Mental Health

Question 1

Chapter 5

The nurse is working with a patient who has quit several jobs and no longer sends
financial support to his two children living with their mother. This behavior is in conflict
with the nurse’s values concerning responsible parenting. When discussing family roles
with the patient, the nurse shows positive regard through which statement?

A) ìHow is not working right now affecting you?î
B) ìHow do you expect your kids to be provided for?î
C) ìYou need to somehow find a way to support your children.î
D) ìCan the children’s mother can get by for a while until you get better?î

Answer 1

A. ìHow is not working right now affecting you?î

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

Question 2

Chapter 5

Which of the following statements is true of the component of a therapeutic
relationshipóìacceptanceî?

A) The nurse accepts the behavior of any inappropriate behavior.
B) It is avoiding judgments of the person, no matter what the behavior is.
C) It involves punishment for inappropriate behavior.
D) It is the ability of the nurse to perceive the meanings and feelings of the client and
to communicate that understanding to the client.

Answer 2

B) It is avoiding judgments of the person, no matter what the behavior is.

Acceptance is avoiding judgments of the person, no matter what the behavior is. It
means accepting the person but not necessarily the behavior. It does not involve
punishment for inappropriate behavior. Empathy is the ability of the nurse to perceive
the meanings and feelings of the client and to communicate that understanding to the
client.

Question 3

Which of the following behaviors by the nurse demonstrate positive regard? Select all
that apply.

A) Communicating judgments about the client’s behavior
B) Calling the client by name
C) Spending time with the client
D) Responding openly
E) Considering the client’s ideas and preference when planning care

Answer 3

Ans: B, C, D, E

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

Question 4

Chapter 9

A client made threats to harm his parents if they come too close to him. The
parents called 911, and the client is now held involuntarily for a psychiatric evaluation.
During this time of involuntary admission, the client retains all client rights except for
which of the following?

A) Confidentiality
B) Right to freedom
C) Periodic treatment review
D) Choice of providers

Civil commitment or involuntary hospitalization curtails the client’s right to freedom
(the ability to leave the hospital when he or she wishes). All other client rights, however,
remain intact.

Answer 4

C) Right to Freedom

Civil commitment or involuntary hospitalization curtails the client’s right to freedom
(the ability to leave the hospital when he or she wishes). All other client rights, however,
remain intact.

Question 5

ch 5

Which is a standard for establishing a code of conduct for living?
A) Acceptance
B) Empathy
C) Values
D) Positive regard

Answer 5

C) Values

Values are abstract standards that give a person a sense of right and wrong and establish
a code of conduct for living. Acceptance occurs when the nurse does not become upset
or respond negatively to a client’s outbursts, anger, or acting out. Empathy is the ability
of the nurse to perceive the meaning and feelings of the client and to communicate that
understanding to the client. Positive regard is an unconditional, nonjudgmental attitude.

Question 6

ch 5

A nurse is working with a patient whose background is very different from hers. A good
question to ask herself to assure she can be effective working with this patient would be,
A) ìCan this person understand me?î
B) ìDo I understand this patient’s expectations of me?î
C) ìWhat experiences do I have with people with similar backgrounds?î
D) ìIs this person going to be able to relate to me?î

Answer 6

C) “What experiences fo I have with people with similar backgrounds?”

To best assess self-awareness, the nurse should ask ìWhat experiences have I had with
people from ethnic groups, socioeconomic classes, religions, age groups, or
communities different from my own?î The nurse should not focus on the patient when
examining self-awareness, rather, how the nurse’s experiences have shaped attitudes and
beliefs.

Question 7

ch 5

The client says to the nurse, ìI feel really close to you. You are the only true friend I
have.î The most therapeutic response the nurse can make is,
A) ìI am sure there are other people in your life who are your friends; besides, we just
met.î
B) ìIt makes me feel good that you trust me so much; it is important for the work we
are doing together.î
C) ìSince ours is a professional relationship, let’s explore other opportunities in your
life for friendship.î
D) ìWe are not friends. This is strictly professional.î

Answer 7

C) “Since ours is a professional relationship, let’s expore other opportunities in your life for friendship”

The nurse’s response must let the client know in clear terms that the relationship is
professional while not demeaning or ridiculing the client. The other choices would not
be appropriate replies in this situation.

Question 8

A client who had been in a substance abuse treatment program asks the nurse for a date
after the client is discharged. The nurse talks to the client about the importance of a
therapeutic relationship and its characteristics. The nurse is using which of the following
techniques?
A) Defining boundaries
B) Defining therapy
C) Letting the client down gently
D) Reprimanding the client

Answer 8

A) Defining boundaries

A therapeutic relationship is professional, and there are no mutual social goals; it is
focused on meeting the client’s needs and is terminated when the client no longer needs
services. It is up to the nurse to maintain professional boundaries. The other choices
would be inappropriate techniques to use toward this client.

Question 9

A nurse is assigned to care for a client whose sexual orientation differs from the nurse’s
sexual orientation. When should the nurse seek clinical supervision?
A) When the nurse tries to assist the client to change values
B) To discuss the nurse’s feelings about the client with a supervisor
C) When the nurse begins to empathize with the client
D) When the nurse identifies anxieties regarding the client’s values and sexuality

Answer 9

A) When the nurse tries to assis the client to change values

It is not the nurse’s role to change the values of the client. The nurse should empathize
with the client and be able to discuss feelings about the client with the nurse’s
supervisor, including anxieties regarding the client’s values and sexuality.

Question 10

A nurse openly admits to not being able to relate to a patient’s experience. According to
Munhall, this will most likely have what influence on the therapeutic relationship?
A) The nurse will avoid imposing any values on the patient.
B) The patient will not trust the nurse’s professional abilities.
C) The nurse will more likely be manipulated by the patient.
D) The patient will be less likely to self-disclose to the nurse.

Answer 10

A) The nurse will avoid imposing any values on the patient

Munhall added another pattern of knowing called unknowing: For the nurse to admit she
or he does not know the client or the client’s subjective world opens the way for a truly
authentic encounter. The nurse in a state of unknowing is open to seeing and hearing the
client’s views without imposing any of his or her values or viewpoints.

Question 11

21. The nurse and patient are visiting about upcoming sporting events of which they both
    share an interest. This form of interaction has the potential to threaten the nurseñpatient
    relationship by
    A) influencing whether the patient likes the nurse or not.
    B) avoiding serious work that can help the patient change.
    C) letting the patient know that the nurse is genuine with diverse interests.
    D) overstepping ethical boundaries that the nurse should maintain.

Answer 11

b

Small talk or socializing is acceptable in nursing, but for the nurseñclient relationship to
accomplish the goals that have been decided on, social interaction must be limited. If the
relationship becomes more social than therapeutic, serious work that moves the client
forward will not be done.

Question 12

During a regular home health visit to an elderly client, the nurse observes that the client
has feelings of hopelessness and despair. The client says, ìI’m old, and my life has no
purpose anymore. But promise me you won’t tell anyone.î How should the nurse
respond?
A) ìDon’t worry, I won’t tell anyone else.î
B) ìI’m sorry, but I can’t keep that kind of secret.î
C) ìLet’s talk about something to cheer you up.î
D) ìWhat can we do to help you feel better?î

Answer 12

b

keeping secrets is not permissible, especially when patient’s safety is concerned

Question 13

During the working phase of a therapeutic relationship, which of the following actions
by the nurse would best help the client to explore problems?
A) Comparing past and present coping strategies
B) Encouraging the client to clarify feelings and behavior
C) Identifying possible solutions for the client’s problems
D) Referring the client to a self-help group

Answer 13

b

Helping the client to clarify feelings and behavior is a first step in problem identification
and exploration. The nurse must remember that it is the client who examines and
explores problem situations and relationships. The nurse must be nonjudgmental and
refrain from giving advice. The other choices would not help the client to explore
problems.

Question 14

Which of the following statements correctly depict the problem of feeling sympathy
toward the client? Select all that apply.
A) This can cause the nurse to feel sad and be unable to help the client.
B) When the nurse’s behavior is rooted in sympathy, the client finds it easier to
manipulate the nurse’s feelings.
C) The client is discouraged from exploring his or her problems, thoughts, and
feelings.
D) The client is discouraged from growth.
E) The client feels dependent on the nurse.

Answer 14

B,C,D,E

The nurse who feels sorry for the client often tries to compensate by trying to please him
or her. When the nurse’s behavior is rooted in sympathy, the client finds it easier to
manipulate the nurse’s feelings. This discourages the client from exploring his or her
problems, thoughts, and feelings; discourages client growth; and often leads to client
dependency.

Question 15

A nurse and patient have just completed reviewing the patient’s take-home medications.
The nurse is exemplifying which role during this intervention?
A) Advocate
B) Caregiver
C) Teacher
D) Parent Surrogate

Answer 15

C

During the working phase of the nurseñclient relationship, the nurse may teach the client
new methods of coping and solving problems. He or she may instruct about the
medication regimen and available community resources. The caregiver role is used
when the nurse helps the client meet psychosocial or physical needs. When functioning
as an advocate, the nurse is acting on the client’s behalf when he or she cannot do so.
Nurses may need to assume a parental role when the patient needs nurturing or limit
setting.

Question 16

During the admission interview, the nurse asks the client what led to his hospitalization.
The client responds, ìThey lied about me. They said I murdered my mother. You’re the
killers. You all killed my mother. She died before I was born.î The best initial response
by the nurse would be,
A) ìI just saw your mother. She’s fine.î
B) ìYou’re having very frightening thoughts.î
C) ìWe’ll put you in a private room until you’re in better control.î
D) ìIf your mother died before you were born, you wouldn’t be here.î

Answer 16

B

When the nurse states, ìYou’re having very frightening thoughts,î the nurse is
verbalizing the implied or voicing what the client has hinted or suggested. The other
responses would not be the best initial response in this situation.

Question 17

The nurse on an addictive disorders unit receives a phone call inquiring about the status
of a client. The caller is not on the client’s allowed contact list. Which of the following
is the appropriate response by the nurse to the caller?
A) ìI cannot confirm or deny the existence of any client here.î
B) ìYou will need to be placed on the client’s contact list before I can discuss any
information with you.î
C) ìThe person you are asking for is not a client here.î
D) ìHold 1 minute while I get the client for you.î

Answer 17

A) I cannot confirm or deny existance of any client here.

The protection and privacy of personal health information is regulated by the federal
government through the Health Insurance Portability and Accountability Act (HIPAA)
of 1996. Protected health information is any individually identifiable health information
in oral, written, or electronic form. Mental health and substance abuse records have
additional special protection under the privacy rules. Requesting placement on the
contact list or getting the client verifies the client’s presence to the caller. Denying the
client’s presence affirms the client’s existence whether present not, which violates client
privacy and confidentiality.

Question 18

A 22-year-old client has been manipulative of staff and disruptive in the milieu.
Although she is not dangerous to herself or others, she has created problems on the unit
and clearly is not making progress. The nurses offer prescribed medication, but she
consistently refuses ìany drugs.î The staff realizes that legally this client can
A) be coerced to accept treatment.
B) be committed by her family to receive needed treatment.
C) have her family sign permission for treatment.
D) continue to refuse treatment.

Answer 18

D) Continue to refuse treatment.

The client maintains the right to refuse treatment even if it is needed when she is not
dangerous to herself or others. If a client able to give consent, she cannot be coerced
into doing so, have her family sign permission for her, or be committed by the family to
receive treatment unless she is a danger to herself or others.

Question 19

A client who had agreed to be hospitalized for depression problems has decided that
now she wants to leave the hospital. The mental health staff caring for her realizes that
at present she can legally
A) be discharged if evaluated through administrative hearings.
B) be retained in the hospital against her will.
C) leave the hospital after giving written notice of her intent to do so.
D) leave without discussing the situation with anyone.

Answer 19

C) Leave the hosptial after giving written notice of her intent to do so

Clients who are not dangerous to themselves or others can leave the hospital against
medical advice. The other choices are not appropriate.

Question 20

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

Answer 20

b

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

Question 21

The physician has prescribed Haldol 10 mg for a severely psychotic client. The client
refuses the medication. Which nursing intervention is an appropriate response?
A) Accept the client’s decision
B) Obtain a discharge order for noncompliance
C) Tell the client that he is too sick to refuse
D) Restrain the client and give the medication IM

Answer 21

A

Clients have the right to refuse medication even when they are psychotic. The client
cannot be discharged just because he refuses to take his medications. In this situation, it
is not appropriate for the nurse to tell the client that he is too sick to refuse. Restraints
are not an appropriate means of getting the client to take the medication.

Question 22

A nurse is performing safety assessments on a client in mechanical restrains as required
by policy. Which action by the nurse demonstrates the ethical principle of
nonmaleficence?
A) Explaining the behavioral requirements for release of restraint to the client
B) Assuring that the restraints are not causing injury to the client
C) Applying restraints based solely on assessment findings and not on attitude
toward the client
D) Releasing the client when stated behavioral control is achieved

Answer 22

b

Assuring that the restraints are not causing injury to the client is an example of
nonmaleficence, or doing no harm. Explaining the behavioral requirements for release
of restraint to the client is providing the client the autonomy to choose behaviors.
Applying restraints based solely on assessment findings and not on attitude toward the
client is displaying justice. Releasing the client when stated behavioral control is
achieved is displaying veracity, or being honest and truthful.

Question 23

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) Refuse treatment
D) Receive treatment in the least restrictive environment

Answer 23

d

The least restrictive environment means that the client must be free of restraint or
seclusion unless it is necessary. Less restrictive treatments must be tried and found to be
ineffective before more restrictive measures can be used. It is not necessary for the
client to provide informed consent for restraints to be used when appropriate. A client
may not refuse restraints if they are to be used when appropriate.

Question 24

Which of the following dilemmas involve the ethical principle of fidelity? Select all that
apply.
A) When the nurse is unable to agree with the policies or common practices of an
agency
B) When the nurse is faced with a decision to violate a policy that is harmful to the
client
C) When the nurse is certain that clients of different racial and ethnic backgrounds
are being treated the same as other clients
D) When the nurse understands that a combative client must be secluded against their
will to prevent harm to others
E) When the client refuses to take medication and the nurse respects the client’s right
to refuse medication

Answer 24

a, b

When the nurse is unable to agree with the policies or common practices of an agency,
the nurse is facing a dilemma about fidelity, which refers to the obligation to honor
commitments and contracts. When the nurse is faced with a decision to violate a policy
that is harmful to the client, the nurse is facing a dilemma about fidelityóthat is, should
the nurse be faithful to the employing agency or the individual client being cared for.
When the nurse is certain that clients of different racial and ethnic backgrounds are
being treated the same as other clients, the nurse is acting in accord with the ethical
principle of justice. When the nurse understands that a combative client must be
secluded against his or her will to prevent harm to others, the nurse is following the
ethical principle of utilitarianism. When a client refuses to take medications and the
nurse respects the client’s right to refuse medication, the nurse is enacting the ethical
principle of autonomy.

Question 25

A client underwent a procedure before the nurse verified the client’s signature on the
consent form. The client actually did not sign the form before the procedure. If the client
is dissatisfied with the outcome of the procedure and files a suit against the health-care
team, which kind of case can the client file?
A) Negligence
B) Malpractice
C) Battery
D) False Imprisonment

Answer 25

c

Battery involves harmful or unwarranted contact with a client. False imprisonment is
defined as the unjustifiable detention of a client such as the inappropriate use of restraint
or seclusion. Negligence is an unintentional tort that involves causing harm by failing to
do what a reasonable and prudent person would do in similar circumstances. Clients or
families can file malpractice lawsuits in any case of injury, loss, or death.

Question 26

The nurse is assessing for negative symptoms of schizophrenia in a newly admitted
client. The nurse would note which behavior as indicative of a negative symptom?
A) Difficulty staying on subject when responding to assessment questions
B) Belief of owning a transportation device allowing for travel to the center of the
Earth
C) Hesitant to answer the nurse’s questions during the assessment interview
D) Mimicking the postural changes made by the nurse during the assessment
interview

Answer 26

C

A negative symptom of schizophrenia is alogia, or the tendency to speak very little or to
convey little substance of meaning (poverty of content). Associative looseness
(fragmented or poorly related thoughts and ideas), delusions (fixed false beliefs that
have no basis in reality), and echopraxia (imitation of the movements and gestures of
another person whom the client is observing) are all positive symptoms.

Question 27

The client with schizophrenia makes the following statement, ìI just don’t know how to
count. The sky turned to fire. I have a ball in my head.î The nurse documents this entire
statement as an example of
A) flight of ideas.
B) ideas of reference.
C) delusional thinking.
D) associative looseness.

Answer 27

D) Associative Looseness

Associative looseness is demonstrated through fragmented or poorly related thoughts
and ideas. The series of disconnected thoughts best exemplifies this concept. Some of
the statements contain delusions, or fixed false beliefs that have no basis in reality.
Flight of ideas refers to rapidly flowing thoughts that are more connected than the
client’s statement. Ideas of reference are false impressions that external events have
special meaning for the person.

Question 28

The nurse is preparing a client with schizophrenia for discharge. The nurse asks the
client, ìHow are you going to care for yourself at home?î The purpose of the nurse’s
question is to assess the client’s
A) self concept.
B) judgment.
C) insight.
D) social support system.

Answer 28

D

Insight refers to the client’s degree of self-awareness and realistic view of life. It can be
severely impaired in schizophrenia. Over time, some clients can learn about the illness,
anticipate problems, and seek appropriate assistance as needed. Judgment refers to
appropriate decision-making ability and is based on the ability to interpret the
environment correctly. At times, lack of judgment is so severe that clients cannot meet
their needs for safety and protection and place themselves in harm’s way.

Question 29

All of the following are nursing diagnoses identified for a client with schizophrenia. The
student nurse correctly anticipates which diagnosis will resolve when the client’s
negative symptoms improve?
A) Impaired verbal communication
B) Risk for other-directed violence
C) Disturbed thought processes
D) Social isolation

Answer 29

D

NANDA diagnoses commonly established based on the assessment of psychotic
symptoms or positive signs are as follows:
- Risk for other-directed violence
- Risk for suicide
- Disturbed thought processes
- Disturbed sensory perception
- Disturbed personal identity
- Impaired verbal communication
NANDA diagnoses based on the assessment of negative signs and functional abilities
include the following:
- Self-care deficits
- Social isolation
- Deficient diversional activity
- Ineffective health maintenance
- Ineffective therapeutic regimen management

Question 30

A client states, ìI am dead. I have come back from the dead.î An appropriate response
by the nurse is,
A) ìWhat is it like to feel dead?î
B) ìNo you did not die. People don’t come back from the dead.î
C) ìShow me what you did in art therapy this morning.î
D) ìI’ll get your medicine and you’ll feel better.î

Answer 30

C) Show me what you did in art therapy this morning.

The client experiencing delusions utterly believes them and cannot be convinced they
are false or untrue. It is the nurse’s responsibility to present and maintain reality by
making simple statements. The nurse must avoid openly confronting the delusion or
arguing with the client about it. The nurse also must avoid reinforcing the delusional
belief by ìplaying alongî with what the client says.

Question 31

A client with schizophrenia is admitted to the inpatient unit. He does not speak when
spoken to but has been observed talking to himself on occasion. What would be the
priority objective at this time?
A) The client will begin talking with other clients
B) The client will express his feelings freely
C) The client will increase his socialization with others
D) The client will increase his reality orientation

Answer 31

D

The client needs to be oriented to reality before he can participate in other therapeutic
activities. The other choices would not be priority goals for this patient right now.

Question 32

The nurse enters the room of a client with schizophrenia the day after he has been
admitted to an inpatient setting and says, ìI would like to spend some time talking with
you.î The client stares straight ahead and remains silent. The best response by the nurse
would be,
A) ìI can see you want to be alone. I’ll come back another time.î
B) ìYou don’t need to talk right now. I’ll just sit here for a few minutes.î
C) ìI’ve got some other things I can do now. I hope you’ll feel like talking later.î
D) ìYou would feel better if you would tell me what you’re thinking.î

Answer 32

B

This response indicates acceptance of the client and shows genuine interest in him,
building rapport and trust. Initially, the client may tolerate only 5 or 10 minutes of
contact at one time. Establishing a therapeutic relationship takes time, and the nurse
must be patient. The nurse must maintain nonverbal communication with the client,
especially when verbal communication is not very successful. This involves spending
time with the client, perhaps through fairly length periods of silence. The presence of
the nurse is a contact with reality for the client and also can demonstrate the nurse’s
genuine interest and caring to the client. The other choices are not consistent with what
is therapeutic for the client.

Question 33

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

Answer 33

A,C,E

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

Question 34

Which of the following questions would best help the nurse to evaluate the effectiveness
of antipsychotic medications for a client who has schizophrenia? Select all that apply.
A) Have the symptoms you were experiencing disappeared?
B) If the symptoms have not disappeared, are you able to carry out your daily life
despite the persistence of some psychotic symptoms?
C) Are you committed to taking the medication as prescribed?
D) Are you satisfied with your quality of life?
E) Do you have access to community agencies that will help you to live successfully
in this community?

Answer 34

A, B, C ,D

The client’s perception of the success of treatment plays a part in evaluation. In a global
sense, evaluation of the treatment of schizophrenia is based on the following:
ï Have the client’s psychotic symptoms disappeared? If not, can the client carry out his
or her daily life despite the persistence of some psychotic symptoms?
ï Does the client understand the prescribed medication regimen? Is he or she committed
to adherence to the regimen?
ï Does the client believe that he or she has a satisfactory quality of life?
The question, ìDo you have access to community agencies that will help you to live
successfully in this community?î is an appropriate question to ask to evaluate the plan of
care but does not directly relate to antipsychotic medications.

Question 35

The parents of a young adult male who has schizophrenia ask how they can recognize
when their son is beginning to relapse. The nurse teaches the family to look for which of
the following? Select all that apply.
A) Excessive sleeping
B) Fatigue
C) Irritability
D) Increased inhibition
E) Negativity

Answer 35

B,C,E

Teaching the client and family members to prevent or manage relapse is an essential
part of a comprehensive plan of care. This includes providing facts about schizophrenia,
identifying the early signs of relapse, and teaching health practices to promote physical
and psychological well-being. Early signs of relapse include impaired cause-and-effect
reasoning, impaired information processing, poor nutrition, lack of sleep, lack of
exercise, fatigue, poor social skills, social isolation, loneliness, interpersonal difficulties,

lack of control, irritability, mood swings, ineffective medication management, low self-
concept, looking and acting different, hopeless feelings, loss of motivation, anxiety and

worry, disinhibition, increased negativity, neglecting appearance, and forgetfulness.

Question 36

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

Answer 36

C

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

Question 37

A parent of a child with autism spectrum disorder asks the nurse if there is anything that
can be done to control the child’s tantrums. Which option should the nurse inform the
parents that may be appropriate?
A) Give the child rewards for resisting tantrums.
B) Reason with the child why tantrums are not effective.
C) Place the child in a time-out when tantrums occur.
D) Explore the use of antipsychotic medications to control tantrums.

Answer 37

D) Explore the use of antipsychotic medications to control tantrums

Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol) or
risperidone (Risperdal), may be effective for specific target symptoms such as temper
tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors.

Question 38

Which one of the following nursing interventions should take priority for a child with
ADHD?
A) Structured daily routine
B) Ensuring the child’s safety and that of others
C) Simplifying instructions and directions
D) Improved role performance

Answer 38

B) Ensuring gthe child’s safety and that of others

Child’s safety is priority

Question 39

The nurse reviews current literature and identifies that which of the following are
included in current studies of biologic theories regarding the etiology of schizophrenia?
Select all that apply.
A) That there is a particular pathologic structure associated with the disease.
B) That genetics is the cause of schizophrenia.
C) Persons with schizophrenia have decreased brain volume and abnormal brain
function in the frontal and temporal areas of persons with schizophrenia.
D) The brain activity of persons with schizophrenia differs from people who do not
have schizophrenia.
E) That the etiology of schizophrenia may be related to the body’s response to
exposure of a virus.

Answer 39

B, C, D, E

In the first half of the 20th century, studies focused on trying to find a particular
pathologic structure associated with the disease, largely through autopsy. Such a site
was not discovered. The biologic theories of schizophrenia focus on genetic factors,
neuroanatomic and neurochemical factors (structure and function of the brain), and
immunovirology (the body’s response to exposure to a virus).

Question 40

The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to
speak to the nurse about her son’s disruptive behavior. The nurse would be most
therapeutic by saying which of the following?
A) ìYour son is a cute child, but he needs to calm down.î
B) ìIt must be difficult to handle your son at home.î
C) ìYou need to take a firmer approach with your son.î
D) ìYour son sure is active.î

Answer 40

B

Validate the parent’s feelings

Question 41

A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin)
in divided doses. If the child takes the first dose at 8 AM, which behavior might the
school nurse expect to see at noon?
A) Increased impulsivity or hyperactive behavior
B) Lack of appetite for lunch
C) Sleepiness or drowsiness
D) Social isolation from peers

Answer 41

A

Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. Giving stimulants during daytime usually combats insomnia.

Question 42

The parents of an autistic child ask the nurse, ìWill my child ever be normal?î Which
would be the most appropriate response by the nurse?
A) ìYou seem worried about your child’s future.î
B) ìAutistic children can fully recover with the right treatment and education.î
C) ìYour child should outgrow autistic traits by adolescence.î
D) ìYour child will probably always have some autistic traits.î

Answer 42

D) Your child will probably always have some autistic traits.

Adult traits of autism may persist into adulthood. CMx: little speech and poor dailing living skills throughout life to adequate social skills that allow relativelu independent functioning.

Question 43

The parents of a child with ADHD express to the nurse, ìWe get so frustrated when our
son never minds us.î 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.

Answer 43

A,C,E

Educating parents and helping them with parenting strategies are crucial components of
effective treatment of ADHD. Effective approaches include providing consistent
rewards and consequences for behavior, offering consistent praise, using time-out, and
giving verbal reprimands. Additional strategies are issuing daily report cards for
behavior and using point systems for positive and negative behavior.

Question 44

Which statement would indicate that medication teaching for the parents of a 6-year-old
child with attention deficit hyperactivity disorder (ADHD) has been effective?
A) ìWe’ll teach him the proper way to take the medication, so he can manage it
independently.î
B) ìWe’ll be sure he takes Ritalin at the same time every day, just before bedtime.î
C) ìWe’re so glad that Ritalin will eliminate the problems of ADHD.î
D) ìWe’ll be sure to record his weight on a weekly basis.î

Answer 44

D

Stimulant medications used to treat ADHD can suppress appetite, and the child may lose
or fail to gain weight properly. The client is too young to manage his medications
independently. Ritalin should be given in divided doses. Ritalin reduces hyperactivity,
impulsivity, and mood lability and helps the child to pay attention more appropriately.

Question 45

The nurse understands that when working with a child with a mental health problem, the
family must be included in the care. Which is one of the best ways the nurse can
advocate for the child?
A) Support transferring the child to a healthy living environment.
B) Teach the parents age-appropriate expectations of the child.
C) Reinforce the parents’ expectations of the child’s behavior.
D) Interpret the child’s thoughts and feelings to the parent.

Answer 45

B

Working with parents is a crucial aspect of dealing with children with these disorders.
Parents often have the most influence on how these children learn to cope with their
disorders. The nurse can teach parents age-appropriate activities and expectations for
clients.

Question 46

Which client would have an increased risk for delirium?
A) An elderly woman with abdominal pain
B) A 3-year-old child with a temperature of 103.2∞F
C) A middle-aged woman newly diagnosed with multiple sclerosis
D) A young adult male with gastroenteritis and dehydration

Answer 46

B

Young children with high fever are at risk for delirium. The other choices would not be
the most likely candidates for increased risk for delirium.

Question 47

The daughter of a woman with dementia asks the nurse if her mother will ever be able to
live independently again. Which would be the most appropriate response by the nurse?
A) ìYou sound like you aren’t ready for her to be dependent on caregivers.î
B) ìHer confusion is a temporary complication of her physical illness and should
subside when the illness gets better.î
C) ìSymptoms of dementia gradually get worse. Unfortunately she will not be
independent again.î
D) ìWith early treatment, mild dementia can be reversed. It may be possible.î

Answer 47

C

The prognosis for dementia involves progressive deterioration of physical and mental
abilities until death. Typically, in the later stages, clients have minimal cognitive and
motor function, are totally dependent on caregivers, and are unaware of their
surroundings or people in the environment. They may be totally uncommunicative or
make unintelligible sounds or attempts to verbalize. Delirium secondary to physical
illness will subside with physical recovery.

Question 48

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

Answer 48

A,B,C,D,F

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

Question 49

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing
mild delirium. The client approaches the nurse and states, ìI’m going to take walk
outside. I’ll be back in about 10 minutes.î Which is the most appropriate nursing action?
A) Further assess the client’s motives for wanting to walk.
B) Give the client permission to go on a walk on the grounds.
C) Tell the client the walk is not allowed and restrict him to the unit.
D) Designate a staff member to accompany the client on the walk.

Answer 49

D

The nurse teaches clients to request assistance for activities such as getting out of bed or
going to the bathroom. If clients cannot request assistance, they require close
supervision to prevent them from attempting activities they cannot perform safely alone.
The nurse responds promptly to calls from clients for assistance and checks clients at
frequent intervals.

Question 50

The nurse is developing interventions to promote socialization in a client with moderate
dementia. Which would provide a safe and secure environment for the client?
A) A card game with other clients
B) An activity with the nurse
C) Decorating a bulletin board with the group
D) Morning stretch group with music

Answer 50

B

The client has to interact only with the nurse, who will behave in a predictable way and
will focus on the client’s needs, without undue or unexpected disruptions. Group
activities do not provide a safe and secure environment like an activity done with the
nurse does.

Question 51

The grown daughter of a woman with Alzheimer’s disease reports to the nurse that she is
trying to keep her mother’s condition from worsening by asking her questions whenever
they are together. Which will be accomplished by this intervention?
A) Decrease environmental misinterpretation
B) Improve memory retention
C) Increase frustration
D) Slow the progress of the disease

Answer 51

C

Alzheimer’s disease is progressive; clients do not learn new information, and they
become frustrated when asked to perform tasks they are not capable of doing.