psychosocial test 6

A newly admitted client is diagnosed with dissociative identity disorder. Which nursing intervention is a priority? A. Establish an atmosphere of safety and security. B. Teach new coping skills to replace dissociative behaviors. C. Process events associated with the origins of the disorder. D. Identify relationships among subpersonalities and work with each equally.

A A growing body of evidence points to the etiology of dissociative identity disorder as a set of traumatic experiences that overwhelms the individual's capacity to cope by any means other than dissociation. It is a priority for the nurse to establish an atmosphere of safety and security in which trust can be established. Trust must be established before a client would feel comfortable to discuss highly charged, past traumatic events.

Which nursing intervention will best address the intense need to control demonstrated by a client receiving treatment of bulimia nervosa? A. Monitoring the client for the presence of suicidal thoughts and behaviors B. Helping the client reframe irrational thinking that leads to dysfunctional eating C. Clearly stating expectations and admitting that they differ from those of the client D. Having the client keep a journal that identifies triggers that cause dysfunctional eating

C A straightforward statement that the nurse's perceptions are different will help avoid a power struggle. Arguments and power struggles intensify the patient's need to control. Suicide assessment relates to client safety. While reframing and journaling are appropriate, those interventions are not associated with the need for the client to control his or her life.

Which of the following medical conditions is commonly found in clients with bulimia nervosa? A. Allergies B. Cancer C. Diabetes mellitus D. Hepatitis A

C Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. Options A, B, and D: The eating disorder isn't typically associated with allergies, cancer, or hepatitis A.

The therapeutic approach in the care of an autistic child include the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child

D The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling.

To establish an open and trusting relationship with a female client who has been hospitalized with severe anxiety, the nurse in charge should? A. Encourage the staff to have frequent interaction with the client B. Share an activity with the client C. Give client feedback on behavior D. Respect client's need for personal space

D: Moving to a client's personal space increases the feeling of threat, which increases anxiety.

Nurse Perry is aware that language development in autistic child resembles: A. Scanning speech B. Speech lag C. Shuttering D. Echolalia

D: The autistic child repeat sounds or words spoken by others.

When considering comorbid conditions, which nursing intervention is most appropriate for a client diagnosed with a dissociative disorder? A. Assessing client for suicidal ideations frequently during the day B. Administering medication to manage constipation as prescribed C. Inspecting skin for signs of damage resulting from repetitive hand washing D. Preparing for diagnostic testing to evaluate client's report that, "my heart skips beats"

A A suicide assessment should be performed with any psychiatric patient. Patients with somatic symptom disorders and related disorders, as well as dissociative disorder patients, may be especially prone to self-harm behaviors. While clients may experience constipation, cardiac arrhythmia, and compulsive behaviors, these conditions are not typically associated with dissociative disorders.

An adolescent with a depressive disorder is more likely than an adult with the same disorder to exhibit: A. negativism and acting out. B. sadness and crying. C. suicidal thoughts. D. weight gain.

A Adolescents sometimes demonstrate behavior that is uncharacteristic of an adult with a psychiatric disorder. In a depressive disorder, an adolescent's negativism and acting out could be signs of depression. Sadness, crying, and suicidal thoughts are behaviors of both adolescents and adults. An adult may experience either weight loss or weight gain while depressed, whereas an adolescent may experience weight loss.

The nurse is planning care for a client who has a phobic disorder manifested by a fear of elevators. Which goal would need to be accomplished first? The client A. demonstrates the relaxation response when asked. B. verbalizes the underlying cause of the disorder. C. rides the elevator in the company of the nurse. D. role plays the use of an elevator.

A The ability to use relaxation is basic to treatment of phobia. Clients with phobias are resistant to insight therapy. Riding the elevator accompanied by the nurse is an appropriate long-term goal. Role playing may be appropriate after the client has learned relaxation.

The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially? A. Actively listen to the parents' concern before planning interventions. B. Encourage the parents to discuss these issues with the mental health team. C. Provide literature regarding the disorder and its management. D. Tell the parents they are overacting to the problem.

A The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions. In option B, the nurse has not explored the problem and is deciding before adequately assessing the situation that the mental team should be consulted. Providing literature regarding the disorder and its management may be useful intervention; however, the initial action needs to involve a more thorough exploration of the parents' concerns. Telling the parents they are overreacting to the problem is inappropriate because it dismisses the parents' legitimate concerns and belittles their feelings.

The school nurse asseses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply. A. Constant fidgeting and squirming B. Excessive fatigue and somatic complaints C. Difficulty paying attention to details D. Easily distracted E. Running away F. Talking constantly, even when inappropriate

A, C, D, F These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive. Options B and E are signs of emotional distress in a child and could be associated with a number of different psychiatric diagnoses.

When working with a male client suffering phobia about black cats, Nurse Trish should anticipate that a problem for this client would be? A. Anxiety when discussing phobia B. Anger toward the feared object C. Denying that the phobia exist D. Distortion of reality when completing daily routines

A: Discussion of the feared object triggers an emotional response to the object.

Which of the following clinical manifestations should the nurse assess in a client with depersonalization disorder? A. Anger B. Mechanical dreamy or detached feelings C. Ambivalence D. A loss of reality testing ability

B A client with depersonalization disorder has a mechanical dreamy or detached feeling. Client anger is not a cardinal sign. The client does not lose the ability to perform reality tests. Ambivalence is not a criterion for the diagnosis of depersonalization disorder.

Which nursing assessment question is focused on determining the client's motivation for binge eating? A. "Does binging help you get the attention you need?" B. "Would you say that you are less depressed after binging?" C. "Are you less likely to hear voices while you are binging?" D. "Do you sleep better at least temporarily after binging?

B Overeating is frequently noted as a symptom of a depression. Binge eaters report that binge eating is soothing and helps to regulate their moods. The dysfunctional eating pattern is not associated with a need for attention, auditory hallucinations, or a sleep disorder.

A 5 year old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. argumentativeness, disobedience, angry outburst B. intolerance to change, disturbed relatedness, stereotypes C. distractibility, impulsiveness and overactivity D. aggression, truancy, stealing, lying

B These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder

The nurse concludes that the treatment plan for a client diagnosed with a dissociative disorder best demonstrates success when which observation is made? A. The client agrees to adhere to interventions identified in the treatment plan B. Client engages in productive discussions related to childhood trauma C. Reports of physical pain have lessened substantially D. Client regularly attends assertiveness training group

B Treatment is considered successful when outcomes are met. An appropriate goal would be that stress is handled adaptively, without the use of dissociation. Being able to engage productively in discussions about a stressful event would demonstrate successful achievement of the goal. While agreement to adhere to the treatment plan is a positive indicator, it doesn't necessarily demonstrate achievement of a foundational goal. The remaining options are associated with a diagnosis of somatic disorder rather than dissociative ones.

The community nurse visits the home of George, a child recently diagnosed with autism. The parents expres feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? A. "Autism is a rare disorder. Your other children shouldn't be affected." B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." C. "Sometimes a lack of prenatal care can be cause of autism." D. "Although autism is genetically inherited, if you didn't have testing you could not have known this would happen."

B his statement is factual and does not cast blame on anything the parents did or did not do. The parents are not questioning whether other children will be affected; their concern is directed to the current situation and their feelings about it. The statement in option 3 is not true: Lack of prenatal care may be a risk factor in pervasive developmental disorders, but it is not the cause of autism. Although it is thought that there is a genetic component in autism, research has not identified specific genes and there is no diagnostic test for this. The statement in option D is misleading and would not alleviate guilt.

Which statement by a nurse providing care for clients diagnosed with personality disorders demonstrates therapeutic management of manipulative client behavior? Select all that apply. A. "Tell me what triggered your angry response to what I said." B. "The staff is responsible for determining unit rules that are fair to all clients." C. "Remember that all clients must follow the rules regarding the use of the telephone." D. "Missing group today means that you will not be able to attend the pizza party later." E. "Tell me what you are trying to accomplish by being so rude to the staff and other clients."

B, C, D Manipulation is the using or controlling of others or of situations for only one's personal benefit. Setting limits/rules, reinforcing the limits/rules, and enforcing consequences for disregarding the limits/rules demonstrates therapeutic management of manipulative behaviors. The remaining options are associated with the management of impulsivity.

A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4″ (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has: A. bulimia nervosa. B. anorexia nervosa. C. depression.

B: Anorexia nervosa is an eating disorder characterized by self-imposed starvation with subsequent emaciation, nutritional deficiencies, and atrophic and metabolic changes. Typically, the client is hypotensive and dehydrated. Depending on the severity of the disorder, anorexic clients are at risk for circulatory collapse (indicated by hypotension), dehydration, and death. Option A: Bulimia nervosa is an eating disorder characterized by binge eating followed by self-induced vomiting. Option C: Although depression may be accompanied by weight loss, it isn't characterized by a body image disturbance or the intense fear of obesity seen in anorexia nervosa.

A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to: A. manipulate her husband. B. gain control of one part of her life. C. commit suicide. D. live up to her mother's expectations.

B: By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. Options A and D: This eating disorder doesn't represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement). Option C: The client isn't attempting to commit suicide through starvation; rather, by refusing to eat, she is expressing feelings of despair, worthlessness, and hopelessness.

Linda is pacing the floor and appears extremely anxious. The duty nurse approaches in an attempt to alleviate Linda's anxiety. The most therapeutic question by the nurse would be? A. Would you like to watch TV? B. Would you like me to talk with you? C. Are you feeling upset now? D. Ignore the client

B: The nurse presence may provide the client with support & feeling of control.

Recognizing that somatic symptom disorders focus on physical symptoms, which client statement best demonstrates the unique characteristic of this type of disorder? A. "I wonder if my fear of cancer is real or imagined." B. "The pain I feel is nearly constant and very specific." C. "I've been to so many doctors but none can find out what's wrong with me." D. "For a while medication helped but now my stomach problems are back again."

C

Which stress management behavior is most reflective of those associated with personality disorders? A. Binge drinking every weekend B. Demonstrating ritualistic behaviors C. Blaming spouse for the client's poor performance at work D. Having difficulty making a decision concerning which movie to view

C

The nurse admitting a client suspected of dissociative amnesia would report which of the following manifestations? A.The amnesia has its etiology in a medical condition B. The client exhibits common forgetfulness C. The client's inability to recall personal information D. The amnesia is the result of prolonged substance abuse

C A client with dissociative amnesia is unable to recall familiar personal information. The amnesia is not associated with a medical condition, such as brain injury, trauma, or toxicity of substances. The amnesia is beyond common forgetfulness.

A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to: A. severely restrict the client's physical activities. B. weigh the client daily, after the evening meal. C. monitor vital signs, serum electrolyte levels, and acid-base balance. D. instruct the client to keep an accurate record of food and fluid intake.

C An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid base balance is crucial. Option A: This may worsen anxiety. Option B: This is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D: This would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.

Which assessment data confirms that the client diagnosed with anorexia nervosa has achieved a fundamental treatment outcome? A. Acknowledges that symptoms of depression exist B. Client has eaten 60% of three meals per day for 3 consecutive weeks C. Client has maintained weight at 87% of ideal body weight for 2 months D. Demonstrates an understanding of what constitutes healthy eating habits

C Some common outcome criteria for patients with anorexia nervosa include normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks and achieving 85% to 90% of ideal body weight; demonstrating two new, healthy eating habits and improved self-acceptance; and participating in treatment of associated psychiatric symptoms (defects in mood, self-esteem), not just acknowledging the presence of symptoms.

A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe

C The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.

Which statement reflects successful achievement of a therapeutic long-term goal for a client diagnosed with somatic symptom disorder? A. "I may have found a doctor who can really help me." B. "My husband is starting to believe I'm really in pain." C. "I haven't missed a day of work in the last 6 months." D. "My symptoms may not be signs of a serious cancer."

C The overall long-term goal in treating individuals with somatic symptom disorders is that people with these disorders will eventually be able to live as normal a life as possible. This includes symptom or pain reduction, improved level of independence, and a better overall quality of life. Not missing work is an indication of desired independence and overall quality of life. The remaining client statements indicate a continued belief that a health problem will be found and that the reports of pain are accepted by family.

A client is experiencing anxiety attack. The most appropriate nursing intervention should include? A. Turning on the television B. Leaving the client alone C. Staying with the client and speaking in short sentences D. Ask the client to play with other clients

C: Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm and medicating as needed.

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader." B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." D. "I do diet around my periods; otherwise, I just get so bloated."

C: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Option A: Most clients with anorexia nervosa don't like the way they look, and their self-perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror. Option B: Preferring fast food over healthy food is common in this age-group. Option D: Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.

When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates achievement of the discharge maintenance goals. Which goal would be most appropriately having been included in the plan of care requiring evaluation? A. The client eliminates all anxiety from daily situations B. The client ignores feelings of anxiety C. The client identifies anxiety-producing situations D. The client maintains contact with a crisis counselor

C: Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid specific stimulus.