others C. Temporarily reduce anxiety D. Adequately contain the client's guilty feelings
C. Temporarily reduce anxiety
A client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client's suicidal risk has increased? A. The client tells the nurse that the client feels as depressed as ever. B. The client is lethargic, remaining isolated from other clients. C. The client says the client feels better, with more energy to interact with others D. The client's energy level and degree of depression remain the same.
C. The client says the client feels better, with more energy to interact with others
A nurse tells a client that the nurse will come back in 10 minutes to reassess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing? A. Empathy B. Sympathy C. Trust D. Closure
C. Trust
What activity should be included in the first step of self-awareness? A. asking others to share their perceptions of you B. categorizing your qualities as being either public or hidden C. identifying one's own values, attitudes, strengths and weakness D. determining whether you actually possess qualities that you are unaware of
C. identifying one's own values, attitudes, strengths and weakness
When working with a client with post traumatic stress disorder (PTSD), who has frequent flashbacks, the nurse should include which intervention? A. encouraging repression of memories associated with the traumatic event B. explaining that physical symptoms are unrelated to the psychological state C. teaching various relaxation techniques D. discussing the event has no real meaning
C. teaching various relaxation techniques
A client is being assessed after experiencing house damage from a tornado. Which client need would be a priority for the nurse to determine? A. how the client will be able to pay bills B. when the client will be able to go back to work C. where the client will stay temporarily D. what type of contact the client needs with insurance
C. where the client will stay temporarily
The client tells the nurse, "I'm frightened about my surgery tomorrow." What response by the nurse is best? A. "What's to be frightened about, the OR crew will take care of you." B. "Didn't the surgeon answer all your questions?" C. "Hundreds of people have this surgery daily." D. "Can you tell me what frightens you?"
D. "Can you tell me what frightens you?"
A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer. A. "Don't worry. Your child will be all right." B. "I don't know how you've managed to cope, this is awful." C. "That is unbelievable. How could you tolerate this behavior?" D. "It sounds like this is very difficult for you, I can see why it causes you stress."
D. "It sounds like this is very difficult for you, I can see why it causes you stress."
After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive? A. "You still need to work on your problem-solving skills." B. "I will not allow you to get that angry again." C. "You should not have let your anger build up like it did." D. "What could you have done when you first started to feel angry?"
D. "What could you have done when you first started to feel angry?"
A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client makes which statement? A. "I think that the federal government is spying on me." B. "I get really 'turned on' by your appearance." C. "That doctor I had today really made me angry." D. "When I get out of here, I'm going to make my neighbor sorry."
D. "When I get out of here, I'm going to make my neighbor sorry."
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 and are formulating a collaborative plan. The child is experiencing signs of which disorder? A. Oppositional defiant disorder B. Asperger's syndrome C. Attention deficit hyperactivity disorder D. Conduct disorder
D. Conduct disorder
The nurse is assessing a client with an eating disorder. Which personality characteristic would the nurse expect to detect when interacting with the client? A. Careless B. Outspoken C. Defiant D. Eager to please
D. Eager to please
All of the following nursing diagnoses are appropriate for the care of a client with anorexia nervosa. Which nursing diagnosis has the priority? A. Activity intolerance B. Ineffective coping C. Chronic low self-esteem D. Imbalanced nutrition: less than body requirements
D. Imbalanced nutrition: less than body requirements
The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says the client still has terrible neck pain, but the client will be better once he gets "a big insurance settlement." What condition might the nurse suspect? A. Hypochondriasis B. La belle indifference C. Conversion reaction D. Malingering
D. Malingering
A nurse is caring for a client who is a veteran with thoughts of missiles screaming and exploding. The client reexperiences feelings of terror first experienced in combat. Upon assessment, the nurse knows these recurrent events are part of which disorder? A. Acute stress disorder B. Generalized anxiety disorder C. Adjustment disorder D. Posttraumatic stress disorder (PTSD)
D. Posttraumatic stress disorder (PTSD)
The client feels that the client's rights have been violated. Placing a client in restraints before using other methods of intervention violates which of the client's rights? A. Receive confidential and respectful care B. Provide informed consent C. Be treated in a timely manner D. Receive treatment in the least restrictive environment
D. Receive treatment in the least restrictive environment
The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate? A. Demonstrate empathy for the client by trying to mimic the client's state of anxiety. B. Tell the client that the nurse must leave to go report the client's symptoms to the psychiatrist on duty. C. Tell the client this is an acute exacerbation with a positive prognosis and low morbidity. D. Stay with the client, emphasizing that the client is safe and that the nurse will remain with the client.
D. Stay with the client, emphasizing that the client is safe and that the nurse will remain with the client.
The nurse is assessing a client who has been receiving treatment for obsessive-compulsive disorder (OCD). What finding helps the nurse to evaluate the effectiveness of the treatment? A. The client completes repetitive behavior faster. B. The client has discontinued medications. C. The client's family is experiencing increased anxiety. D. The client is able effectively carry out functional and occupational tasks.
D. The client is able effectively carry out functional and occupational tasks.
With a client who is aggressive with a potential for violence, which item would the nurse want to limit or remove from the breakfast tray? A. eggs B. skim milk C. wheat toast D. coffee
D. coffee
A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although the client is not dangerous to the client or others, the client has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but the client consistently refuses "any drugs." The staff realizes that legally this client can ... A. be coerced to accept treatment. B. be committed by the client's family to receive needed treatment. C. have the client's family sign permission for treatment. D. continue to refuse treatment.
D. continue to refuse treatment.
A nurse is seeing a client in the emergency department who repeatedly presents with gastrointestinal discomfort. Despite exhaustive medical investigations, there are no significant medical findings to explain the discomfort. The nurse should suspect: A. endocrine dysfunction. B. chronic obstructive pulmonary disease. C. heart disease. D. somatic symptoms.
D. somatic symptoms.
