ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING CHAPTERS 1 UPDATED ACTUAL
EXAM QUESTIONS CORRECT ANSWERS GRADED A PLUS
Question:
medication you try to give me."
Answer:
ANS: A Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential
for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The
incorrect options do not feature violation of another's rights. 2. Which scenario predicts the highest
risk for directing violent behavior toward others? a. Major depression with delusions of
worthlessness b. Obsessive-compulsive disorder; performing many rituals c. Paranoid delusions of
being followed by alien monsters d. Completing alcohol withdrawal and beginning a rehabilitation
program - ✓✓ANS: C The correct answer illustrates the greatest disruption of ability to perceive
reality accurately. People who feel persecuted may strike out against those believed to be
persecutors. The patients identified in the distracters have better reality- testing ability. 3. A patient
is hospitalized after an arrest for breaking windows in the home of a former domestic partner. The
history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for
disorderly conduct. Which nursing diagnosis has priority? a. Risk for injury b. Posttrauma response
c. Disturbed thought processes d. Risk for other-directed violence -✓✓ANS: D The defining
characteristics for Risk for other-directed violence include a history of being abused as a child,
having committed other violent acts, and demonstrating poor impulse control. The defining
characteristics for the other diagnoses are not present in this scenario. 4. A confused older adult
patient in a skilled care facility is in bed sleeping. The nurse enters the room quietly and touches the
bed to see if it is wet. The patient awakens and hits the nurse in the face. Which statement best
explains the patient's action? a. Older adult patients often demonstrate exaggerations of behaviors
used earlier in life. b. Crowding in skilled care facilities increases individual tendencies toward
violence. c. The patient interpreted the health care worker's behavior as potentially harmful. d. This
patient learned violent behavior by watching other patients act out. - ✓✓ANS: C Confused patients
are not always able to evaluate accurately the actions of others. This patient behaved as though
provoked by the intrusive actions of the staff member. 5. A patient is pacing the hall near the nurses'
station, swearing loudly. An appropriate initial intervention for the nurse would be to address the
patient by name and say: a. "Hey, what's going on?" b. "Please quiet down immediately." c. "I'd like
to talk with you about how you're feeling right now." d. "You must go to your room and try to get
control of yourself." -✓✓ANS: C Intervention should begin with an analysis of the patient and
situation. With this response, the nurse is attempting to hear the patient's feelings and concerns,
which leads to the next step of planning an intervention. 6. A patient was responding to auditory
,hallucinations earlier in the morning. The patient approaches the nurse, shaking a fist and shouting,
"Back off!" and then goes into the day room. As the nurse follows the patient into the day room, the
nurse should: a. make sure adequate physical space exists between the nurse and the patient. b. move
into a position that allows the patient to be close to the door. c. maintain one arm's length distance
from the patient. d. sit down in a chair near the patient. -✓✓ANS: A Making sure space is present
between the nurse and the patient avoids invading the patient's personal space. Personal space needs
increase when a patient feels anxious and threatened. Allowing the patient to block the nurse's exit
from the room is not wise. Closeness may be threatening to the patient and provoke aggression.
Sitting is inadvisable until further assessment suggests the patient's aggression is abating. One arm's
length is inadequate space. 7. An intramuscular dose of antipsychotic medication needs to be given
to a patient who is becoming increasingly more aggressive. The patient is in the day room. The
nurse should enter the day room: a. and say, "Would you like to come to your room and take some
medication your doctor prescribed for you?" b. accompanied by three staff members and say,
"Please come to your room so I can give you some medication that will help you feel more
comfortable." c. and place the patient in a basket-hold and then say, "I am going to take you to your
room to give you an injection of medication to calm you." d. accompanied by a male nursing
assistant and tell the patient, "You can come to your room willingly so I can give you this
medication, or the aide and I will take you there." -✓✓ANS: B A patient gains feelings of security if
he or she sees that others are present to help with control. The nurse gives a simple direction,
honestly states what is going to happen, and reassures the patient that the intervention will be
helpful. This positive approach assumes that the patient can act responsibly and will maintain
control. Physical control measures should be used only as a last resort. 8. After an assault by a
patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The
nurse says, "I dread facing potentially violent patients." Which response would be the most urgent
reason for this nurse to seek supervision? a. Startle reactions b. Difficulty sleeping c. Wish for
revenge d. Preoccupation with the incident -✓✓ANS: C The desire for revenge signals an urgent
need for professional supervision to work through anger and counter the aggressive feelings. The
distracters are normal in a person who has been assaulted. Nurses are usually relieved with crisis
intervention and follow-up designed to give support, help the individual regain a sense of control,
and make sense of the event. 9. The staff development coordinator plans to teach the use of physical
management techniques when patients become assaultive. Which topic should be emphasized? a.
Practice and teamwork b. Spontaneity and surprise c. Caution and superior size d. Diversion and
physical outlets -✓✓ANS: A Intervention techniques are learned behaviors that must be practiced to
be used in a smooth, organized fashion. Every member of the intervention team should be assigned a
specific task to carry out before beginning the intervention. The other options are useless if the staff
does not know how to use physical techniques and how to apply them in an organized fashion. 10.
An adult patient assaults another patient and is restrained. One hour later, which statement by this
restrained patient necessitates the nurse's immediate attention? a. "I hate all of you!" b. "My fingers
are tingly." c. "You wait until I tell my lawyer." d. "It was not my fault. The other patient started it."
-✓✓ANS: B The correct response indicates impaired circulation and necessitates the nurse's
immediate attention. The incorrect responses indicate that the patient has continued aggressiveness
and agitation. 11. Which is an effective nursing intervention to assist an angry patient to learn to
,manage anger without violence? a. Help the patient identify a thought that increases anger, find
proof for or against the belief, and substitute reality-based thinking. b. Provide negative
reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence
is present. c. Use aversive conditioning, such as popping a rubber band on the wrist, to help
extinguish angry feelings. d. Administer an antipsychotic or antianxiety medication. -✓✓ANS: A
Anger has a strong cognitive component; therefore using cognition to manage anger is logical. The
incorrect options do nothing to help the patient learn anger management. 12. Which assessment
finding presents the greatest risk for violent behavior? A patient who: a. is severely agoraphobic. b.
has a history of spousal abuse. c. demonstrates bizarre somatic delusions. d. verbalizes hopelessness
and powerlessness. -✓✓ANS: B A history of prior aggression or violence is the best predictor of
patients who may become violent. Patients with anxiety disorders are not particularly prone to
violence unless panic occurs. Patients experiencing hopelessness and powerlessness may have
co-existing anger, but violence is not often demonstrated. Patients with paranoid delusions are at
greater risk for violence than those with bizarre somatic delusions. 13. A patient being admitted
suddenly pulls a knife from a coat pocket and threatens, "I will kill anyone who tries to get near me."
An emergency code is called. The patient is safely disarmed and placed in seclusion. Justification
for the use of seclusion is that the patient: a. evidences a thought disorder, rendering rational
discussion ineffective. b. presents a clear and present danger to others. c. presents a clear escape
risk. d. is psychotic. -✓✓ANS: B The patient's threat to kill self or others with the knife he possesses
constitutes a clear and present danger to self and others. The distracters are not sufficient reasons for
seclusion. 14. A patient sits in silence for 20 minutes after a therapy appointment, appearing tense
and vigilant. The patient abruptly stands and paces back and forth, clenching and unclenching fists,
and then stops and stares in the face of a staff member. The patient is: a. demonstrating withdrawal.
b. working through angry feelings. c. attempting to use relaxation strategies. d. exhibiting clues to
potential aggression. -✓✓ANS: D The description of the patient's behavior shows the classic signs
of someone whose potential for aggression is increasing. 15. A cognitively impaired patient has
been a widow for 30 years. This patient is frantically trying to leave the unit, saying, "I have to go
home to cook dinner before my husband arrives from work." To intervene with validation therapy,
the nurse should say: a. "You must come away from the door." b. "You have been a widow for many
years." c. "You want to go home to prepare your husband's dinner?" d. "Was your husband angry if
you did not have dinner ready on time?" -✓✓ANS: C Validation therapy meets the patient "where
she or he is at the moment" and acknowledges the patient's wishes. Validation does not seek to
redirect, reorient, or probe. The other options do not validate patient feelings. 16. A patient with a
history of anger and impulsivity is hospitalized after an accident resulting in injuries. When in pain,
the patient loudly scolds the nursing staff for "not knowing enough to give me pain medicine when I
need it." Which nursing intervention would best address this problem? a. Tell the patient to notify
nursing staff 30 minutes before the pain returns so the medication can be prepared. b. Urge the
health care provider to change the prescription for pain medication from as needed to a regular
schedule. c. Tell the patient that verbal assaults on nurses will not shorten the wait for pain
medication. d. Have the clinical nurse leader request a psychiatric consultation. -✓✓ANS: B
Scheduling the medication at specific intervals will help the patient anticipate when the medication
can be given. Receiving the medication promptly on schedule, rather than expecting nurses to
, anticipate the pain level, should reduce anxiety and anger. The patient cannot predict the onset of
pain before it occurs. 17. A patient has a history of impulsively acting out anger by striking others.
Which would be an appropriate plan for avoiding such incidents? a. Explain that restraint and
seclusion will be used if violence occurs. b. Help the patient identify incidents that trigger impulsive
acting out. c. Offer one-on-one supervision to help the patient maintain control. d. Give the patient
lorazepam (Ativan) every 4 hours to reduce anxiety. -✓✓ANS: B Identifying trigger incidents
allows the patient and nurse to plan interventions to reduce irritation and frustration that lead to
acting out anger and to put more adaptive coping strategies eventually into practice. 18. A patient
with severe injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the
patient screams, "Don't touch me! You are so stupid. You will make it worse!" Which intervention
uses a cognitive technique to help the patient? a. Wordlessly discontinue the dressing change, and
then leave the room. b. Stop the dressing change, saying, "Perhaps you would like to change your
own dressing." c. Continue the dressing change, saying, "Do you know this dressing change is
needed so your wound will not get infected?" d. Continue the dressing change, saying,
"Unfortunately, you have no choice in this because your doctor ordered this dressing change."
-✓✓ANS: C Anger is cognitively driven. The correct answer helps the patient test his cognitions
and may help lower his anger. The incorrect options will escalate the patient's anger by belittling or
escalating the patient's sense of powerlessness. 19. Which medication should a nurse administer to
provide immediate intervention for a psychotic patient whose aggressive behavior continues to
escalate despite verbal intervention? a. lithium (Eskalith) b. trazodone (Desyrel) c. olanzapine
(Zyprexa) d. valproic acid (Depakene) -✓✓ANS: C Olanzapine is a short-acting antipsychotic drug
that is useful in calming angry, aggressive patients regardless of their diagnosis. The other drugs
listed require long-term use to reduce anger. Lithium is for patients with bipolar disorder. Trazodone
is for patients with depression, insomnia, or chronic pain. Valproic acid is for patients with bipolar
disorder or for those who are borderline bipolar. 20. An emergency department nurse realizes that
the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should
the nurse use to prevent escalation of anger? a. Explain that the patient's condition is not life
threatening. b. Periodically provide an update and progress report on the patient. c. Explain that all
patients are treated in order, based on their medical needs. d. Suggest that the spouse return home
until the patient's treatment is completed. -✓✓ANS: B Periodic updates reduce anxiety and defuse
anger. This strategy acknowledges the spouse's presence and concerns. The incorrect options would
be likely to increase anger because they imply that the anxiety is inappropriate. 21. Information
from a patient's record that indicates marginal coping skills and the need for careful assessment of
the risk for violence is a history of: a. childhood trauma. b. family involvement. c. academic
problems. d. chemical dependence. -✓✓ANS: D The nurse should suspect marginal coping skills in
a patient with chemical dependence. He or she is often anxious, may be concerned about inadequate
pain relief, and may have a personality style that externalizes blame. The incorrect options do not
signal as high a degree of risk as chemical dependence. 22. A patient with pneumonia has been
hospitalized for 4 days. Family members describe the patient as "a difficult person who finds fault
with others." The patient verbally abuses nurses for their poor care. The most likely explanation lies
in: a. poor childrearing that did not teach respect for others. b. automatic thinking, leading to
cognitive distortion. c. personality style that externalizes problems. d. delusions that others wish to
EXAM QUESTIONS CORRECT ANSWERS GRADED A PLUS
Question:
medication you try to give me."
Answer:
ANS: A Aggression is harsh physical or verbal action that reflects rage, hostility, and the potential
for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The
incorrect options do not feature violation of another's rights. 2. Which scenario predicts the highest
risk for directing violent behavior toward others? a. Major depression with delusions of
worthlessness b. Obsessive-compulsive disorder; performing many rituals c. Paranoid delusions of
being followed by alien monsters d. Completing alcohol withdrawal and beginning a rehabilitation
program - ✓✓ANS: C The correct answer illustrates the greatest disruption of ability to perceive
reality accurately. People who feel persecuted may strike out against those believed to be
persecutors. The patients identified in the distracters have better reality- testing ability. 3. A patient
is hospitalized after an arrest for breaking windows in the home of a former domestic partner. The
history reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for
disorderly conduct. Which nursing diagnosis has priority? a. Risk for injury b. Posttrauma response
c. Disturbed thought processes d. Risk for other-directed violence -✓✓ANS: D The defining
characteristics for Risk for other-directed violence include a history of being abused as a child,
having committed other violent acts, and demonstrating poor impulse control. The defining
characteristics for the other diagnoses are not present in this scenario. 4. A confused older adult
patient in a skilled care facility is in bed sleeping. The nurse enters the room quietly and touches the
bed to see if it is wet. The patient awakens and hits the nurse in the face. Which statement best
explains the patient's action? a. Older adult patients often demonstrate exaggerations of behaviors
used earlier in life. b. Crowding in skilled care facilities increases individual tendencies toward
violence. c. The patient interpreted the health care worker's behavior as potentially harmful. d. This
patient learned violent behavior by watching other patients act out. - ✓✓ANS: C Confused patients
are not always able to evaluate accurately the actions of others. This patient behaved as though
provoked by the intrusive actions of the staff member. 5. A patient is pacing the hall near the nurses'
station, swearing loudly. An appropriate initial intervention for the nurse would be to address the
patient by name and say: a. "Hey, what's going on?" b. "Please quiet down immediately." c. "I'd like
to talk with you about how you're feeling right now." d. "You must go to your room and try to get
control of yourself." -✓✓ANS: C Intervention should begin with an analysis of the patient and
situation. With this response, the nurse is attempting to hear the patient's feelings and concerns,
which leads to the next step of planning an intervention. 6. A patient was responding to auditory
,hallucinations earlier in the morning. The patient approaches the nurse, shaking a fist and shouting,
"Back off!" and then goes into the day room. As the nurse follows the patient into the day room, the
nurse should: a. make sure adequate physical space exists between the nurse and the patient. b. move
into a position that allows the patient to be close to the door. c. maintain one arm's length distance
from the patient. d. sit down in a chair near the patient. -✓✓ANS: A Making sure space is present
between the nurse and the patient avoids invading the patient's personal space. Personal space needs
increase when a patient feels anxious and threatened. Allowing the patient to block the nurse's exit
from the room is not wise. Closeness may be threatening to the patient and provoke aggression.
Sitting is inadvisable until further assessment suggests the patient's aggression is abating. One arm's
length is inadequate space. 7. An intramuscular dose of antipsychotic medication needs to be given
to a patient who is becoming increasingly more aggressive. The patient is in the day room. The
nurse should enter the day room: a. and say, "Would you like to come to your room and take some
medication your doctor prescribed for you?" b. accompanied by three staff members and say,
"Please come to your room so I can give you some medication that will help you feel more
comfortable." c. and place the patient in a basket-hold and then say, "I am going to take you to your
room to give you an injection of medication to calm you." d. accompanied by a male nursing
assistant and tell the patient, "You can come to your room willingly so I can give you this
medication, or the aide and I will take you there." -✓✓ANS: B A patient gains feelings of security if
he or she sees that others are present to help with control. The nurse gives a simple direction,
honestly states what is going to happen, and reassures the patient that the intervention will be
helpful. This positive approach assumes that the patient can act responsibly and will maintain
control. Physical control measures should be used only as a last resort. 8. After an assault by a
patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The
nurse says, "I dread facing potentially violent patients." Which response would be the most urgent
reason for this nurse to seek supervision? a. Startle reactions b. Difficulty sleeping c. Wish for
revenge d. Preoccupation with the incident -✓✓ANS: C The desire for revenge signals an urgent
need for professional supervision to work through anger and counter the aggressive feelings. The
distracters are normal in a person who has been assaulted. Nurses are usually relieved with crisis
intervention and follow-up designed to give support, help the individual regain a sense of control,
and make sense of the event. 9. The staff development coordinator plans to teach the use of physical
management techniques when patients become assaultive. Which topic should be emphasized? a.
Practice and teamwork b. Spontaneity and surprise c. Caution and superior size d. Diversion and
physical outlets -✓✓ANS: A Intervention techniques are learned behaviors that must be practiced to
be used in a smooth, organized fashion. Every member of the intervention team should be assigned a
specific task to carry out before beginning the intervention. The other options are useless if the staff
does not know how to use physical techniques and how to apply them in an organized fashion. 10.
An adult patient assaults another patient and is restrained. One hour later, which statement by this
restrained patient necessitates the nurse's immediate attention? a. "I hate all of you!" b. "My fingers
are tingly." c. "You wait until I tell my lawyer." d. "It was not my fault. The other patient started it."
-✓✓ANS: B The correct response indicates impaired circulation and necessitates the nurse's
immediate attention. The incorrect responses indicate that the patient has continued aggressiveness
and agitation. 11. Which is an effective nursing intervention to assist an angry patient to learn to
,manage anger without violence? a. Help the patient identify a thought that increases anger, find
proof for or against the belief, and substitute reality-based thinking. b. Provide negative
reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence
is present. c. Use aversive conditioning, such as popping a rubber band on the wrist, to help
extinguish angry feelings. d. Administer an antipsychotic or antianxiety medication. -✓✓ANS: A
Anger has a strong cognitive component; therefore using cognition to manage anger is logical. The
incorrect options do nothing to help the patient learn anger management. 12. Which assessment
finding presents the greatest risk for violent behavior? A patient who: a. is severely agoraphobic. b.
has a history of spousal abuse. c. demonstrates bizarre somatic delusions. d. verbalizes hopelessness
and powerlessness. -✓✓ANS: B A history of prior aggression or violence is the best predictor of
patients who may become violent. Patients with anxiety disorders are not particularly prone to
violence unless panic occurs. Patients experiencing hopelessness and powerlessness may have
co-existing anger, but violence is not often demonstrated. Patients with paranoid delusions are at
greater risk for violence than those with bizarre somatic delusions. 13. A patient being admitted
suddenly pulls a knife from a coat pocket and threatens, "I will kill anyone who tries to get near me."
An emergency code is called. The patient is safely disarmed and placed in seclusion. Justification
for the use of seclusion is that the patient: a. evidences a thought disorder, rendering rational
discussion ineffective. b. presents a clear and present danger to others. c. presents a clear escape
risk. d. is psychotic. -✓✓ANS: B The patient's threat to kill self or others with the knife he possesses
constitutes a clear and present danger to self and others. The distracters are not sufficient reasons for
seclusion. 14. A patient sits in silence for 20 minutes after a therapy appointment, appearing tense
and vigilant. The patient abruptly stands and paces back and forth, clenching and unclenching fists,
and then stops and stares in the face of a staff member. The patient is: a. demonstrating withdrawal.
b. working through angry feelings. c. attempting to use relaxation strategies. d. exhibiting clues to
potential aggression. -✓✓ANS: D The description of the patient's behavior shows the classic signs
of someone whose potential for aggression is increasing. 15. A cognitively impaired patient has
been a widow for 30 years. This patient is frantically trying to leave the unit, saying, "I have to go
home to cook dinner before my husband arrives from work." To intervene with validation therapy,
the nurse should say: a. "You must come away from the door." b. "You have been a widow for many
years." c. "You want to go home to prepare your husband's dinner?" d. "Was your husband angry if
you did not have dinner ready on time?" -✓✓ANS: C Validation therapy meets the patient "where
she or he is at the moment" and acknowledges the patient's wishes. Validation does not seek to
redirect, reorient, or probe. The other options do not validate patient feelings. 16. A patient with a
history of anger and impulsivity is hospitalized after an accident resulting in injuries. When in pain,
the patient loudly scolds the nursing staff for "not knowing enough to give me pain medicine when I
need it." Which nursing intervention would best address this problem? a. Tell the patient to notify
nursing staff 30 minutes before the pain returns so the medication can be prepared. b. Urge the
health care provider to change the prescription for pain medication from as needed to a regular
schedule. c. Tell the patient that verbal assaults on nurses will not shorten the wait for pain
medication. d. Have the clinical nurse leader request a psychiatric consultation. -✓✓ANS: B
Scheduling the medication at specific intervals will help the patient anticipate when the medication
can be given. Receiving the medication promptly on schedule, rather than expecting nurses to
, anticipate the pain level, should reduce anxiety and anger. The patient cannot predict the onset of
pain before it occurs. 17. A patient has a history of impulsively acting out anger by striking others.
Which would be an appropriate plan for avoiding such incidents? a. Explain that restraint and
seclusion will be used if violence occurs. b. Help the patient identify incidents that trigger impulsive
acting out. c. Offer one-on-one supervision to help the patient maintain control. d. Give the patient
lorazepam (Ativan) every 4 hours to reduce anxiety. -✓✓ANS: B Identifying trigger incidents
allows the patient and nurse to plan interventions to reduce irritation and frustration that lead to
acting out anger and to put more adaptive coping strategies eventually into practice. 18. A patient
with severe injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the
patient screams, "Don't touch me! You are so stupid. You will make it worse!" Which intervention
uses a cognitive technique to help the patient? a. Wordlessly discontinue the dressing change, and
then leave the room. b. Stop the dressing change, saying, "Perhaps you would like to change your
own dressing." c. Continue the dressing change, saying, "Do you know this dressing change is
needed so your wound will not get infected?" d. Continue the dressing change, saying,
"Unfortunately, you have no choice in this because your doctor ordered this dressing change."
-✓✓ANS: C Anger is cognitively driven. The correct answer helps the patient test his cognitions
and may help lower his anger. The incorrect options will escalate the patient's anger by belittling or
escalating the patient's sense of powerlessness. 19. Which medication should a nurse administer to
provide immediate intervention for a psychotic patient whose aggressive behavior continues to
escalate despite verbal intervention? a. lithium (Eskalith) b. trazodone (Desyrel) c. olanzapine
(Zyprexa) d. valproic acid (Depakene) -✓✓ANS: C Olanzapine is a short-acting antipsychotic drug
that is useful in calming angry, aggressive patients regardless of their diagnosis. The other drugs
listed require long-term use to reduce anger. Lithium is for patients with bipolar disorder. Trazodone
is for patients with depression, insomnia, or chronic pain. Valproic acid is for patients with bipolar
disorder or for those who are borderline bipolar. 20. An emergency department nurse realizes that
the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should
the nurse use to prevent escalation of anger? a. Explain that the patient's condition is not life
threatening. b. Periodically provide an update and progress report on the patient. c. Explain that all
patients are treated in order, based on their medical needs. d. Suggest that the spouse return home
until the patient's treatment is completed. -✓✓ANS: B Periodic updates reduce anxiety and defuse
anger. This strategy acknowledges the spouse's presence and concerns. The incorrect options would
be likely to increase anger because they imply that the anxiety is inappropriate. 21. Information
from a patient's record that indicates marginal coping skills and the need for careful assessment of
the risk for violence is a history of: a. childhood trauma. b. family involvement. c. academic
problems. d. chemical dependence. -✓✓ANS: D The nurse should suspect marginal coping skills in
a patient with chemical dependence. He or she is often anxious, may be concerned about inadequate
pain relief, and may have a personality style that externalizes blame. The incorrect options do not
signal as high a degree of risk as chemical dependence. 22. A patient with pneumonia has been
hospitalized for 4 days. Family members describe the patient as "a difficult person who finds fault
with others." The patient verbally abuses nurses for their poor care. The most likely explanation lies
in: a. poor childrearing that did not teach respect for others. b. automatic thinking, leading to
cognitive distortion. c. personality style that externalizes problems. d. delusions that others wish to
