Exam (elaborations) NURSING NR 326 Mental health Study Guide

Which of the following are typical behaviors observed in clients with frotteuristic disorder? A. The sexual focus is on nonliving objects. B. Exposure of one's genitals to an unsuspecting stranger C. Observation of an unsuspecting person who is naked D. Touching and rubbing against a nonconsenting person Answer is D. Touching and rubbing against a non-consenting person describes a person with frotteuristic disorder A nursing instructor is teaching a class about normal human sexuality. Which of the following information should be included? A. Gender identity develops during adolescence. B. Sexual drives remain consistent throughout the life span. C. Many medications can impact sexual functioning. D. The elderly have little interest in sexual activity. Answer: C Medications, such as antihypertensives, mood stabilizers and antidepressants, can impede sexual functioning. Which of the following medications is appropriate in the treatment of male erectile disorder? A. Rivastigmine (Exelon) B. Tadalafil (Cialis) C. Somatropin (Zorbtive) D. Phenelzine (Nardil) Answer: B Tadalafil's therapeutic effects enhance blood flow to the corpus cavernosum resulting in an erection sufficient to allow sexual intercourse. Which is characteristic of the diagnosis of anorexia nervosa? A. Obsession with weight gain B. Body image disturbance C. Disregard for the feelings of others D.Healthy family relationships Answer:B The distortion in body image by a client diagnosed with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated. Which assessment finding would the nurse expect in clients diagnosed with bulimia? A.They are below normal weight. B.They binge when they experience hunger. C.They will be highly motivated to seek help. D.They are within their normal weight range. Answer: D Clients diagnosed with bulimia nervosa are often able to maintain a normal weight by purging after binging. The nurse is teaching a class on obesity prevention. Which statement by a student indicates that learning about obesity has occurred? A."Obesity is classified as a psychiatric disorder in the DSM-5." B. "Obesity is defined as a body mass index (BMI) of 25.0 to 29.9." C. "Eighty percent of offspring of two obese parents are obese." D."Lesions in the appetite center in the thalamus may contribute to obesity." Answer: C Genetics have been implicated in the development of obesity. Research indicates that 80 percent of offspring of two obese parents are obese. A client is 5'8'' tall and weighs 105 pounds. The client has been taking laxatives daily, an self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? A.Ineffective denial B.Disturbed body image C.Low self-esteem D.Imbalanced nutrition: less than body requirements Answer: D This client is malnourished and underweight due to self-induced vomiting and laxative abuse. Nutritional status is compromised and this problem must be prioritized to establish physiological integrity. A client diagnosed with a personality disorder is cold, aloof, and avoids others on the unit. The nurse recognizes that this behavior is symptomatic of which personality disorder?_ A. Schizoid personality disorder B. Dependent personality disorder C. Borderline personality disorder D.Antisocial personality disorder Answer: A A hallmark of the schizoid personality is a marked withdrawal from social contact. The client behaviors presented in the question are indicative of schizoid personality disorder. A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe? A. Social isolation B. Suspiciousness of others C. Bizarre speech patterns D. Generates conflict among the staff Answer: D Clients diagnosed with borderline personality disorder, having little empathy toward others, are unable to accept both positive and negative feelings, and view others as all good or all bad. They tend to split staff, generating conflict. In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe?_ A.Predictability B.Controlled anger C.Little tolerance for being alone D.Stable and satisfactory relationships Answer: C Clients diagnosed with borderline personality disorder have little tolerance for being alone. They prefer a frantic search for companionship no matter how unsatisfactory rather than experience feelings of loneliness, emptiness, and boredom. An individual, with a history of antisocial personality disorder, was arrested for driving _under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected? A. "It's not my fault." B. "I'm too ashamed to talk about it." C. "I just don't remember doing it." D. "I'm really sorry about all the people I've hurt." Answer: A Individuals diagnosed with antisocial personality disorder lack remorse about their actions and view themselves as victims. This individual would most likely refuse to acknowledge responsibility for the accident. Hospitalized and diagnosed in the fourth stage of NCD due to Alzheimer's disease, a client, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the client exhibiting? A. Aphasia B. Confabulation C. Delirium D. Apraxia Answer: B Confabulation is a behavioral reaction to memory loss in which the client fills in memory gaps with information about events that have not occurred. During the fourth stage of Alzheimer's dementia, a client will use confabulation in an effort to maintain self-esteem. A client is newly diagnosed with second stage NCD due to Alzheimer's disease. Which cognitive change would a nurse observe? A. Memory disturbance B. Confabulation C. Apraxia D. Inability to plan or organize Answer: A In the second stage of the illness, losses in short-term memory are common and the individual may begin to lose things or forget names of people. It's at this stage that a diagnosis may be considered. Which statement is true about vascular NCD? A. Vascular NCD is reversible. B. Vascular NCD is characterized by plaques and tangles in the brain. C. Vascular NCD involves a gradual, progressive cognitive deterioration. D. Vascular NCD involves a variable pattern of cognitive functioning. Answer: D In vascular NCD, clients suffer the equivalent of small strokes that destroy many areas of the brain. The pattern of deficits is variable, depending on which regions of the brain have been affected. A client has recently been diagnosed with mild to moderate NCD due to Alzheimer's _disease. Which medication would the nurse expect the physician to order for this client's cognitive impairment? A. Nortriptyline (Pamelor) B. Zaleplon (Sonata) C. Donepezil (Aricept) D. Quetiapine (Seroquel) Answer: C Donepezil is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer's disease. Its action improves cholinergic function by inhibiting acetylcholinesterase. An elderly client, newly admitted to a nursing home, refuses to participate in activities of daily living (ADLs). Which nursing intervention would best help the client to be as independent as possible in meeting self-care needs? A. Assign a variety of caregivers so that one person does not do everything for the client. B. Establish a specified amount of time for ADL completion. C. Set client expectations at the beginning of each day. D. Structure the activities of daily living to mirror previous home routines. Answer:D Structuring the activities of daily living to mirror previous home routines can help foster independence in activities of daily living. Maintaining familiar routines will ease the transition to residential care and increase client compliance in meeting self-care needs. An adolescent, diagnosed with attention-deficit/ hyperactivity disorder (ADHD), is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client's task performance? A. Mandate that the client remains in his room until all homework is complete. B. Remove privileges if homework has not been completed within a 2-hour period. C. Encourage dividing tasks into smaller, attainable steps and reward successful completion. D. Seek a physician's order to discontinue the stimulant methylphenidate (Ritalin). Answer: C A client with a short attention span can be over-whelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self-esteem and provide incentives for future positive behaviors. Which is a potential side effect from the prolonged use of methylphenidate (Ritalin)? A. Psychosis B. A decreased intelligence quotient (IQ) C. Weight gain D. A decrease in rate of growth and development Answer: D A temporary decrease in the rate of growth and development may be a side effect of Ritalin therapy Conduct disorder may be a precursor to the _ diagnosis of which personality disorder? A. Narcissistic personality disorder B. Antisocial personality disorder C. Histrionic personality disorder D. Passive-aggressive personality disorder Answer: B Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others. Conduct disorder can be a precursor to the diagnosis of antisocial personality disorder. A diagnosis of antisocial personality disorder would not be assigned until a client is 18 years of age or older. A client hates her mother because of _ childhood neglect. The nurse determines which_ client statement represents the use of the_ defense mechanism of reaction formation? A. "I don't like to talk about my relationship with my mother." B. "My mother hates me." C. "I have a very wonderful mother whom I love very much." D. "My mom always loved my sister more than she loved me." Answer: C The client hides her negative unacceptable feelings by the exaggerated expression of positive feelings. This is an example of the defense mechanism of reaction formation. A widow of 23 years has not removed any of her husband's possessions including his slippers beside their bed. Which pathological grief response is being exhibited by this client? A. Inhibited grief response B. Prolonged grief response C. Delayed grief response D. Distorted grief response Answer: B The prolonged grief response is characterized by intense preoccupation with memories of the lost person years after the loss has occurred. This is how this client has responded to her husband's death. A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the preinteraction phase of the nurse-patient relationship, which interaction should the nurse employ? A. Acknowledging the client's actions and encouraging alternative behaviors. B. Establishing rapport and developing treatment goals. C. Providing community resources on aggression management. D. Exploring personal thoughts and feelings that may adversely impact the provision of care. Answer: D In the preinteraction phase, the nurse must clarify personal attitudes, values, and beliefs to become aware of how these might affect the nurse's ability to care for various clients. This occurs before the nurse meets the client. The unit manager needs to meet with a client who is exhibiting escalating hostility. Which would be the most appropriate location for the nurse to meet with this client? A.The client's room with the door shut B. quiet corner of the day room C. The nurse's station D. The unit's treatment room Answer: B A quiet corner of the day room provides for some privacy in a neutral space while not limiting access to help if safety issues arise. As the move-out date to leave the shelter gets closer, a battered wife states, "I'm afraid to leave here. I'm afraid for my safety and the safety of my children." Which nursing statement is most supportive? A. "This is a difficult transition. Let's formulate a plan to keep you all safe in the community." B. "It's the policy that clients can only live here 30 days. Maybe we can ask for more time." C. "You've had a month to come up with a plan for keeping you and your family safe." D. "Hopefully, your husband has been in counseling. I'm sure this will work out fine." Answer: A The nurse is using the therapeutic techniques of "reflection" and "formulating a plan of action." The use of these communication facilitators indicates that the nurse is supportive of the client's feelings and appreciates the need for a safety plan. A college student is hospitalized after suicide attempt. During an interview, the father reveals that his ex-wife was punitive and scolded his daughter during toilet training. Freud would describe this student as fixated in which stage of psychosexual development? A. Oral B. Anal C. Phallic- masturbating D. Latency Answer: B The developmental task of the anal stage is learning independence and control with focus on the excretory function. Freud believed that the manner in which children are toilet trained has far-reaching effects on the child's personality. Children who had harsh and rigid training utilize those same approaches internally when evaluating their adult actions. The current situation reflects an alteration in fulfilling the child's need for independence and control during the anal stage. A 40-year-old man is estranged from his children and states, "I'm the only one I can count on to meet my needs. The kids just want my money." Using Erikson's theory, with which developmental conflict is this client struggling? A. Industry versus inferiority B. Intimacy versus isolation C. Ego integrity versus despair D. Generativity versus stagnation Answer: D Generativity versus stagnation occurs in middle adulthood (30 to 65), which are primarily the working years. The major task is to achieve life goals established for oneself while also considering the welfare of future generations. This situation presents a client who is self-absorbed and unable to consider the welfare of his children. This situation is reflective of the developmental conflict of generativity versus stagnation. A nursing student is learning about the human limbic system. Which student statement demonstrates that teaching about the function of the limbic system has been effective? A. "The limbic system helps stabilize emotional behavior." B. "The limbic system functions to assist with symbolic thinking." C. "The limbic system aids in analytical thinking." D. "The limbic system helps modulate motor coordination." Answer: A The limbic system is the "emotional brain" and can help in stabilizing emotional behavior. A client is brought to the ED and diagnosed with a panic level of anxiety. What biological system domination would be responsible for this diagnosis? A. Parasympathetic division of the autonomic nervous system B. Sympathetic division of the autonomic nervous system C. The cerebral cortex D. The cerebellum Answer: B A client is brought to the ED and diagnosed with a panic level of anxiety. What biological system domination would be responsible for this diagnosis? The nurse is encouraging a child, diagnosed with autism, to verbalize needs. Which nursing intervention reflects the behavior therapy of shaping? A. The nurse provides no rewards to the child to encourage independence. B. The nurse rewards the child regardless of speech improvement. C. The nurse rewards the child at the conclusion of the therapy. D. The nurse rewards the child incrementally as improvement in speech occurs. Answer: D In shaping the behavior of another, reinforcements are given for increasingly closer approximations to the desired response. In this situation, the nurse is providing rewards incrementally as the child's speech begins to improve. A client diagnosed with alcoholism has recently been prescribed disulfiram (Antabuse). The nurse recognizes this as which type of behavior therapy? A. Overt sensitization B. Flooding C. Reciprocal inhibition D. Systematic desensitization Answer: A The nurse recognizes the use of Antabuse as overt sensitization behavior therapy. This is a type of aversion therapy that produces unpleasant consequences for undesirable behavior. Instead of the euphoric feeling normally experienced from alcohol (the positive reinforcement for drinking), an individual taking Antabuse will experience nausea, vomiting, palpitations, and headache if alcohol is consumed. The client receives a severe punishment that is intended to extinguish the unacceptable behavior (drinking alcohol). A nurse is using covert sensitization to help a client control compulsive overeating. Which nursing intervention reflects this behavior therapy? A. Asking the client to visualize and imagine smelling a rotting potato B. Encouraging the client to practice relaxation exercises when tempted to eat C. Introducing the client to a peer who has overcome obesity D. Providing small rewards for periodic weight loss Answer: A Covert sensitization relies on the individual's imagination to produce unpleasant symptoms as negative stimuli. The mental image (rotting potatoes) is visualized when the individual is about to succumb to an attractive (ice cream sundae) but undesirable behavior (compulsive eating). The technique is under the client's control and can be used whenever and wherever it is required. A client diagnosed with severe depression states, "When I wasn't invited to my niece's wedding, it was obvious that the in-laws did not think I was good enough to be included." The nurse understands that this automatic thought is an example of which common cognitive error? A. Arbitrary inference B. Overgeneralization (absolute thinking) C. Dichotomous thinking D. Personalization Answer: A This client statement indicates the use of arbitrary inference. When arbitrary inference is used, the individual automatically comes to a conclusion about an incident without supporting facts. A client states, "I just failed my college English course. I've never failed a class before so when my parents find out they are going to disown me. They'll hate me and never forgive me for this." The nurse recognizes this client's statement as which type of automatic thought? A. Arbitrary influence B. Minimization C. Catastrophic thinking D. Personalization Answer: C Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. By stating "...when my parents find out they are going to disown me. They'll hate me and never forgive me for this," the client is expressing the automatic thought of catastrophic thinking. A nurse is using decatastrophizing techniques to help a client modify automatic thoughts and schemas. Which nursing statement could be used in this process? A. "First you must decide if this negative thought is valid." "Let's really look at that thought pattern. What evidence made you come to that conclusion?" "When you start to have a negative thought, start visualizing a pleasant experience." D. "Let's explore some other possibilities related to this thinking." Answer: A This nursing statement could be used during the technique of decatastrophizing. __Decatastrophizing assists the client to examine the validity of a negative automatic thought. Even if some validity exists, the client is then encouraged to review ways to cope adaptively, moving beyond the current crisis situation. Two clients disagree on what movie to watch during free activity time. One client says to the other, "I would like to watch the comedy instead of the murder mystery." The nurse recognizes this as which form of communication response pattern? A. Nonassertive B. Assertive C. Aggressive D. Passive-Aggressive Answer: B Assertive individuals express feelings openly and honestly. Individuals using this communication pattern use "I" statements and communicate tactfully. The example presented in the question demonstrates the use of an assertive communication pattern. A nurse is conducting an assertiveness training class. Which of the following characteristics of assertive behavior should the nurse include? A. Eye contact should be steady and continuous. B. Invasion of intimate space can be interpreted as assertive behavior. C. While interacting, individuals should turn slightly away from the other person. D. The facial expression is congruent with the verbal message. Answer: D Various facial expressions convey different messages. In assertive communication, the facial expression is congruent with the verbal message A client expresses a desire to begin attending the self-help group Alcoholics Anonymous (AA). Which nursing response gives the client pertinent information about this type of group? A. "In this type of group, membership is always within a fixed time frame." B. "Group members receive comfort and advice from others undergoing similar experiences." C. "The purpose of this type of group is to convey information to a number of individuals." D. "The function of this type of group is to accomplish a specific outcome." Answer: B AA is a type of self-help group. In this type of group members share their experiences and strengths and receive comfort and advice from others undergoing similar experiences. The nurse is giving the client pertinent information about AA. After a supportive-therapeutic group, a nurse hears one client say to another, "I never thought that other people had the same problems that I have." The nurse ascertains that this statement represents which curative factors described by Yalom? A. Catharsis B. Group cohesiveness C. Universality D. Imitative behavior Answer: C According to Yalom, the curative factor of universality occurs when group members realize that they are not alone in their feelings and experiences. During a group meeting, a client raises the concern that noise at the nurses' station keeps him awake at night. The nurse, present in the meeting, interrupts, stating, "I'll handle this matter. We need to move on." The nurse is demonstrating which type of leadership style? A. Democratic B. Autocratic C. Laissez-faire D. Surrogate Answer: B This is an example of an autocratic leadership style that restricts client participation in planning care. The nurse is in control and client autonomy is limited. A client, diagnosed with depression, tells the nurse that marriage and children were chosen over law school. The client states, "My mother was furious with my decision." The nurse recognizes this as an example of which maladaptive family behavior? A. Avoiding B. Demanding proof of love C. Attacking D. Ignoring individuality Answer: D Ignoring individuality occurs when one person expects another to do things or behave in ways that do not fit with the latter's individuality or current life situation. The client is fulfilling personal dreams and the mother reacts with anger because the client is not fulfilling the mother's expectations. In assessing a family, which behavior would the_ nurse identify as a functional family interaction _ pattern? A. Triangling B. Differentiation of self C. Family projection process D. Scapegoating family members Answer: B Differentiation of self is the ability to define oneself as a separate being and is a functional family interaction pattern. Which contemporary family therapy emphasizes the role of the stories people construct about their experiences? A. Narrative therapy B. Feminist family therapy C. Social constructionist therapy D. Psychoeducational family therapy Answer: A Narrative therapy is an approach to therapy that emphasizes the role of the stories people construct about their experiences. An operating room nurse asks a psychiatric nurse, "How can you work with the mentally ill day in and day out?" The psychiatric nurse replies, "It's just the right thing to do." The psychiatric nurse is operating from which ethical framework?_ A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism Answer: A Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse's response indicates a Kantian perspective. As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, "I'll sue you for assault and battery." The unit manager determines that the nurses are protected under which condition?_ A. The client is voluntarily committed and poses a danger to others on the unit. B. The client is voluntarily committed and has a history of being a danger to others. C. The client is involuntarily committed because of a history of violent behavior. D. The client is involuntarily committed and is refusing treatment. Answer A: As a threat to others, the client can be restrained despite objections and voluntary commitment. Which psychiatric diagnosis is common within the Native American culture? A.Schizophrenia B.Alcohol use disorder C.Posttraumatic stress disorder D.Impulse control disorder Answer B A variety of physical, sociocultural, and environmental causes have been linked to the high rate of alcoholism among Native Americans An individual experienced the death of a parent two years ago. This individual has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes this individual's problem? A. Posttrauma syndrome R/T parent's death B. Anxiety (severe) R/T parent's death C. Coping, ineffective, R/T parent's death D. Grieving, complicated, R/T parent's death Answer: D The excessive reactions the individual continues to exhibit such as daily crying, the inability to return to work, and the inability to look at parent's belongings after a two-year period, are indicative of dysfunctional or complicated grieving. This individual's grieving response has arrested in the anger stage, is being turned inward on the self, and is manifested by symptoms of depression. A suicidal client, with a history of manic behavior, is admitted to the ED. The client's diagnosis is documented as bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder?_ A. The physician does not believe the client is suffering from major depression. B. The client has experienced a manic episode in the past. C. The client does not exhibit psychotic symptoms. D. There is no history of major depression in the client's family. Answer: B The client's past history of mania and current suicide attempt support the diagnosis of bipolar I disorder: current episode depressed. According to the DSM-5 criteria, a manic episode rules out the diagnosis of major depressive disorder. In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis?_ A. Risk for injury related to excessive hyperactivity B. Disturbed sleep pattern related to manic hyperactivity C. Imbalanced nutrition, less than body requirements related to inadequate intake D. Situational low self-esteem related to embarrassment secondary to high-risk behaviors Answer: A According to Maslow's hierarchy of needs, maintaining client safety is always a priority. The impulsiveness and hyperactivity seen in clients diagnosed with acute mania puts them at risk for injury. Which would the nurse identify as a maladaptive grieving response? A.An individual thought she saw her dead husband when she was out shopping. B.A client is experiencing marked feelings of worthlessness and low self-esteem. C.A woman has not cried since the death of her husband. D.A year after his death, a wife maintains all of her husband's belongings. Answer: B The difference between normal and maladaptive grieving is the loss of self-esteem. Research has shown that marked feelings of worthlessness are indicative of maladaptive rather than uncomplicated bereavement. A client is admitted with a diagnosis of brief psychotic disorder with catatonic features. Which symptoms are associated with the catatonic specifier? A. Strong ego boundaries and abstract thinking B. Ataxia and akinesia C. Stupor, muscle rigidity, and negativism D. Substance abuse and cachexia Answer: C Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors. A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. Identify with the person speaking B. Imitate the nurse's movements D. Alleviate alogia D. Alleviate avolition Answer: A Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt by the client to identify with the person who is speaking. To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented?_ A. Reinforce the perceptual distortions until the client develops new defenses B. Provide an unstructured environment C. Avoid making connections between anxiety-producing situations and hallucinations D. Distract the client's attention Answer: D The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities. A client, diagnosed with schizophrenia, states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response?_ A. "I find that hard to believe." B. "What would make you think such a thing?" C. "I know your roommate. He would do no such thing." D. "I can see why you feel that way." Answer: A This client is experiencing a persecutory delusion. This nursing response is an example of "voicing doubt," which expresses uncertainty as to the reality of the client's perceptions. This is an appropriate therapeutic communication technique in dealing with clients who are experiencing delusional thinking. The nurse is assessing a client for side effects of electroconvulsive therapy (ECT). Which side effects are common and to be expected? A. Temporary disorientation B. Enduring memory loss C. Residual seizure disorders D. Cardiovascular complications Answer: A Temporary memory loss and confusion are common side effects of ECT. A client is preparing to undergo electroconvulsive therapy (ECT). Which nursing intervention is appropriate? A. Keep the client NPO 24 hours before the procedure. B. Verify that informed consent has been granted. C. Ascertain that client has dentures securely in place. D. Place side rails down for easy access to the restroom. Answer: B Informed consent must be obtained prior to ECT In the posttreatment period of electroconvulsive therapy (ECT), which is an appropriate nursing intervention? A. Monitor vital signs every 30 minutes during the first hour. B. Place client on back to facilitate comfort. C. Orient client to time and place. D. Ambulate immediately to promote adequate circulation. Answer: C Orienting to time and place assists with overcoming the temporary confusion and disorientation that often follow the ECT treatments. Two months ago, Ms. T was sexually assaulted while jogging in an isolated park. She is hospitalized for suicidal ideation at this time. She awakens in the middle of the night screaming about having nightmares of the incident. Which of the following is the most appropriate initial nursing intervention?_ A.Call the doctor to report the incident. B.Stay with Ms. T until the anxiety has subsided. C.Administer prn alprazolam. D.Allow her some privacy to work through the emotions. Answer: B It is important to not leave a client who is experiencing flashbacks or nightmares alone. Clients often feel they are "going crazy" when this happens, and the presence of a trusted individual calms fears and reassures the client of her safety A client, experiencing lower extremity paralysis, is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder? A. Conversion disorder B. Illness anxiety disorder C. Malingering D. Somatic symptom disorder Answer: A Conversion disorder is a loss or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder. The situation presented in the question describes a conversion disorder. A client is experiencing pain that has no organic etiology. This pain allows the client to avoid going to work at a job he hates. What best describes what this client is experiencing?_ A. The client is experiencing altered social interaction. B. The client is experiencing disturbed thought processes. C. The client is experiencing primary gain. D. The client is experiencing secondary gain Answer: C Primary gain describes the benefit to the client of avoidance of some unpleasant activity due to experiencing psychologically based pain. This avoidance directly decreases the client's anxiety. The situation presented in the question describes primary gain. According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in a client with dissociative amnesia?_ A. Suppression B. Sublimation C.Displacement D.Repression Answer: D Repression, which is the involuntary blocking of unpleasant feelings and experiences from one's awareness, is the defense mechanism most used by clients experiencing amnesia. Freud believed that dissociative behaviors, including amnesia, occurred when individuals repressed distressing mental contents from conscious awareness. He believed that this mechanism protected the client from emotional pain. When working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action?_ A. Avoid discussing social and personal problems. B. Focus on the physical symptoms. C. Always meet the client's dependency needs. D. Gradually minimize time focusing on physical symptoms. Answer: D The nurse's attention should be on the client's social and personal problems, which are the underlying cause of the somatic symptom disorder. Time focused on physical symptoms should be minimized to avoid reinforcement. From a biological theory perspective, which of the following predisposes individuals to be abusive? A. Unmet needs for security resulting in an underdeveloped ego and a weak super ego. B. Imitation of individuals who have a predisposition toward aggressive behavior. C. Various levels of norepinephrine, dopamine, and serotonin. D.The influence of culture and social structure. Answer: C Various components of the neurological system in both humans and animals have been implicated in both the facilitation and the inhibition of aggressive impulses. One biological theory suggests that norepinephrine, dopamine, and serotonin may play a role in aggressive behavior A 12-year-old girl suddenly refuses to change for gym, participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. What should the school nurse consider when assessing this child's symptoms? _ A.Sexual abuse B.Emotional neglect C.Physical neglect D.Emotional abuse Answer: A Sexual abuse of a child may be considered a possibility when the child has difficulty walking or sitting; suddenly refuses to change for gym or to participate in physical activities; reports nightmares or bedwetting; experiences a sudden change in appetite; demonstrates bizarre, sophisticated, or unusual sexual knowledge; becomes pregnant or contracts a venereal disease; runs away; or reports sexual abuse by a parent or another adult caregiver. After assessing the data, the school nurse should further investigate this child's unexplained symptoms, and if warranted, report findings to authorities. A young mother in a severely abusive relationship is admitted to the psychiatric unit after an attempted suicide. The client tells the nurse, "I'm sure things will be better between us once I go home." Which is the most appropriate nursing response? _ A."Research shows that men who batter get worse rather than improve." B."Aren't you concerned about your children?" C."You really shouldn't return home to that violent situation." D."Let's develop a safety plan in case he becomes violent in the future. Answer: D It is critical to stress to the client the importance of safety. The client must be made aware of the variety of resources that are available to her. Most major cities in the United States now have safe houses or shelters where women can go to be assured of protection for them and their children. Helping the client develop a safety strategy will increase her sense of control and decrease her sense of powerlessness. After an examination and treatment for rape, the nurse prepares to discharge a client from the ED. Which discharge teaching should the nurse provide?_ A.Information on available community resources. B.The names and phone numbers of local attorneys who defend rape victims. C.When to return to the emergency room for follow-up care. D. The phone number of the battered women's shelter or safe house. Answer: A The client must be made aware of the variety of resources that are available to her. These may include crisis hotlines, community groups for women who have been abused, and counseling services. Knowledge of available community resources decreases the victim's sense of powerlessness. A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), spends _one hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior? A. It relieves anxiety. B. It fosters organizational skills. C. It delays meeting unfamiliar people in the day room. D. It makes the client feel good. Answer: A OCD is characterized by recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind and actions that an individual is unable to refrain from performing (compulsions). This behavior directs the client away from the underlying anxiety and focuses the client on a repetitive activity such as packing and unpacking, folding and refolding personal belongings. For the last year, a college student, continually and unrealistically worries about _academic performance and love-life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which diagnosis? A. Agoraphobia B. Generalized anxiety disorder (GAD) C. Social phobia disorder D. Obsessive-compulsive disorder (OCD) Answer: B GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least six months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object as in phobia or event as in PTSD. When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? A. Leave the client alone to maintain privacy. B. Instruct the client regarding unit rules and regulations. C. Sit with the client in the day room to provide comfort. D. Communicate with simple words and brief messages. Answer: D When communicating with a client experiencing a panic attack, the nurse needs to use simple words and brief messages, spoken calmly and clearly. Any communication that is loud and demanding would only escalate anxiety.