89 Item Psychiatric Nursing Exam II : Substance Abuse, Eating disorders and
Impulse control disorders Correct Answers and Rationale
Topic: Substance Abuse, Eating disorders, Impulse control disorders.
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1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned
and doesn't know what to do with her life. She says she has quit her last five jobs because
her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend
broke up with her after she drove his car into a tree after an argument. The client's initial
diagnosis is borderline personality disorder. Which nursing observations support this
diagnosis?
A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness
C. Lack of self-esteem, strong dependency needs, and impulsive behavior
D. Insensitivity to others, sexual acting out, and violence
Rationale: Borderline personality disorder is characterized by lack of self-esteem, strong
dependency needs, and impulsive behavior. Instability in interpersonal relationships,
mood, and poor self-image also is common. Typically, the client can't tolerate being alone
and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and
unusual dress are characteristic of schizoid personality disorder. Suspiciousness,
hypervigilance, and emotional coldness are seen in paranoid personality disorders. In
antisocial personality disorder, clients are usually insensitive to others and act out
sexually; they may also be violent
2.In a toddler, which of the following injuries is most likely the result of child abuse?
A. A hematoma on the occipital region of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity
Rationale: Small circular burns on a child's back are no accident and may be from
cigarettes. Toddlers are injury prone because of their developmental stage, and falls are
frequent because of their unsteady gait; head injuries aren't uncommon. A small area of
ecchymosis isn't suspicious in this age-group.
3. A client is admitted to the emergency department after being found unconscious. Her
blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and
appears dehydrated and emaciated. After regaining consciousness, she reports that she
has had trouble eating lately and can't remember what she ate in the last 24 hours. She
also states that she has had amenorrhea for the past year. She is convinced she is fat and
refuses food. The nurse suspects that she has:
A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
,D. schizophrenia.
Rationale: Anorexia nervosa is an eating disorder characterized by self-imposed
starvation with subsequent emaciation, nutritional deficiencies, and atrophic and
metabolic changes. Typically, the client is hypotensive and dehydrated. Depending on the
severity of the disorder, anorexic clients are at risk for circulatory collapse (indicated by
hypotension), dehydration, and death. Bulimia nervosa is an eating disorder characterized
by binge eating followed by self-induced vomiting. Although depression may be
accompanied by weight loss, it isn't characterized by a body image disturbance or the
intense fear of obesity seen in anorexia nervosa. Schizophrenia may cause bizarre eating
patterns, but it rarely causes the full syndrome of anorexia nervosa.
4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses
to eat. Which of the following statements is the best response from the nurse?
A. "You don't have to eat. It's your choice."
B. "I hope you'll eat your food by mouth. Tube feedings and I.V. lines can be
uncomfortable."
C. "Why do you think you're fat? You're underweight. Here — look in the mirror."
D. "You really look terrible at this weight. I hope you'll eat."
Rationale: Clients with anorexia can refuse food to the point of cardiac damage. Tube
feedings and I.V. infusions are ordered to prevent such damage. The nurse is informing
her of her treatment options. Option A doesn't tell the client about the consequences of
choosing not to eat. Telling clients that they are too thin won't change their self-image.
5. A client with a history of substance abuse has been attending Alcoholics Anonymous
meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm
not going to those meetings anymore. I'm not like the rest of those people. I'm not a
drunk. "What is the most appropriate response?
A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."
Rationale: The substance abuser uses the substance to cope with feelings and may deny
the abuse. Asking if the client is upset about the meetings encourages the client to
identify and deal with feelings instead of covering them up. Arguing with the client about
the substance abuse (option A) or insisting that the client attend the meetings (option D)
wouldn't help the client identify resistance to treatment. Option B isn't therapeutic
behavior because it plays down the importance of attending meetings.
6. A client is admitted to the inpatient adolescent unit after being arrested for attempting
to sell cocaine to an undercover police officer. The nurse plans to write a behavioral
contract. To best promote compliance, the contract should be written:
A. abstractly.
, B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
Rationale: A contract written jointly by the client and nurse most successfully promotes
cooperation and consistent behavior. The most effective contract — and the type least
likely to allow for manipulation and misinterpretation — states the behavioral terms as
concretely as possible. A contract written solely by the client may not be agreeable to
staff members; one written by the physician and nurse may not be agreeable to the client.
7. During which phase of alcoholism is loss of control and physiologic dependence
evident?
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
Rationale: The crucial phase is marked by physical dependence. The prealcoholic phase
is characterized by drinking to medicate feelings and for relief from stress. The early
phase is characterized by sneaking drinks, blackouts, rapidly gulping drinks, and
preoccupation with alcohol. The chronic phase is characterized by emotional and physical
deterioration.
8. Which of the following is important when restraining a violent client?
A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain
the client.
D. Secure restraints to the gurney with knots to prevent escape.
Rationale: Emergency department personnel should use an organized, team approach
when restraining violent clients so that no one is injured in the process. The leader,
located at the client's head, should take charge; four staff members are required to hold
and restrain the limbs. For safety reasons, restraints should be fastened to the bed frame
instead of the side rails. For quick release, loops should be used instead of knots
9. A client who's actively hallucinating is brought to the hospital by friends. They say that
the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine
[PCP]) at a concert. Which of the following common assessment findings indicates that
the client may have ingested PCP?
A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood
Impulse control disorders Correct Answers and Rationale
Topic: Substance Abuse, Eating disorders, Impulse control disorders.
http://www.pinoybsn.tk
1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned
and doesn't know what to do with her life. She says she has quit her last five jobs because
her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend
broke up with her after she drove his car into a tree after an argument. The client's initial
diagnosis is borderline personality disorder. Which nursing observations support this
diagnosis?
A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness
C. Lack of self-esteem, strong dependency needs, and impulsive behavior
D. Insensitivity to others, sexual acting out, and violence
Rationale: Borderline personality disorder is characterized by lack of self-esteem, strong
dependency needs, and impulsive behavior. Instability in interpersonal relationships,
mood, and poor self-image also is common. Typically, the client can't tolerate being alone
and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and
unusual dress are characteristic of schizoid personality disorder. Suspiciousness,
hypervigilance, and emotional coldness are seen in paranoid personality disorders. In
antisocial personality disorder, clients are usually insensitive to others and act out
sexually; they may also be violent
2.In a toddler, which of the following injuries is most likely the result of child abuse?
A. A hematoma on the occipital region of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity
Rationale: Small circular burns on a child's back are no accident and may be from
cigarettes. Toddlers are injury prone because of their developmental stage, and falls are
frequent because of their unsteady gait; head injuries aren't uncommon. A small area of
ecchymosis isn't suspicious in this age-group.
3. A client is admitted to the emergency department after being found unconscious. Her
blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and
appears dehydrated and emaciated. After regaining consciousness, she reports that she
has had trouble eating lately and can't remember what she ate in the last 24 hours. She
also states that she has had amenorrhea for the past year. She is convinced she is fat and
refuses food. The nurse suspects that she has:
A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
,D. schizophrenia.
Rationale: Anorexia nervosa is an eating disorder characterized by self-imposed
starvation with subsequent emaciation, nutritional deficiencies, and atrophic and
metabolic changes. Typically, the client is hypotensive and dehydrated. Depending on the
severity of the disorder, anorexic clients are at risk for circulatory collapse (indicated by
hypotension), dehydration, and death. Bulimia nervosa is an eating disorder characterized
by binge eating followed by self-induced vomiting. Although depression may be
accompanied by weight loss, it isn't characterized by a body image disturbance or the
intense fear of obesity seen in anorexia nervosa. Schizophrenia may cause bizarre eating
patterns, but it rarely causes the full syndrome of anorexia nervosa.
4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses
to eat. Which of the following statements is the best response from the nurse?
A. "You don't have to eat. It's your choice."
B. "I hope you'll eat your food by mouth. Tube feedings and I.V. lines can be
uncomfortable."
C. "Why do you think you're fat? You're underweight. Here — look in the mirror."
D. "You really look terrible at this weight. I hope you'll eat."
Rationale: Clients with anorexia can refuse food to the point of cardiac damage. Tube
feedings and I.V. infusions are ordered to prevent such damage. The nurse is informing
her of her treatment options. Option A doesn't tell the client about the consequences of
choosing not to eat. Telling clients that they are too thin won't change their self-image.
5. A client with a history of substance abuse has been attending Alcoholics Anonymous
meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm
not going to those meetings anymore. I'm not like the rest of those people. I'm not a
drunk. "What is the most appropriate response?
A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."
Rationale: The substance abuser uses the substance to cope with feelings and may deny
the abuse. Asking if the client is upset about the meetings encourages the client to
identify and deal with feelings instead of covering them up. Arguing with the client about
the substance abuse (option A) or insisting that the client attend the meetings (option D)
wouldn't help the client identify resistance to treatment. Option B isn't therapeutic
behavior because it plays down the importance of attending meetings.
6. A client is admitted to the inpatient adolescent unit after being arrested for attempting
to sell cocaine to an undercover police officer. The nurse plans to write a behavioral
contract. To best promote compliance, the contract should be written:
A. abstractly.
, B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
Rationale: A contract written jointly by the client and nurse most successfully promotes
cooperation and consistent behavior. The most effective contract — and the type least
likely to allow for manipulation and misinterpretation — states the behavioral terms as
concretely as possible. A contract written solely by the client may not be agreeable to
staff members; one written by the physician and nurse may not be agreeable to the client.
7. During which phase of alcoholism is loss of control and physiologic dependence
evident?
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
Rationale: The crucial phase is marked by physical dependence. The prealcoholic phase
is characterized by drinking to medicate feelings and for relief from stress. The early
phase is characterized by sneaking drinks, blackouts, rapidly gulping drinks, and
preoccupation with alcohol. The chronic phase is characterized by emotional and physical
deterioration.
8. Which of the following is important when restraining a violent client?
A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain
the client.
D. Secure restraints to the gurney with knots to prevent escape.
Rationale: Emergency department personnel should use an organized, team approach
when restraining violent clients so that no one is injured in the process. The leader,
located at the client's head, should take charge; four staff members are required to hold
and restrain the limbs. For safety reasons, restraints should be fastened to the bed frame
instead of the side rails. For quick release, loops should be used instead of knots
9. A client who's actively hallucinating is brought to the hospital by friends. They say that
the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine
[PCP]) at a concert. Which of the following common assessment findings indicates that
the client may have ingested PCP?
A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood
