Anxiety questions personality disorders exam questions and answers complete solution docs new 2021 exam practice solution

Anxiety questions personality disorders exam questions and answers complete solution docs new 2021 exam practice solution Anxiety questions 1. The client with heart failure has severe dyspnea and is anxious, tachypneic, tachycardic. Which intervention should be the nurse’s priority? a. Administer diazepam 2.5 mg iv b. Administer morphine sulfate 2 mg iv c. Increase dopamine iv infusion by mcg/kg/min d. Increase nitroglycerin iv infusion by 5 mcg/min ans= b The nurse’s priority should be giving morphine sulfate. This medication improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea 2. The parents whose child died after being accidentally shot, tell the nurse about their involvement in gun safety legislation. The parents are using which defense mechanism? a. Denial-refusal to accept a painful reality by pretending it didn't happen b. Sublimation c. Identification-involves taking on attributes and characteristics of someone admired d. Intellectualization-excessive focus on reasoning to avoid feelings associated with a situation ans= b sublimation involves redirecting unacceptable feelings or drives into an acceptable channel 3. The client states “ for 5 years i have been physically ill and have had frequent crying episodes, feelings of worthlessness and loss of appetite on the anniversary of when my spouse died.” What should be the nurse’s focus when counseling the client? a. Anticipatory grief- grief before a loss b. Uncomplicated grief- clients self esteem remains intact with symptom resolution c. Delayed grief reaction- absence of the expression of grief d. Distorted grief reaction ans= D the nurse’s focus for counseling should be directed toward the clients distorted grief reaction. The symptoms reported by the client are exaggerated and prolonged 4. The client is being discharged after hospitalizaton for a suicide attempt. Which question asked by the nurse assesses the learned prevention and future coping strategies of the client? a. How did you try to kill yourself b. Why did you think life isn't worth living? c. What skills can you utilize if you experience problems again? d. Do you have the phone number of the suicide prevention center ans= c asking the client directly what skills he or she could utilize if similar problems occured in the future, provides the client with an opportunity to reflect on learned behaviors and to determine a plan for future prevention 5. The nurse is caring for the client with a major depressive disorder. Which client problem should be the nurse’s priority? a. Powerlessness b. Attempted suicide c. Anticipatory grieving d. Disturbed sleep pattern ans= b the potential for suicdal behavior is priority for the client with a major depressive disorder who previously attempted suicide 6. The client is newly prescribed tramadol hydrochloride for chronic pain. The client is also taking fluoxetine 40 mg daily for depression. Which nursing action is most important? a. Instruct the client to drink plenty of water b. Ask the hcp about increasing the fluoxetine dose c. Monitor the signs of serotonin syndrome d. Administer both medications with food Ans- c tramadol hydrochloride (ultram) a centrally acting analgesic, and fluoxetine (prozac) an ssri, both inhibit the reuptake of serotonin in the cns. This combination can result in serotonin syndrome, a life threatening event. 7. The newly admitted client is diagnosed with generalized anxiety disorder. Which nursing assessment findings would be consistent with the diagnosis? a. Irritability b. Muscle tension c. Expansive mood with pressured speech d. Restlessness or feeling keyed up or on edge e. Difficulty controlling the anxiety ans=a, b, d, e 8. The client tells the nurse “i have an intense fear of dogs. I can't visit others unless i know that there are no dogs around. This fear seems unreasonable, but it continues to be a problem. Which conclusion by the nurse is accurate? ans= a fear that is recognized as excessive and unreasonable is a criterion for phobias. 9. The client with an anxiety disorder tells the nurse that being in crowds creates thought of losing control and the need to quickly leave. Which therapy should the nurse recommend for this client? a. Family systems therapy- when its dysfunction pertaining to the family b. Psychoanalytical therapy- repressed conflicts that are both conscious/unconscious c. Electroconvulsive therapy- intervention for major depression, med admin during ect d. Cognitive behavioral therapy ans=d cognitive behavioral therapy is a treatment that focuses on patterns of thinking that are maladaptive and would be an effective choice for the described symptoms 10. The nurse is caring for a victim of sexual assault brought to the ed by a roommate. How should the nurse respond when the client begins to angrily insist upon reporting the details of the assault? a. Ask the roommate to sit with the client until the exam can be resumed b. Redirect the client to the physical tasks related to securing any existing evidence c. Encourage the client to use deep breathing techniques to regain emotional control d. Listen quietly as the client expresses the anger and rage currently being experienced. ans= d ● It is important to allow, even encourage the victim to express these emotions in order to best initiate treatment 11. The young adult who was robbed is attending counseling sessions to address anxiety issues. What is the best response when the client asks when will things get better for me? by using the skills you're learning the goal for you is to feel better or be back to normal in about 6 weeks. ● This response is the best because it answers the clients question and addresses the goal of counseling. Goal is to get patient back to pre crisis level 12. The client who does not speak or understand english was assaulted and an agency interpreter is present at the time of assessment. Which action is most appropriate for the nurse while utilizing the interpreter? Asking the question directly to the client ● It allows the client and nurse to develop a relationship and allows the client to feel included in his or her plan of care 13. A 10 year old who was sexually abused by a relative experiences flashback of a disagreement with that adult and resulting sexual assault. Which suggestion by the nurse to the child's parents would help minimize this reaction? You and your child should regularly discuss bad memories to decrease their effect. 14. The child who was physically abused has begun pulling out hair. The behavior appears to be a result of the child's repressed anger. To facilitate the child's recovery the nurse encourages the parent to initially implement which response? Accept the hair pulling until therapy can substitute this behavior by addressing the anger Personality disorders 15. The nurse is assessing the client with paranoid personality disorder. Which behavior should the nurse expect? Analyzes the behavior of others to find hidden and threatening meanings ● exhibits mistrust and suspicion of others such that the behavior of others is analyzed to find hidden and threatening meaning 16. The nurse is working with the client with paranoid personality disorder. The nurse considers that the client likely experienced what in the past? Little affection or approval during the childhood years 17. The nurse is caring for the client with paranoid personality disorder. Which approach should the nurse use when working with the client? Use a businesslike manner using clear, concrete, and specific words ● They take everything seriously and are attuned to the actions and motivations of others. Will decrease ambiguity 18. The client who has no psychiatric history is in the EDn after physically assaulting his wife. The client is frightened by his loss of control, which he states was precipitated by his wifes complaining and lack of support. The client states, I'm self-employed, expanded my company nationally, and have many well-known friends. The client's wife states “ the business is losing money, yet he continues his lavish lifestyle; what is important to him is who he knows and how it looks! The nurse determines that the client behavior is typical of which disorder? a. Paraphilia - sexual fantasies or behaviors involving repetitive sexual activity with real or simulated suffering or humiliation b. Psychogenic amnesia -neurocognitive disorder caused by an impact to the head or other mechanism that displaces the brain c. Borderline personality disorder- self injury before injuring others d. Narcissistic personality disorder ● Characterized by constant seeking of praise and attention; an egocentric attitude, and envy, rage, and violence when others are not supportive 19. During the initial home visit, the nurse discovers cluttered possessions taking up 75% of the clients living space and obstructing access into the home and all rooms except the bathroom. How should the nurse interpret the client's behavior? a. Inability to focus related to possible passive-aggressive personality disorder b. An attention-seeking behavior related to possible histrionic personality disorder c. Hoarding behavior obsessive compulsive personality disorder d. Inattentiveness to surroundings related to possible bpd ● Hoarding behavior is associated with ocd and obsessive compulsive personality disorder. It is due to fear and anxiety concerning loss of control over situations, objects, or people. ● Passive aggressive personality disorder-involves the resentment of responsibility and the expression of distaste, does not include behavior exhibited by the client ● Histrionic disorder involves attention seeking behavior, the accumulation of possessions would not be typical attention-seeking behavior ● BPD - involves fear of rejection in relationships and impulsivity, and not inattentiveness to their surroundings ● 20. The nurse is developing the plan of care with schizoid personality disorder. Which primary outcome should the nurse include? a. Recognizes limits b. Able to cope and control emotions c. Validates ideas before taking action d. Able to function independently in the community ● An outcome for the individual with schizoid personality disorder focuses on improving functioning within the community 21. The nurse is planning care for the client with avoidant personality disorder. Which interventions should the nurse plan? Select all that apply a. Using reframing technique- b. Explore positive self-aspects c. Practice social skills with client d. Use decatastrophizing technique e. Identify negative response from others ● Reframing is a cognitive behavioral technique where alternative points of view are examined to explain events and used to enhance self worth of the person with avoidant personality disorder ● Exploring positive aspects of self is used to enhance self worth of the person with avoidant personality disorder ● Practicing social skills with the client in the safety of the nurse client relationship will help the client reduce social fears and develop meaningful social contact and relationship skills ● Decatastrophizing is a method of learning to assess situations in a realistic manner instead of assuming a catastrophe will happen. Using this can enhance self worth. 22. The nurse is working with the individual with obsessive compulsive personality disorder. Which approach should the nurse use? a. Inflexible and autocratic b. Calm and confrontational c. Direct, hurried, and organized d. Uninterrrupted and confrontational ● Persons with obsessive compulsive personality disorder ten to maintain control by carefully and thoroughly following procedures. It is important to use a calm and non confrontational approach, as any request is likely to increase the client's anxiety level 23. The client with OCD is refusing treatment for hand and face wounds caused by excessive washing and treatment for the OCD diagnosis. Which nursing actions are appropriate? Select all that apply? a. Do no treat the client; client is competent b. Treat the clients injuries; the client is incompetent c. Notify the clients family, teh client is incompetent d. Notify the hcp of the refusal, the client is competent e. Notify the hcp of the refusal the client is incompetent ● The client has the right to refuse treatment, the client is competent ● The nurse should notify the clients hcp of the refusal for treatment, and acknowledge that the client is competent. A diagnosis of OCD does not indicate that the client is incompetent 24. The nurse observes that the client diagnosed with obsessive compulsive personality disorder is exhibiting reaction formation. The nurse should plan to assess for which other defense mechanisms commonly associated with this disorder? Select all that apply? a. Isolation b. Undoing c. Projection- attributing to another person the feelings or impulses that are unacceptable to oneself d. Introjection- internalization of the beliefs and values of another person e. Rationalization f. intellectualization ● Isolation is a defense mechanism to separate a thought or memory from the feelings or emotions associated with it ● Undoing is a defense mechanism to symbolically negate or cancel out a previous action or experience that is found to be intolerable ● Rationalization is the attempt to make excuses or formulate logical reasons to justify unacceptable feeling or behaviors ● Intellectualization is an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis 25. The nurse is planning a counseling session with the client who has antisocial personality disorder. The nurse should anticipate that the client would use which primary ego defense mechanism? a. Projection b. sublimation - channeling of unacceptable impulses, thoughts, and emotions into acceptable ones c. Compensation- counterbalancing weaknesses with strengths d. Rationalization- putting things into a different acceptable perspective ● Projection is attributing feelings or impulses that are unacceptable to oneself onto another person. The person with antisocial personality disorder will exploit and manipulate others for personal gain 26. The hcp writes in the clients progress notes. “Will switch medications from the older medications to a newer gabaergic anticonvulsant to treat clients instability of mood, transient mood crashes, and inappropriate and intense outbursts of anger.” which medication should the nurse consider when reviewing the hcp new prescriptions? a. Lithium b. Gabapentin c. Valproic acid d. Carbamazepine ● Gaba is the main inhibitory neurotransmitter in the CNS. GABAergic anticonvulsants such as gabapentin (neurontin) appear to act by regulating neural firing in the mesolimbic area ● Lithium (lithobid) is an older medication used to control mood and has a greater number of side effects ● Valproic acid (depacon) is an older medication used to control mood and has a greater number of side effects ● Carbamazepine (carbatrol) is an older medication used to control mood and has a greater number of side effects 27. A 75 year old patient. The nurse is checking the mar illustrated for the client newly admitted to a behavioral health unit. Which med should the nurse question a. Risperdone 1mg on day 1, 2 mg on day 2, 3 mg on day 3 b. Fluoxetine 10 mg orally c. Carbamazepine 200 mg oral bid d. Docusate sodium 100 mg oral daily ● Risperidone (risperdal) an antipsychotic medication, is prescribed at the regular adult dose and is not at an appropriate dose for an older adult. Metabolism is slowed with aging and adverse reactions can occur quickly in older adults. 28. The client with BPD is prescribed phenelzine for decreasing impulsivity and self- destructive acts. The nurse teaches the client to avoid foods high in tyramine when taking phenelzine to prevent what effect? a. A hypotensive crisis b. A hypertensive crisis c. Poor absorption of tyramine d. Cardiac rhythm abnormalities The combination of tyramine-containing foods and MAOI”S such as phenelzine (nardil) can result in a hypertensive crisis 29. The client has antisocial personality disorder. What is the nurse's best rationale for including milieu therapy in the client's treatment plan? a. Sets limits on the clients unacceptable behavior b. Provides a very structured setting that helps the client learn how to behave c. Simulates a social community where the client can learn to interact with peers d. Provides on on one interaction and reality orientation with client and nursing personnel ● Milieu therapy helps the client with antisocial personality disorder learn to respond adaptively to feedback from peers. Community meetings and group therapy sessions simulate the societal situation in which the client must live.