NUR 326 Exam 4 Practice Questions
and Answers
The nursing diagnosis that would be most appropriate for a 22-year old client who uses
ritualistic behavior would be:
A. Ineffective coping
B. Impaired adjustment
C. Personal identity disturbance
D. Sensory/perceptual alterations - ANS-A (Ineffective coping is the impairment of a
person's adaptive behaviors and problem-solving abilities in meeting life's demands;
ritualistic behavior fits under this category as a defining characteristic.)
A 20-year old college student has been brought to the psychiatric hospital by her
parents. Her admitting diagnosis is borderline personality disorder. When talking with
the parents, which information would the nurse expect to be included in the client's
history? Select all that apply.
a. Impulsiveness
b. Lability of mood
c. Ritualistic behavior
d. psychomotor retardation
e. Self-destructive behavior - ANS-A B E
A hospitalized client, diagnosed with a borderline personality disorder, consistently
breaks the unit's rules. This behavior should be confronted because it will help the
client:
A. Control anger
B. Reduce anxiety
C. Set realistic goals
D. Become more self-aware - ANS-D (Client's must first become aware of their behavior
before they can change it. Option C occurs after the client is aware of the behavior and
has a desire to change the behavior.)
When working with the nurse during the orientation phase of the relationship, a client
with a borderline personality disorder would probably have the most difficulty in:
A. Controlling anxiety
B. Terminating the session on time
C. Accepting the psychiatric diagnosis
,D. Setting mutual goals for the relationship - ANS-D (Clients with borderline personality
disorders frequently demonstrate a pattern of unstable interpersonal relationships,
impulsiveness, affective instability, and frantic efforts to avoid abandonment; these
behaviors usually create great difficulty in establishing mutual goals.)
A client with a diagnosis of borderline personality disorder has negative feelings toward
the other clients on the unit and considers them all to be "bad." The nurse understands
this defense is known as:
A. Splitting
B. Ambivalence
C. Passive aggression
D. Reaction formation - ANS-A (Splitting is the compartmentalization of opposite-affect
states and failure to integrate the positive and negative aspects of self or others.)
A person with antisocial personality disorder has difficulty relating to others because of
never having learned to:
A. Count on others
B. Empathize with others
C. Be dependent on others
D. Communicate with others socially - ANS-B
When caring for a client with a diagnosis of schizotypal personality disorder, the nurse
should:
A. Set limits on manipulative behavior
B. Encourage participation in group therapy
C. Respect the client's needs for social isolation
D. Understand that seductive behavior is expected. - ANS-C (These clients are
withdrawn, aloof, and socially distant; allowing distance and providing support may
encourage the eventual development of a therapeutic alliance. Group therapy would
increase this client's anxiety; cognitive or behavioral therapy would be more
appropriate.)
A client with a diagnosis of narcissistic personality disorder has been given a day pass
from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client
telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like
coming back at 7:30." The nurse would be most therapeutic by telling the client to:
A. Return immediately, to demonstrate control
B. Return on time or restrictions will be imposed
C. Come back at 6:45, as a compromise to set limits
D. Come back as soon as possible or the police will be sent - ANS-B (This sets limits,
points out reality, and places responsibility for behavior on the client.)
, An adult client with a borderline personality disorder become nauseated and vomits
immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The
most appropriate initial response by the nurse would be to:
A. Promptly notify the attending physician
B. Immediately initiate suicide precautions
C. Sit quietly with the client until nausea and vomiting subsides
D. Assess the client's vital signs and administer syrup of ipecac - ANS-C (This
intervention demonstrates the nurse's caring presence which is vital for this client. (1)
Although the treatment team does need to know about the event, notification is not the
immediate concern. (2) This is premature and it reinforces the client's predisposition to
manipulative behavior. (4) This medication is inappropriate in this situation; vomiting
would be expected after the ingestion of shampoo.)
A nurse notices that a client is mistrustful and shows hostile behavior. Which of the
following types of personality disorder is associated with these characteristics?
A. Antisocial
B. Avoidant
C. Borderline
D. Paranoid - ANS-D (Paranoid individuals have a need to constantly scan the
environment for signs of betrayal, deception, and ridicule, appearing mistrustful and
hostile. They expect to be tricked or deceived by others.)
Which of the following statements is typical for a client diagnosed with a paranoid
personality disorder?
A. "I understand you're the one to blame."
B. "I must be seen first; it's not negotiable."
C. "I see nothing humorous in this situation."
D. "I wish someone would select the outfit for me." - ANS-C (Clients with paranoid
personality disorder tend to be extremely serious and lack a sense of humor.)
A client with antisocial personality is trying to convince a nurse that he deserves special
privileges and that an exception to the rules should be made for him. Which of the
following responses is the most appropriate?
A. "I believe we need to sit down and talk about this."
B. "Don't you know better than to try to bend the rules?"
C. "What you're asking me to do is unacceptable."
D. "Why don't you bring this request to the community meeting?" - ANS-C (These
clients often try to manipulate the nurse to get special privileges or make exceptions to
the rules on their behalf. By informing the client directly when actions are inappropriate,
the nurse helps the client learn to control unacceptable behaviors by setting limits. By
sitting down to talk about the request, the nurse is telling the client there's room for
negotiating when there is none.)
and Answers
The nursing diagnosis that would be most appropriate for a 22-year old client who uses
ritualistic behavior would be:
A. Ineffective coping
B. Impaired adjustment
C. Personal identity disturbance
D. Sensory/perceptual alterations - ANS-A (Ineffective coping is the impairment of a
person's adaptive behaviors and problem-solving abilities in meeting life's demands;
ritualistic behavior fits under this category as a defining characteristic.)
A 20-year old college student has been brought to the psychiatric hospital by her
parents. Her admitting diagnosis is borderline personality disorder. When talking with
the parents, which information would the nurse expect to be included in the client's
history? Select all that apply.
a. Impulsiveness
b. Lability of mood
c. Ritualistic behavior
d. psychomotor retardation
e. Self-destructive behavior - ANS-A B E
A hospitalized client, diagnosed with a borderline personality disorder, consistently
breaks the unit's rules. This behavior should be confronted because it will help the
client:
A. Control anger
B. Reduce anxiety
C. Set realistic goals
D. Become more self-aware - ANS-D (Client's must first become aware of their behavior
before they can change it. Option C occurs after the client is aware of the behavior and
has a desire to change the behavior.)
When working with the nurse during the orientation phase of the relationship, a client
with a borderline personality disorder would probably have the most difficulty in:
A. Controlling anxiety
B. Terminating the session on time
C. Accepting the psychiatric diagnosis
,D. Setting mutual goals for the relationship - ANS-D (Clients with borderline personality
disorders frequently demonstrate a pattern of unstable interpersonal relationships,
impulsiveness, affective instability, and frantic efforts to avoid abandonment; these
behaviors usually create great difficulty in establishing mutual goals.)
A client with a diagnosis of borderline personality disorder has negative feelings toward
the other clients on the unit and considers them all to be "bad." The nurse understands
this defense is known as:
A. Splitting
B. Ambivalence
C. Passive aggression
D. Reaction formation - ANS-A (Splitting is the compartmentalization of opposite-affect
states and failure to integrate the positive and negative aspects of self or others.)
A person with antisocial personality disorder has difficulty relating to others because of
never having learned to:
A. Count on others
B. Empathize with others
C. Be dependent on others
D. Communicate with others socially - ANS-B
When caring for a client with a diagnosis of schizotypal personality disorder, the nurse
should:
A. Set limits on manipulative behavior
B. Encourage participation in group therapy
C. Respect the client's needs for social isolation
D. Understand that seductive behavior is expected. - ANS-C (These clients are
withdrawn, aloof, and socially distant; allowing distance and providing support may
encourage the eventual development of a therapeutic alliance. Group therapy would
increase this client's anxiety; cognitive or behavioral therapy would be more
appropriate.)
A client with a diagnosis of narcissistic personality disorder has been given a day pass
from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client
telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like
coming back at 7:30." The nurse would be most therapeutic by telling the client to:
A. Return immediately, to demonstrate control
B. Return on time or restrictions will be imposed
C. Come back at 6:45, as a compromise to set limits
D. Come back as soon as possible or the police will be sent - ANS-B (This sets limits,
points out reality, and places responsibility for behavior on the client.)
, An adult client with a borderline personality disorder become nauseated and vomits
immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The
most appropriate initial response by the nurse would be to:
A. Promptly notify the attending physician
B. Immediately initiate suicide precautions
C. Sit quietly with the client until nausea and vomiting subsides
D. Assess the client's vital signs and administer syrup of ipecac - ANS-C (This
intervention demonstrates the nurse's caring presence which is vital for this client. (1)
Although the treatment team does need to know about the event, notification is not the
immediate concern. (2) This is premature and it reinforces the client's predisposition to
manipulative behavior. (4) This medication is inappropriate in this situation; vomiting
would be expected after the ingestion of shampoo.)
A nurse notices that a client is mistrustful and shows hostile behavior. Which of the
following types of personality disorder is associated with these characteristics?
A. Antisocial
B. Avoidant
C. Borderline
D. Paranoid - ANS-D (Paranoid individuals have a need to constantly scan the
environment for signs of betrayal, deception, and ridicule, appearing mistrustful and
hostile. They expect to be tricked or deceived by others.)
Which of the following statements is typical for a client diagnosed with a paranoid
personality disorder?
A. "I understand you're the one to blame."
B. "I must be seen first; it's not negotiable."
C. "I see nothing humorous in this situation."
D. "I wish someone would select the outfit for me." - ANS-C (Clients with paranoid
personality disorder tend to be extremely serious and lack a sense of humor.)
A client with antisocial personality is trying to convince a nurse that he deserves special
privileges and that an exception to the rules should be made for him. Which of the
following responses is the most appropriate?
A. "I believe we need to sit down and talk about this."
B. "Don't you know better than to try to bend the rules?"
C. "What you're asking me to do is unacceptable."
D. "Why don't you bring this request to the community meeting?" - ANS-C (These
clients often try to manipulate the nurse to get special privileges or make exceptions to
the rules on their behalf. By informing the client directly when actions are inappropriate,
the nurse helps the client learn to control unacceptable behaviors by setting limits. By
sitting down to talk about the request, the nurse is telling the client there's room for
negotiating when there is none.)
