MH Final Exam Flashcards
A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed?
A. “The goal of recovery is improved health and wellness.”
B. “The goal of recovery is expedient, comprehensive behavioral change.”
C. “The goal of recovery is the ability to live a self-directed life.”
D. “The goal of recovery is the ability to reach full potential.”
B. “The goal of recovery is expedient, comprehensive behavioral change.”
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental health disorders and substance use disorders as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Change in recovery is not an expedient process. It occurs incrementally over time.
Which situation presents an example of the basic concept of a recovery model?
A. The client’s family is encouraged to make decisions in order to facilitate discharge.
B. A social worker, discovering the client’s income, changes the client’s discharge placement.
C. A psychiatrist prescribes an antipsychotic drug on the basis of observed symptoms.
D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.
D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.
The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care.
A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed?
A. “Recovery occurs via many pathways.”
B. “Recovery emerges from strong religious affiliations.”
C. “Recovery is supported by peers and allies.”
D. “Recovery is culturally based and influenced.”
B. “Recovery emerges from strong religious affiliations.”
SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. Recovery emerges from hope, but affiliation with any particular religion would have little bearing on the recovery process.
A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the SAMHSA, which dimension of recovery is supporting this client?
A. Health
B. Home
C. Purpose
D. Community
B. Home
SAMHSA describes the dimension of Home as a stable and safe place to live.
A client diagnosed with obsessive-compulsive disorder states, “I really think my future will improve because of my successful treatment choices. I’m going to make my life better.” Which guiding principle of recovery has assisted this client?
A. Recovery emerges from hope.
B. Recovery is person-driven.
C. Recovery occurs via many pathways.
D. Recovery is holistic.
A. Recovery emerges from hope.
A nurse maintains a client’s confidentiality, addresses the client appropriately, and does not discriminate on the basis of gender, age, race, or religion. Which guiding principle of recovery has this nurse employed?
A. Recovery is culturally based and influenced.
B. Recovery is based on respect.
C. Recovery involves individual, family, and community strengths and responsibility.
D. Recovery is person-driven.
B. Recovery is based on respect.
The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. This nurse accepts and appreciates clients who are affected by mental health and substance use problems. This nurse protects the rights of clients and does not discriminate against them.
A nurse on an inpatient unit helps a client understand the significance of treatments and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the “Tidal Model of Recovery?”
A. Know that Change Is Constant
B. Reveal Personal Wisdom
C. Be Transparent
D. Give the Gift of Time
C. Be Transparent
Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. This nurse is employing the Be Transparent commitment.
Which is the priority focus of recovery models?
A. Empowerment of the health-care team to bring their expertise to decision-making
B. Empowerment of the client to make decisions related to individual health care
C. Empowerment of the family system to provide supportive care
D. Empowerment of the physician to provide appropriate treatments
B. Empowerment of the client to make decisions related to individual health care
A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model should be employed, and what action reflects this step?
A. Step 3: Triggers that cause distress or discomfort are listed.
B. Step 4: Signs indicating relapse are identified and plans for responding are developed.
C. Step 5: A specific plan to help with symptoms is formulated.
D. Step 6: Following client-designed plan, caregivers now become decision-makers.
D. Step 6: Following client-designed plan, caregivers now become decision-makers.
A nursing instructor is teaching about components present in the recovery process, as described by Andresen and associates, which led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed?
A. “A client has a better chance of recovery if he or she truly believes that recovery can occur.”
B. “If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover.”
C. “A client who has a positive sense of self and a positive identity is likely to recover.”
D. “A client has a better chance of recovery if he or she has purpose and meaning in life.”
B. “If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover.”
A client states, “My illness is so devastating, I feel like my life is on hold.” The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates?
A. Moratorium
B. Awareness
C. Preparation
D. Rebuilding
A. Moratorium
A client states, “I have come to the conclusion that this disease has not paralyzed me.” The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates?
A. Moratorium
B. Awareness
C. Preparation
D. Rebuilding
B. Awareness
A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to find when assessing this client?
A. A client feeling confident about achieving goals in life.
B. A client who is aware of the need to set goals in life.
C. A client who has mobilized personal and external resources.
D. A client who begins to actively take control of his or her life.
A. A client feeling confident about achieving goals in life.
Which of the following has the SAMHSA described, as major dimensions of support for a life of recovery? Select all that apply.
A. Health B. Community C. Home D. Religious affiliation E. Purpose
A. Health
B. Community
C. Home
E. Purpose
A nurse uses the commitments of the Tidal Model of Recovery in psychiatric nursing practice. Which of the following nursing actions reflect the use of the Develop Genuine Curiosity commitment? Select all that apply.
A. The nurse expresses interest in the client’s story.
B. The nurse asks for clarification of certain points.
C. The nurse encourages the client to speak his own words in his own unique way.
D. The nurse assists the client to unfold the story at his or her own rate.
E. The nurse provides the clients with copies of all documents relevant to care.
A. The nurse expresses interest in the client’s story.
B. The nurse asks for clarification of certain points.
D. The nurse assists the client to unfold the story at his or her own rate.
Order the six steps of The Wellness Recovery Action Plan (WRAP) Model as described by Copeland et al.
A.\_\_\_\_\_\_\_\_ Daily Maintenance List B.\_\_\_\_\_\_\_\_ Things Are Breaking Down or Getting Worse C. \_\_\_\_\_\_\_\_Crisis Planning D.\_\_\_\_\_\_\_\_ Develop a Wellness Toolbox E.\_\_\_\_\_\_\_\_\_Early Warning Signs F. \_\_\_\_\_\_\_\_ Triggers
Step1: Develop a Wellness Toolbox Step2: Daily Maintenance List Step3: Triggers Step4: Early Warning Signs Step5: Things Are Breaking Down or Getting Worse Step6: Crisis Planning
________________________ from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Recovery
A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this clients safety?
A. Assess for medication noncompliance
B. Note escalating behaviors and intervene immediately
C. Interpret attempts at communication
D. Assess triggers for bizarre, inappropriate behaviors
B. Note escalating behaviors and intervene immediately
A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse?
A. The side effects of medications
B. Deep breathing techniques to decrease stress
C. How to make eye contact when communicating
D. How to be a leader
C. How to make eye contact when communicating
A 16-year-old client diagnosed with schizophrenia experiences command hallucinations to harm others. The clients parents ask a nurse, Where do the voices come from? Which is the appropriate nursing reply?
A. Your child has a chemical imbalance of the brain, which leads to altered thoughts.
B. Your childs hallucinations are caused by medication interactions.
C. Your child has too little serotonin in the brain, causing delusions and hallucinations.
D. Your childs abnormal hormonal changes have precipitated auditory hallucinations.
A. Your child has a chemical imbalance of the brain, which leads to altered thoughts.
Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response?
A. Tell him to stop discussing the voices.
B. Ignore what he is saying, while attempting to discover the underlying cause.
C. Focus on the feelings generated by the hallucinations and present reality.
D. Present objective evidence that the voices are not real.
C. Focus on the feelings generated by the hallucinations and present reality.
A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, Do you receive special messages from certain sources, such as the television or radio? The nurse is assessing which potential symptom of this disorder?
A. Thought insertion
B. Paranoia
C. Magical thinking
D. Delusions of reference
D. Delusions of reference
A client diagnosed with schizophrenia spectrum disorder states, Cant you hear him? Its the devil. Hes telling me Im going to hell. Which is the most appropriate nursing response?
A. Did you take your medicine this morning?
B. You are not going to hell. You are a good person.
C. I’m sure the voices sound scary. I don’t hear any voices speaking.
(The voices must sound scary, but the devil is not talking to you. This is part of your illness)
D. The devil only talks to people who are receptive to his influence.
C. I’m sure the voices sound scary. I don’t hear any voices speaking.
(The voices must sound scary, but the devil is not talking to you. This is part of your illness)
A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client?
- Disturbed sensory perception
- Altered thought processes
- Risk for violence: directed toward others
- Risk for injury
- Risk for violence: directed toward others
Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder?
- Provide neon lights and soft music.
- Maintain continual eye contact throughout the interview.
- Use therapeutic touch to increase trust and rapport.
- Provide personal space to respect the client’s boundaries.
- Provide personal space to respect the client’s boundaries.
Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder?
- Establishing personal contact with family members
- Being reliable, honest, and consistent during interactions
- Sharing limited personal information
- Sitting close to the client to establish rapport
- Being reliable, honest, and consistent during interactions
A paranoid client diagnosed with schizophrenia spectrum disorder states, “My psychiatrist is out to get me. I’m sad that the voice is telling me to stop him.” What symptom is the client exhibiting, and what is the nurse’s legal responsibility related to this symptom?
- Magical thinking; administer an antipsychotic medication.
- Persecutory delusions; orient the client to reality.
- Command hallucinations; warn the psychiatrist.
- Altered thought processes; call an emergency treatment team meeting.
- Command hallucinations; warn the psychiatrist.
A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine?
- Tactile hallucinations
- Tardive dyskinesia
- Restlessness and muscle rigidity
- Reports of hearing disturbing voices
- Restlessness and muscle rigidity
A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client’s positive and negative symptoms of schizophrenia?
- Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia.
- Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia.
- Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia.
- Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.
- Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia.
A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?
- Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications
- Agranulocytosis treated by administration of clozapine (Clozaril)
- Extrapyramidal symptoms treated by administration of benztropine (Cogentin)
- Tardive dyskinesia treated by discontinuing antipsychotic medications
- Tardive dyskinesia treated by discontinuing antipsychotic medications
After taking chlorpromazine (Thorazine) for 1 month, a client presents to an ED with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5°C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?
- Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium)
- Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication
- Dystonia treated by administering trihexyphenidyl (Artane)
- Dystonia treated by administering bromocriptine (Parlodel)
- Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene
A client diagnosed with schizophrenia spectrum disorder takes an antipsychotic agent daily. Which assessment finding should a nurse prioritize?
- Respirations of 22 beats/minute
- Weight gain of 8 pounds in 2 months
- Temperature of 104°F (40°C)
- Excessive salivation
- Temperature of 104°F (40°C)
An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate?
- “Make sure you concentrate on taking slow, deep, cleansing breaths.”
- “Watch your diet and try to engage in some regular physical activity.”
- “Rise slowly when you change position from lying to sitting or sitting to standing.”
- “Wear sunscreen and try to avoid midday sun exposure.”
- “Rise slowly when you change position from lying to sitting or sitting to standing.”
A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately?
- Sore throat, fever, and malaise
- Akathisia and hypersalivation
- Akinesia and insomnia
- Dry mouth and urinary retention
- Sore throat, fever, and malaise
During an admission assessment, a nurse assesses that a client diagnosed with schizophrenia spectrum disorder has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated?
- Haloperidol (Haldol), because it is used only in older patients
- Clozapine (Clozaril), because it is incompatible with desipramine
- Risperidone (Risperdal), because it exacerbates symptoms of depression
- Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
- Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis?
- The client has experienced impaired reality testing for a 24-hour period.
- The client has experienced auditory hallucinations for the past 3 hours.
- The client has experienced bizarre behavior for 1 day.
- The client has experienced confusion for 3 weeks.
- The client has experienced auditory hallucinations for the past 3 hours.
A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client’s symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)?
- Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not.
- Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not.
- Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.
- Catatonic features may be associated with BPD, whereas SIPD has no catatonic features
- Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.
A nurse prepares to assess a client using the Abnormal Involuntary Movement Scale (AIMS). Which side effect of antipsychotic medications led to the use of this assessment tool?
- Dystonia
- Tardive dyskinesia
- Akinesia
- Akathisia
- Tardive dyskinesia
Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.)
- Group therapy
- Medication management
- Deterrent therapy
- Supportive family therapy
- Social skills training
- Group therapy
- Medication management
- Deterrent therapy
- Social skills training
A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would most likely decrease because of the therapeutic effect of this medication? (Select all that apply.)
- Somatic delusions
- Social isolation
- Gustatory hallucinations
- Flat affect
- Clang associations
1 Somatic delusions
3 Gustatory hallucinations
5 Clang associations
Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would a nurse expect to observe during assessment? (Select all that apply.)
- Apathy
- Social withdrawal
- Anhedonia
- Auditory hallucinations
- Delusions
- Apathy
- Social withdrawal
- Anhedonia
The diagnosis of catatonic disorder associated with another medical condition is made when the client’s medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.)
- Hyperthyroidism
- Hypothyroidism
- Hyperadrenalism
- Hypoadrenalism
- Hyperaphia
- Hyperthyroidism
- Hypothyroidism
- Hyperadrenalism
- Hypoadrenalism
___________________________ disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania).
Schizoaffective
___________________________ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses.
Hallucinations
A nursing instructor is teaching about trauma and stressor-related disorders. Which student statement indicates that further instruction is needed?
A. “The trauma that women experience is more likely to be sexual assault and child sexual abuse.”
B. “The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury.”
C. “After exposure to a traumatic event, only 10 percent of victims develop post-traumatic stress disorder (PTSD).”
D. “Research shows that PTSD is more common in men than in women.”
D. “Research shows that PTSD is more common in men than in women.”
Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)?
A. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events.
B. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to “normal” daily events.
C. Depressive symptoms occur in PTSD and not in AD.
D. Depressive symptoms occur in AD and not in PTSD.
A. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events.
Which client would a nurse recognize as being at highest risk for the development of an AD?
A. A young married woman
B. An elderly unmarried man
C. A young unmarried woman
D. A young unmarried man
C. A young unmarried woman
A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that learning has occurred?
A. “How clients perceive events and view the world affect their response to trauma.”
B. “The psychic numbing in PTSD is a result of negative reinforcement.”
C. “The individual becomes addicted to the trauma owing to an endogenous opioid response.”
D. “Believing that the world is meaningful and controllable can protect an individual from PTSD.”
B. “The psychic numbing in PTSD is a result of negative reinforcement.”
As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client’s symptom?
A. Anxiety
B. Altered thought processes
C. Complicated grieving
D. Altered sensory perception
C. Complicated grieving
A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ?
A. Encourage the journaling of feelings.
B. Assess for the stage of grief in which the client is fixed.
C. Provide community resources to address the client’s concerns.
D. Encourage attending a grief therapy group.
B. Assess for the stage of grief in which the client is fixed.
Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)?
A. Anxiety, feelings of hopelessness, and worry
B. Truancy, vandalism, and fighting
C. Nervousness, worry, and jitteriness
D. Depressed mood, tearfulness, and hopelessness
D. Depressed mood, tearfulness, and hopelessness
Both situational and intrapersonal factors most likely contribute to an individual’s stress response. Which factor would a nurse categorize as intrapersonal?
A. Occupational opportunities
B. Economic conditions
C. Degree of flexibility
D. Availability of social supports
C. Degree of flexibility
A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client’s problem?
A. Rates anxiety as 4 out of 10 by discharge.
B. States anxiety level has decreased by day one.
C. Accomplishes activities of daily living independently.
D. Demonstrates ability for adequate social functioning by day three.
A. Rates anxiety as 4 out of 10 by discharge.
Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder?
A. Adjustment disorder
B. Generalized anxiety disorder
C. Panic disorder
D. Post-traumatic stress disorder
D. Post-traumatic stress disorder
After a teaching session about grief, a client says to the nurse, “I seem to be stuck in the anger stage of grieving over the loss of my son.” How would the nurse assess this statement, and in what phase of the nursing process would this occur?
A. Assessment phase; nursing actions have been successful in achieving the objectives of care.
B. Evaluation phase; nursing actions have been successful in achieving the objectives of care.
C. Implementation phase; nursing actions have been successful in achieving the objectives of care.
D. Diagnosis phase; nursing actions have been successful in achieving the objectives of care
B. Evaluation phase; nursing actions have been successful in achieving the objectives of care.
By which biological mechanism does EMDR achieve its therapeutic effect?
A. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
B. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness.
C. EMDR achieves its therapeutic effect by causing an increase in memory access.
D. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.
A. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
A client receiving EMDR therapy says, “After only two sessions of my therapy, I am feeling great. Now I can stop and get on with my life.” Which of the following nursing responses is most appropriate?
A. “I am thrilled that you have responded so rapidly to EMDR.”
B. “To achieve lasting results, all eight phases of EMDR must be completed.”
C. “If I were you, I would complete the EMDR and comply with doctor’s orders.”
D. “How do you feel about continuing the therapy?”
B. “To achieve lasting results, all eight phases of EMDR must be completed.”
A nurse would recognize which treatment as most commonly used for AD and its appropriate rationale?
A. Psychotherapy; to examine the stressor and confront unresolved issues
B. Fluoxetine (Prozac); to stabilize mood and resolve symptoms
C. Eye movement desensitization therapy; to reprocess traumatic events
D. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety
A. Psychotherapy; to examine the stressor and confront unresolved issues
A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client’s plan of care?
A. The client will have no flashbacks.
B. The client will be able to feel a full range of emotions by discharge.
C. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.
D. The client will refrain from discussing the traumatic event.
C. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.
A client diagnosed with PTSD is receiving paliperidone (Invega). Which symptoms should a nurse identify that would warrant the need for this medication?
A. Flat affect and anhedonia
B. Persistent anorexia and 10 lb weight loss in 3 weeks
C. Flashbacks of killing the enemy
D. Distant and guarded in relationships
C. Flashbacks of killing the enemy
A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis?
A. The client worries continually and appears nervous and jittery.
B. The client complains of a depressed mood, is tearful, and feels hopeless.
C. The client is belligerent, violates others’ rights, and defaults on legal responsibilities.
D. The client complains of many physical ailments, refuses to socialize, and quits her job.
D. The client complains of many physical ailments, refuses to socialize, and quits her job.
A client has been extremely nervous ever since a person died as a result of the client’s drunk driving. When assessing for the diagnosis of AD, within what time frame should the nurse expect the client to exhibit symptoms?
A. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within one year of the accident.
B. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within three months of the accident.
C. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within six months of the accident.
D. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within nine months of the accident.
B. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within three months of the accident.
A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder?
A. The 60-year-old, because of memory deficits.
B. The 60-year-old, because of decreased cognitive processing ability.
C. The 20-year-old, because of limited cognitive experiences.
D. The 20-year-old, because of lack of developmental maturity.
D. The 20-year-old, because of lack of developmental maturity.
A client diagnosed with an adjustment disorder says to the nurse, “Tell me about medications that will cure this problem.” Which of the following are appropriate nursing responses? (Select all that apply.)
A. “Medications can interfere with your ability to find a more permanent problem solution.”
B. “Medications may mask the real problem at the root of this diagnosis.”
C. “Adjustment disorders are not commonly treated with medications.”
D. “Psychoactive drugs carry the potential for physiological and psychological dependence.”
E. “Psychoactive drugs will be prescribed only if your problems persist for more than three months.”
A. “Medications can interfere with your ability to find a more permanent problem solution.”
B. “Medications may mask the real problem at the root of this diagnosis.”
C. “Adjustment disorders are not commonly treated with medications.”
D. “Psychoactive drugs carry the potential for physiological and psychological dependence.”
A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms might the nurse expect to assess? (Select all that apply.)
A. Feelings of guilt that precipitate social isolation
B. Aggressive behavior that affects job performance
C. Relationship problems
D. High levels of anxiety
E. Escalating symptoms lasting less than one month
A. Feelings of guilt that precipitate social isolation
B. Aggressive behavior that affects job performance
C. Relationship problems
D. High levels of anxiety
A family asks the nurse why their son was diagnosed with PTSD and others in the accident were not. Which of the following information should the nurse offer? (Select all that apply.)
A. An individual’s religious affiliation can affect response to trauma.
B. Responses are affected by how an individual handled previous trauma.
C. Protectiveness of family and friends can help an individual deal with trauma.
D. Control over the possibility of recurrence can affect the response to trauma.
E. The time in which the trauma occurred can affect the individual’s response.
B. Responses are affected by how an individual handled previous trauma.
C. Protectiveness of family and friends can help an individual deal with trauma.
D. Control over the possibility of recurrence can affect the response to trauma.
E. The time in which the trauma occurred can affect the individual’s response.
A nurse would recognize which of the following as the best predictors of PTSD in Vietnam veterans? (Select all that apply.)
A. The severity of the stressor
B. The degree of ego strength
C. The degree of psychosocial isolation in the recovery environment
D. The attitudes of society regarding the experience
E. The presence of preexisting psychopathology
A. The severity of the stressor
C. The degree of psychosocial isolation in the recovery environment
A client diagnosed with PTSD states, “Why did my doctor prescribe an antidepressant rather than an antianxiety drug for me?” Which of the following are the most appropriate nursing responses? (Select all that apply.)
A. “I’m not sure, because antianxiety drugs have been approved by the FDA for PTSD.”
B. “Antidepressants are now considered first-line treatment choice for PTSD.”
C. “Many people have adverse reactions to antianxiety drugs.”
D. “Because of their addictive properties, antianxiety drugs are less desirable.”
E. “There have been no controlled studies on the effect of antianxiety drugs on PTSD.”
B. “Antidepressants are now considered first-line treatment choice for PTSD.”
D. “Because of their addictive properties, antianxiety drugs are less desirable.”
E. “There have been no controlled studies on the effect of antianxiety drugs on PTSD.”
An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects is called _________________
Trauma
A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child’s face and arms. What other symptoms should indicate to the nurse that the child may have been physically abused?
A. The child shrinks at the approach of adults.
B. The child begs or steals food or money.
C. The child is frequently absent from school.
D. The child is delayed in physical and emotional development.
A. The child shrinks at the approach of adults.
A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect?
A. The woman may be exhibiting a controlled response pattern.
B. The woman may have a history of childhood neglect.
C. The woman may be exhibiting codependent characteristics.
D. The woman may be a victim of incest.
D. The woman may be a victim of incest.
A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included?
A. Power and control are central to the dynamic of domestic violence.
B. Poor communication and social isolation are central to the dynamic of domestic violence.
C. Erratic relationships and vulnerability are central to the dynamic of domestic violence.
D. Emotional injury and learned helplessness are central to the dynamic of domestic violence.
A. Power and control are central to the dynamic of domestic violence.
A client is brought to an emergency department after being violently raped. Which nursing action is appropriate?
A. Discourage the client from discussing the rape, because this may lead to further emotional trauma.
B. Remain nonjudgmental while actively listening to the client’s description of the violent rape event.
C. Meet the client’s self-care needs by assisting with showering and perineal care.
D. Probe for further, detailed description of the rape event.
B. Remain nonjudgmental while actively listening to the client’s description of the violent rape event.
A raped client answers a nurse’s questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this client’s responses?
A. The client may be lying about the incident.
B. The client may be experiencing a silent rape reaction.
C. The client may be demonstrating a controlled response pattern.
D. The client may be having a compounded rape reaction.
C. The client may be demonstrating a controlled response pattern.
A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, “Why doesn’t she just leave him?” Which is the nursing supervisor’s most appropriate response?
A. “These clients don’t know life any other way, and change is not an option until they have improved insight.”
B. “These clients have limited cognitive skills and few vocational abilities to be able to make it on their own.”
C. “These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation.”
D. “These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.”
D. “These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.”
A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, “The beatings have been getting worse, and I’m afraid, next time, he will kill me.” Which is the appropriate nursing response?
A. “Leopards don’t change their spots, and neither will he.”
B. “There are things you can do to prevent him from losing control.”
C. “Let’s talk about your options so that you don’t have to go home.”
D. “Why don’t we call the police so that they can confront your husband with his behavior?”
C. “Let’s talk about your options so that you don’t have to go home.”
A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner?
A. “I know that it was not my fault.”
B. “My boyfriend has trouble controlling his sexual urges.”
C. “If I don’t put myself in a dating situation, I won’t be at risk.”
D. “Next time I will think twice about wearing a sexy dress.”
A. “I know that it was not my fault.”
A client asks, “Why does a rapist use a weapon during the act of rape?” Which is the most appropriate nursing response?
A. “To decrease the victimizer’s insecurity.”
B. “To inflict physical harm with the weapon.”
C. “To terrorize and subdue the victim.”
D. “To mirror learned family behavior patterns related to weapons.”
C. “To terrorize and subdue the victim.”
When questioned about bruises, a woman states, “It was an accident. My husband just had a bad day at work. He’s being so gentle now and even brought me flowers. He’s going to get a new job, so it won’t happen again.” This client is in which phase of the cycle of battering?
A. Phase I: The tension-building phase
B. Phase II: The acute battering incident phase
C. Phase III: The honeymoon phase
D. Phase IV: The resolution and reorganization phase
C. Phase III: The honeymoon phase
Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse?
A. Have ready access to a gun and learn how to use it.
B. Research lawyers that can aid in divorce proceedings.
C. File charges of assault and battery.
D. Have ready access to the number of a safe house for battered women.
D. Have ready access to the number of a safe house for battered women.
A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense?
A. Controlled response pattern
B. Compounded rape reaction
C. Expressed response pattern
D. Silent rape reaction
C. Expressed response pattern
Which assessment data should a school nurse recognize as a sign of physical neglect?
A. The child is often absent from school and seems apathetic and tired.
B. The child is very insecure and has poor self-esteem.
C. The child has multiple bruises on various body parts.
D. The child has sophisticated knowledge of sexual behaviors.
A. The child is often absent from school and seems apathetic and tired.
A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, “My father has recently moved back to town.” What should the nurse suspect?
A. Possible major depressive disorder
B. Possible history of childhood incest
C. Possible histrionic personality disorder
D. Possible history of childhood physical abuse
B. Possible history of childhood incest
In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (Select all that apply.)
A. It often takes several attempts before a woman leaves an abusive situation.
B. Substance abuse is a common factor in abusive relationships.
C. Until children reach school age, they are usually not affected by abuse between their parents.
D. Women in abusive relationships usually feel isolated and unsupported.
E. Economic factors rarely play a role in the decision to stay.
A. It often takes several attempts before a woman leaves an abusive situation.
B. Substance abuse is a common factor in abusive relationships.
D. Women in abusive relationships usually feel isolated and unsupported.
Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.)
A. Low self-esteem B. Powerlessness C. Disturbed personal identity D. Knowledge deficit E. Non-adherence
A. Low self-esteem
B. Powerlessness
A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.)
A. “Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner.”
B. “Intimate partner violence is used to gain power and control over the other intimate partner.”
C. “Fifty-one percent of victims of intimate violence are women.”
D. “Women ages 25 to 34 experience the highest per capita rates of intimate violence.”
E. “Victims are typically young married women who are dependent housewives.”
A. “Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner.”
B. “Intimate partner violence is used to gain power and control over the other intimate partner.”
D. “Women ages 25 to 34 experience the highest per capita rates of intimate violence.”
Order the description of the progressive phases of Walker’s model of the “cycle of battering?”
_______ This phase is the most violent and the shortest, usually lasting up to 24 hours.
_______ In this phase, the man’s tolerance for frustration is declining.
_______ In this phase, the batterer becomes extremely loving, kind, and contrite.
- Acute battering incident phase. This phase is the most violent and the shortest, usually lasting up to 24 hours.
- Tension building phase. In this phase, the man’s tolerance for frustration is declining.
- Honeymoon phase. In this phase, the batterer becomes extremely loving, kind, and contrite.
A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed_______?
battering
Physical _____ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision.
neglect
During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior?
A. “You are very disrespectful. You need to learn to control yourself.”
B. “I understand that you are angry, but this behavior will not be tolerated.”
C. “What behaviors could you modify to improve this situation?”
D. “What anti-personality-disorder medications have helped you in the past?”
B. “I understand that you are angry, but this behavior will not be tolerated.”
A client diagnosed with antisocial personality disorder comes to a nurses’ station at 11:00 p.m., requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate?
A. “Go ahead and use the phone. I know this pending divorce is stressful.”
B. “You know better than to break the rules. I’m surprised at you.”
C. “It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow.”
D. “The decision to divorce should not be considered until you have had a good night’s sleep.”
C. “It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow.”
A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?
A. Provide objective evidence that violence is unwarranted.
B. Initially restrain the client to maintain safety.
C. Use clear, calm statements and a confident physical stance.
D. Empathize with the client’s paranoid perceptions.
C. Use clear, calm statements and a confident physical stance.
A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?
A. Allow the clients to apply the democratic process when developing unit rules.
B. Maintain consistency of care by open communication to avoid staff manipulation.
C. Allow the client spokesperson to verbalize concerns during a unit staff meeting.
D. Maintain unit order by the application of autocratic leadership.
B. Maintain consistency of care by open communication to avoid staff manipulation.
Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder?
A. Being firm, consistent, and empathetic, while addressing specific client behaviors
B. Promoting client self-expression by implementing laissez-faire leadership
C. Using authoritative leadership to help clients learn to conform to societal norms
D. Overlooking inappropriate behaviors to avoid promoting secondary gains
A. Being firm, consistent, and empathetic, while addressing specific client behaviors
Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder?
A. A physically healthy client who is dependent on meeting social needs by contact with 15 cats
B. A physically healthy client who has a history of depending on intense relationships to meet basic needs
C. A physically healthy client who lives with parents and relies on public transportation
D. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security
C. A physically healthy client who lives with parents and relies on public transportation
A pessimistic client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of “suffering” in silence. Which underlying cause of this client’s personality disorder should a nurse recognize?
A. “Nurturance was provided from many sources, and independent behaviors were encouraged.”
B. “Nurturance was provided exclusively from one source, and independent behaviors were discouraged.”
C. “Nurturance was provided exclusively from one source, and independent behaviors were encouraged.”
D. “Nurturance was provided from many sources, and independent behaviors were discouraged.”
B. “Nurturance was provided exclusively from one source, and independent behaviors were discouraged.”
Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply?
A. “Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.”
B. “Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, whereas clients diagnosed with avoidant personality disorder do not.”
C. “Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant.”
D. “Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, whereas clients diagnosed with avoidant personality disorder remain based in reality.”
A. “Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.”
During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered?
A. “I really don’t have a problem. My family is inflexible, and every relative is out to get me.”
B. “I am so excited about working with you. Have you noticed my new nail polish, ‘Ruby Red Roses’?”
C. “I spend all my time tending my bees. I know a whole lot of information about bees.”
D. “I am getting a message from the beyond that we have been involved with each other in a previous life.”
D. “I am getting a message from the beyond that we have been involved with each other in a previous life.”
A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred?
A. “Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling.”
B. “Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.”
C. “They tend to develop few relationships because they are strongly independent but generally maintain deep affection.”
D. “They pay particular attention to details, which can frustrate the development of relationships.”
B. “Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.”
Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?
A. Altered thought processes R/T increased stress
B. Risk for suicide R/T loneliness
C. Risk for violence: directed toward others R/T paranoid thinking
D. Social isolation R/T inability to relate to others
D. Social isolation R/T inability to relate to others
When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?
A. The use of highly lethal methods to commit suicide
B. The use of suicidal gestures to evoke a rescue response from others
C. The use of isolation and starvation as suicidal methods
D. The use of self-mutilation to decrease endorphins in the body
B. The use of suicidal gestures to evoke a rescue response from others
Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder?
A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse’s arm and whispers, “The night nurse is evil. You have to stay.”
B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse’s arm and states, “I will be up all night if you don’t stay with me.”
C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse’s arm, yelling, “Please don’t go! I can’t sleep without you being here.”
D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, “I cut myself because you are leaving me.”
D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, “I cut myself because you are leaving me.”
Which nursing diagnosis should be prioritized when providing care to a client diagnosed with paranoid personality disorder?
A. Risk for violence: directed toward others R/T suspicious thoughts
B. Risk for suicide R/T altered thought
C. Altered sensory perception R/T increased levels of anxiety
D. Social isolation R/T inability to relate to others
A. Risk for violence: directed toward others R/T suspicious thoughts
Using a behavioral approach, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder?
A. Seclude the client when inappropriate behaviors are exhibited.
B. Contract with the client to reinforce positive behaviors with unit privileges.
C. Teach the purpose of antianxiety medications to improve medication compliance.
D. Encourage the client to journal feelings to improve awareness of abandonment issues.
B. Contract with the client to reinforce positive behaviors with unit privileges.
A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?
A. “You really don’t have to go by that schedule. I’d just stay home sick.”
B. “There has got to be a hidden agenda behind this schedule change.”
C. “Who do you think you are? I expect to interact with the same nurse every Saturday.”
D. “You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”
D. “You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”
Looking at a slightly bleeding paper cut, the client screams, “Somebody help me, quick! I’m bleeding. Call 911!” A nurse should identify this behavior as characteristic of which personality disorder?
A. Schizoid personality disorder
B. Obsessive-compulsive personality disorder
C. Histrionic personality disorder
D. Paranoid personality disorder
C. Histrionic personality disorder
Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?
A. Interpreting the compliment as a secret code used to increase personal power
B. Feeling the compliment was well deserved
C. Being grateful for the compliment but fearing later rejection and humiliation
D. Wondering what deep meaning and purpose are attached to the compliment
C. Being grateful for the compliment but fearing later rejection and humiliation
Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder?
A. The client experiences unwanted, intrusive, and persistent thoughts.
B. The client experiences unwanted, repetitive behavior patterns.
C. The client experiences inflexibility and lack of spontaneity when dealing with others.
D. The client experiences obsessive thoughts that are externally imposed.
C. The client experiences inflexibility and lack of spontaneity when dealing with others.
Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors?
A. A client diagnosed with antisocial personality disorder
B. A client diagnosed with borderline personality disorder
C. A client diagnosed with schizoid personality disorder
D. A client diagnosed with paranoid personality disorder
B. A client diagnosed with borderline personality disorder
When planning care for clients diagnosed with personality disorders, what should be the anticipated treatment outcome?
A. To stabilize pathology with the correct combination of medications
B. To change the characteristics of the dysfunctional personality
C. To reduce inflexibility of personality traits that interfere with functioning and relationships
D. To decrease the prevalence of neurotransmitters at receptor sites
C. To reduce inflexibility of personality traits that interfere with functioning and relationships
The nurse plans to confront a client about secondary gains related to extreme dependency on her spouse. Which nursing statement would be most appropriate?
A. “Do you believe dependency issues have been a lifelong concern for you?”
B. “Have you noticed any anxiety during times when your husband makes decisions?”
C. “What do you know about individuals who depend on others for direction?”
D. “How have the specifics of your relationship with your spouse benefited you?”
D. “How have the specifics of your relationship with your spouse benefited you?”
The nurse should recognize which factors that distinguish personality disorders from psychosis?
A. Functioning is more limited in personality disorders than in psychosis.
B. Major disturbances of thought are absent in personality disorders.
C. Personality disordered clients require hospitalization more frequently.
D. Personality disorders do not affect family relationships as much as psychosis.
B. Major disturbances of thought are absent in personality disorders.
Which client statement would demonstrate a common characteristic of Cluster “B” personality disorder?
A. “I wish someone would make that decision for me.”
B. “I built this building by using materials from outer space.”
C. “I’m afraid to go to group because it is crowded with people.”
D. “I didn’t have the money for the ring, so I just took it.”
D. “I didn’t have the money for the ring, so I just took it.”
When a client on an acute care psychiatric unit demonstrates behaviors and verbalizations indicating a lack of guilt feelings, which nursing intervention would help the client to meet desired outcomes?
A. Provide external limits on client behavior.
B. Foster discussions of rationales for behavioral change.
C. Implement interventions consistently by only one staff member.
D. Encourage the client to involve self in care.
A. Provide external limits on client behavior.
While improving, a client demands to have a phone installed in the intensive care unit (ICU) room. When a nurse states, “This is not allowed; it is a unit rule,” the client angrily demands to see the doctor. Which approach should the nurse use in this situation?
A. Provide an explanation for the necessity of the unit rule.
B. Assist the client to discuss anger and frustrations.
C. Call the physician and relay the request.
D. Arrange for a phone to be installed in the client’s unit room.
B. Assist the client to discuss anger and frustrations.
Which nursing statement reflects a common characteristic of a client diagnosed with paranoid personality disorder?
A. “This client consistently criticizes care and has difficulty getting along with others.”
B. “This client is shy and fades into the background.”
C. “This client expects special treatment, and setting limits will be necessary.”
D. “This client is expressive during group and is very pleased with self.”
A. “This client consistently criticizes care and has difficulty getting along with others.”
A client diagnosed with Cluster C traits sits alone and ignores other’s attempts to converse. When ask to join a group the client states, “No, thanks.” In this situation, which should the nurse assign as an initial nursing diagnosis?
A. Fear R/T hospitalization
B. Social isolation R/T poor self-esteem
C. Risk for suicide R/T to hopelessness
D. Powerlessness R/T dependence issues
B. Social isolation R/T poor self-esteem
Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? Select all that apply.
A. The client will relate one empathetic statement toward another client in group, by day 2
B. The client will identify one personal limitation by day 1.
C. The client will acknowledge one strength that another client possesses by day 2.
D. The client will list four personal strengths by day 3.
E. The client will list two lifetime achievements by discharge.
A. The client will relate one empathetic statement toward another client in group, by day 2
B. The client will identify one personal limitation by day 1.
C. The client will acknowledge one strength that another client possesses by day 2.
A nurse is caring for a group of clients within the DSM-5 Cluster B category of personality disorders. Which factors should the nurse consider when planning client care? Select all that apply.
A. These clients have personality traits that are deeply ingrained and difficult to modify.
B. These clients need medications to treat the underlying physiological pathology.
C. These clients use manipulation, making the implementation of treatment problematic.
D. These clients have poor impulse control that hinders compliance with a plan of care.
E. This client is likely to have secondary diagnoses of substance abuse and depression.
A. These clients have personality traits that are deeply ingrained and difficult to modify.
C. These clients use manipulation, making the implementation of treatment problematic.
D. These clients have poor impulse control that hinders compliance with a plan of care.
E. This client is likely to have secondary diagnoses of substance abuse and depression.
Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder?
- A physically healthy client who is dependent on meeting social needs by contact with 15 cat
- A physically healthy client who has a history of depending on intense relationships to meet basic
needs - A physically healthy client who lives with parents and depends on public transportation
- A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide security
- A physically healthy client who lives with parents and depends on public transportation
A highly emotional client presents at an outpatient clinic appointment and states, “My dead husband returned to me during a séance.” Which personality disorder should a nurse associate with this behavior?
- Obsessive-compulsive personality disorder
- Schizotypal personality disorder
- Narcissistic personality disorder
- Borderline personality disorder
- Schizotypal personality disorder
A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.)
- The client has been diagnosed with sickle cell anemia.
- The client has an inflated self-appraisal and feels a sense of entitlement.
- The client has a history of a substance use disorder.
- The client is odd and eccentric but not delusional.
- The client has an intellectual developmental disorder.
- The client has been diagnosed with sickle cell anemia.
- The client has a history of a substance use disorder.
- The client has an intellectual developmental disorder.
A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.)
- Ego-centrism and goal setting based on personal gratification.
- Incapacity for mutually intimate relationships.
- Frequent feelings of being down miserable and/or hopeless.
- Disregard for and failure to honor financial and other obligations.
- Intense feelings of nervousness, tenseness, or panic.
- Ego-centrism and goal setting based on personal gratification.
- Incapacity for mutually intimate relationships.
- Disregard for and failure to honor financial and other obligations.
___ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.
Schizoid
___ personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people.
Histrionic
__ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.
Dependent
___ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.
Paranoid
A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which personality disorder characteristics?
- Experiences intense and chaotic relationships with fluctuating attitudes toward others.
- Socially irresponsible, exploitative, guiltless, and disregards rights of others.
- Self-dramatizing, attention seeking, overly gregarious, and seductive.
- Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange.
- Self-dramatizing, attention seeking, overly gregarious, and seductive.
A nurse is working with a client diagnosed with SSD. What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)?
- The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not.
- The client diagnosed with SSD experiences a change in the quality of self-awareness, and the client diagnosed with IAD does not.
- The client diagnosed with SSD disorder has a perceived disturbance in body image or appearance, and the client diagnosed with IAD does not.
- The client diagnosed with SSD only experiences anxiety about the possibility of illness, and the client diagnosed with IAD does not.
- The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not.
Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with SSD?
- The client will admit to fabricating physical symptoms to gain benefits by day three.
- The client will list three potential adaptive coping strategies to deal with stress by day two.
- The client will comply with medical treatments for physical symptoms by day three.
- The client will openly discuss physical symptoms with staff by day four.
- The client will list three potential adaptive coping strategies to deal with stress by day two.
Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain, may experience?
- Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications
- Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor
- Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion
- Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards
- Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards
A nursing instructor is teaching about the etiology of IAD from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred?
- “They tend to have a familial predisposition to this disorder.”
- “When the sick role relieves them from stressful situations, their physical symptoms are reinforced.”
- “They misinterpret and cognitively distort their physical symptoms.”
- “They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems.”
- “They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems.”
An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority?
- Encourage exploration of sexual abuse.
- Encourage guided imagery.
- Establish trust and rapport.
- Administer antianxiety medications.
- Establish trust and rapport.
A client diagnosed with DID switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function?
- It is a means to attain secondary gain.
- It is a means to explore feelings of excessive and inappropriate guilt.
- It serves to isolate painful events so that the primary self is protected.
- It serves to establish personality boundaries and limit inappropriate impulses.
- It serves to isolate painful events so that the primary self is protected.
A client is diagnosed with DID. What is the primary goal of therapy for this client?
- To recover memories and improve thinking patterns.
- To prevent social isolation.
- To decrease anxiety and need for secondary gain.
- To collaborate among sub-personalities to improve functioning.
- To decrease anxiety and need for secondary gain.
According to the DSM-5 diagnostic criteria for dissociative amnesia (DA), what symptom would be essential to meet the criteria for the subcategory of dissociative fugue?
- An inability to recall important autobiographical information
- Clinically significant distress in social and occupational functioning
- Sudden unexpected travel or bewildered wandering
- “Blackouts” related to alcohol toxicity
- Clinically significant distress in social and occupational functioning
Which situation is an example of selective amnesia?
- A client cannot relate any lifetime memories.
- A client can describe driving to Ohio but cannot remember the car accident that occurred.
- A client often wanders aimlessly after sunset.
- A client cannot provide personal demographic information during admission assessment.
- A client can describe driving to Ohio but cannot remember the car accident that occurred.
Neurological tests have ruled out pathology in a client’s sudden lower-extremity paralysis. Which nursing care should be included for this client?
- Deal with physical symptoms in a detached manner.
- Challenge the validity of physical symptoms.
- Meet dependency needs until the physical limitations subside.
- Encourage a discussion of feelings about the lower-extremity problem.
- Deal with physical symptoms in a detached manner.
Which combination of diagnoses and appropriate pharmacological treatments are correctly matched?
- SSD: predominantly pain; treated with venlafaxine (Effexor)
- IAD; treated with cefadroxil (Duricef)
- Conversion disorder; treated with cyclobenzaprine (Flexeril)
- Depersonalization-derealization disorder; treated with mometasone (Elocom)
- SSD: predominantly pain; treated with venlafaxine (Effexor)
A nurse is reviewing progress notes on a newly admitted client. One progress note reveals that the client purposefully inserted a contaminated catheter into urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder?
- Illness anxiety disorder
- Factitious disorder
- Functional neurological symptom disorder
- Depersonalization-derealization disorder
- Factitious disorder
A nursing instructor is teaching about the DSM-5 diagnosis of depersonalization-derealization disorder (D-DD). Which student statement indicates a need for further instruction?
- “Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time.”
- “Clients with this disorder can experience unreality or detachment with respect to their surroundings.”
- “During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted.”
- “During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning.”
- “During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning.”
A client is diagnosed with IAD. Which of the following symptoms is the client most likely to exhibit? (Select all that apply.)
- Obsessive-compulsive behaviors
- Pseudocyesis
- Anxiety
- Flat affect
- Depression
- Obsessive-compulsive behaviors
- Anxiety
- Depression
A client is diagnosed with functional neurological symptom disorder (FNSD). Which of the following symptoms is the client most likely to exhibit? (Select all that apply.)
- Anosmia
- Anhedonia
- Akinesia
- Aphonia
- Amnesia
- Anosmia
- Akinesia
- Aphonia
A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis? Select all that apply.
A. “Have you taken any new medications recently?”
B. “Have you ever traveled suddenly or unexpectedly away from home?”
C. “Have you recently experienced any traumatic event?”
D. “Have you ever felt detached from your environment?”
E. “Have you had any history of memory problems?”
A. “Have you taken any new medications recently?”
C. “Have you recently experienced any traumatic event?”
E. “Have you had any history of memory problems?”
The DSM-5 diagnosis of functional neurological symptom disorder can also be identified as ___ disorder
Conversion
