Mood Disorders- Videback Ch 17 plus few from ch18

Question 1

Which best explains the neurochemical processes responsible for depression?
A) Increased activity of dopamine
B) Decreased glucocorticoid activity
C) Decreased serotonin and norepinephrine activity
D) Potentiating of the kindling process

Answer 1

Ans: C
Feedback:
Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid, or 5-HIAA) of serotonin found in the blood or cerebrospinal fluid occur in people with depression. Norepinephrine levels may be deficient in depression and increased in mania. Elevated glucocorticoid activity is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression. Kindling is the process by which seizure activity in a specific area of the brain is initially stimulated.

Question 2

Which is a freudian explanation of the etiology of depression?
A) Depression is a reaction to a distressing life experience.
B) Depression results from being raised by rejecting or unloving parents.
C) Depression results from cognitive distortions.
D) Depression is anger turned inward.

Answer 2

Ans: D
Feedback:
Freud looked at the self-depreciation of people with depression and attributed that self- reproach to anger turned inward related to either a real or perceived loss. Meyer viewed depression as a reaction to a distressing life experience such as an event with psychic causality. Horney believed that children raised by rejecting or unloving parents were prone to feelings of insecurity and loneliness. Beck saw depression as resulting from specific cognitive distortions in susceptible people.

Question 3

Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply.
A) Norepinephrine levels may be increased in mania.
B) Manic episodes are a ìdefenseî against underlying depression.
C) Acetylcholine seems to be implicated in mania.
D) The id takes over the ego and acts as an undisciplined hedonistic being (child).

Answer 3

Ans: B, D
Feedback:
Most psychoanalytic theories of mania view manic episodes as a ìdefenseî against underlying depression, with the id taking over the ego and acting as an undisciplined hedonistic being (child). Norepinephrine levels may be increased in mania, and acetylcholine seems to be implicated in mania, but these are neurochemical theories.

Question 4

Which variables represent the highest risk for developing major depressive disorder? Select all that apply.
A) Male gender
B) Mood disorder in first-degree relatives
C) Substance abuse
D) Divorced
E) Older adult

Answer 4

Ans: B, D Feedback:
Major depression is twice as common in women and has a 1.5 to 3 times greater incidence in first-degree relatives than in the general population. Incidence of depression decreases with age in women and increases with age in men. Single and divorced people have the highest incidence. Depression in prepubertal boys and girls occurs at an equal rate.

Question 5

A concerned family member tells the nurse, ìI am concerned about my brother. He has been acting very different lately.î Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder?
A) Taking unnecessary risks
B) Sleeping more
C) Intense focus
D) Showing low self-esteem

Answer 5

Ans: A
Feedback:
The diagnosis of a manic episode or mania requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments.

Question 5

A concerned family member tells the nurse, ìI am concerned about my brother. He has been acting very different lately.î Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder?
A) Taking unnecessary risks
B) Sleeping more
C) Intense focus
D) Showing low self-esteem

Answer 5

Ans: A
Feedback:
The diagnosis of a manic episode or mania requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments.

Question 6

A client is admitted for major depression. What should the nurse expect to find during assessment?
A) Anhedonia, feelings of worthlessness, and difficulty focusing
B) Depressed mood, guilt, and pressured speech
C) Changes in sleep pattern, tired, and grandiose mood
D) Difficulty focusing, feelings of helplessness, and flight of ideas

Answer 6

Ans: A
Feedback:
Symptoms of major depressive disorder include depressed mood; anhedonism (decreased attention to and enjoyment from previously pleasurable activities); unintentional weight change of 5% or more in a month; change in sleep pattern; agitation or psychomotor retardation; tiredness; worthlessness or guilt inappropriate to the situation (possibly delusional); difficulty thinking, focusing, or making decisions; or hopelessness, helplessness, and/or suicidal ideation. Grandiose mood, pressured speech, and flight of ideas are associated with mania.

Question 7

A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?
A) Immediately after a family visit
B) On the anniversary of significant life events in the client’s life
C) During the first few days after admission
D) Approximately 2 weeks after starting antidepressant medication

Answer 7

Ans: D
Feedback:
Observe the client closely for suicide potential, especially after antidepressant medication begins to raise the client’s mood. Risk for suicide increases as the client’s energy level is increased by medication. The other choices are not significantly associated with increased risk for suicide.

Question 8

8. The nurse is planning care for a client with major depression. Which is an appropriate expected outcome?
   A) The client will avoid causing harm to others.
   B) The client will be free from stress.
   C) The client will independently carry out activities of daily living.
   D) The client will not experience agitation.

Answer 8

Ans: C Feedback:
Expected outcomes for the depressed client include the following:
ï The client will not injure himself or herself.
ï The client will independently carry out activities of daily living (showering, changing clothing, grooming).
ï The client will establish a balance of rest, sleep, and activity.
ï The client will establish a balance of adequate nutrition, hydration, and elimination.
ï The client will evaluate self-attributes realistically.
ï The client will socialize with staff, peers, and family/friends.
ï The client will return to occupation or school activities.
ï The client will comply with the antidepressant regimen.
ï The client will verbalize symptoms of a recurrence.
Avoiding agitation and harm to others are outcomes more appropriate for a client with mania. It is unrealistic to be completely free from stress.

Question 9

A client who is depressed begins to cry and states, ìI’m just really sick of feeling this way. Nothing ever seems to go right in my life.î Which would be the most appropriate response by the nurse?
A) ìDon’t cry. Try to look at the positive side of things.î
B) ìYou are feeling really sad right now. It’s a hard time.î
C) ìHang in there. Your medication will start helping in a few days.î
D) ìNothing ever goes right?î

Answer 9

Ans: B
Feedback:
Do not cut off interactions with cheerful remarks or platitudes. Do not belittle the client’s feelings. Accept the client’s verbalizations of feelings as real, and give support for expressions of emotions, especially those that may be difficult for the client (like anger). Allow (and encourage) the client to cry. It is important that the nurse does not attempt to ìfixî the client’s difficulties

Question 10

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?
A) Administering a sedative that has been prescribed to be used PRN.
B) Insisting the client take a ìtime-outî in his room
C) Clearing the area of all other clients
D) Setting limits on aggressive and intimidating behavior

Answer 10

Ans: D
Feedback:
Because of the safety risks that clients in the manic phase take, safety plays a primary role in care, followed by issues related to self-esteem and socialization. It is necessary to set limits when they cannot set limits on themselves. Giving the client the opportunity to exercise self-control is most therapeutic. If the client cannot control his or her behavior, then more restrictive measures can be taken, such as room restriction or sedation. Clearing the area is not necessary during limit setting and may cause excessive panic on the part of other clients. When setting limits, it is important to clearly identify the unacceptable behavior and the expected, appropriate behavior. All staff must consistently set and enforce limits for those limits to be effective.

Question 11

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic?
A) Peanut butter sandwich, chips, cola
B) Fried chicken, mashed potatoes, milk
C) Ham sandwich, cheese slices, milk
D) Spaghetti, garlic bread, salad, tea

Answer 11

Ans: C
Feedback:
Finger foods, or things clients can eat while moving around, are the best options to improve nutrition. Such foods should be as high in calories and protein as possible.

Question 12

A client who is manic states, ìWhat time is it? I have to see the doctor. Is breakfast here yet? I’ve got to see the doctor first. Can I get my cereal out of the kitchen?î Which would be the most appropriate response by the nurse?
A) ìPlease slow down. I’m not sure what you need first.î
B) ìYou will have to be quiet and have breakfast after the doctor comes.î
C) ìAre you hungry?î
D) ìYour thoughts seem to be racing this morning.î

Answer 12

Ans: A
Feedback:
The speech of manic clients may be pressured: rapid, circumstantial, rhyming, noisy, or intrusive with flights of ideas. The nurse must keep channels of communication open with clients, regardless of speech patterns. The nurse can say, ìPlease speak more slowly. I’m having trouble following you.î This puts the responsibility for the communication difficulty on the nurse rather than on the client.

Question 13

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time?
A) Accompany the client to his or her room to get dressed.
B) Put the client in seclusion for his or her own protection.
C) Tell other clients to ignore the behavior because it is harmless.
D) Tell the client that the behaviors have to stop right now.

Answer 13

Ans: A
Feedback:
Redirecting the client to appropriate behavior without confrontation is most effective. Seclusion is not an appropriate intervention for this situation. Ignoring the behavior is not indicated. The client is in the manic phase; telling him or her to stop the behavior may make the behaviors escalate.

Question 14

The client with mania attempts to hit the nurse. Which is the best response by the nurse?
A) ìDo not swing at me again. If you cannot control yourself, we will help you.î
B) ìIf you do that one more time, you will be put in seclusion immediately.î
C) ìStop that. I didn’t do anything to provoke an attack.î
D) ìWhy do you continue that kind of behavior? You know I won’t let you do it.î

Answer 14

Ans: A
Feedback:
This response firmly states behavioral expectations and lets the client know his behavior will be safely controlled if he is unable to do so. The other choices are not appropriate responses to this situation.

Question 15

During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse?
A) ìDo you think you could sit still for a few minutes so we can talk?î
B) ìHow are you ever going to get any rest if you keep that music on?î
C) ìLet’s go to the conference room and talk for a while.î
D) ìTurn the radio down so we can hear ourselves talk.î

Answer 15

Ans: C
Feedback:
Redirecting the client to a quieter, smaller room will decrease external stimuli and promote calmness, so the client will eventually rest and sleep.

Question 16

At 1 AM, the client with mania rushes to the nurses’ station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse’s most therapeutic response?

A) Go to the day room and wait while I call your psychiatrist
B) Don’t be unreasonable. I can’t call the psychiatrist at this time of night.
C) I can’t call the psychiatrist now, but you and I can talk about your request for a pass.
D)You must really be upset to want a pass immediately; I’ll give you some medication.

Answer 16

C
Feedback:
This response states a limit on an unreasonable request while providing the opportunity to discuss the request. Answer choices A, B, and D are not therapeutic.

Question 17

A client with mania is in the dining room at lunchtime and is observed taking food from other clients’ trays. The nurse’s intervention should be based on which rationale?
A) As soon as lunch is over, the client will calm down.
B) Other clients need to be protected from the intrusive behavior.
C) The client’s behavior is not an imminent threat to anyone’s physical safety.
D) The client needs food and fluids in any way possible.

Answer 17

Ans: B
The nurse must set limits on this intrusive behavior because other clients have the right to be protected. The client is in the manic phase; the client may not calm down after lunch. The behavior could be an imminent threat to individual safety for many reasons, infection control included. The client’s need for food and fluids does not supersede any of the other clients’ needs for food and fluids.

Question 18

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?
A) Decrease the client’s environmental stimuli.
B) Give the client feedback about his behavior.
C) Introduce the client to other staff on the unit.
D) Tell the client about hospital rules and policies.

Answer 18

Ans: A

When the client is agitated, decreasing stimuli is the priority. Answer choices A, B, and C are not priority interventions.

Question 19

The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, ìI saw you sitting alone and thought I might keep you company.î The client turns away from the nurse. Which would be the most therapeutic nursing intervention?
A) Move to another chair closer to the client and say, ìThe staff is here to help you.î
B) Move to a chair a little further away and say, ìWe can just sit together quietly.î
C) Remain in place and say, ìHow are you feeling today?î
D) Say, ìI’ll visit with you a little later,î and leave the client alone for a while.

Answer 19

Ans: B

Moving away gives the client more personal space; staying with the client indicates acceptance and genuine interest. It is not necessary for the nurse to talk to the client the entire time; rather, silence can convey that clients are worthwhile even if they are not interacting.

Question 20

A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate?
A) Allowing the client to direct her participation at her own pace
B) Giving the client several choices of projects, so she can choose her favorite
C) Staying away from the client during the session to encourage free expression
D) Structuring the activity to facilitate completion of one specific task

Answer 20

Ans: D
The client needs to experience success in the group but is unlikely to do that independently. The other choices would not be appropriate actions for the client who is lethargic and apathetic.

Question 21

A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention?
A) Stating, ìThe effects of medications will not last forever. You will need to
eventually learn to function without them.î
B) Stating, ìMedications help your brain function better, but the therapy helps you achieve lasting behavior change.
C) Stating, Both are recommended. Since your insurance covers both, that is the best
plan for you.
D) Asking, Do you have reservations about going to therapy?

Answer 21

Ans: B

Clients and family should know that treatment outcomes are best when psychotherapy and antidepressants are combined. Psychotherapy helps clients to explore anger, dependence, guilt, hopelessness, helplessness, object loss, interpersonal issues, and irrational beliefs. The goal is to reverse negative views of the future, improve self- image, and help clients gain competence and self-mastery.

Question 22

A client who has been discharged home on Celexa (citalopram) calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions?
A) Make an appointment to change to a different medication.
B) Take the medication at night.
C) Be patient while this early side effect subsides.
D) Skip a dose if drowsiness is excessive.

Answer 22

Ans: B

Citalopram (Celexa) causes drowsiness, sedation, insomnia, nausea, vomiting, weight gain, constipation, and diarrhea. Nursing implications for drowsiness and sedation include instructing the client to administer the dose at 6 PM or later.

Question 23

The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of her husband. The nurse suggests the wife implement the limit- setting skills she has learned in family therapy. In this instance, the nurse’s action would be considered

A) inappropriate; the nurse should not give advice to the wife.
B) inappropriate; the husband has the legal right to spend personal money.
C) appropriate; the wife is responsible for the husband’s actions since he has a mental illness.
D) appropriate; the wife needs support in setting boundaries.

Answer 23

Ans: D

Family members often say they know clients have stopped taking their medication when, for example, clients become more argumentative, talk about buying expensive items that they cannot afford, hotly deny anything is wrong, or demonstrate any other signs of escalating mania. People sometimes need permission to act on their observations.

Question 24

A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply.
A) Weigh self weekly at the same time of day.
B) Drink a 2-L bottle of decaffeinated fluid daily.
C) Do not alter dietary salt intake.
D) See the doctor if you get the flu.
E) Restrict involvement in intense exercise.

Answer 24

Ans: B, C, D

Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so the lithium level will be too low. If there is too much water, lithium is diluted, and the lithium level will be too low to be therapeutic. Drinking too little water or losing fluid through excessive sweating, vomiting, or diarrhea increases the lithium level, which may result in toxicity. Monitoring daily weights and the balance between intake and output and checking for dependent edema can be helpful in monitoring fluid balance. The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration.

Question 25

The nurse is teaching a 70-year-old man about his depression. Which statement by the client would indicate that teaching has been effective?
A) All old people get depressed at times.
B) I’m glad I’ll feel better in 2 or 3 days.
C) I never knew depression could just happen for no specific reason.
D) When I reduce the stress in my life, the depression will go away.

Answer 25

Ans: C
Depression can be endogenous, with no external cause or event. Clients must understand that depression is an illness, not a lack of willpower or motivation. Major depression typically involves 2 or more weeks of a sad mood or lack of interest in life activities with at least four other symptoms of depression.

Question 26

Which individual is at highest risk for committing suicide?
A) A 71-year-old male, alcohol user, independent minded
B) A 16-year-old female, diabetic, two best friends
C) A 47-year-old male, schizophrenic, unemployed
D) A 57-year-old female, depression, active in church

Answer 26

Ans: A

In the United States, men commit approximately 72% of suicides, which is roughly three times the rate of women, although women are four times more likely than men to attempt suicide. Adults older than age 65 years compose 10% of the population but account for 25% of suicides. Suicide is the second leading cause of death (after accidents) among people 15 to 24 years of age. Clients with psychiatric disorders, especially depression, bipolar disorder, schizophrenia, substance abuse, posttraumatic stress disorder, and borderline personality disorder, are at increased risk for suicide. Chronic medical illnesses associated with increased risk for suicide include cancer, HIV or AIDS, diabetes, cerebrovascular accidents, and head and spinal cord injury. Environmental factors that increase suicide risk include isolation, recent loss, lack of social support, unemployment, critical life events, and family history of depression or suicide.

Question 27

Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide?

A) The relative’s suicide offers a sense of permission or acceptance of suicide as a method of escaping a difficult situation.
B) Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation.
C) Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation.
D) The relative’s suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide.

Answer 27

Answer: A

Those with a relative who committed suicide are at increased risk for suicide: the closer the relationship, the greater the risk. One possible explanation is that the relative’s suicide offers a sense of ìpermissionî or acceptance of suicide as a method of escaping a difficult situation. Treatment with antidepressants and spring increase in sunlight and energy may give a person with suicidal ideation the energy to act on it. If a relative commits suicide, the family members may recognize that suicide is emotionally harmful to the ones left behind and vow not to consider suicideóthis does not increase the risk of suicide.

Question 28

Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply.
A) After starting antidepressant therapy but not having reached the therapeutic level
B) After having reached the therapeutic level of antidepressants and maintained it for
several years
C) If the client has made a choice to discontinue antidepressant therapy without
medical supervision and is becoming gradually more depressed
D) If the client does not adhere to the medication regimen and takes antidepressant
medications irregularly
E) Prior to initiating antidepressant therapy but before the depression results in lack
of energy

Answer 28

Ans: A, C, D, E

Question 29

Which client is at highest risk for carrying out a suicide plan?
A) A client who plans to take a bottle of sleeping pills.
B) A client who says, ìMy life is over.î
C) A client who has a private gun collection.
D) A client who says, ìI’m going to jump off the next bridge I see.

Answer 29

Ans: C

Question 30

A client who is depressed states, ìI think my family would be better off without me. They don’t need to worry.î Which would be the most appropriate response by the nurse?
A) ìAre you planning to commit suicide?î
B) ìWhat do you think they are worried about?î
C) ìWhere are you going?î
D) ìYou don’t mean that. Your family loves you.î

Answer 30

Ans: A

Question 31

A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at his time?
A) Confiscate the soda can as a restricted item.
B) Pour the soda into a plastic cup.
C) Ask the visitor to place the soda can at the nurse’s desk until he or she leaves.
D) Ask the visitor not to bring outside items on the unit in the future.

Answer 31

Ans: B
Feedback:
For clients who are suicidal, staff members remove any item they can use to commit suicide, such as sharp objects, shoelaces, belts, lighters, matches, pencils, pens, and even clothing with drawstrings. The client could access the soda can and commit self-harm.

Question 32

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority?
A) Hopelessness related to recent divorce
B) Ineffective coping related to inadequate stress management
C) Spiritual distress related to conflicting thoughts about suicide and sin
D) Risk for suicide related to a highly lethal plan

Answer 32

Ans: D

Safety is the priority. The overall goal for the client who is suicidal is to first keep the client safe and later to help him or her to develop new coping skills that do not involve self-harm. The other choices would not be the highest priority diagnosis for this client.

Question 33

The nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. Which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal?
A) ìI just don’t understand why anyone would want to kill themselves.î
B) ìI think suicide is wrong and selfish.î
C) ìI get frustrated when my client negates all the positives I try to point out.î
D) ìI can see how much my client is hurting inside.î

Answer 33

Ans: B

Some health-care professionals consider suicidal people to be failures, immoral, or unworthy of care. These negative attitudes may result from several factors. They may reflect society’s negative view of suicide: many states still have laws against suicide, although they rarely enforce these laws. If this anxiety is not resolved, the staff person can demonstrate avoidance, demeaning behavior, and superiority to suicidal clients. Therefore, to be effective, the nurse must be aware of his or her own feelings and beliefs about suicide.

Question 34

Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply.
A) Negative societal view of suicide
B) Feeling inadequate and anxious about suicide and/or his or her own mortality
C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety
D) Being unaware of his or her own feelings and beliefs about suicide
E) Implementing nursing interventions to decrease the risk of suicide

Answer 34

Ans: A, B, C, D
Some health-care professionals consider suicidal people to be failures, immoral, or unworthy of care. These negative attitudes may result from several factors. They may reflect society’s negative view of suicide. Health-care professionals may feel inadequate and anxious dealing with suicidal clients, or they may be uncomfortable about their own mortality. Many people have had thoughts about ìending it all,î even if for a fleeting moment when life is not going well. The scariness of remembering such flirtations with suicide causes anxiety. If this anxiety is not resolved, the staff person can demonstrate avoidance, demeaning behavior, and superiority to suicidal clients. Therefore, to be effective, the nurse must be aware of his or her own feelings and beliefs about suicide.

Question 35

Chapter 18 Which disorder is characterized by pervasive mistrust and suspiciousness of others?
A) Paranoid personality disorder
B) Schizoid personality disorder
C) Histrionic personality disorder
D) Dependent personality disorder

Answer 35

Ans: A
Feedback:
Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.

Question 36

Of the following personality disorders, which are most likely related to lack of caring about others? Select all that apply.
A) Schizotypal personality disorder
B) Borderline personality disorder
C) Antisocial personality disorder
D) Narcissistic personality disorder
E) Obsessiveñcompulsive personality disorder

Answer 36

Ans: A, C, D
Feedback:
Schizotypal personality disorder is characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities. Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. Antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of othersóand with the central characteristics of deceit and manipulation. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Obsessiveñcompulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency.

Question 37

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder?
A) Insisting that others follow the rules of the unit
B) Wondering why others are being friendly to her
C) Having a tantrum if not getting enough attention
D) Getting others to make decisions for her

Answer 37

Ans: C

Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Clients usually seek treatment for depression, unexplained physical problems, and difficulties in relationships. Obsessiveñcompulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.

Question 38

A nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then display negativity. The nursing student may be showing signs of which personality disorder or behavior?
A) Paranoid
B) Borderline
C) Narcissistic
D) Passive-aggressive behavior

Answer 38

Ans: D

Passive-aggressive behavior is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances. Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Borderline personality disorder is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of empathy.

Question 39

Which thought process would cause a client with antisocial personality disorder to want to do everything for himself?
A) Belief in his own self-worth
B) Inability to delay gratification
C) Rewards for competitive behavior
D) Sense of mistrust of others

Answer 39

Ans: D
Clients believe others are just like them, that is, ready to exploit and use others for their own gain. These clients are devoid of personal emotions, and actually the self is quite shallow and empty. These clients view relationships as serving their needs and pursue others only for personal gain. There is no competition because these clients believe they are only taking care of themselves because no one else will.

Question 40

what would the nurse expect to assess in a client with narcissistic personality disorder?
A) Genuine concern for others
B) Mistrust of others
C) Grandiose and superior self-concept
D) Dependence on others for decision making

Answer 40

Ans: C

Clients with narcissistic personality disorder believe themselves superior to others and expect to be treated as such.

Question 41

Which term describes the extent to which a person considers himself to be an integral part of the universe?
A) Cooperativeness
B) Self-directedness
C) Self-transcendence
D) Character

Answer 41

Ans: C
Self-transcendence describes the extent to which a person considered himself or herself to be an integral part of the universe. Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self- confident. Character consists of concepts about the self and the external world.

Question 42

The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply.
A) Paranoid
B) Antisocial
C) Schizotypal
D) Narcissistic
E) Avoidant

Answer 42

Ans: A, B, D

Paranoid, antisocial, and narcissistic personalities need a serious, straightforward approach that includes limit setting and a matter-of-fact approach. Schizotypal personalities need to improve community functioning through social skills training. Avoidant personalities require support and reassurance to promote self-esteem.