Psych quiz 2
A client with the diagnosis of obsessive-compulsive disorder who has a need to wash his hands 50 to 60 times a day tearfully tells the nurse, "I know that my hands aren't dirty, but I just can't stop washing them." What is the best response by the nurse? "Let's talk about why you feel that you have to wash your hands." "I think you're getting better; you're beginning to understand your problem." "Don't worry about it; these actions are part of your illness, and the feelings will pass." "I understand that—maybe we can work together to limit the number of times you wash them."
"I understand that—maybe we can work together to limit the number of times you wash them." The nurse shows an understanding of the client's needs by not totally restricting the handwashing and by working with the client to set limits on the behavior. At this time the client is still too anxious to be capable of coping with the reasons for handwashing. Continued handwashing does not reveal an understanding of the underlying problem, nor is it a sign of progress. Telling the client not to worry denies the client's feelings and may close off communication.
A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When unable to do this, the client becomes upset. What should the nurse do? Distract the client, which will help the client forget about touching the chairs Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed
Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because the client uses the ritual as a defense against anxiety.
What characteristic of an environment should the nurse consider important for a confused older adult with socially aggressive behavior? Sets limits Has variety Is group oriented Allows freedom of expression
Because they have poor control, these individuals cannot set limits for themselves and require an environment in which appropriate limits for behavior are set for them. Variety will increase anxiety. The daily routine should be structured and repetitive. A group-oriented environment is too stimulating for a person with socially aggressive behavior. Freedom of expression may result in injury to the client or others, because the client may be unable to control impulses.
A client is admitted to a psychiatric hospital after a month of unusual behavior that has included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors?
Bipolar disorder, manic phase This kind of hyperactive behavior is typical of the manic flight into reality associated with mood disorders. The behaviors are more indicative of a mood disorder than a personality disorder. Ritualistic, not manic, behavior is indicative of obsessive-compulsive disorder. A flat affect and apathy are more indicative of a schizophrenic disorder.
A man with bipolar disorder, manic episode, has been traveling around the country, dating multiple women, and buying his dates expensive gifts. He is admitted to the hospital when he becomes exhausted and runs out of money. The nurse anticipates that during a manic episode the client is most likely experiencing feelings of what? Guilt Grandeur Worthlessness Self-deprecation
During a manic episode a client has an inflated self-esteem that replaces feelings with which the client cannot cope. Feelings of guilt, worthlessness, and self-deprecation are not associated with bipolar disorder, manic episode.
What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation? Electroconvulsive therapy Short-term psychoanalysis Nondirective psychotherapy High doses of anxiolytic drugs
Electroconvulsive therapy
The nursing staff is discussing the best way to develop a relationship with a new client who has antisocial personality disorder. What characteristic of clients with antisocial personality should the nurses consider when planning care?
Exhibits lack of empathy for others
To further assess a client's suicidal potential, the nurse should be especially alert to the client's expression of what?
Helplessness and hopelessnes
A nurse is caring for a female client during the manic phase of bipolar disorder. What should the nurse do to help the client with personal hygiene?
Guide her to dress appropriately in her own clothing.
A nurse is preparing to care for a client who engages in ritualistic behavior. What is the most appropriate intervention to include in the plan of care? Redirecting the client's energy into activities to help others Teaching the client that the behavior is not serving a realistic purpose Administering antianxiety medications that block out the memory of internal fears Helping the client understand that the behavior is caused by maladaptive coping with increased anxiety
Helping clients understand that a behavior is being used to control anxiety usually makes them more amenable to psychotherapy. Treatment includes activities to help the client, not others. The client usually understands already that the behavior is not serving a realistic purpose. Administering antianxiety medications that block out the memory of internal fears will only mask symptoms and will not get at the root of what is bothering the client.
A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Select all that apply.
Impulsiveness Lability of mood Self-destructive behavior Clients with borderline personality disorder often lead complex, chaotic lives because of their inability to control or limit impulses. Extremes of emotions, ranging from apathy and boredom to anger, may be displayed within short periods. Impulsive self-destructive acts such as reckless driving, spending money, and engaging in unsafe sex often result in negative consequences. Ritualistic behavior is associated with obsessive-compulsive disorders. Psychomotor retardation is associated with mood disorders such as depression.
A male client with a history of schizophrenia comes to the emergency department, accompanied by his wife. What is the emergency department nurse's priority intervention? Observing and evaluating his behavior Writing a plan of care for the mental health team Obtaining a copy of the client's past medical records Meeting separately with his wife and exploring why he came to the hospital
Observing and evaluating his behavior
A client with major depression that includes psychotic features tells the nurse, "All of my relatives have been killed because I've been sinful and need to be punished." What is the primary focus of nursing interventions? Protecting the client against any suicidal impulses Supporting the client's interest in the outside world Helping the client manage the concern for family members Reassuring the client that past behaviors are not being punished
Protecting the client against any suicidal impulses Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress; the client's safety is the focus of nursing interventions. Supporting the client's interest in the outside world is of very low priority. The client is focusing on the current personal situation, not the outside world. Helping the client manage the concern for family members is a secondary concern. Reassurance will not change the client's belief.
A client who complains of memory loss, nervousness, insomnia, and fear of leaving the house is admitted to the hospital after several days of increasing incapacitation. What nursing action is the priority in light of this client's history? Evaluating the client's adjustment to the unit Providing the client with a sense of security and safety Exploring the client's memory loss and fear of going out Assessing the client's perception of reasons for the hospitalization
Providing the client with a sense of security and safety
What should a nurse who is caring for a hospitalized older client with dementia consider before planning care?
Routines provide stability for clients with dementia.
A nurse is working in the orientation phase of a therapeutic relationship with a client who has borderline personality disorder. What will be most difficult for the client at this stage of the relationship?
Setting mutual goals for the relationship Clients with borderline personality disorder frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals. Although the client with a borderline personality disorder may have difficulty in the areas of controlling anxiety, ending sessions on time, and accepting the diagnosis, none is the most significant issue.
A client who was recently admitted to the psychiatric unit with the diagnosis of an obsessive-compulsive disorder engages in a handwashing ritual. When the nurse interrupts the ritual, the client becomes angry and acts out. What is the most probable cause for this behavior? The client is feeling overwhelmed in this situation. The client resents the nurse's authoritarian manner. The client's personality is clashing with the nurse's. The client's response reflects an aggressive personality.
The client is feeling overwhelmed in this situation. The ritual reduces anxiety; when not permitted to complete the ritual, a client with an obsessive-compulsive disorder will experience increased anxiety, frustration, and anger and may act out. The client is experiencing anxiety not related to a personality clash, the nurse's manner, or an aggressive personality.
A client with the diagnosis of schizophrenia who has been hospitalized on a mental health unit for 2 weeks is to be discharged home. The client is vacillating between being happy and sad about going home. What term best describes these conflicting emotions? Double bind Ambivalence Loose association Inappropriate affect
The simultaneous existence of two conflicting emotions, impulses, or desires is known as ambivalence. A single communication containing two conflicting messages is known as a double-bind message. A lack of connections between thoughts is known as loose associations. Inappropriate affect is not two conflicting emotions but instead the inappropriate expression of emotions.
A client with moderate dementia often assaults nursing staff, and the staff members decide to develop a plan to minimize this behavior. What should the plan include? Limiting the time staff and the client spend together An outline of the consequences for uncooperative behavior The client's preferences for use as a reward or a punishment Identification of nursing staff members whom the client prefers
The type of care needed by the client requires trust in the caregiver, which develops more rapidly when there is a cooperative relationship and client input is accepted. Limiting staff time may place the client in jeopardy. The staff should not be put in the position of punishing the client; the client with dementia cannot be held responsible for uncooperative behavior. Clients with moderate dementia will not remember and learn from a reward system.
How should a nurse intervene when a confused and anxious client voids on the floor in the sitting room of the mental health unit? Make the client mop the floor. Restrict the client's fluids for the rest of the day. Toilet the client more frequently with supervision. Withhold the client's privileges each time the client voids on the floor.
Toilet the client more frequently with supervision.
A nurse is caring for a client with an antisocial personality disorder. What consistent approach should the nurse use with this client? Warm and firm without being punitive Indifferent and detached but nonjudgmental Conditionally acquiescent to client demands Clearly communicative of personal disapproval
Warm and firm without being punitive The client needs positive relationships with other adults, but clear, consistent limits must be presented to minimize attempts at manipulation. Acting indifferent and detached but nonjudgmental is not a therapeutic approach. Being indifferent and detached gives the impression that the nurse does not care. Being conditionally acquiescent to client demands is not a therapeutic approach because clear, consistent limits are necessary to prevent manipulation. Being clearly communicative of personal disapproval is a judgmental attitude that should be avoided.