Psychiatric Mental Health Nursing Videbeck for Grade A, with answer KEY at the end of each segment, LATEST

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Chapter 1 1. The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the nurse identify as having a positive impact on the individ... ual's mental health? A) Not needing others for companionship B) The ability to effectively manage stress C) A family history of mental illness D) Striving for total self-reliance 2. Which of the following is true regarding mental health and mental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. D) Persons who engage in fantasies are mentally ill. 3. A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be... A) “You may have a temporary mental illness because you are experiencing so much pain.” B) “You are not mentally ill. This is an expected reaction to the loss you have experienced.” C) “Were you generally dissatisfied with your relationship before your husband's death?” D) “Try not to worry about that right now. You never know what the future brings.” 4. The nurse consults the DSM for which of the following purposes? A) To devise a plan of care for a newly admitted client B) To predict the client's prognosis of treatment outcomes C) To document the appropriate diagnostic code in the client's medical record D) To serve as a guide for client assessment 5. Which of the following would be a reason for a student nurse to use the DSM-5? A) Identifying the medical diagnosis B) Choose clients' treatment C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses.6. Legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill? A) The widespread use of community-based services B) The advancement in pharmacotherapies C) Increased access to hospitalization D) Improved rights for clients in long-term institutional care 7. Which one of the following is a result of federal legislation? A) Making it easier to commit people for mental health treatment against their will. B) Making it more difficult to commit people for mental health treatment against their will. C) State mental institutions being the primary source of care for mentally ill persons. D) Improved care for mentally ill persons. 8. The goal of the 1963 Community Mental Health Centers Act was to... A) ensure clients' rights for the mentally ill B) deinstitutionalize state hospitals C) provide funds to build hospitals with psychiatric units D) treat people with mental illness in a humane fashion 9. The creation of asylums during the 1800s was meant to... A) improve treatment of mental disorders B) provide food and shelter for the mentally ill C) punish people with mental illness who were believed to be possessed D) remove dangerous people with mental illness from the community 10. Which of the following is a major problem with large state institutions? Select all that apply. A) Attendants were accused of abusing the residents B) Stigma associated with residence in an insane asylum C) Clients were geographically isolated from family and community D) Increasing financial costs to individual residents E) Clients were not given proper nutrition or clothed properly 11. A significant change in the treatment of people with mental illness occurred in the 1950s when... A) community support services were established. B) legislation dramatically changed civil commitment procedures. C) the Patient's Bill of Rights was enacted.D) psychotropic drugs became available for use. 12. Before the period of the enlightenment, treatment of the mentally ill included... A) creating large institutions to provide custodial care. B) focusing on religious education to improve their souls. C) placing the mentally ill on display for the public's amusement. D) providing a safe refuge or haven offering protection. 13. The first training of nurses to work with persons with mental illness was in 1882 in which state? A) California B) Illinois C) Massachusetts D) New York 14. What is meant by the term "revolving door effect" in mental health care? A) An overall reduction in incidence of severe mental illness B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness C) Flexible treatment settings for mentally ill D) Most effective and least expensive treatment settings 15. Which of the following statements by the nurse to the client's family is true of treatment of people with mental illness in the United States today? A) Substance abuse is effectively treated with brief hospitalization. B) Financial resources are reallocated from state hospitals to community programs and support. C) Only one in four people needing mental health services are receiving those services. D) Emergency department visits by persons who are acutely disturbed are declining. 16. The case manager is providing an educational seminar for the nursing staff, she includes objectives from Healthy People 2020. Which of the following is the priority of the objectives for mental health? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness 17. Which is a positive aspect of treating clients with mental illness in a community-basedcare? A) “You will not be allowed to go out with your friends while in the program.” B) “You will have to have supervision when you want to go anywhere else in the community.” C) “You will be able to live in your own home while you still see a therapist regularly.” D) “You will have someone in your home at all times to ask questions if you have any concerns.” 18. One of the unforeseen effects of the movement toward community mental health services is... A) fewer clients suffering from persistent mental illnesses. B) an increased number of hospital beds available for clients seeking treatment. C) an increased number of admissions to available hospital services. D) Longer hospital stays for people needing mental health services. 19. Which is included in Healthy People 2020 objectives? A) To decrease the incidence of mental illness B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives C) To provide mental health services only in the community D) To decrease the numbers of people who are being treated for mental illness 20. A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes... A) medical management of symptoms. B) daily psychotherapy. C) constant staff supervision. D) psychological stabilization. 21. There are many areas of practice in psychiatric mental health nursing. One of those is advanced-level practice. Which of the following is considered an advanced-level function? A) Case management B) Counseling C) Evaluation D) Health teaching 22. Nursing education has become broad in practice settings. The addition of Psychiatric nursing became a requirement in nursing education in 1950 by whom?A) State Boards of Nursing B) American Nurses Association C) National League of Nursing D) Nurse Practice Act 23. A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including... A) providing clinical supervision. B) using effective communication skills. C) adjusting client medications. D) directing program development. 24. Which of the following is one of the American Nurses Association standards of practice for psychiatric–mental health nursing? A) Prescriptive authority is granted to psychiatric–mental health registered nurses. B) All aspects of Standard 5: Implementation may be carried out by psychiatric–mental health registered nurses. C) Some aspects of Standard 5: Implementation may only be carried out by psychiatric–mental health advanced practice nurses. D) Psychiatric–mental health advanced practice nurses are the only ones who may provide milieu therapy. 25. The nurse knows that mental health issues are constantly changing. Which of the following is a standard of professional performance to keep in current practice? A) Assessment B) Education C) Planning D) Implementation 26. Which of the following is a standard of practice? A) Quality of care B) Outcomes identification C) Collegiality D) Performance appraisal 27. A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions? Select all that apply. A) Tells the client about personal events and interestsB) Discusses the anxious feelings with the instructor C) Assumes that the client's unwillingness to talk to a student nurse is a personal insult or failure D) Builds rapport with the patient before asking personal questions E) Consults the instructor if a shocking situation arises F) Gravitates to clients that the student may know personally 28. The appropriate action for a student nurse who says the wrong thing is to... A) pretend that the student nurse did not say it. B) restate it by saying, “That didn't come out right. What I meant was...” C) state that it was a joke. D) ignore the error, since no one is perfect. 29. The newly licensed RN has been hired at the local hospital in the Geri-Psych unit. Today is her first day of orientation to this facility. What would be the nurse's priority action if a client becomes aggressive? A) assist other staff on the unit to take down the client safely B) maintain a safe distance from the client C) keep the client secluded from others D) reinforce boundaries when aggression is seen to maintain a safe environment 30. The Geri-Psych nurse understands that the DSM-5 describes all mental disorders with specific criteria. The DSM-5 has the following purposes: Select all that apply. A) to provide the practitioner with standards of care for all clients. B) to provide a standardized nomenclature and language for all mental health professionals. C) to provide standards for hospital and community based institutions. D) to present defining characteristics or symptoms that differentiate specific diagnoses. E) to assist in identifying the underlying causes of disorders. 31. If a client states, "I carry this lucky rabbit's foot for luck, my dad did too, and it really works," which statement by the nurse reflects respect for the client's belief? A) "A rabbit's foot has never brought me luck. I don't know why people carry them." B) "Yes, the rabbit's foot can bring luck to some." C) "I can accept that you feel it is lucky, so let's get to our activities for the day." D) "It is not appropriate to harm small animals for their parts." 32. A client with schizophrenia has been non-compliant with medications. The client requires frequent admissions to the psychiatric unit for acute psychotic episodes. What is this process called?A) escalated admissions B) revolving door C) deinstitutionalization D) boarding 33. What organization developed and maintains standards of practice that are used to determine safe quality care, and that can be used legally, if incorporated into the state practice act or nurse's rules and regulations, that guide the nursing profession? A) APNA (American Psychiatric Nurses Association) B) DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5th ed.) C) ANA (American Nurses Association) D) USDHHS (U. S. Department of Health and Human Services)Answer Key 1. B 2. C 3. B 4. D 5. D 6. A 7. B 8. B 9. B 10. A, C, E 11. D 12. C 13. C 14. B 15. C 16. D 17. C 18. C 19. B 20. A 21. C 22. C 23. B 24. C 25. B 26. B 27. B, D, E 28. B 29. B 30. B, D, E 31. C 32. B 33. CChapter 2 1. The nurse is assessing a client suffering a head injury as a result of an altercation with two other individuals. The client has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala 2. The nurse is educating the client and family regarding schizophrenia. She explains to them that it is associated with an abnormality of which of the following structures of the cerebrum? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes 3. A client diagnosed with bipolar disorder asks the nurse, "Why did I get this illness? I don't want to be sick." What response should the nurse provide to best answer the client's question? A) "People who develop mental illnesses often had very traumatic childhood experiences." B) "There is some evidence that contracting a virus during childhood can lead to mental disorders." C) "Sometimes people with mental illness have an overactive immune system." D) "We don't fully understand the cause, but mental illnesses do seem to run in families." 4. Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors. 5. The nurse is teaching the client with anxiety about the mechanisms of benzodiazepines. Which of the following is increased with this medication? A) Dopamine B) GABA C) NorepinephrineD) Epinephrine 6. When the physician orders a neurotransmitter for a client who has difficulty in regulating some chemicals in the brain. The nurse knows which of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA 7. The nurse is preparing a client for an MRI scan of the head. The nurse should ask the client... A) "Have you ever had an allergic reaction to radioactive dye?" B) "Have you had anything to eat in the last 24 hours?" C) "Does your insurance cover the cost of this scan?" D) "Are you anxious about being in tight spaces?" 8. How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease. 9. A client is being seen in the crisis unit reporting that poison letters are coming in the mail. The client has no history of psychiatric illness. Which of the following medications would the client most likely be started on? A) Aripiprazole B) Risperidone C) Fluphenazine D) Fluoxetine 10. Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine B) SertralineC) Imipramine D) Phenelzine 11. The nurse knows that the client understands the rationale for dietary restrictions when taking an MAOI when the client makes which of the following statements? A) "I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate." B) "Certain foods will cause me to have sexual dysfunction when I take this medication." C) "Foods that are high in tyramine will reduce the medication's effectiveness." D) "I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels." 12. In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose 13. A mother is concerned about her child being given stimulant medication for ADHD. The nurse tells the mother, which of the following medications was the first nonstimulant medication specifically designed and tested for ADHD? A) Methylphenidate B) Amphetamine C) Atomoxetine D) Pemoline 14. When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram, the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication. 15. When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic? A) “This is a good medication! It will be effective within 20 minutes of the first dose.”B) “You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication.” C) “It will probably take months for the medication to work. In the meantime, you should work on improving your attitude.” D) “If you believe it will work, then it will. You have to have faith!” 16. A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time. 17. A client is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The client is symptom-free and therefore does not need to adhere to the medication regimen. B) The client cannot clearly see the instructions written on the prescription bottle. C) The client dislikes the weight gain associated with antipsychotic therapy. D) The client sells the antipsychotics to addicts in the neighborhood. 18. Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy 19. The nurse is educating a client and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time.20. The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements? A) “I'm glad I can eat pizza since it's my favorite food.” B) “I must follow this diet or I will have severe vomiting.” C) “It will be difficult for me to avoid pepperoni.” D) “None of the foods that are restricted are part of a regular daily diet.” 21. When teaching a client about restrictions for tranylcypromine, the nurse will tell the client to avoid which of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods 22. A nurse is formulating a teaching plan with the client and the client's family. The client has been newly diagnosed with depression, and the teaching plan includes medication, activities, and family support. For the client, the nurse knows that teaching is effective when the client and/or family state: A) Medication should be taken only when the client is feeling depressed and resists family activities. B) Medication should be taken on schedule only, and activities should be twice a week to prevent weight gain. C) Missed dosages should be taken right away, even when it is close to the next dose time, and activities should be increased. D) It may take a few weeks for the medication to become effective; activity will help to foster compliance. 23. A nurse is instructing a client on taking lithium for bipolar disorder. The client will need to have blood draws every 2 to 3 days initially to determine what about the drug level? A) its rebound effect B) its efficacy C) its potency D) its half-life 24. A nurse is administering an MAO to a client with depression. The nurse must be aware of what effects this drug can have? Select all that apply. A) hypertensive crisis if food with tyramines are ingested B) interaction with other MAO's and antidepressants C) diminished thoughts of suicide in depressed clientsD) decreased sedation and anticholinergic effects E) can be given safely with meperidine 25. A nurse is recording subjective information from the family of an aggressive client who was brought to the ED via ambulance. The client is non-compliant with the medication regimen. What statement by the family informs the nurse of their understanding of mental illness? A) "We know the intention was not to take medications, as it was relayed medication was no longer needed." B) "Because of mental illness, my brother cannot think clearly or understand the need for meds." C) "This situation occurs because of thoughts that no one cares and because he is getting attention." D) "This 'mental illness' has been used as an excuse to get away with this behavior for years." 26. A child with ADHD just started school. The mother visits with the school nurse regarding administration of his medications during school hours and to learn about behavior and effects of the medication. The mother asks, "Is there any medications that do not require being given at school?" Which is the appropriate response to the mother? A) "Yes, there are medications that are sustained release and would not require being given at school." B) "You will need to speak to the superintendent about medications regarding your child." C) "Only the nurse can administer stimulants to a child during school hours." D) "You child will need to bring his or her medications to me each day."Answer Key 1. A 2. B 3. D 4. D 5. B 6. A 7. D 8. B 9. A 10. B 11. D 12. D 13. C 14. B 15. B 16. D 17. C 18. B, E 19. B, C, E 20. C 21. A 22. D 23. B 24. A, B, D 25. B 26. AChapter 3 1. A nurse is teaching decision-making skills to a client with dependent personality disorder. According to Erikson, the likely cause of the client developing dependent personality is failure to meet the critical task of which developmental stage? A) Trust B) Autonomy C) Initiative D) Industry 2. The nurse understands that crises are self-limiting. This implies that upon evaluation of crisis intervention, the nurse should assess for which outcome? A) The patient will identify possible causes for the crisis. B) The patient will discover a new sense of self-sufficiency in coping. C) The patient will resume the precrisis level of functioning. D) The patient will express anger regarding the crisis event. 3. A client who has been working on controlling impulsive behavior shows a strengthening ego through which of the following behaviors? A) Going to therapy only when there is nothing more desirable to do B) Weighing the advantages and disadvantages before making a decision C) Telling others in the group the right way to act D) Reporting having fun at a recent social event 4. A client has just been told she has cervical cancer. When asked about how this is impacting her, she states, "It's just an infection; it will clear up." The statement indicates that this patient… A) needs education on cervical cancer. B) is unable to express her true emotions. C) should be immediately referred to a cancer support group. D) is using denial to protect herself from an emotionally painful thought. 5. A teenage client defies the nurse's repeated requests to turn off the video game and go to sleep. The teen says angrily, "You sound just like my mother at home!" and continues to play the video game. The nurse understands that this statement likely indicates… A) the need for stricter discipline at home. B) early signs of oppositional defiant disorder. C) the presence of transference. D) expression of developing autonomy.6. A client reports a pattern of being suspicious of others, causing difficulty in sustaining lasting relationships. Which stage according to Erikson's psychosocial development was not successfully completed? A) Trust vs. Mistrust B) Autonomy vs. Shame and Doubt C) Initiative vs. Guilt D) Industry vs. Inferiority 7. The nurse has established a therapeutic relationship with a patient. The patient is beginning to share feelings openly with the nurse. The relationship has entered which phase according to Peplau's theory? A) Orientation B) Identification C) Exploitation D) Resolution 8. A nurse is meeting with a crisis support group. In efforts to help patients identify with one another, the nurse explains which of the following about the crisis experience? A) "Even happy events can cause a crisis if the stress is overwhelming." B) "Only people who have unfortunate life events will experience a crisis." C) "A person has no control over how a crisis will affect him or her." D) "People can prevent all crises if they develop good coping skills early." 9. A client presents to the ED with a flat affect and disheveled appearance. The nurse objectively can see that the client has experienced an adventitious crisis. Which of the following are examples of adventitious crises? Select all that apply. A) Death of a loved one B) Natural disasters C) Violent crimes D) War E) Leaving home for the first time 10. A nursing supervisor reprimands an employee for being chronically late for work. If the employee handles the reprimand using the defense mechanism of displacement, he would most likely do which of the following? A) Argue with the supervisor that he is usually on time B) Make a special effort to be on time tomorrow C) Tell fellow employees that the supervisor is picking on him D) Tell the unit housekeeper that his (the unit housekeeper's) work is sloppy11. The nurse is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. The nurse recognizes this behavior as which of the following defense mechanisms? A) Dissociation B) Displacement C) Intellectualization D) Suppression 12. A college student decides to go to a party the night before a major exam instead of studying. After receiving a low score on the exam, the student tells a fellow student, “I have to work too much and don't have time to study. It wouldn't matter anyway because the teacher is so unreasonable.” The defense mechanisms the student is using are... A) denial and displacement B) rationalization and projection C) reaction formation and resistance D) regression and compensation 13. A client is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asks for a bed bath, and makes many demands of the nurses. He also yells that they are lazy and incompetent. The client's behavior is an example of which of the following defense mechanisms? A) Introjection B) Projection C) Rationalization D) Reaction formation 14. A client begins to take stock of his life and look into the future. The nurse assesses that this client is in which of Erikson's developmental stages? A) Identity versus role confusion B) Industry versus inferiority C) Integrity versus despair D) Generativity versus stagnation 15. A basic assumption of Freud's psychoanalytic theory is that... A) all human behavior can be caused and can be explained. B) human behavior is entirely unconscious. C) free association is the key to understanding. D) sexuality does not relate to behavior.16. The nurse is assisting a middle-age couple with marital counseling. Which of the following is a major developmental task of middle adulthood? A) Developing intimacy B) Learning to manage conflict C) Reexamining life goals D) Resolving the past 17. A mother is concerned about her child's development. The nurse knows which cognitive mode, according to Harry Stack Sullivan, begins in early childhood as the child begins to connect experiences in sequence? A) Prototaxic mode B) Parataxic mode C) Bitaxic mode D) Syntaxic mode 18. Group members are actively discussing a common topic. Members are sharing that they identify with what others are saying. The nurse leader recognizes that the group is in which stage of group development? A) Planning B) Initial C) Working D) Termination 19. The family members of a patient with bipolar disorder express frustration with the proposed treatment plan of their loved one. Which group should the nurse suggest as most helpful to this family? A) Family therapy group B) Family education group C) Psychotherapy group D) Self-help support group 20. A student nurse attends a self-help group as part of a class assignment. While there the student recognizes a family friend. Upon returning home, the student talks about the friend's attendance with the family. The student's actions can be described as... A) appropriate; persons familiar with group members are allowed self-help group membership. B) appropriate; self-help groups are not professional and therefore are open to public knowledge. C) inappropriate; most self-help groups have a rule of confidentiality.D) inappropriate; the student should not have been allowed to attend the group. 21. The nurse would recommend individual therapy for the client who expresses a desire to A) bring about personal changes. B) gain a sense of belonging. C) develop leadership skills. D) learn more about treatment. 22. Which one of the following statements is most accurate regarding the cohesiveness of a group in group therapy? A) It is commonly present in the first meeting of the group. B) It is necessary for the group to have maximum cohesiveness, the more the better. C) Group cohesiveness is the degree to which members think alike and many things are left unspoken. D) Cohesiveness is a desirable group characteristic that is associated with positive group outcomes. 23. The client asks the nurse how to select a therapist to help with support and understanding of mental illness. Which one of the following is an important characteristic of an effective therapist-client relationship in individual psychotherapy? A) Homogeneity between the client and the therapist. B) Mutual benefit for the client and the therapist. C) The client must adapt to the therapist's style of therapy and theoretical beliefs. D) Match between the theoretical beliefs and style of therapy and the client's needs and expectations of therapy. 24. Which of the following is most essential when planning care for a client who is experiencing a crisis? A) Explore previous coping strategies B) Explore underlying personality dynamics C) Focus on emotional deficits D) Offer a referral to a self-help group 25. During the initial interview with a client in crisis, the initial priority is to... A) assess the adequacy of the support system. B) assess for substance use. C) determine the precrisis level of functioning. D) evaluate the potential for self-harm.26. The nurse on the Psych unit reinforces to the clients that they can earn off-unit privileges for daily use of socially appropriate behavior. This is an example of employing which concept of behavior modification? A) Systematic desensitization B) Negative reinforcement C) Classical conditioning D) Operant conditioning 27. A patient states, "I hate spending time with my family. They're always on my back about something! I won't do 'anything' they ask me to do." Which response by the nurse reflects a behavioral perspective? A) "Do you feel that being argumentative makes you right and them wrong?" B) "Some medicines really help with anger. Are you interested in talking to your physician about starting you on something?" C) "That's probably your way of getting back at them for being strict with you when you were younger." D) "If you agree to start doing what your parents request, then they have agreed to respect your privacy more." 28. A nurse is working with a patient with an eating disorder who refuses to eat a muffin. The nurse asks the patient "Is there any way that you could see the muffin as just flour and water, basic nutrients your body needs?" In this statement, the nurse is using which type of therapy? A) Rational emotive therapy B) Cognitive therapy C) Gestalt therapy D) Reality therapy 29. A patient is blaming his impending divorce on the fact that his wife goes out frequently with her girlfriends. If using reality therapy, the nurse would help the patient with which of the following responses? A) "If you really love her, she should love you as well." B) "What does being divorced mean for you?" C) "How do you feel about your marriage ending?" D) "What role do you think you have played in the end of your marriage?" 30. A nurse is assisting a patient who is working on the technique of systematic desensitization. When the patient feels anxious, the nurse can best use the principles of this technique by stating... A) "Use the deep breathing techniques we practiced yesterday." B) "What is the worst that will happen if you confront this fear?" C) "Tell me how you are feeling right now."D) "I can see you are anxious. Let's stop for a minute." 31. The nurse is working with a client who has a history of inflicting spousal abuse. Although the nurse does not condone domestic violence, the nurse treats the client with unconditional positive regard through which of the following? A) The nurse tries to understand the feelings that might have led to violent behavior. B) The nurse uses honest emotional expression in relating to client. C) The client is still viewed as someone worthy of respect and assistance. D) The nurse relates to the client as if he were her own spouse. 32. A patient is being admitted to an inpatient unit for treatment of anorexia nervosa. Of the following assessment data, which should the nurse place as highest priority in the plan of care? A) Weight 24% below normal for height B) Distorted body image C) Feelings of inadequacy D) Frequent vomiting after meals 33. Which of the following considerations should have the most influence in the nurse's choice of the treatment for the client? A) The client's feelings and perceptions about his or her situation B) The nurse's beliefs about the theories of psychosocial development C) The nurse's familiarity with the type of treatment D) Any approach to treatment should work with any client. 34. Which approach to therapy is most effective when planning for a client with negative thinking? A) Behavior modification B) Client-centered therapy C) Cognitive therapy D) Reality therapy 35. Which of the following theories could be classified as humanistic theories? Select all that apply. A) Cognitive therapy B) Maslow's hierarchy of needs C) Gestalt therapy D) Rogers' client-centered therapy E) Rational emotive therapy F) Piaget's cognitive stages of development36. A client has asked about complementary and alternative therapies. The nurse replies that the client will need to discuss this with the physician and that the physician will order any additional therapies. Which of the following are complementary and alternative therapies? Select all that apply. A) massage and osteopathic therapy B) support group therapy C) aromatherapy D) self-help therapy E) music and art therapy 37. A nurse has a difficult client has become frustrated. Which entry in nursing documentation is considered nonjudgmental in reporting findings? A) The client is displaying bizarre behavior. B) The client demonstrates deceitful behavior. C) The client does not recognize family members. D) The client is uncooperative. 38. A client tells a nurse that he or she is using herbal supplements in addition to prescription medications. What would be the nurse's best response? A) "Herbs are not classified as drugs in the United States, so there is no contraindication to using them." B) "Herbs have pharmacological effects on the body and can interact with some prescription medications." C) "It is never permissible to use herbal supplements with prescription medications." D) "I will refer you to an herbalist who can help you decide which medications you can take." 39. A nurse is participating in a group therapy session along with four clients. One client is experiencing moderate anxiety. Which of the following are indicators of moderate anxiety? Select all that apply. A) diaphoresis B) nausea C) higher pitched voice D) increased pulse rate E) unable to communicate verbally 40. According to Peplau, there are several roles of the nurse in a therapeutic relationship. These can be seen individually with the client or in a group setting. Which role would be used to offer direction to the client or group? A) resource personB) teacher C) counselor D) leaderAnswer Key 1. D 2. C 3. B 4. D 5. C 6. A 7. B 8. A 9. B, C, D 10. D 11. C 12. B 13. B 14. C 15. A 16. C 17. B 18. C 19. B 20. C 21. A 22. D 23. D 24. A 25. D 26. D 27. D 28. B 29. D 30. A 31. C 32. D 33. A 34. C 35. B, C, D 36. A, C, E 37. C 38. B 39. A, C, D 40. DChapter 4 1. Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present? A) Progress in treatment options for mentally ill persons B) The growth of managed care C) Less stigma associated with mental illness D) The current use of milieu therapy 2. The factor having the most influence on the current trend in treatment settings is the fact in recent years... A) funding for community programs has been inadequate. B) laws have enabled more people to be committed to treatment. C) state hospitals have expanded to meet the demand. D) community programs have been fully developed to meet treatment needs. 3. A client who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this client at this time? A) Partial hospitalization B) Residential treatment C) Inpatient hospital treatment D) Clubhouse 4. A client with depression is admitted to an inpatient hospital unit for treatment. The type of therapy most likely provided in this setting includes… A) leisure skills. B) self-monitoring of treatment. C) skills for daily living. D) talk therapy. 5. Which of the following is the highest priority for admission to inpatient care? A) Confusion or disorientation B) Need for medication changes C) Safety of self or others D) Withdrawal from alcohol or other drugs 6. The priority of inpatient care for people with severe mental illness is... A) family issues.B) insight into illness. C) social skills. D) symptom management. 7. Discharge planning from inpatient care for people with severe mental illness must address which of the following to be effective? Select all that apply. A) Finding housing for the client B) Finding a job for the client C) Finding transportation for the client D) Improving family support E) Identifying ideal recreational activities 8. Which type of community residential treatment setting is most likely to be permanent in any state? A) Halfway house B) Respite housing C) Independent living programs D) Evolving consumer household 9. A client is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually do what? A) meet with a therapist on a weekly basis B) resolve crises within a shorter time period C) fulfill daily responsibilities without supervision D) use the increased emotional support of paid staff 10. What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood? A) To provide information to correct misinformation related to stereotypes of persons with mental illnesses B) To persuade neighborhood residents that mentally ill people need safe, affordable, and desirable housing C) To provide for the safety and security of the neighborhood D) To ensure the security of persons in the group home 11. What are the two essential components of transitional care discharge model that is used in Canada and Scotland? A) Peer support and bridging staff B) Collaboration and funding C) Relapse and hospitalizationD) Poverty and entitlements 12. Some residential treatment settings are transitional. This means that clients are eventually expected to do which of the following? A) no longer need therapy B) find employment C) no longer need medication D) relocate to another setting 13. The primary advantage of an evolving consumer household is that clients… A) are provided with adequate income to combat poverty. B) do not have to relocate as they become more independent. C) have on-site staff supervision 24 hours a day. D) receive on-site medical care. 14. The primary goal of a psychiatric rehabilitation program is to promote... A) return to prior level of functioning. B) medication compliance. C) quality of life. D) stabilization and management of symptoms. 15. The nurse is working with the discharge planner for her client's discharge to a facility that uses a transitional care model. The nurse knows this model is effective in promoting the client's health and well-being and preventing relapse and rehospitalization due to which of the following? Select all that apply. A) Collaboration B) Administrative support C) Adequate funding D) Family support E) Completely different providers F) Isolation from peers who successfully live in the community 16. A client has just begun daily participation in a community-based partial hospitalization program. The patient can expect the nurse and staff to assist with which of the following treatment goals? Select all that apply. A) Stabilizing psychiatric symptoms B) Finding a better job C) Improving activities of daily living D) Learning to structure time E) Improved family supportF) Developing social skills 17. The nurse has referred a client to a psychosocial rehabilitation program. The nurse explains that the benefits of being involved in such a program include which of the following? Select all that apply. A) continuous monitoring of symptoms B) increased independence C) increased involvement in treatment decisions D) recovery from mental illness E) increased community integration F) greater opportunities for personal growth 18. The nurse is discharging her client today to be placed in a community rehabilitation area that will provide the client with meaningful work, relationships, a place to come to and a place to return if necessary. Which type of referral will she make? A) Clubhouse model B) Assertive community treatment C) Group homes D) Respite housing 19. The nurse wants her client to have some face-to-face interaction in his home or community. The Assertive Community Treatment (ACT) is such a program, which can attend to his needs. What does this program have? A) Setting limits on mundane life issues B) Making a wide range of referrals C) Providing services in offices D) Problem-solving orientation 20. Which of the following are advantages of a crisis resolution team or home treatment team? Select all that apply. A) It is a residential treatment setting. B) It is more likely to help a client to perceive his or her situation more accurately. C) It is designed to assist clients in dealing with mental health crises without hospitalization. D) The client may feel better about asking for help. E) The client must meet multiple criteria to receive this type of care. 21. A nurse is meeting with the city council to advocate for mentally ill persons and the establishment of a group home in a neighborhood where the plans have been strongly opposed by the neighbors. The nurse can effectively educate the public on the realitiesof group home by citing research that indicates… A) property values quickly rebound in neighborhoods that have group homes. B) police surveillance will be increased to avert any violence by residents. C) most people with mental illness do not represent a significant danger to others. D) neighborhoods that provide park areas provide children a centralized and safe place to play. 22. A client with bipolar disorder has a long history of both hospitalizations and incarcerations. The client has no permanent residence and has infrequent contact with his family. Upon admission to the inpatient psychiatric unit for stabilization, the nurse documents all of the following in the record. Which of the following data most suggests a positive outcome for this client? A) Client reports meeting with the same case manager monthly for the last 3 years B) History of residential stays at several local homeless shelters C) Last contact with siblings 4 years ago D) Income from day labor for 2 days last month 23. A nurse is orienting to a new position working the infirmary in the state penitentiary. When working with prisoners who are also mentally ill, the nurse examines her own attitudes. Which of the following beliefs should the nurse discuss with her supervisor before caring for incarcerated patients? A) People with mental illness are inherently violent. B) The mentally ill can get better treatment in prison than in the community. C) People with mental illness are more vulnerable to victimization when incarcerated. D) Many mentally ill would not be in prison if they were stabilized on medication. 24. The nurse is part of a group setting up a mobile crisis service in conjunction with the local police department. Community education on which of the following will the team's focus include? A) Teaching police officers counseling skills B) Crisis counseling services to be provided in the prison system C) Educating about the dangers of the mentally ill in the community D) Assisting police officers to recognize mental illness 25. A client has been started on antidepressants. The interdisciplinary team member most responsible for monitoring effectiveness and side effects of this new medication is the... A) pharmacist. B) psychiatrist. C) psychiatric nurse. D) psychologist.26. A client is encouraged to join in daily outdoor games with peers on the unit. The interdisciplinary team member who will monitor the client's involvement will be the… A) occupational therapist. B) recreation therapist. C) vocational rehabilitation therapist. D) psychiatric nurse. 27. A client with bipolar disorder taking lithium returns from a walk outside and reports feeling shaky and dizzy. The nurse suspects the patient is experiencing a toxic reaction to the lithium and immediately notifies the... A) psychiatrist. B) psychiatric nurse. C) nurse manager. D) recreation therapist. 28. A nurse documents that a patient has successfully acquired a job performing janitorial services at a local manufacturing company. The goal of which of the following levels of prevention has been achieved? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Community prevention 29. A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health-care need? A) Influencing schizophrenic patients to adhere to medication regimens B) Assisting high school students to effectively manage stress C) Coaching patients with depression to obtain employment D) Informing parents of the early signs of attention deficit disorder in children 30. A psychiatric nurse is planning activities aimed at secondary prevention of mental illness. Which activity would be most appropriate to develop? A) Self-esteem building with a local after-school program B) Social skills training for chronic schizophrenics C) Parenthood classes at a local community center D) Depression screening in an assisted living facility31. Which element would be present in an assertive community treatment (ACT) program? A) 24-hour-a-day services B) Infrequent contact with clients C) Many clients to each staff member D) Limited length of service 32. An inmate is brought to the ED via ambulance after a severe altercation at the prison. Which characteristics should a nurse expect to observe in a person who has been in jail? Select all that apply. A) non-educated B) homeless C) frequently changes jobs D) acute and chronic mental illness E) poor functioning level 33. Military veterans with mental issues often do not seek treatment. The nurse in a VA hospital knows which disorder is moderately higher in veterans than in the general population? A) bipolar disorder B) paranoid disorder C) obsessive-compulsive disorder D) depressive disorder 34. A nurse is planning to discharge a client. A client's ability to remain in the community is closely related to what? A) living environment B) participation in social events C) taking meals at the food bank D) supporting neighborhood watch programs 35. A nurse reviews a client's history and knows that in preparation for discharge planning of the client, success of planning can be impeded by which of the following? Select all that apply. A) alcohol and drug abuse B) inability to secure employment C) evolving community D) violent or criminal behaviors E) medication non-complianceAnswer Key 1. B 2. A 3. C 4. D 5. C 6. D 7. A, C 8. D 9. C 10. A 11. A 12. D 13. B 14. C 15. A, B, C 16. A, C, D, F 17. B, C, D, E, F 18. A 19. D 20. B, C, D 21. C 22. A 23. A 24. D 25. C 26. B 27. A 28. C 29. B 30. D 31. A 32. B, D, E 33. C 34. A 35. A, D, EChapter 5 1. Which of the following statements is true of empathy? Select all that apply. A) It is the ability to place oneself into the experience of another for a moment in time. B) It involves interjecting the nurse's personal experiences and interpretations of the situation. C) It is developed by gathering information from the client. D) It results in negative therapeutic outcomes. E) The client must learn to develop empathy for the nurse. 2. The nurse understands that empathy is essential to the therapeutic relationship. When a client makes the statement, "I am just devastated that my marriage is falling apart"; the nurse can best show empathy through which of the following responses? A) "I feel so bad for what you are going through." B) "You feel like your world is falling apart right now." C) "I have been divorced, too. I know how hard it is." D) "It will get better; let's talk about it." 3. The nurse is working with a client who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the client, the nurse shows positive regard through which statement? A) "How is not working right now affecting you?" B) "How do you expect your kids to be provided for?" C) "You need to somehow find a way to support your children." D) "Can the children's mother can get by for a while until you get better?" 4. Which of the following statements is true of the component of a therapeutic relationship termed "acceptance"? A) The nurse accepts the presence of any inappropriate behavior. B) It is avoiding judgments of the person, no matter what the behavior is. C) It involves punishment for inappropriate behavior. D) It is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client. 5. Which of the following behaviors by the nurse demonstrates positive regard? Select all that apply. A) Communicating judgments about the client's behavior B) Calling the client by name C) Spending time with the clientD) Responding openly E) Considering the client's ideas and preference when planning care 6. The nurse initiating a therapeutic relationship with a client should explain the purpose, which is to... A) alleviate stressors in life. B) allow the client to know the nurse's feelings. C) establish relationships. D) facilitate a positive change. 7. Which of the following is the most important skill the nurse must bring to the therapeutic nurse-client relationship? A) Confrontation B) Empathy C) Humor D) Reframing 8. The nurse must be able to make decisions that are based on the principles of right and wrong. What is the standard for establishing such a code of conduct for living? A) Acceptance B) Empathy C) Values D) Positive regard 9. A nurse makes the statement in a treatment team meeting, "It's not worth it to try to teach this client how to make better choices. He has been here many times before and goes back home and does the same thing." As the supervisor addresses the nurse and her statement, the supervisor understands the nurse is sharing which of the following? A) Value B) Awareness C) Belief D) Attitude 10. The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as… A) confrontation. B) countertransference. C) incongruence. D) transference.11. The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is, A) "I am sure there are other people in your life who are your friends; besides, we just met." B) "It makes me feel good that you trust me so much; it is important for the work we are doing together." C) "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." D) "We are not friends. This is strictly professional." 12. A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. The nurse is using which of the following techniques? A) Defining boundaries B) Defining therapy C) Letting the client down gently D) Reprimanding the client 13. Which one of the following statements about the nurse and ethnocentrism is true? A) Nurses have a tendency to inwardly view their own culture as superior to others. B) Ethnocentrism is a desirable trait in a nurse. C) Nurses must deny their ethnocentrism. D) A nurse must not think of his or her own attitudes and beliefs. 14. A nurse is using the Johari window to identify the degree to which he feels comfortable communicating with others. After completing the exercise, the nurse discovers that quadrant 1 has the longest list of qualities. This indicates which of the following about the nurse? A) The nurse conceals personal information about himself. B) The nurse needs to increase insight into his own characteristics. C) The nurse is open to others. D) The client is sharing more than the nurse in the therapeutic relationship. 15. A nurse is assigned to care for a client whose sexual orientation differs from the nurse's sexual orientation. When should the nurse seek guidance from the supervisor? A) When the nurse desires to assist the client to change values B) when the nurse wants to discuss goals and the plan of care C) When the nurse begins to empathize with the client D) When the nurse identifies anxieties regarding the client's values and sexuality16. While in the day room of the psych unit the nurse notices a client sitting quietly alone, eyes downcast, and looking sad. The nurse says to the client, "You look like something is bothering you." Which pattern of knowing did the nurse use to respond to the client? A) Empirical knowing B) Personal knowing C) Ethical knowing D) Aesthetic knowing 17. The nurse assesses fine hand tremors in a client with a history of heavy alcohol use. If the nurse understands that the tremors are a direct result of alcohol use, the nurse is using which pattern of knowing, according to Carper? A) Aesthetic knowing B) Ethical knowing C) Personal knowing D) Empirical knowing 18. While the nurse and client are interacting during a therapy session, the nurse openly admits to not being able to relate to a client's experience. According to Munhall, this will most likely have what influence on the therapeutic relationship? A) The nurse will avoid imposing any values on the client. B) The client will not trust the nurse's professional abilities. C) The nurse will more likely be manipulated by the client. D) The client will be less likely to self-disclose to the nurse. 19. The nurse and client are visiting about upcoming sporting events of which they both share an interest. This form of interaction has the potential to threaten the nurse-client relationship by which of the following? A) influencing whether the patient likes the nurse or not B) avoiding serious work that can hinder the client from reaching set goals C) letting the client know that the nurse is genuine with diverse interests D) overstepping ethical boundaries that the nurse should maintain 20. The nurse is mindful of maintaining relationships with clients that are therapeutic. Certain characteristics of the relationships the nurse will foster include which of the following? Select all that apply. A) Offering sound advice to the client. B) Establishing boundaries for both the nurse and client. C) Maintaining a client-focus at all times. D) Sharing personal feelings openly with the client.E) Avoiding concern with whether the client likes the nurse. 21. What is the primary differences between social and therapeutic relationships? A) The amount of emotion invested. B) The degree of satisfaction obtained. C) The kind of information given. D) The focus of the relationship 22. The nurse is meeting with her client for the first time. During the orientation phase of the nurse-client relationship, the nurse directs the client to do which of the following? A) Identify problems to examine B) Express needs and feelings C) Develop interpersonal skills D) Identify self-care strategies 23. The nurse has been working with a client with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurse-patient relationship? Select all that apply. A) Exploring perceptions of reality B) Promoting a positive self-concept C) Explaining the boundaries of the relationship D) Working through resistance E) Assisting in identifying problems 24. A client being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the client. The nurse can best assist the client in this stage of the relationship with which of the following responses? A) "We have to go over these instructions before you can go. Please try to listen." B) "Would you rather not be discharged today?" C) "I can sense you are angry this morning. Tell me how you feel about being discharged today." D) "You should be able to regulate your feelings better by now. Why are you angry?" 25. During a regular home health visit to an elderly client, the nurse observes that the client has feelings of hopelessness and despair. The client says, "I'm old, and my life has no purpose anymore. But promise me you won't tell anyone." How should the nurse respond? A) "Don't worry, I won't tell anyone else." B) "I'm sorry, but I can't keep that kind of secret."C) "Let's talk about something to cheer you up." D) "What can we do to help you feel better? 26. What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it a secret that the client plans to kill a family member? A) The student nurse must respect the client's privacy and not tell anyone. B) The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. C) The student nurse must tell the client that the student nurse will keep the secret and then tell the instructor and/or staff members. D) The student nurse must tell the instructor and then ask the instructor to keep it secret. 27. During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems? A) Comparing past and present coping strategies B) Encouraging the client to clarify feelings and behavior C) Identifying possible solutions for the client's problems D) Referring the client to a self-help group 28. Nurses must be aware of the importance of boundaries, not only for the client but also for the nurse. Which of the following occurrences is considered a breach of professional boundaries? A) Patient asking a nurse for her phone number B) Refusing a gift from a patient C) Changing the subject in response to a patient compliment D) Having a lengthy social conversation with a patient 29. Which of the following statements correctly depict the problem of feeling sympathy toward the client? Select all that apply. A) This can cause the nurse to feel sad and be unable to help the client. B) When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. C) The client is discouraged from exploring his or her problems, thoughts, and feelings. D) The client is discouraged from growth. E) The client feels dependent on the nurse. 30. The client is getting ready to be discharged from the psych unit. A nurse and client has just completed reviewing the client's take-home medications. The nurse is exemplifying which role during this intervention? A) AdvocateB) Caregiver C) Teacher D) Parent Surrogate 31. The nurse is caring for her client that has a history of being neglected. Which role of the nurse is most likely to create difficulty for the nurse-client relationship if the client confuses physical care with intimacy and sexual interest? A) Teacher B) Caregiver C) Advocate D) Parent surrogate 32. During a therapeutic communication session, the nurse tells the client of a past experience. Which of the following statements is true about a nurse's self-disclosure? A) It is the basis for effective communication. B) Self-disclosure should be used with all clients to some degree. C) The more the nurse discloses, the more the client will disclose. D) Self-disclosure on the nurse's part should benefit the client. 33. A tool the nurse uses to learn more about his or her qualities and communication with others is called? A) Carper's Pattern B) Johari Window C) Peplau's Preconceptions D) Nursing Boundary Index 34. A client recently experienced a panic attack. A nurse has worked with the client to redirect the client's thoughts and to aid in calming the situation even though it is past the nurse's shift. This is an example of which pattern of knowing? A) empirical B) personal C) ethical D) aesthetic 35. What are possible warnings or signals of abuse of the nurse-client relationship? Select all that apply. A) nurse making exceptions to client B) keeping secrets C) talking to team members about clients D) inappropriate conversations in the nurse-client relationshipE) accepting behavior 36. A nurse in the geri-psych unit witnesses another nurse violate the boundaries of the professional relationship with the client. What role is the nurse taking as he or she speaks to the supervisor about this situation and then the offending nurse? A) teacher B) parent surrogate C) advocate D) care giver 37. An experienced nurse takes pride in the therapeutic use of self. Nurse-client relationships are meaningful to both the nurse and the client. Nurses that have use of self skills help clients do which of the following? A) grow, change, and heal B) participate in all aspect of care C) maintain skills after discharge D) serve as peer clients for new admissionsAnswer Key 1. A, C 2. B 3. A 4. B 5. B, C, D, E 6. D 7. B 8. C 9. D 10. D 11. C 12. A 13. A 14. C 15. A 16. B 17. D 18. A 19. B 20. B, C, E 21. D 22. A 23. A, B, D 24. C 25. B 26. B 27. B 28. D 29. B, C, D, E 30. C 31. B 32. D 33. B 34. C 35. A, B, D 36. C 37. AChapter 6 1. The nurse uses a variety of therapeutic communication skills when working with clients. Which of the following is a therapeutic goal that can be accomplished through the use of therapeutic communication skills? A) Inform the client of priority problems B) Assess the client's perception of a problem C) Assist the client to control emotions D) Provide the client with a plan of action 2. Which one of the following goals of therapeutic communication would the nurse strive to attain first? A) Facilitate the client's expression of emotions. B) Establish a therapeutic nurse–client relationship. C) Teach the client and family necessary self-care skills. D) Implement interventions designed to address the client's needs. 3. The nurse using therapeutic communication asks the client what he would like to talk about. This is an example of which of the following? A) Broad opening B) Encouraging expression C) Focusing D) Offering self 4. A client says, "Its' been so long since I've been with my family." Which statement by the nurse is an example of restating? A) "You say you haven't seen your family in a while." B) "Tell me what happened when you last saw your family." C) "Go on. Tell me more." D) "When was the last time you saw your family?" 5. The client expresses frustration that the doctor does not spend enough time with her when making rounds. The nurse replies, "The doctors are very busy. What can I help you with?" The nurse incorporated which nontherapeutic technique in this response? A) Belittling B) Defending C) Disagreeing D) Introducing an unrelated topic6. During a session with a client, the client asks the nurse what she should do about her "cheating" husband. The nurse replies, "You should divorce him. You deserve better than that." The nurse used which nontherapeutic communication technique? A) Giving information B) Verbalizing the implied C) Giving advice D) Agreeing 7. The nurse asks the client to describe the quality of an experience. Which communication skill is the nurse using? A) Encouraging expression B) Encouraging description of perceptions C) Accepting D) Requesting an explanation 8. The nurse should avoid nontherapeutic techniques. Which of the following are nontherapeutic techniques? Select all that apply. A) Silence B) Voicing doubt C) Agreeing D) Challenging E) Giving approval F) Exploring 9. Which of the following statements would be an empathetic response in a client interaction? A) "You must have been embarrassed when your father yelled at you in the grocery store." B) "You really should find your own housing and get out of the situation with your father." C) "Well, it sounds like your father has difficulty controlling his temper." D) "Why do you think your father chose that time and place to yell at you?" 10. While the nurse and client are in a therapy session, the nurse says to the client, "You become very anxious when we start talking about your drinking." Which of the following techniques is the nurse using? A) Confronting behavior B) Making an observation C) Translating into feelings D) Verbalizing the implied11. The nurse is sitting down with a client to begin a conversation. Which of the following positions should the nurse take to convey acceptance of the client? A) Leaning forward with arms on the table sitting directly across for the client B) Turned slightly to the side of the clients with arms folded across the chest C) Leaning back in the chair next to the client with legs crossed at the knees D) Sitting upright facing the client with both feet on the floor 12. A client states, "I feel fine. It's a good day." The nurse notes the client looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse? A) "I'm glad you are feeling good today." B) "I'm not sure I believe you." C) "Tell me what is good about today." D) "You say you feel fine, but you don't really sound fine." 13. The nurse watches the expressions the client is making as group therapy is conducted. Which of the following statements about verbal and nonverbal communication skills is accurate? A) One third of meaning is transmitted nonverbally and two thirds is communicated verbally. B) Nonverbal communication is as important, if not more than, verbal communication. C) Verbal communication is most important because it is what the patient says. D) Verbal communication involves the unconscious mind. 14. The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to... A) increase the client's awareness of nonverbal behavior. B) investigate the source of nonverbal behavior. C) validate the client's feelings. D) validate the meaning of the nonverbal behavior. 15. A nurse has invited a client to sit down and have a conversation. The client takes the first seat. The nurse pulls up another chair to sit with the client. Approximately how far from the client should the nurse place her chair? A) 1 to 2 feet B) 3 to 6 feet C) 6 to 8 feet D) 8 to 10 feet 16. The nurse is sitting with a client who is crying. After a few minutes the nurse placesone hand on the client's shoulder. Which of the following best describes the purpose of the nurse's touch with this client? A) To express sympathy to the client B) To assess the client's skin temperature and circulation status C) To offer comfort and support for the client D) To extend an offer of friendship to the client 17. The client frequently attempts to touch the nurse and the nurse has explained the prohibition against this. Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff? A) Because some clients with mental illness have difficulty knowing when touch is or is not appropriate B) Because clients often perceive being touched as a threat and may attempt to protect himself or herself by striking the staff person C) Because it can be threatening to both the client and the nurse D) Because touching always leads to more touching 18. A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the client while respecting the client's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client? A) In the client's room when the client's roommate is present and 3 feet away B) At the nurse's station when other clients and visitors are less than 4 feet away C) In an interview room in a remote section of the unit with the nurse 1 foot away from the client D) In a quiet corner of the dayroom at least 4 feet away from others 19. The mother of a small client holds her child close during the initial assessment. Which of the following distance zones is acceptable for people who mutually desire personal contact? A) Social B) Intimate C) Personal D) Public 20. The nurse should use clear, concrete messages when working with clients displaying which of the following conditions? Select all that apply. A) Anxiety B) Anorexia C) Dementia D) SchizophreniaE) Illness anxiety disorder 21. The nurse and the client are using therapeutic communication skills. Which statements are true of concrete and abstract messages? Select all that apply. A) Abstract messages include figures of speech that are difficult to interpret. B) Abstract messages are important for accurate information exchange. C) Concrete messages require the listener to interpret what the speaker says. D) Concrete messages are clear, direct, and easy to understand. E) Abstract messages are best used for persons who are anxious. 22. The nurse asks the client, "What was it like for you when you first knew you had no place to go?" The client looks down and pauses for quite some time. Which action by the nurse is most therapeutic? A) Change the subject to something the patient will discuss B) Encourage the patient to express any unpleasant feelings C) Apologize for asking such a personal question D) Sit quietly until the patient responds 23. A client remarks, "You know, it's the same thing every time." The nurse should respond by stating, A) "I understand." B) "I'm sure everyone is doing their best." C) "I'm not sure what you mean. Please explain." D) "It's the same thing every time?" 24. A client states, "Right before I got here I was doing all right. My job was going well, my wife and I were happy, and we just moved into a new apartment." The nurse responds, "You said you and your wife were happy. Tell me more about that." This is an example of which therapeutic technique? A) Encouraging comparison B) General lead C) Restating D) Exploring 25. A client is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the client to talk? A) "If you are sleepy, would you like me to help you back to your room?" B) "You look like you are deep in thought." C) "Is something wrong?" D) "Why are you sitting with your eyes closed?"26. A client yells, "All the nurses here are so mean. None of you really care about us!" The most therapeutic response would be what? A) "I cannot allow you to yell like that." B) "We care about you." C) "Oh, really?!" D) "You seem very irritated." 27. The client says to the nurse, "I wonder what's playing at the movies tonight." The most therapeutic response would be what? A) "Are you telling me you would like to go to the movies?" B) "Why don't you look in the newspaper?" C) "There's nothing worth watching." D) "We may have some DVD's available." 28. The client says to the nurse, “I have special powers because I am the mother of God. I can heal everyone in the hospital.” The nurse's best response would be... A) "That sounds interesting. I'm not sure that I follow." B) "It would be unusual for anyone to have that kind of power." C) "You could not heal everyone. No one has that much power." D) "Well, you can certainly try." 29. During the admission interview, the nurse asks the client what led to his hospitalization. The client responds, "They lied about me. They said I murdered my mother. You're the killers. You all killed my mother. She died before I was born." What would be the best initial response by the nurse? A) "I just saw your mother. She's fine." B) "You're having very frightening thoughts." C) "We'll put you in a private room until you're in better control." D) "If your mother died before you were born, you wouldn't be here." 30. The client stated, "I was so upset about my sister ignoring me when I was talking about being ashamed." Which nontherapeutic communication technique would the nurse be using if the nurse would state, "How are your stress reduction classes going?" A) Changing the subject B) Offering advice C) Challenging D) Disapproving31. During the mental status assessment, the client expresses the belief that the CIA is stalking him and plans to kidnap him. Which would be the best response by the nurse? A) "That makes no sense at all." B) "You can tell me about that after I finish asking these questions." C) "What kinds of things have been happening?" D) "Why would the CIA be interested in you?" 32. The nurse is trying to obtain some information about family relationships from the client. Which of the following statements is best? A) "Is it upsetting for you to talk about your family?" B) "Is your family ready for you to come home?" C) "So, how is your family?" D) "Tell me your feelings about your family situation." 33. A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction? A) Broad opening B) Focusing C) Giving information D) Silence 34. When preparing for the first clinical experience with clients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students' beliefs and fears surrounding forensic clients. The primary reason for discussing personal beliefs is to... A) practice reflective communication skills in a role-play situation. B) assign the most compatible patients to the students. C) assess the appropriateness of the setting for implementing nursing skills. D) become aware of possible barriers to developing therapeutic relationships. 35. A nurse is working with a client whose background is very different from hers. A good question to ask herself to assure she can be effective working with this client would be... A) "Can this person understand me?" B) "Do I understand this patient's expectations of me?" C) "What experiences do I have with people with different backgrounds?" D) "Is this person going to be able to relate to me?" 36. The nurse fails to assess personal values surrounding homosexuality before caring for a client who is openly gay. The nurse is most at risk for which of the following when working with this client?A) Holding a prejudice toward this client B) Neglecting to include the client's desires in the plan of care C) Being manipulated by this client D) Expressing shock when assessing the client's history 37. How can a nurse avoid the possibility of finding the client's behavior unacceptable or distasteful? A) By being aware of the client's behavior and background before beginning the relationship, and exploring with a colleague the possibility of a conflict. B) By using silence instead of verbal responses for all instance of the client describing his or her behavior C) By using facial expressions of annoyance if the client expresses behavior that the nurse disapproves of D) By turning away from the client when the nurse does not want the client to see his or her facial expression 38. A nurse has interactions with several clients throughout the day. When would a formal setting for discussion be indicated? A) when a client is displaying aggressive behaviors B) when a client has difficulty maintaining boundaries C) when a client is showing signs of sadness D) when a client is displaying hearing voices 39. A student nurse is helping with discussion with a client. Which of these is an explanation why a student nurse does not use active listening? A) The student nurse is bored with the unit. B) The student nurse is uncomfortable with the client. C) The student nurse is thinking ahead for answers. D) The student nurse is unable to understand cues. 40. Nurses develop empathy with their clients while gathering information about the client. Which of the following hinders the development of empathy? A) interjecting personal experiences B) asking the client to restate for clarity C) asking leading questions D) focusing on one issue 41. A nurse is developing a therapeutic relationship with the client. To do this, the nurse must respect the client's religious and spiritual beliefs. Which of the following will occur if the nurse does not show this respect?A) frustration for the client B) longer rehabilitation C) leads to mental health relapse D) eroding trust 42. A nurse has been waiting for over an hour for the ancillary department of laboratory to draw blood on a non-critical client with bipolar disorder in the ED. Which response is an example of assertive communication from the nurse to the laboratory personnel? A) "So nice of you to join us, it's about time." B) "When you are late to draw blood the family gets upset, and I don't like having to repeat that you are on your way." C) "When you work, we never get blood drawn on time." D) "It's about time, we were beginning to think I would have to do your job and mine too."Answer Key 1. B 2. B 3. A 4. A 5. B 6. C 7. A 8. C, D, E 9. A 10. B 11. D 12. D 13. B 14. D 15. B 16. C 17. A 18. D 19. B 20. A, C, D 21. A, D 22. D 23. C 24. D 25. B 26. D 27. A 28. B 29. B 30. A 31. C 32. D 33. A 34. D 35. C 36. A 37. A 38. B 39. C 40. A 41. D 42. BChapter 7 1. The nurse is assessing the anxiety level of a young school-age child. The nurse encourages the child to express feelings through the use of toys in a play situation. The purpose for this approach to assessment is largely related to which of the following? A) The child has cognitive impairment and has limited vocabulary skills. B) The child has not been intellectually stimulated and can only express self through play. C) Children may not have developed the language to fully describe their feelings. D) Children will not express themselves openly unless instructed to do so by parents. 2. Which one of the following statements is most accurate regarding the age at onset of a mental illness such as schizophrenia? A) Persons who are diagnosed at a younger age will more likely have a poorer outcome. B) Persons who are diagnosed at a younger age will more likely have a better outcome. C) Age at diagnosis is not related to outcomes. D) Younger clients have more experiences that will help them. 3. Genetics have been shown to play which of the following roles in a person's mental and emotional health? A) Several mental disorders appear to run in families. B) Specific genes have been linked to certain mental disorders. C) Biologic factors can be modified to change the influence on emotional health. D) Psychiatric treatment is effective regardless of an individual's biologic influences. 4. Which one of the following statements about the roles that biologic makeup plays in a client's emotional responses is most accurate? A) Biologic differences can affect a client's response to treatment with psychotropic drugs. B) Biologic differences do not affect a client's response to treatment with psychotropic drugs. C) Heredity and biologic factors are under voluntary control. D) Persons cannot change their health status and improve the ability to cope. 5. Which of the following individual factors can a person modify to improve mental and emotional health? Select all that apply. A) Serotonin deficiency B) Lack of exercise C) Poor nutrition D) Type I diabetes E) Sleeplessness6. The nurse is preparing to administer PRN medication to a client of a Japanese descent who is anxious. The prescription reads, "Alprazolam (Xanax) 0.25 to 1.0 mg PO PRN." The best dose for the nurse to give initially is which of the following? A) 0.25 mg. B) 0.5 mg. C) 0.75 mg. D) 1.0 mg. 7. A client's prognosis is said to be good due to a high degree of self-efficacy. Which of the following best characterizes self-efficacy? A) The client is self-motivated and asks for help when needed. B) The client is able to resist illness when under stress. C) The client responds well in stressful situations. D) The client uses good problem-solving abilities. 8. A client is actively involved in community service activities. The benefit of involvement in meaningful daily activities will most directly contribute to which of the following attributes? A) Self-efficacy B) Resilience C) Resourcefulness D) Hardiness 9. It is recorded in the client's chart that the family is resilient. The nurse concludes which of the following characteristics about the family life of this client? Select all that apply. A) Family members are independent of one another. B) Family members spend time together. C) Family members engage in recreational activities together. D) Family members share the same personal goals. E) Family members have daily routines independent of one another. 10. Spirituality is especially important in helping people cope primarily for which of the following reasons? A) Spirituality helps people set personal goals. B) Spirituality gives people meaningful daily activities in which to participate. C) Spirituality provides a reliable support network. D) Spirituality guides beliefs about the meaning of life events. 11. Which of the following statements about hope and symptoms of mental illness aretrue? Select all that apply. A) Hope is not realistic and therefore is not related to mental well-being. B) Persons having more hope experienced fewer actual symptoms. C) Hope is a cause of mental illness. D) There is not a significant relationship between hopelessness and increased symptoms. E) A possible way to help clients manage and decrease symptoms would be to support the development of hope. 12. Which of the following personal characteristics influence a client's response to stressors? Select all that apply. A) Self-efficacy B) Sense of belonging C) Spirituality D) Hardiness E) Resilience F) Resourcefulness 13. Which of the following statements about spirituality is true? Select all that apply. A) Many clients with mental disorders have disturbing religious delusions. B) Religious activities have been shown to be linked with better health and a sense of well-being. C) Spirituality only involves religion. D) Hope and faith are two critical factors in psychiatric and physical rehabilitation. E) Spirituality may include a relationship with the environment. 14. Individuals who grow up in “at-risk” environments but are able to become productive, successful citizens are believed to possess which of the following characteristics? A) Hardiness B) Resilience C) Social skills D) Tolerance 15. Which of the following factors would be the most influential in determining a client's response to a particular stressor? A) The client's experience with stress B) The client's perception of the stressor C) Duration of the stressor D) Severity of the stressor 16. The client says to the nurse, "I know I can learn to cope with my family situation. Bygetting help here at the clinic, I'll be able to deal with them more effectively, and I won't be so stressed out all the time." This client is demonstrating a high level of which personal characteristic? A) hardiness B) resilience C) sense of belonging D) self-efficacy 17. A client reports feeling like he belongs among his peers with whom he shares a group home. The nurse incorporates this sense of belonging when formulating discharge plans because the nurse understands which of the following? A) Living with a peer group often increases anxiety. B) Peers may alienate the client from daily living activities. C) The client will likely feel needed by his peers. D) Peer groups often do too much for each other, causing dependency. 18. Which of the following situations would most likely provide social support to a client? A) A friend who will share his or her perspective on an issue B) The transportation service that provides access to daily rehabilitation services C) Fellow teammates participating in a community softball league D) The teacher assisting a client to obtain a GED 19. The nurse is taking care of a client with schizophrenia and alcohol abuse. In formulating a holistic plan of recovery, it would be especially important to a client from which of the following cultural groups? A) American Indian B) African American C) Mexican American D) Arab American 20. A nurse and a client of Chinese heritage are collaborating on treatment goals. The nurse would document which of the following as the client's priority goal? A) The client will be free of pain and excess stress. B) The client will express a feeling of balance and harmony. C) The client will be free of physical symptoms of illness. D) The client will express gratefulness to God for recovery. 21. The nurse is preparing to conduct an admission assessment interview with a Mexican American client. During the interview, the nurse should respect the client's culture through which behavior?A) Greet the client with a hug. B) Encourage direct eye contact during questioning. C) Prohibiting the next of kin to remain present D) Introduce self with a handshake 22. A nurse is working with a Middle-Eastern client being treated for major depression. The client is expressing feelings of guilt for not being able to "snap out of it." A therapeutic response by the nurse would be which of the following? A) "You have to keep trying to feel better." B) "What do you think could have caused your depression?" C) "Clinical depression is not something you have brought on yourself." D) "It will take several weeks for your medicine to start to help you feel better." 23. Several family members arrive to visit an African American client. The nurse can best meet this client's need for socialization by providing the client and family which of the following? A) Individual visits to provide the client with a calm environment B) Group gatherings and open conversation C) Inclusion of ritualistic health practices with the family present D) A spiritual healer to remove the illness and protect the family 24. A Filipino client meets the nurse for the first time. The client simply smiles at the nurse when introduced. The nurse interprets this behavior as... A) a display of being shy and introverted. B) a typical greeting for a Filipino client. C) constricted verbal skills associated with the client's illness. D) a sign that the client may be suspicious of the nurse. 25. The nurse is caring for a young female client. Females from which of the following cultures are most likely to be expected to move in with the husband's family? A) African Americans B) Mexican Americans C) South Asians D) Haitians 26. Culture has the most influence on a person's health beliefs and practices. The nurse is taking care of an African American in the ED with a new diagnosis of schizophrenia. African Americans may believe that the cause of mental illness occurs because of which of the following? A) Lack of harmony of emotionsB) Supernatural causes C) Heredity D) Lack of spiritual balance 27. The nurse notices a group of clients sitting in a cluster in the day room. A client from which of the following cultural groups is likely to prefer closeness in personal space? A) Arab Americans B) Chinese C) Cubans D) African Americans 28. The nurse is assessing the mental status of a client. Direct eye contact is preferred by which of the following cultures? A) Native Americans B) Cambodians C) Russians D) Chinese 29. Beliefs about the causes of pain and illness vary among cultures. In the United States (Western culture), pain and illness are generally attributed to which of the following? A) economic class B) psychological influences C) physiologic causes D) sociocultural factors 30. The nurse considers cultural variations pertaining to a client's nonverbal communication. Which of the following is the primary rationale for considering alternative meanings of nonverbal communication? A) The nurse must become expert at interpreting the client's gestures. B) Nonverbal signs indicative of certain mental illnesses transcend cultural differences. C) Mental illnesses impair a client's ability to express nonverbal messages. D) Nonverbal messages have different meanings in various cultures. 31. The nurse is taking care of clients in a large metropolitan city. Which of the following cultural phenomena should be assessed by the nurse that includes preference such as touch and eye contact? A) Communication B) Social organization C) Environmental control D) Biologic variations32. Which of the following questions best encourages the client to disclose information that the nurse must assess to provide culturally competent care? A) "How do you want me to help you?" B) "Do you want me to contact your preacher?" C) "What special diet do you have?" D) "Which family members do you want to receive calls from?" 33. The nurse is making a cultural assessment of a Russian client. Which of the most important data about a client's cultural beliefs? A) objective data about the culture B) subjective data from the client C) subjective data from the family D) subjective data from society 34. The nurse is taking care of a Haitian client. How might the nurse best provide culturally competent care? A) Behave as appropriate for the nurse's culture. B) Find out as much as possible about a client's cultural values, beliefs, and health practices. C) Know what to expect from many cultural groups. D) Validate knowledge about culture through continuing education. 35. A teenage client presents to the ED along with several other teenagers. The nurse can see they have a good support system. What two key components must be necessary for a support system to be effective? A) The collaborative information gathered from the group regarding presenting events. B) Client's perception of the support system and the responsiveness of the support system. C) The protective mechanisms shown by the support system in a matter-of-fact manner. D) Client's perception of the ED and how quickly he or she can be cared for. 36. A nurse is gathering information regarding discharging a client and documenting the client's support system. Which of the following are factors in family support? A) loving and caring B) concerned and inquisitive C) cautious of commitment D) available only at discharge 37. A nurse is using therapeutic communication with a Navajo client. The nurse knows thefollowing about this culture? Select all that apply. A) have long periods of direct eye contact B) uses frequent long pauses in conversation C) are willing to share information regarding family D) a light touch hand shake is a sign of respect E) openly discuss their beliefs and practices with strangers 38. A nurse is caring for a client who is Filipino. What should the nurse keep in mind about the client's culture when attempting to foster communication with the client? A) This culture views mental illness as a stressor. B) This culture views mental illness as being from a supernatural cause. C) This culture views mental illness as a shameful event brought to the client and family. D) This culture views mental illness as a disruption of the harmony between the body and the spiritual world. 39. A nurse is providing culturally competent care. In order to so adequately the nurse must do which of the following? A) inquire about client values, beliefs, and health practices B) engage other family members to get a broader perspective C) open all initial visits with a firm kind hand shake D) maintain good eye contact at all times during the interviewAnswer Key 1. C 2. A 3. A 4. A 5. B, C, E 6. A 7. A 8. D 9. B, C 10. D 11. B, E 12. A, C, D, E, F 13. A, B, D, E 14. B 15. B 16. D 17. C 18. A 19. A 20. B 21. D 22. C 23. B 24. B 25. C 26. D 27. A 28. C 29. C 30. D 31. A 32. A 33. B 34. B 35. B 36. A 37. B, D 38. D 39. AChapter 8 1. When assessing a client's mental health status, which of the following describes the purpose of the psychosocial assessment? Select all that apply. A) To assess the client's current emotional state B) To assess the client's mental capacity C) To assess the client's behavioral function D) To assess the client's plan of care E) To assess the client's physical health status 2. Which of the following factors influencing assessment is under the nurse's control? A) Client participation and feedback B) Client's health status C) Nurse's attitude and approach D) Client's ability to understand 3. Which of the following are components of the assessment of thought process and content? Select all that apply. A) What the client is thinking B) Sensory perception C) How the client is thinking D) Clarity of ideas E) Self-harm or suicide urges 4. A client is being evaluated for dementia. The nurse knows that a client who is able to complete very few tasks is most likely to have... A) A greater cognitive deficit B) A less precise mental status exam C) More potential for agitation D) No bearing on mental status 5. During the assessment, the nurse asks the client to describe his problems. The purpose of this question is to obtain information about which of the following? A) admitting diagnosis B) communication skills C) perception of the problem D) personal needs 6. A delusion represents a problem in which of the following areas?A) Memory B) Motivation C) Orientation D) Thinking 7. The nurse asks a patient to list the days of the week in reverse order. The nurse is assessing which of the following? A) Concentration B) Memory C) Orientation D) Abstract thinking 8. When the nurse asks the client to restate the following in his or her own words, which sensorium and intellectual process is the nurse attempting to identify? The nurse states, "A stitch in time saves nine." A) The client's orientation B) The client's memory C) The client's ability to concentrate D) The client's ability to use abstract thinking 9. The nurse best assesses a client's memory by asking which of the following questions? A) "Do you have any problems with memory?" B) "What did you have for lunch yesterday?" C) "Do you know why you are here?" D) "Who is the current president?" 10. A client is showing no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which of the following terms when documenting the client's affect? A) Absent affect B) Restricted affect C) Broad affect D) Flat affect 11. During a therapy session, the client states that he is 14 trillion years old and created the world. The nurse documents this statement as an example of which type of thinking displayed by the client? A) Delusional thinking B) Ideas of reference C) Word saladD) Hallucination 12. A client is known to express tangential thinking. The nurse would assess for which of the following when interacting with the client? A) Stopping abruptly in the middle of expressing himself B) Jumping from one idea to another C) Wandering off the topic and never answering the question D) Excessive and fast talking about an array of ideas 13. A nurse can best assess a client's ability to use abstract thinking by asking the client which of the following questions? A) "What would you do if you found a wallet containing $100 on the sidewalk?" B) "What do I mean when I say, 'Don't sweat the small stuff?'" C) "What are you going to do next time you hear voices?" D) "Can you begin with the number 100 and subtract 7, and then subtract 7 again?" 14. A client reported to the nurse that on his way to the clinic, a policeman in a patrol car turned on his lights and pulled him over. When asked what he did next, the client stated, "I pulled over, of course." Which of the following was the nurse trying to assess? A) The client's judgment B) The client's insight C) The client's concentration D) The client's self-concept 15. The client spoke of a current event in the national news and described it as it relates to the client. Then the client spoke of a historical event and described it as being directly related to the client. Which of the following questions might the nurse ask to determine if the client is experiencing ideas of reference? A) "Where were you when this happened?" B) "Why do you think that?" C) "Are you sure?" D) "That is unbelievable!" 16. Which of the following questions is best to ask when assessing the client's judgment? A) "Can you describe your usual daily activities for me?" B) "If you found yourself downtown without money or a car, how would you get home?" C) "On a scale of 1 to 10, how stressed would you rate yourself?" D) "What problem would you like to work on while you're hospitalized?"17. The nurse asks the client, “What is similar about a cow and a horse?” and “What do a bus and an airplane have in common?” These questions would best assess which of the following areas? A) Intellectual function B) Insight C) Judgment D) Memory 18. Which of the following would best assess a client's judgment? A) Counting by serial sevens B) Discussing hypothetical situations C) Interpreting proverbs D) Spelling words backward 19. The nurse plans to assess a client's self-concept in the admission assessment knowing that self-concept influences which of the following? Select all that apply. A) Body image B) Cognitive processing C) Frequently experienced emotions D) Coping strategies E) Responsiveness to medications 20. Which of the following are the types of roles that are usually included when assessing roles and relationships? Select all that apply. A) Family B) Hobbies C) Occupation D) Activities E) Race F) Ethnicity 21. Knowing that relationships with others are significant to mental health, the nurse effectively assesses a client's family relationships through which of the following? A) "Do you feel your family helps you?" B) "How many people are in your family?" C) "Whom are you closest to in your family?" D) "Describe your relationships with your family." 22. A nurse assesses that a depressed client is lethargic during the day and does notactively participate in unit activities. The notes from the night shift document that the client did not sleep well. The most probable interpretation of these data is... A) the client's medications are ineffective. B) the client is being kept awake at night due to noise on the unit. C) the client's depressed mood is impairing restful sleep patterns. D) the client is resisting treatment recommendations to participate in unit activities 23. A nurse suspects that a client is abusing alcohol while taking prescribed medications. The nurse plans to educate the client on the dangers of mixing medicine with alcohol. Which of the following would be the most effective way for the nurse to approach this subject with the client? A) Firmly inform the client of the dangers of mixing medications with alcohol. B) Recommend a higher level of care, so the client can be more closely supervised. C) Emphasize the importance of truthful information using a nonjudgmental approach. D) Recognize the client's right to self-determination and avoid addressing the subject. 24. The nurse has completed the psychosocial assessment. Which of the following is the best approach toward analysis of the data to identify nursing diagnoses and develop an appropriate plan of care? A) Focus individually on each piece of information obtained from the patient. B) Look for patterns reflected in the overall assessment. C) Consider only the abnormal findings in the assessment. D) Present all data obtained in the treatment team meeting. 25. The nurse reviews results of the Minnesota Multiphasic Personality Inventory (MMPI) recorded in a client's record. While considering the usefulness of these data for her clients care, the nurse is mindful that the MMPI has which limitation? A) The patient must be able to read to complete the MMPI. B) The results of the MMPI could be culturally biased. C) The MMPI assesses a narrow scope of functioning. D) The MMPI does not have established validity. 26. The client tells the nurse, "That new TV anchor is telling the world about me." This is an example of what type of thought processing? A) Ideas of reference B) Persecutory delusions C) Thought broadcasting D) Thought insertion 27. During the admission assessment, the nurse asks the client, “How are you feeling?”The client responds, “I was able to purchase gas for 7 cents a gallon less than yesterday, which saved me a total of 84 cents. My car has a 12-gallon gas tank. Usually I am able to put in 11.7 gallons. I am very happy to have saved so much money.” The nurse recognizes this response as which of the following? A) Circumstantial thinking B) Echolalia C) Flight of ideas D) Neologisms 28. A client is admitted to the psychiatric unit and states, "I am president of the largest corporation in the world. Everyone comes to me for advice." The nurse knows the client is exhibiting which of the following? A) Flight of ideas B) Thought broadcasting C) Delusion D) Loose associations 29. In the space of 5 minutes, the client has been laughing and euphoric, then angry, and then crying for no reason that is apparent to the nurse. This behavior would be best described as... A) flight of ideas. B) lack of insight. C) labile mood. D) tangential thinking. 30. Throughout the assessment, the client displays disorganized thinking, jumping from one idea to another with no clear relationship between the thoughts. The nurse would assess the client as having which of the following? A) Tangential thinking B) Ideas of reference C) Loose associations D) Word salad 31. Sexuality and self-harm behaviors are often difficult areas for nurses to assess. An effective way for nurses to deal with this discomfort includes which of the following? A) recognizing that these areas may also be uncomfortable for the patient to discuss B) share feelings of discomfort with the patient C) defer assessing these areas to a more experienced nurse D) develop a standard question to ask of all patients during this area of assessment32. Which of the following is the most compelling reason for the nurse to discuss suicide? A) It is required by law by the federal government and by most states in the U.S. B) It is the nurse's professional responsibility to keep safety needs first and foremost. C) This is commonly required documentation for every encounter with every client. D) It allows the nurse to gain valuable experience in these kind of difficult discussions. 33. What factor is most important in the psychosocial assessment of the mental health client in order to formulate a plan of care? A) financial support B) developmental level C) history of multiple physicians D) ability to obtain transportation 34. A nurse is assessing a client's speech. Which traits will be assessed? Select all that apply. A) accent B) quality C) vocabulary D) perseveration E) quantity 35. A client stops abruptly in the middle of a sentence while speaking. The nurse should analyze this as indicative of which disorder? A) circumstantial thinking B) loose associations C) thought blocking D) blunted affect 36. A nurse is assessing a newly-diagnosed depressed client. What question should the nurse prioritize? A) "Are you thinking about killing yourself?" B) "Do I need to call someone for you to talk to about this?" C) "Have you told anyone else about this?" D) "Do you want to share your feelings in group?" 37. A nurse observes a client talking at the end of the hall to himself. The client states, "No, I don't want to go." What does the nurse suspect regarding this information? A) The client has schizophrenia. B) The client has multiple personalities. C) The client is expressing attention seeking behavior.D) The client is having auditory hallucinations.Answer Key 1. A, B, C 2. C 3. A, C, D, E 4. A 5. C 6. D 7. A 8. D 9. D 10. D 11. A 12. C 13. B 14. A 15. A 16. B 17. A 18. B 19. A, C, D 20. A, B, C, D 21. D 22. C 23. C 24. B 25. B 26. A 27. A 28. C 29. C 30. C 31. A 32. B 33. B 34. B, C, D, E 35. C 36. A 37. DChapter 9 1. A client made threats to harm his parents if they come too close to him. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for which of the following? A) Confidentiality B) Right to freedom C) Periodic treatment review D) Choice of providers 2. Which of the following would be an example of circumstances in which a client could be subjected to involuntary hospitalization? Select all that apply. A) When a client states that he or she intends to commit suicide and is making plans to do so. B) When a client does not bathe regularly or change clothes often. C) When a client states that he or she intends to harm others by a deliberate act. D) When a client who has diabetes refuses to follow the prescribed diet. E) When a client is unable to control his or her rage and is assaulting everyone around him or her. 3. A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff? A) Calling security and asking them to detain the client B) Allowing the client to leave with community resources for follow-up care C) Contacting the psychiatrist for initiation of commitment proceedings D) Contacting the client's family to request they convince the client to stay 4. Which of the following clients would most likely be mandated outpatient treatment? A) A client who is addicted to alcohol who has two DUI offenses B) A client with schizophrenia who lives in a single family home with siblings C) A client with bipolar disorder who has quit three jobs in the last 6 months D) A homeless client who has been arrested for petty theft of groceries from a convenience store. 5. Under which conditions would it be in the client's best interest for the court to appoint a conservator, or legal guardian? Select all that apply. A) Gravely disabled B) Mentally incompetentC) Noncompliant D) Unable to provide basic needs when resources exist E) Act only on his or her own interests 6. An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is... A) inappropriate; room restriction is not treatment in the least restrictive environment. B) inappropriate; the adolescent should be offered a sedative before room restriction. C) appropriate; room restriction is an effective behavior modification technique. D) appropriate; the adolescent should not have conflicts with others. 7. The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which of the following is the appropriate response by the nurse to the caller? A) "I cannot confirm or deny the existence of any client here." B) "You will need to be placed on the client's contact list before I can discuss any information with you." C) "The person you are asking for is not a client here." D) "Hold one minute while I get the client for you." 8. Which of the following client situations most urgently requires the nurse to break confidentiality and warn a third party? A) An abused woman states, "I have dreams that he is dead." B) A mother states, "Sometimes I feel like killing my kids!" C) A paranoid woman states, "I'll get them before they get me." D) A jealous man states, "I am getting my gun and going to shoot my wife's lover!" 9. A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although she is not dangerous to herself or others, she has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but the client consistently refuses "any drugs." The staff realizes that legally this client can... A) be coerced to accept treatment. B) be committed by her family to receive needed treatment. C) have her family sign permission for treatment. D) continue to refuse treatment. 10. A client who had agreed to be hospitalized for depression has decided that now she wants to leave the hospital. The mental health staff caring for her realizes that at present she can legally...A) be discharged if evaluated through administrative hearings. B) be retained in the hospital against her will. C) leave the hospital after giving written notice of her intent to do so. D) leave without discussing the situation with anyone. 11. Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error? A) Confidentiality allows for the disclosure of information under specific circumstances. B) If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights. C) Privileged communication does not apply to medical records, and they can be used in court. D) Clients can never be held against their will. 12. When is a nurse legally obligated to breach confidentiality? A) At any time a client is threatening B) If threats are made to an identifiable third party C) Whenever the client becomes aggressive D) When the client violates the nurse's boundaries 13. A client was brought to the emergency department by police after neighbors complained that he was loud and disruptive. The client is paranoid and upset and states, "No one can be trusted." Which of the criteria for involuntary admission does this client meet? A) Dangerous to self B) Dangerous to others C) Gravely disabled D) He does not meet any of the necessary criteria 14. The physician has prescribed Haldol 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response? A) Accept the client's decision B) Obtain a discharge order for noncompliance C) Tell the client that he is too sick to refuse D) Restrain the client and give the medication IM 15. Disclosure of client information beyond the interdisciplinary team without consent of the client is a breach of... A) beneficence. B) confidentiality.C) duty. D) veracity. 16. A client who is depressed and suicidal is scheduled for electroconvulsive therapy (ECT), which requires consent. After the physician has explained the procedure, the nurse knows that legally, who should sign the consent for this treatment? A) A member of the treatment team B) The client C) The client's spouse D) The psychiatrist 17. A nurse is questioning whether it is ethical to seclude a client because of loud and intrusive behavior on the unit. What is the ethical principle that will best guide the decision on appropriate use of seclusion? A) Autonomy B) Beneficence C) Justice D) Veracity 18. A nurse is performing safety assessments on a client in mechanical restraints as required by policy. Which action by the nurse demonstrates the ethical principle of nonmaleficence? A) Explaining the behavioral requirements for release of restraint to the client B) Assuring that the restraints are not causing injury to the client C) Applying restraints based solely on assessment findings and not on attitude toward the client D) Releasing the client when stated behavioral control is achieved 19. An adult client is put in restraints after all other attempts to reduce aggression have failed. Which of the following is required now that restraints have been instituted? A) Review of the appropriateness of restraints every 8 hours B) A face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint. C) A documented nursing assessment every 4 hours D) Constant one-on-one supervision during the first hour and then video monitoring 20. Which of the following are criteria for instituting the short-term use of restraint or seclusion? Select all that apply. A) The client is aggressive. B) The client is being punished.C) The client is imminently dangerous to himself or herself or to others. D) The client is physically and emotionally self-controlled. E) All other means of calming the client have been unsuccessful. 21. The client feels his rights have been violated. Placing a client in restraints before using other methods of intervention violates which of the client's rights? A) Receive confidential and respectful care B) Provide informed consent C) Be treated in a timely manner D) Receive treatment in the least restrictive environment 22. A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful? A) The nurse did not have a duty. B) The nurse did not breach duty. C) The client did not suffer some type of loss, damage, or injury. D) There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury. 23. Ensuring that the client has provided informed consent for a treatment regimen displays which of the following ethical principles? A) Fidelity B) Nonmaleficence C) Justice D) Autonomy 24. A client being served in a busy inpatient psychiatric unit becomes very noisy and combative. The other clients are complaining about the noise and are afraid that they will be hurt by the client. The nurse determines that the best course of action for all involved is to seclude the client until the client is able to regain control of his behavior. On which ethical principle did the nurse base this decision? A) Utilitarianism B) Deontology C) Nonmaleficence D) Veracity 25. The nurse is attending an in-service training on safe take-down techniques for aggressive clients. Practicing these techniques help to reinforce the proper handling ofthis situation. Preparation for safe physical handling prepares the nurse to practice which ethical principle? A) Veracity B) Nonmaleficence C) Justice D) Autonomy 26. Which of the following dilemmas involves the ethical principle of fidelity? Select all that apply. A) When the nurse is unable to agree with the policies or common practices of an agency B) When the nurse is faced with a decision to violate a policy that is harmful to the client C) When the nurse is certain that clients of different racial and ethnic backgrounds are being treated the same as other clients D) When the nurse understands that a combative client must be secluded against his/her will to prevent harm to others E) When the client refuses to take medication and the nurse respects the client's right to refuse medication 27. Which one of the following is the most common reason for ethical dilemmas being a challenge to nurses? A) Ethical dilemmas are often charged with emotion. B) There are no clear ethical codes established for guidance. C) A multitude of laws must be understood to make a clear decision. D) Clients are not familiar with the ethical code that nurses must follow. 28. The term "standards of care" refers to expectations of nursing performance given to all clients. Standards of care are developed from which of the following? Select all that apply. A) Code of Ethics for Nurses with Interpretive Statements B) Licensure examinations C) State Nurse Practice Acts D) Agency job descriptions E) Professional nursing organizations 29. During rounds, the depressed client is discovered to have completed a suicide attempt in the bathroom. The staff on the inpatient psychiatric unit have been very busy and fell behind on periodic assessment for this client. Which type of lawsuit could the client's family file? A) Malpractice B) Causation C) AssaultD) Injury or damage 30. A nurse in the emergency department is planning for a client with mental illness to be placed in an inpatient hospitalization. Which is a condition of this type of admission? A) is noncompliant with medication at home B) present a clear danger to self or others C) develops new symptoms of the illness D) has no support systems in the community 31. A student nurse is assigned to administer oral medications to a client. Which of these actions should a student nurse take if a client refuses to take prescribed oral medications? A) tell the client that the nurse will receive a poor grade if he or she does not administer the medication B) tell the client that refusal is not permitted and staff will require the client to take the medication C) document the client's refusal on the medication administration record without comment D) ask the client's reason for refusing and report it to the primary care nurse 32. A nurse is reviewing medical records to look for violations of client rights. What finding would signal a violation of client rights? A) no documentation of benefits of treatment or treatment options B) client belongings searched at admission C) physical restraint used to prevent harm to self D) client was placed on one-to-one continuous observation 33. A nurse is discharging a client who is seriously mentally ill into a group home. What is a practical outcome for the client being treated in a community setting? A) the ability to maintain stability in the community B) an absence of symptoms and improved level of functioning C) functioning at a moderate to high level of social integration D) socially acceptable interactions within the community, good self-care, and adequate nutrition 34. Which nursing intervention constitutes false imprisonment? A) The client is confused, combative, and insists that no one can stop him from leaving. The nurse restrains the client without a physician's order, then seeks the order. B) The client has been “pesky,” seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion.C) A psychotic client is admitted as an involuntary client and runs out of the psychiatric unit. The nurse runs after the client and succeeds in talking the client into returning to the unit. D) A client is hospitalized as an involuntary admission and attempts to leave the unit. The nurse calls the security team per hospital protocol. They prevent the client from leaving.Answer Key 1. B 2. A, C, E 3. C 4. A 5. A, B, D 6. A 7. A 8. D 9. D 10. D 11. B 12. B 13. D 14. A 15. B 16. B 17. A 18. B 19. B 20. A, C, E 21. D 22. B 23. D 24. A 25. B 26. A, B 27. A 28. A, C, D, E 29. A 30. B 31. D 32. A 33. A 34. BChapter 10 1. A young couple just ended their relationship after a 9-month engagement. One of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing? A) Safety loss B) Loss of security and sense of belonging C) Loss of self-esteem D) Loss related to self-actualization 2. A child who has witnessed the murder of his classmate while at school would experience which kind of loss? A) Physiologic loss B) Loss of self-esteem C) Loss related to self-actualization D) Safety loss 3. Which of the following terms is used to describe the process by which a person experiences the grief? A) Anticipatory grieving B) Disenfranchised grief C) Bereavement D) Mourning 4. A client has just been informed of a diagnosis of terminal cancer. The client states, “God has to have mercy on me because my children need me. He knows I'll change if he gets me through this.” The nurse documents that the wife is expressing signs of which of Kubler-Ross's stages of grief? A) Denial B) Anger C) Bargaining D) Depression5. After being laid off from work, a client becomes increasingly withdrawn and fatigued, spends entire days in bed, is unkempt, and is eating and sleeping poorly. The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Anger B) Bargaining C) Denial D) Depression 6. The client says to the nurse, “I really want to see my first grandchild born before I die. Is that too much to ask?” The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross? A) Acceptance B) Anger C) Bargaining D) Depression 7. Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn. Which is stage five of Kubler-Ross's stages of grieving? A) Denial B) Bargaining C) Acceptance D) Anger 8. Friends of a teenage male recently killed in a car accident are discussing their sense of loss. Which of the following comments best indicates that the friends are trying to make sense of the loss cognitively? A) "Why did he have to die so young?" B) "He shouldn't have been driving so recklessly." C) "If we had only stayed longer, he would not have been on that road."D) "It took the ambulance too long to get there." 9. The nurse is working with a woman who lost her partner nearly 3 weeks ago. The woman has recently become less emotional and expressed an interest in possibly returning to work. Which response by the nurse is most appropriate at this time? A) "I am concerned. You are starting to show signs of ineffective grieving." B) "You must feel some anger. It is all right to let that out." C) "Let's look at the things in your life that you still enjoy." D) "You are just starting to accept that this loss is real." 10. The nurse is working with a client who lost her youngest child two months ago. When the nurse approaches, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases her response to the client on the understanding of which of the following? A) Hostility is a common behavioral response to grief. B) It is too soon after the loss to empathize with the client. C) Personality traits such as aggressiveness are exaggerated during the grief process. D) The nurse may have nonverbally indicated a judgmental attitude toward the client. 11. The bereaved client has worked through many processes of grief with the nurse. Which of the following are eventual outcomes of the emotional dimension of grieving? Select all that apply. A) The survivor begins to reestablish a sense of personal identity, direction, andpurpose for living. B) The survivor begins to gain independence and confidence. C) The survivor develops new ways of managing life and new relationships. D) The survivor's life returns to the same state as it was before the loss. E) The survivor forgets about the loss. 12. The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which of the following physical symptoms of grief would the nurse most likely expect to detect in the history? A) Hair loss B) Insomnia C) Compulsive behaviors D) Vomiting 13. The nurse is caring for a hospice client whose death is imminent. In preparing the family for the death of their loved one, then nurse prepares to assist the family in which of the following, regardless of the family's cultural preferences? Select all that apply. A) Dealing with the shock of losing a loved one B) Burial plans after death had occurred C) Efforts to stay connected to the client after death D) Use of support from family and friends E) Anger at the loss of a loved one 14. The most effective way for the nurse to provide culturally competent care to individuals who are grieving is which of the following? A) Understand the practices associated with a client's culture. B) Suggest developing a new ritual to make mourning meaningful.C) Ask the client which rituals are personally meaningful. D) Contact a spiritual leader from the client's culture to become involved. 15. A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that she and the client were having an illicit affair. Which of the following is the best action by the nurse after learning of this relationship? A) Give the name of a clergy to the visitor and suggest she contact him for support B) Encourage the visitor to ask for support from the friends who are present C) Ignore the information about the affair and tend to the family D) Privately offer support to the visitor who was having the affair with the client 16. A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience? A) Anticipatory grief B) Absence of grief C) Complicated grief D) Disenfranchised grief 17. Which of the following losses are likely to result in disenfranchised grief? Select all that apply. A) A young adult whose spouse has just died suddenly B) A family whose long-time pet snake has just died C) A nurse who has just witnessed the death of a patientD) A couple who has just experienced pregnancy loss E) The gay lover of a man who just died from AIDS F) The mother and sister of a soldier who was killed in war 18. The nurse visits with a client who was recently in a motor vehicle accident. Which of the following is most likely to prevent the client from experiencing complicated grief? A) Tendency to suppress emotions B) History of depression C) Places trust in others who are familiar D) Social isolation 19. Which of the following persons are most likely experiencing complicated grieving? Select all that apply. A) The spouse of a person who died 7 years ago and visits the grave several times a day. B) The grandchild of a soldier killed in war who visits the grave once a year on Memorial Day. C) A driver whose spouse and children all died as a result of his driving drunk. D) An adult who insisted for many years that she hated her deceased parent. E) The parent of a child who died after the having left the child in a car on a hot day. 20. The nurse is having an initial meeting with a client who has just spontaneously lost her unborn child. After establishing rapport, the priority nursing intervention should focus on which of the following? A) Assessing the client's support system B) Exploring what this loss means for the client C) Discussing helpful ways to cope with the lossD) Assessing what knowledge the client desires about the situation 21. The nurse is assessing the new grieving widow. Which of the following are critical components to assess in a grieving person? Select all that apply. A) Genetic risk B) Perception of the loss C) Support system D) Coping behaviors E) Religion 22. A client with terminal cancer has been told he has 3 or 4 months to live. Which of the following would indicate to the nurse that further interventions are needed? A) The client says he wants to live life to the fullest. B) The client hopes for a peaceful and dignified death. C) The client is reviewing his life and talking about death. D) The client says he is well and is making future plans. 23. A young client tells the nurse that her husband died 3 months ago, and she is feeling alone and vulnerable. Which of the client would indicate that her coping skills are adequate? A) I can't understand why this happened to me. B) I'm mentally healthy. I can solve my own problems. C) I will find a support group. D) What can I do? My husband abandoned me. 24. A couple came to the emergency department with their 5-month-old son.He was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to do which of the following? A) postpone notification of the extended family B) delay the grieving process until they are ready to cope C) minimize their discussion of the death with others D) plan funeral arrangements for their son 25. The nurse is establishing outcomes for a grieving client. Which of the following is an appropriate outcome? A) The client will develop a plan for coping with the loss. B) The client will demonstrate self-reliance during the grief process. C) The client will suppress emotions related to the loss. D) The client will verbalize that loss will not adversely affect the quality of life. 26. The nurse approaches a client who looks very sad and is sitting alone crying. The best response by the nurse in this situation is... A) "I'm sorry you are sad. Is there anything I can do to help you feel better?" B) "Please don't cry. It will get better." C) "You look very sad. What is happening?" D) "What is bothering you?" 27. A woman has just been served divorce papers from her husband. She has no financial resources and little social support. She states, "He's not really leaving. He'll be back." The most appropriate response by the nurse would be which of the following? A) "Has he done this before?" B) "I'll call social services and get you signedup for financial assistance." C) "You have to face reality. Here are the papers." D) "How is this affecting you right now?" 28. An elderly woman who lives alone is beginning to have difficulty maintaining her household and performing daily tasks. The nurse asks her to identify someone who can help her. The woman replies, "I don't need help. I've been managing for years." Which of the following responses helps the client shift from denial to consciously coping with her situation? A) "You don't think you need any help? But your family is worried about you." B) "It must be hard to lose your independence. I'll ask a social worker to see what can be arranged." C) "If you were to need help with your house, who might you ask for help?" D) "If you don't ask for some help, then the only option is to move to an assisted living facility." 29. A client who has been grieving the loss of his wife 2 weeks ago says to the nurse, "The best part of my day is when I am back at work. Is that wrong?" The nurse states to the client that work and other daily activities serve which purpose? A) "You cannot work effectively this soon. You should finish grieving first." B) "Working reminds you of your loss. It may be too early to go back." C) "Working is your way of avoiding grief, which will make it harder for you to move on." D) "Working is letting you take an emotional break from grieving. There's nothing wrong with that." 30. While the nurse is observing the grievingclient, which of the following are critical components in assessment of a person's grief? Select all that apply. A) Adequate perception regarding the loss B) Adequate time to experience the loss C) Adequate support while grieving for the loss D) Adequate opportunities to say goodbye to the person E) Adequate coping behaviors during the process 31. A client comes to the physician's office for an annual checkup. During the interview, the nurse learns that the client's husband died unexpectedly of a heart attack two months ago. The most appropriate response by the nurse would be... A) "At least you and your husband enjoyed life right until the end." B) "It's better to go quickly like your husband did instead of suffering." C) "The loss of your husband must be very painful for you." D) "You'll feel better after you get over the shock of your husband's death." 32. A woman has just delivered a stillborn baby boy. Which of the following would be the most appropriate nursing response? A) "Can I do anything for you?" B) "If something was wrong, it's better this way." C) "Your son is in heaven with God now." D) "Would you like to hold your son?" 33. A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on... A) the client's plans for reconstructivesurgery. B) the meaning of the mastectomy to the client. C) whether the client truly understands the surgery. D) why the client seems depressed. 34. A client states to a nurse, "They found a lump in my neck, and now they tell me I have an incurable disease." The client is young and appears to find this information hard to believe. The client's statement shows the pattern of response called… A) restitution. B) shock and disbelief. C) physiologic grieving. D) recovery. 35. After the death of a client's wife, a man tells the nurse “I can never live without my wife. My wife was my whole life.” Which is the most therapeutic response from the nurse? A) "Remember, your wife is no longer suffering." B) "Your wife's death is a terrible loss for you." C) "Each day will get a little better." D) "Your friends will help you cope with this." 36. A nurse is caring for a client who is mourning the loss of a loved one. Which factor would the nurse expect to make the mourning process more difficult for the client? A) The client was relatively independent of the deceased. B) The client had few unresolved conflicts in the relationship with the deceased. C) The client has a good support system with meaningful relationships evident. D) The client has experienced a number ofprevious losses. 37. A client grieving her husband's sudden death tells the bereavement nurse, “I am not feeling very well. Yesterday, I was sitting in my kitchen and a saw my husband walk through the door and stop and smile at me. Then he just faded away. I think I must be going crazy.” The most appropriate action for the nurse to take is to… A) assess for recent substance use. B) suggest a referral to the mental health clinic. C) arrange for a prescription for risperidone. D) counsel that visualizations are a normal part of grieving. 38. A nurse cared for a terminally ill client over a period of a month. The nurse found that spending time with the client was a pleasure. When the client died, the nurse experienced feelings of sadness, sleeping poorly, lacking energy, and feeling mildly depressed. Eventually the nurse explained the feelings to the nurse supervisor. The nurse supervisor is aware of which of the following? A) The nurse needs to use stress reduction strategies. B) The nurse needs to seek therapy for dysfunctional grief. C) The nurse is experiencing disenfranchised grief. D) The nurse needs to consider taking a leave of absence to pursue healing.Answer Key 1. B 2. D 3. C 4. C 5. D 6. C 7. C 8. A 9. D 10. A 11. A, B, C 12. B 13. A, C, E 14. C 15. D 16. D 17. B, C, D, E 18. C 19. A, C, D, E 20. B 21. B, C, D, E 22. D 23. C 24. D 25. A 26. C 27. D 28. C 29. D 30. A, C, E 31. C 32. D 33. B 34. B 35. B 36. D 37. D 38. CChapter 11 1. A nurse is working with a client who has frequent angry outbursts. Which of the following statements is most helpful when working with this client? A) "Anger is a normal feeling, and you can use it to solve problems." B) "You need to learn to suppress your angry feelings." C) "You can reduce your anger by hitting a punching bag." D) "You need to learn how to be less assertive in your communications." 2. Which of the following statements about anger, hostility, and aggression are accurate? Select all that apply. A) Anger is an emotional response to a real or perceived provocation. B) Hostility stimulates the sympathetic nervous system. C) Physical aggression involves harming other persons or property. D) Anger, hostility, and physical aggression are normal human emotions. E) Hostility is also referred to as verbal aggression. F) Physical aggression often progresses to hostility. 3. A married man expresses to the nurse that his wife's frequent nagging angers him. The nurse role-plays assertive communication techniques with the husband. Which of the following indicates the husband understands how to use assertive techniques effectively? A) "I really wish you would stop nagging me." B) "You are not perfect either." C) "I feel unappreciated when you criticize me."D) "Are you telling me you want me to change?" 4. Which one of the following statements about anger is most accurate? A) Anger is an abnormal human emotion that is always negative. B) It is best to express anger by whatever means possible to minimize its consequences. C) Most men are socialized to suppress anger. D) Anger awareness and expression are necessary for women's growth and development. 5. The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior? A) Triggering B) Escalation C) Crisis D) Postcrisis 6. The nurse should assess clients' risks for anger or aggression in the care of clients with which of the following psychiatric diagnoses? Select all that apply. A) Alzheimer's dementia B) Schizophrenia C) Anorexia nervosa D) Acute alcohol intoxication E) Generalized anxiety disorder 7. The nurse gathers information to formulate a plan of care for the client with aggressive issues. Which of the following is most likely to be the subject of an aggressive attack from a client withmental illness? A) Other people B) The client C) Animals D) Objects 8. The client is being assessed for anger attacks. Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression? A) Delusions B) Depression C) Dementia D) Delirium 9. A client is observed pacing the hall with clenched fists and swearing at others. The nurse intervenes immediately in a calm manner to prevent the client from moving to which phase of the aggression cycle? A) Triggering B) Escalation C) Crisis D) Recovery 10. As the nurse is performing an assessment on the client, the client's son is yelling and is hitting his hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client's son is exhibiting? A) Triggering B) Escalation C) Crisis D) Recovery 11. The nurse is teaching a client to recognize early signs of anger and aggression. The nurse explores ways that the client can recognize which of the following? A) Decreased problem-solving ability B) Restlessness and irritabilityC) Remorse D) Severe muscle tension 12. A client suddenly jumps up from the chair and begins yelling and cursing at the nurse. Which would be the best response by the nurse? A) "I can see that you need attention; you should calmly ask for what you want." B) "I don't want to hear that kind of language; don't ever do that again." C) "I will limit your smoking privileges if you can't control yourself." D) "You seem angry. Tell me more about how you're feeling." 13. A client approaches the nurse and loudly states, “I'm not putting up with this anymore!” The most appropriate response by the nurse would be which of the following? A) "I can see you are angry. Tell me what's going on." B) "You are not allowed to make threats. Please keep your voice down.” C) "Why do you say that?" D) "You are here voluntarily. You can leave if you want." 14. A client is clenching his fists and yelling at another client on the unit. He appears to be close to losing control of his anger. Which of the following actions by the nurse is appropriate at this time? A) Clear others out of the immediate area. B) Prepare a PRN sedative. C) Tell the client to stop and take a time-out. D) Alert the security department of an impending aggressive outburst. 15. In the psychiatric setting, what is the most effective intervention in preventing thehostile client's behavior from escalating to physical aggression? A) Getting as far away from him or her as possible B) Engaging the hostile person in dialogue C) Yelling at the client to settle down now D) Ensuring that the client gets his or her way 16. An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. The most appropriate action by the nurse would be which of the following? A) Call for an emergency response from trained personnel. B) Approach the client and firmly say, “Stop, put it down.” C) Calmly call the client by name and encourage verbal expression of anger. D) Assist the client to use problem-solving techniques instead of aggression. 17. A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. Which would be the best approach for the nurse to use? A) Have a sense of humor to show a lack of fear. B) Provide close contact to increase the client's sense of safety. C) Use brief statements and questions to obtain information. D) Use open-ended questions, so the client can elaborate. 18. The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid? A) Anticipating that a loss of control is possible and planning accordingly B) Explaining the consequences the clientwill face if control is lost C) Interviewing the client with another staff member present D) Responding to verbal threats by terminating the interview and obtaining assistance 19. When interacting with a client in the day room, the nurse determines that a violent outburst is imminent. Which of the following should the nurse do first? A) Call for assistance. B) Give the client choices. C) Remove the other clients. D) Talk to the client calmly. 20. The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as which of the following? A) controlling B) manipulation C) progress D) regression 21. The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? A) Give the client a physical outlet to express anger. B) Give the client permission to be angry. C) Point out the senselessness of anger. D) Tell the client not to be angry all the time. 22. The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following? A) Client's mood B) Client's safety C) Court order D) Physician's order23. The nurse observes two clients in the day room arguing. One client runs into the corner and huddles while the other follows and continues with verbal abuse. Which is the best action by the nurse? A) Take an authoritatively step between the two clients. B) Comfort the client huddled in the corner. C) Directly address both clients and ask what is going on. D) Engage the attention of the client who is still yelling and ask what is happening. 24. Which of the following interventions would assist the client with the appropriate expression of anger? A) Encourage catharsis B) Encourage verbalization C) Improve self-esteem D) Isolate the client from others 25. A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints by the nursing team. Which statement should the nurse make to explain the use of restraints to the client? A) "The length of time you'll be in restraints is undetermined." B) "The staff will monitor your behavior closely." C) "This is what happens when you lose control." D) "This is a means of keeping you and others safe." 26. Which of the following interventions is most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply. A) Planning group activities such as playinggames B) Scheduling one-to-one interactions with the client C) Providing structure and consistency in the unit D) Avoiding discussions among clients on the unit E) Discouraging clients from negotiating solutions 27. Which of the following statements about the crisis phase of aggression when the client becomes physically aggressive is true? A) All staff should act to take charge of the situation. B) The client must be restrained or sedated at once. C) Staff should avoid communicating with the client. D) Four to six trained staff members are needed to restrain. 28. After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which of the following is the most helpful response to the client at this time? A) "We will have to talk about this later." B) "You really scared me. I'm glad you are okay." C) "What happened that got you so upset?" D) "What can you do differently next time you get angry?" 29. After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive? A) "You still need to work on your problem-solving skills." B) "I will not allow you to get that angry again." C) "You should not have let your angerbuildup like you did." D) "What could you have done when you first started to feel angry?" 30. One of the first steps that a nurse should take to deal effectively with aggressive clients is which of the following? A) Reflect on abilities to handle own feelings of anger B) Learn professional skills of anger management C) Become proficient using reflective communication techniques D) Understand how to activate crisis response teams 31. Which of the following is most important to maintain therapeutic boundaries when working with aggressive clients? A) Encourage clients to express how the nurse can avoid causing emotional irritation. B) Discuss difficult patient care situations with a supervisor. C) Reflect on your actions that may have instigated the client's anger. D) Do not personalize a client's anger 32. Which of the following are important issues for nurses to be aware of when working with angry, hostile, or aggressive clients? Select all that apply. A) Nurses must be aware of their own feelings about anger and their use of assertive communication and conflict resolution. B) Nurses must not allow themselves to become angry under any circumstances. C) Nurses must know that a client's anger or aggressive behavior is preventable by a skilled nurse. D) Nurses must discuss situations or the care of potentially aggressive clients withexperienced nurses. E) Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior. 33. What a culture considers acceptable strongly influences the expression of anger. Which culture-bound syndrome is a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at other people and objects? A) Hwa-Byung B) Hwabyeong C) Amok D) Bouffée delirante 34. Which client should be assessed as demonstrating aggression? A) a client who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from another client standing at the pool table B) a client who bursts into tears, leaves the community meeting, and sits on the bed hugging a pillow and sobbing C) a client who tells the primary nurse, “When you told me that I could not have a pass, I felt angry.” D) a client who tells the medication nurse, “I am not going to take that, or any other, medication.” 35. Which client on the mental health unit should be assessed as being at highest risk for directing violent behavior toward others? A) a client who has obsessive-compulsive disorder and performs many rituals B) a client who has paranoid delusions and believes is being followed by members of the mafiaC) a client who has severe depression with delusions of worthlessness D) a client who has completed alcohol withdrawal and is beginning a rehabilitation program 36. Which behavior is considered inconsistent with the clinical picture of a client who is becoming increasingly aggressive? A) pacing B) sobbing inconsolably C) rigid posture with a clenched jaw D) staring with narrowed eyes into the eyes of another 37. A client is pacing the hall near the nurses' station and swearing loudly. An appropriate initial intervention for the nurse would be to address the client by name and say which response? A) "Please quiet down." B) "Hey, what's up?" C) "You seem upset. Tell me about it." D) "You need to go to your room until you can control yourself." 38. A staff development coordinator is planning to teach the use of physical management techniques when clients become physically aggressive. The coordinator should stress the importance of which technique? A) spontaneity and surprise B) practice and teamwork C) caution and superior size D) diversion and physical outletsAnswer Key 1. A 2. A, C, E 3. C 4. D 5. C 6. A, B, D 7. B 8. B 9. C 10. B 11. B 12. D 13. A 14. C 15. B 16. A 17. C 18. B 19. A 20. C 21. B 22. B 23. D 24. B 25. D 26. A, B, C 27. D 28. C 29. D 30. A 31. D 32. A, D, E 33. C 34. A 35. B 36. B 37. C 38. BChapter 12 1. The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply. A) The client has few friends. B) The client holds a dominant role in the family. C) The client is in charge of the family finances. D) There is a large amount of alcohol use in the home. E) The client reports that the father was abusive during childhood. 2. A young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. Which of the following should be a consideration in providing care for this client? A) Most views regarding domestic violence are universal across cultures. B) She may fear deportation if she seeks public assistance. C) Immigrants have expedited access to public legal services. D) The nurse should ignore the details and focus on treatment. 3. Which of the following is the best explanation for why family violence tends to occur over multiple generations of families? A) A tendency toward violence is hereditary. B) Family violence may be perpetuated between generations of families by role modeling and social learning. C) All persons who have become victims of family violence will grow up to perpetratefamily violence. D) Family violence does not tend to have an intergenerational transmission process. 4. Which of the following are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply. A) Abuse of power and control B) Alcohol and other drug abuse C) Intergenerational transmission D) Social isolation E) Victim instigates 5. Which of the following are common reasons why abused women remain with the abusive partner? Select all that apply. A) The abused person is personally and financially dependent on the abuser. B) The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work. C) The abused person uses alcohol or illegal drugs in the home. D) The abused person believes that she is unable to function without her husband. E) The abused person is afraid that the abuser will kill her if she tries to leave. 6. Which of the following are typical characteristics of the perpetrator of intimate partner abuse? Select all that apply. A) The perpetrator often believes that the partner is his own property. B) The perpetrator is often irrationally jealous, even of his own children. C) The perpetrator is emotionally immature and needy. D) The perpetrator respects his partner. E) The perpetrator is intimidated by his partner.7. The nurse is caring for a 16-year-old boy with a history of sexual abuse. What might the nurse expect to assess with this client? A) The client will experience long-term emotional trauma. B) The client will have no ill effects due to his age. C) The client will have high self-esteem. D) The client will easily share his concerns with the nurse. 8. Which of the following behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child? A) The child has a preference for associating with peers, rather than adults. B) The child has learning problems and shyness. C) The child tells sexually explicit stories to peers. D) The child wears dirty and threadbare clothing. 9. Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim of intimate partner violence? A) Encourages the partner to have a life outside the intimate relationship B) An inflated sense of self-esteem C) Needy and possessive of the partner D) An ability to feel remorse for the abuse 10. The client is talking to the nurse about her intimate relationships. Which one of the following statements regarding intimate partner violence is true? A) Males are never the victim in intimate partner violence. B) It is common for abusers to use one typeof abuse only. C) Intimate partner violence can exist with former partners. D) Psychological abuse is not as harmful as physical abuse. 11. The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is which of the following? A) Neglect B) Physical abuse C) Sexual abuse D) Emotional abuse 12. A coherent elderly woman has been financially and emotionally abused by her adult children for the past several years, but has failed to report the abuse to anyone. Which is the most likely reason that the woman neglects to report the abuse? A) She cannot claim abuse if there is no evidence of physical harm. B) Laws do not provide protection against abuse when the suspect(s) is/are family members. C) She has no financial resources to hire legal representation against her children. D) She is emotionally close to her children and does not want to bring them harm. 13. A school nurse is educating a group of adolescent girls about rape and sexual assault. The nurse evaluates the students' understanding when they report which of the following as a high-risk factor regarding the incidence of rape? A) The highest incidence of rape occurs in adolescents and young adult women. B) Most rapes are committed by strangers.C) Most rapes are random acts of violence. D) A victim is at highest risk in unfamiliar neighborhoods. 14. Which of the following are common behavioral and emotional responses to abuse? Select all that apply. A) One third of abusive men are likely to have come from violent homes. B) Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. C) Dependency on the abuser is a common trait found in victims of domestic violence. D) The victim caused the abuse. E) It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance. 15. A woman is in treatment for an anxiety disorder. Her history reveals that she was sexually abused repeatedly by her husband. Which of the following interventions would be appropriate in relation to this piece of data? A) Avoid discussing the abuse so as not to upset her. B) Encourage her to talk about feelings related to the abuse. C) Request an anxiolytic to reduce her anxiety levels. D) Help her explore her role in perpetuating the abuse. 16. The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which of the following data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse?A) The parents appear overprotective of the child B) Bruises over the child's bony prominences C) The injury occurring several days before the parents sought treatment D) Both parents reporting the exact same details pertaining to the injurious event 17. A woman has just presented at the emergency department after being raped. The initial nursing action would be to... A) provide emotional support. B) refer her to a rape crisis hotline. C) encourage her to file charges immediately. D) perform a nursing history and physical as quickly as possible. 18. The nurse is working in the emergency department with a woman who was raped one hour ago. Which of the following is most important for the nurse to remember when planning care? A) The client should set aside any angry feelings until physical care is completed. B) Evidence collection according to procedures is not as important as treating the client's injuries. C) The nurse will need to make decisions for this client. D) The woman may feel threatened by some of the procedures. 19. A young woman telephones the emergency department and loudly tells the nurse, “I've been raped! Please help me!” Which of the following is the priority for the nurse to determine? A) If the client was in a safe place, her condition, and if transportation is available B) If the client knew her assailant, knew her location, and had notified the police C) If the client has insurance, if she could getto the hospital by herself, and if pregnancy is a possibility D) If the client had bathed, douched, or changed clothes 20. The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. Which of the following statements made by the expectant mother would be of greatest concern to the nurse? A) "I am going to rely on my sisters for a lot of help raising my baby." B) "I was raised with very strict discipline." C) "My child will love me, unlike my parents ever did." D) "I am not sure how I am going to pay for all the things my child will need." 21. The community health nurse meets with the family members of an elderly client. The nurse includes which of the following in the plan of care as a preventive measure to guard against elder abuse? A) Reassure the primary caregiver that he or she in the best position to provide care to the elder B) Teach the primary caregiver skills to meet all of the elder's needs C) Assist in the transfer of legal authority for elder care to the primary caregiver D) Provide the primary caregiver with additional resources to meet the elder's needs 22. The nurse at a university health services clinic has been asked to meet with a freshman class of women about warning signs of relationship violence. The nurse points out which of the following danger signs the students should be alert for in a date?A) Dislikes your fiends B) Acts indifferent to your life choices C) Is excessively jealous D) Views you as superior to himself 23. A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." Which of the following is most likely true of the situation? A) The student is overreacting. B) This is a situation requiring a restraining order. C) The student's boyfriend is simply insecure and needs reassurance. D) This is characteristic of the tension-building phase of the violence cycle. 24. The nurse is working with a client at the battered women's shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, “What do you think about that?” Which is the best response by the nurse? A) “Batterers never change, so it would be best for you to leave.” B) “If you don't leave, he'll think you're going to continue to endure his abuse.” C) “If you leave, maybe he'll see that he has to change his behavior.” D) “You may be in more physical danger after you leave him.” 25. The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse donext? A) Ask the client when and how the bruises occurred B) Call the nursing supervisor immediately C) Follow the facility's policy and procedures for reporting abuse D) Notify the physician that abuse is suspected 26. A nurse is working with a client who has a history of repeated abusive intimate relationships. The nurse has difficulty understanding why a woman would repeatedly enter into relationships with abusive partners. When working with this client, the nurse can best maintain a therapeutic relationship through which of the following approaches? A) Keeping focused on the client's feelings about her life situation B) Honestly asking the client why she repeats the cycles of victimization C) Convincing the client to develop a self-rescue plan D) Not prying into the details of the client's private life 27. Which referral would a nurse make for a client who was badly beaten by a spouse, has no place to go, and no financial means? A) community food bank B) vocational counseling C) law enforcement D) a women's shelter 28. An elderly client with dementia lives with her daughter. During the day the client attends a Day Center. The nurse notices the client is unkempt and smells of urine. Upon examining the client, the nurse notes bruising on her arms and back. From the nurse's observations, which ofthe following is the type of abuse suspected? A) psychological abuse B) physical abuse C) financial abuse D) sexual abuse 29. The client tells the nurse that her husband abuses her often with he drinks, just as his father had beaten him and his mother. He always apologizes and is remorseful after the event. Which stage is this in the cycle of violence? A) tension building stage B) acute battering stage C) honeymoon stage D) recovery stage 30. A community health nurse visits a home and finds a child who stayed home from school to care for a younger sibling. The nurse observes that the house is cluttered and dirty. When asked about the parents, the child states he does not think his father likes him because he calls him "stupid." The nurse suspects which type of abuse? A) physical abuse B) sexual abuse C) emotional abuse D) economic abuse 31. A client has not been to work in three days. When she returns to work, she is wearing dark glasses. Facial and body bruises are visible. Her supervisor takes her to the occupational nurse. Which assessment is the priority for the nurse? A) coping mechanisms B) emotional distress C) physical injuries D) psychological traumaAnswer Key 1. A, D, E 2. B 3. B 4. A, B, C, D 5. A, B, D, E 6. A, B, C 7. A 8. C 9. C 10. C 11. A 12. D 13. A 14. A, B, C, E 15. B 16. C 17. A 18. D 19. A 20. C 21. D 22. C 23. D 24. D 25. A 26. A 27. D 28. B 29. C 30. C 31. CChapter 13 1. Which of the following statements regarding the individual responses to trauma and stressors is a positive outcome? A) Many individuals are unable to cope with the event, manage their stress and emotions, or resume the daily activities of their lives. B) Some individuals may develop enhanced coping as a result of dealing with the stressor. C) These events are only significant in individuals who have risk for or actual mental health problems or issues. D) Large numbers or groups of people may be affected by a traumatic event. 2. What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder? A) In acute stress disorder, the client is likely to develop exacerbation of symptoms. B) In PTSD, the recovery rate is 80% within 3 months. C) The severity and duration of the trauma are the most important variables in acute stress disorder. D) In PTSD, the symptoms occur 3 months or more after the trauma. 3. Which of the following statements about posttraumatic stress disorder (PTSD) is accurate? A) Estimates are that the disorder is very rare. B) Estimates are that up to 60% of people at risk develop PTSD. C) Only 20% of victims of rape develop PTSD. D) PTSD symptoms usually begin at the time of the trauma.4. Which of the following might the nurse recognize when dealing with a client, as longer-term responses to trauma and stress? Select all that apply. A) Acute stress disorder B) Posttraumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorder 5. The client is experiencing night terrors. Which of the following would the nurse know are the major elements of posttraumatic stress disorder (PTSD)? Select all that apply. A) Trying to avoid any places, people or situations that may trigger memories of the trauma B) Re-experiencing the trauma through dreams or recurrent and intrusive thoughts C) Becoming increasingly more isolated D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal 6. Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply. A) Being a survivor of a tsunami that resulted in thousands of deaths B) Being stranded at the office during a typical winter storm that was anticipated C) Being a marine in a combat situation where the entire platoon was wiped out, except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of themoment when the plane hit the second tower on 9/11 7. Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed containing a patient with the same diagnosis as her father. The nurse saw her father's facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing? A) A flashback B) Emotional numbing C) Hyperarousal D) A dream 8. A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A) Re-experiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal D) Feeling mildly anxious E) Occurs 2 weeks after the trauma 9. A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental healthcrisis unit for further evaluation. Which of the following is the man potentially suffering from? Select all that apply. A) Depersonalization disorder B) Dissociative identity disorder C) Repressed memories D) Dissociative amnesia E) False memory syndrome 10. Which of the following statements by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that she had arrived at the scene of an automobile–pedestrian accident and unsuccessfully performed CPR on a victim three days ago? The nurse and her colleague are sitting in the break room and no one else is present. A) “Tell me what you saw.” B) “That is horrible!” C) “Why did you perform CPR?” D) “I know how you feel; the same thing happened to me several years ago and I never recovered.” 11. Which of the following outcomes would take priority for a client who has survived trauma or abuse? Select all that apply. A) The client will demonstrate healthy, effective ways of dealing with the stress. B) The client will be physically safe. C) The client will establish a social support system in the community. D) The client will distinguish between ideas of self-harm and taking action on those ideas. E) The client will express emotions nondestructively. 12. A fireman survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter incounseling, the nurse evaluates which of the following as positive outcomes for this client? Select all that apply. A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community. D) The client will report nightmares and flashbacks of the fire. 13. The traumatized client has suddenly changed demeanor and voice pitch. Which of the following is true about the use of touch with a client with dissociative identity disorder? A) It is best not to touch the client without his or her permission. B) Make sure the client knows the touch is friendly and supportive. C) Touch the client only if you are in his or her direct line of vision. D) Touching will convey a sense of security to the client. 14. Which of the following interventions would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse? A) To identify a list of support people or activities in the community B) To remind them to calm down when they appear to be experiencing a flashback C) To encourage them to tell their story repeatedly to everyone they meet D) To help them to refocus their view of themselves from being victims to being survivors 15. A nurse is providing education about trauma and its effects to a communitygroup in a community that has just been hit by a devastating tornado. One of the participants asks about what kind of support a survivor of the tornado will need. Which would be the best response of the nurse? A) If a person is willing to share his or her feelings about what has happened, he or she is not dealing with their feelings effectively. B) It is counterproductive for people to share what has happened to them and their feelings about it as there is nothing more to be done. C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD. D) It is best to wait until a survivor's life has returned to normal before dealing with the trauma. 16. Which of the following should be an action of a nurse who is having feelings of judgment regarding a client's contributory behavior to an automobile accident that resulted in deaths? A) Discussing the nurse's personal feelings with a peer or a counselor B) Acknowledging to the client the judgment regarding his or her contributory behavior C) Sharing the client's horror and encouraging him or her to avoid thinking about it D) Letting the client know that he or she is now traumatized beyond repair 17. A nurse is caring for a client who is a veteran with thoughts of missiles screaming and exploding. The client re-experiences feelings of terror first experienced in combat one year ago. Upon assessment, the nurse knows these recurrent events are part of which disorder?A) acute stress disorder B) generalized anxiety disorder C) adjustment disorder D) posttraumatic stress disorder 18. A nurse interviewing a client with suspected posttraumatic stress disorder (PTSD) should be alert to findings indicating the client has which traits? Select all that apply. A) experiences flashbacks B) demonstrates hypervigilance C) feels detached or empty inside D) feels driven to repeat behaviors E) avoids people and places that arouse painful memories F) experiences sympathetic nervous system symptoms suggestive of a heart attack 19. When working with a client with posttraumatic stress disorder (PTSD), who has frequent flashbacks, the nurse should include which intervention? A) encouraging repression of memories associated with the traumatic event B) explaining that physical symptoms are unrelated to the psychological state C) teaching various relaxation techniques D) discussing the event has no real meaning 20. A client tells a nurse about recent episodes of strange behavior that the client cannot recall, but has discussed with family. The client reports being told of going out late at night dressed, but not in the usual wardrobe. Upon return, the client cannot recall any of the event. The nurse suspects the client is dealing with which personality disorder? A) antisocial personality B) borderline personality C) dissociative identity disorder D) body dysmorphic disorder21. For a client with dissociative identity disorder, the nurse understands that the disturbed personal identity is most likely related to which characteristic? A) poor impulse control B) chronic low self-esteem C) high risk for self-directed violence D) unresolved childhood abuse issuesAnswer Key 1. B 2. D 3. B 4. B, C, D, E 5. B, D, E 6. A, C, D, E 7. A 8. A, B, C 9. A, B, D 10. A 11. B, D 12. A, B, C 13. A 14. D 15. C 16. A 17. D 18. A, B, C, E 19. C 20. C 21. DChapter 14 1. The nurse knows that which of the following are stages in Selye's general adaptation syndrome? Select all that apply. A) Alarm reaction stage B) Resistance stage C) Coping stage D) Exhaustion stage E) Panic stage 2. The nurse knows that which one of the following statements is true about stress and anxiety? A) All people handle stress in the same way. B) Stress is a person's reaction to anxiety. C) Anxiety occurs when a person has trouble dealing with life situations, problems, and goals. D) Stress is the wear and tear that life causes on the body. 3. The nursing student answers the test item correctly when identifying which of the following statements as true? A) Anxiety and fear are the same. B) Anxiety cannot be completely eliminated from life. C) Anxiety is always harmful. D) Fear is feeling threatened by an unknown entity. 4. The student nurse correctly identifies that which one of the following statements applies to the parasympathetic nervous system? A) It is activated during the alarm reaction stage. B) It is activated at the end of the resistance stage. C) It is activated during the exhaustion stage.D) It is commonly referred to as the fight, flight, or freeze response. 5. The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which of the following characteristics? A) Focusing only on immediate task B) Faster rate of speech C) Narrowed perceptual field D) Heightened focus 6. A client says to the nurse, “I just can't talk in front of the group. I'm trembling and I feel like I'm going to pass out.” The nurse assesses the client's anxiety to be at which level? A) Mild B) Moderate C) Severe D) Panic 7. A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at, and listening to, the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly in a high pitched voice. The professor understands that the student is likely experiencing which level of anxiety? A) Mild B) Moderate C) Severe D) Panic 8. A client who suffers from frequent panic attacks describes the attack as feelingdisconnected from himself. The nurse notes in the client's chart that the client reports experiencing... A) hallucinations B) depersonalization C) derealization D) denial 9. Which of the following statements about the use of defense mechanisms in persons with anxiety disorders is accurate? Select all that apply. A) Defense mechanisms are a human's attempt to reduce anxiety. B) Persons are usually aware when they are using defense mechanisms. C) Defense mechanisms can be harmful when overused. D) Defense mechanisms are cognitive distortions. E) The use of defense mechanisms should be avoided. F) Defense mechanisms can control the awareness of anxiety. 10. The client has been defensive toward communication with the nurse today. Which one of the following can be a positive outcome of using defense mechanisms? A) Defense mechanisms can inhibit emotional growth. B) Defense mechanisms can lead to poor problem-solving skills. C) Defense mechanisms can create difficulty with relationships. D) Defense mechanisms can help a person to reduce anxiety. 11. The nurse is working with a young client with anxiety. Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective?A) Anxiety is learned in childhood through interactions with caregivers. B) Anxiety is learned throughout life as a response to life experiences. C) Anxiety stems from an unconscious attempt to control awareness. D) Anxiety results from conforming to the norms of a cultural group. 12. Which of the following theories about anxiety is based upon intrapsychic theories? A) A person's innate anxiety is the stimulus for behavior. B) Anxiety is generated from problems in interpersonal relationships. C) A nurse can help the client to achieve health by attending to interpersonal and physiologic needs. D) Anxiety is learned through experiences. 13. The nurse is working with several clients with anxiety disorders. Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply. A) Sigmund Freud's theory B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory D) Pavlov's theory 14. A nurse is working with a client to develop assertive communication skills. The nurse documents achievement of treatment outcomes when the client makes a statement such as which of the following? A) "I'm sorry. I'm not picking this up very quickly." B) "I feel upset when you interrupt me." C) "You are pushing me too hard." D) "I'm not going to listen to other people anymore."15. A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called which of the following? A) systematic desensitization B) flooding C) cognitive restructuring D) combination therapy 16. Which techniques would be most effective for a client who has situational phobias? Select all that apply. A) Flooding B) Reminding the person to calm down C) Systematic desensitization D) Assertiveness training E) Decatastrophizing 17. A client is currently experiencing a panic attack. Which of the following is the most appropriate response by the nurse? A) "Just try to relax." B) "There is nothing here to harm you." C) "You are safe. Take a deep breath." D) "What are you feeling right now?" 18. A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" The nurse is using this response to... A) appraise his situation more realistically. B) assist the client to make alternative plans for the future. C) assess if the client has health problems compounded by stress. D) clarify the client's meaning.19. Which of the following statements about the assessment of persons with anxiety and anxiety disorders is most accurate? A) When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition. B) Panic attacks are the most common late-life anxiety disorders. C) An elder person with anxiety may be experiencing ruminative thoughts. D) Agoraphobia that occurs in late life may be related to trauma experienced or anticipated. 20. The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to... A) Approach the client and ask, "What's wrong?" B) Call for help and say, "Calm down." C) Turn and walk away from the room without saying anything. D) Stand at the doorway and say, "You seem upset." 21. The nurse is teaching about postoperative wound care. As the wound is uncovered, the client begins mumbling, breathing rapidly, and trying to get out of bed, and the client does not respond when the nurse calls his name. Which of the following should be the nurse's first action? A) Ask the client to describe his feelings. B) Proceed with wound care quickly. C) Replace the dressing on the wound. D) Get the assistance of another nurse. 22. The nursing student understands correctly when identifying which objective isappropriate for all clients with anxiety disorders? A) The client will experience reduced anxiety and accept the fact that underlying conflicts cannot be treated. B) The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations. C) The client will experience reduced anxiety and learn to control primitive impulses. D) The client will experience reduced anxiety and strive for insight through psychoanalysis. 23. A client is learning to cope with anxiety and stress. The expected outcome is that the client will... A) change reactions to stressors. B) ignore situations that cause stress. C) limit major stressors in his or her life. D) avoid anxiety at all costs. 24. A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" The best response by the nurse would be... A) "Both therapies are effective. You can eventually choose one or the other." B) "You cannot get the full effect of your medications without cognitive therapy as well." C) "As soon as your medications reach therapeutic level, you can omit the therapy." D) "Medications combined with therapy help you change how well you function." 25. A client asks how his prescribed alprazolam helps his anxiety disorder. The nurse explains during teaching of medications, that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed tobe dysfunctional in anxiety disorders? A) Serotonin B) Norepinephrine C) GABA D) Dopamine 26. The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which of the following schedules for practicing stress management techniques? A) Reserve these techniques for episodes of panic. B) Use the techniques as needed when experiencing severe anxiety. C) Practice the techniques when relatively calm. D) Expect to practice the techniques when meeting with a therapist. 27. The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which of the following in the discharge teaching? Select all that apply. A) Continued development of positive coping skills B) Weaning off of medications as necessary C) Lessening the amount of daily responsibilities D) Continued practice of relaxation techniques E) Development of a regular exercise program 28. When teaching a client with generalized anxiety disorder, which is the highest priority for the nurse to teach the client to avoid? A) Caffeine B) High-fat foods C) Refined sugars D) Sodium29. An anxiolytic agent, lorazepam, has been prescribed for the client. Which of the following statements by the client would indicate to the nurse that client education about this medication has been effective? A) "My anxiety will be eliminated if I take this medication as prescribed." B) "This medication presents no risk of addiction or dependence." C) "I will probably always need to take this medication for my anxiety." D) "This medication will relax me, so I can focus on problem solving." 30. The nurse is caring for clients in the out-patient unit. Which of the following would be key points for the nurse to remember when working with persons who are suffering from anxiety disorders? A) It is important for the nurse to "fix" the client's problems. B) Remember to practice techniques to manage stress and anxiety in your own life. C) If you have any uncomfortable feelings, do not tell anyone about them. D) Remember that only people who suffer from anxiety disorders have stress that can interfere with daily life and work. 31. Which of the following are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply. A) To provide better care for the client B) To help understand the role anxiety plays in performing nursing responsibilities C) To help the nurse to mask his or her own feelings of anxiety D) So the nurse can identify that his or her own needs are more important than the clientsE) To help nurses to function at a high level 32. Which of the following are cognitive–behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A) Positive reframing B) Decatastrophizing C) Assertiveness training D) Humor E) Unlearning 33. When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities when considering the client's safety? Select all that apply. A) Remain with the client to assess needs B) Request a prescription for an antianxiety agent. C) Offer the client therapy to calm down D) Turn off any televisions or radios in the immediate area E) Engage the client in recreational activities. 34. A psychiatric nurse visits a client at home. The client tells the nurse that he or she experiences chest pain, shortness of breath, and sweating whenever leaving home. The client has been unable to go to work for six weeks. The nurse recognizes this problem as which behavior? A) mysophobia B) claustrophobia C) acrophobia D) agoraphobia 35. A client is seeking treatment for a specific phobia. The nurse in the anxiety disorders clinic documents that the client's anxiety is related to exposure to the phobic object. Which is a realistic outcome for anxietyself-control in this situation? A) avoid the feared object whenever possible B) face the feared object without supportive assistance C) state that the fear of the object is unrealistic and inappropriate D) practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object 36. When a psychiatrist prescribes alprazolam for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions? A) eat a tyramine-free diet B) report drowsiness C) avoid alcoholic beverages D) adjust dose and frequency of ingestion based on anxiety level 37. A nurse caring for a client with generalized anxiety disorder tells a supervisor “I find myself feeling uncomfortable and anxious when the client starts trembling and perspiring. I develop cold clammy hands and my pulse races." In such an interaction, the client will most likely develop which of the following? A) fatigue B) claustrophobia C) increased anxiety D) improved self-esteem 38. A nurse detects that a client is experiencing panic-level anxiety. Which intervention should be immediately implemented? A) teach relaxation techniques B) administer anxiolytic medication C) provide calm, brief, directive communicationD) gather a show of force in preparation for physical controlAnswer Key 1. A, B, D 2. D 3. B 4. B 5. D 6. C 7. B 8. B 9. A, C, D, F 10. D 11. A 12. A 13. B, C 14. B 15. A 16. A, C 17. C 18. A 19. A 20. D 21. C 22. B 23. A 24. D 25. C 26. C 27. A, D, E 28. A 29. D 30. B 31. A, B, E 32. A, B, C 33. A, D 34. D 35. D 36. C 37. C 38. CChapter 15 1. The nursing student correctly identifies that which of the following statements is true of the etiology of OCD? Select all that apply. A) The cognitive model for OCD etiology focuses on childhood and environmental experiences of growing up. B) The etiology of OCD is not definitively explained at this time. C) OCD is caused by immune dysfunction. D) The primary etiology of OCD is genetics. E) Cognitive models may partially explain why people develop OCD. 2. Which of the following are features of the thinking of a person who has OCD, according to the cognitive model? Select all that apply. A) The person with OCD employs a minimalist approach to all aspects of his or her life. B) The person with OCD believes one's thoughts are overly important and has a need to control those thoughts as they overestimate the threat posed by their thoughts. C) The person with OCD is always aware that his or her behavior is related to OCD. D) The person with OCD is concerned with perfectionism and has an intolerance of uncertainty. E) The person with OCD has an inflated personal responsibility. 3. The nurse is caring for her first client with obsessive–compulsive disorder. During the treatment team meeting, the nurse shares her frustration as to the client's inability to stop washing his hands. The nurse manager offers which one of the following explanations?A) The hand washing represents a way to exert independence from the staff. B) The client is not aware of the excessive hand washing. C) The client does not think anything is abnormal with washing his hands repeatedly. D) The client feels terrible but cannot stop washing his hands to try to get rid of his anxiety. 4. The nurse correctly identifies that which of a client with OCD's self-soothing behaviors may involve self-destruction of the body? Select all that apply. A) Dermatillomania B) Trichotillomania C) Onychophagia D) Kleptomania E) Oniomania 5. The student nurse correctly identifies that which of the following are characteristics of hoarding disorder? Select all that apply. A) Excessive acquisition of animals or apparently useless things B) Cluttered living spaces that become uninhabitable C) Significant distress or impairment for the individual D) Obsessive cleaning of environment E) Disposing of articles that are of no value 6. The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders? A) Hoarding disorder B) Body dysmorphic disorder C) Pyromania D) Body identity integrity disorder7. Which of the following statements about the typical history of illness is consistent with OCD? A) OCD usually requires hospitalization. B) OCD treatment is usually outpatient. C) OCD only affects the client's ability to perform ADLs and work, not his or her leisure life. D) Most people seek treatment as soon as they observe the symptoms. 8. The client has shown much improvement for OCD. Which of the following would be appropriate outcomes for a client with OCD? Select all that apply. A) The client will stop engaging in the compulsive activity. B) The client will spend less time performing rituals. C) The client will complete daily routine activities within a realistic time frame. D) The client will conceal the behavior from all persons to avoid anxiety. E) The client will demonstrate effective use of behavior therapy techniques. 9. The client and nurse have interacted for several months. Which of the following is the most important variable in determining the likelihood of success in improving life for a client with OCD? A) The client must be willing to make changes in his or her behavior. B) The client must acknowledge that the behavior is not in his or her control. C) The client must allow the nurse to decide the appropriate intervention for him or her. D) The client must be willing to try all new relaxation techniques. 10. Which of the following is an importantpart of therapeutic communication for clients who have OCD? A) To encourage the client to keep the obsession secret. B) To encourage the client to discuss his or her obsession with the nurse. C) The nurse must have the same obsession as the client. D) The nurse must instruct the client to discuss the obsession. 11. Which of the following interventions by the nurse will increase the client's sense of security? A) Allowing the client to perform the rituals B) Distracting the client from rituals with other activities C) Encouraging the client to talk about the purpose of the rituals D) Stopping the client from performing the rituals 12. Before eating a meal, a client with obsessive-compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. When evaluating the progress of the client, what is the most important objective for this client? A) Allow ample time for completion of all rituals before each meal. B) Gradually decrease the amount of time spent for performing rituals. C) Increase the client's acceptance of the need for medication to control rituals. D) Omit one ritualistic behavior every 4 days until all rituals are eliminated. 13. The nurse is preparing for outpatient placement of the client with OCD. Which of the following treatment modalities is most effective for OCD? A) Behavioral techniquesB) Medication C) Behavioral techniques and medication D) Ignoring it 14. Which of the following is essential for the nurse to communicate to the client with OCD and to the client's family? A) The client's diagnosis should be kept secret from everyone outside the immediate family and friends. B) The importance of medication compliance and that it may be necessary for medication to be changed to find the one that works best. C) It is important for the client to avoid following a routine. D) It is helpful for others to give unsolicited advice about other activities the client with OCD can engage in. 15. The nurse is providing education to a group of persons from several community agencies about hoarding by elder persons. Which of the following is important for the nurse to emphasize? A) Treatment will likely start to be effective in the short term. B) If the person had help to clean up his or her environment, the hoarding would be cured. C) It is not beneficial to tell the client that his thoughts and rituals interfere with his life or that his ritual actions really have no lasting effect on anxiety. D) One agency should be able to address all of the client's needs. 16. Which of the following is the desired outcome for a client with OCD? A) That the client will no longer experience any signs or symptoms of OCD B) That the client will no longer experience anxietyC) That the OCD symptoms no longer interfere with the client's responsibilities D) To relieve the client with OCD of any responsibilities 17. Which of the following are important for the nurse to remember when teaching relaxation and behavioral techniques to a client with OCD? Select all that apply. A) It is important to teach the client to use relaxation techniques when the client's anxiety is low. B) The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. C) The client must be willing to engage in exposure and response prevention. D) The client must be forced to use relaxation techniques. E) It is unnecessary to assess the baseline of ritualistic behaviors in the client with OCD. 18. The nurse has a student with her today and is teaching assessment skills. The student nurse correctly identifies that which one of the following statements is true regarding clients with OCD? A) Since the client is aware that his or her behavior is bizarre, the client should just stop the behavior. B) Clients with OCD seem normal on the outside but suffer from overwhelming fear and anxiety. C) Once a person is successfully treated for OCD, he or she has been cured. D) Persons with OCD must avoid stress. 19. A nurse is caring for a client who believes her feet are enormous compared with the rest of her body. She has visited an orthopedic surgeon to see if surgery is possible. She spends hours trying to buyshoes that make her feet look smaller, and she prefers social interactions where she can sit with her feet concealed under a table. The nurse assesses that the client's symptoms are consistent with which disorder? A) illness anxiety disorder B) somatoform pain disorder C) body dysmorphic disorder D) depersonalization disorder 20. A nurse is caring for a client diagnosed with body dysmorphic disorder and perceives to have a disturbed body image due to a reddened face. Which is a long-term outcome for this client? A) The client will recognize the exaggeration of a reddened face by day two of therapy. B) The client will acknowledge the link between anxiety and exaggerated perceptions. C) The client will use behavioral modification techniques to begin accepting the reddened face. D) The client will verbalize acceptance of the reddened face by the three month follow-up appointment. 21. A nurse is working with the family of a client with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan? A) The thoughts, images, and impulses are voluntary. B) The thoughts, images, and impulses tend to worsen with stress. C) The family should pay immediate attention to symptoms. D) OCD is a chronic disorder that does not respond to treatment. 22. A nurse is caring for a client who has been diagnosed with OCD. The nurse ispreparing a plan of care. Which is a safety priority for the nurse to observe? A) antisocial behaviors and demeanor B) eating, drinking, and elimination C) demeanor with other clients D) daily routines and habits 23. A nurse is visiting an elderly client at home. The client has been seen hoarding, and the smell is offensive when the nurse comes to visit. Which is an indicator of hoarding? A) a collection of magazines scattered in the living room B) a single path throughout the yard and house C) an untidy house and yard D) a complaint from the neighbors about the catAnswer Key 1. A, B, E 2. B, D, E 3. D 4. A, B, C 5. A, B, C 6. B 7. B 8. B, C, E 9. A 10. B 11. A 12. B 13. C 14. B 15. C 16. C 17. A, B, C 18. B 19. C 20. D 21. B 22. B 23. BChapter 16 1. The most commonly supported neuroanatomic theory of schizophrenia suggests which etiology? A) Excessive amounts of dopamine and serotonin in the brain B) Ineffective ability of the brain to use dopamine and serotonin C) Insufficient amounts of dopamine in the brain D) Decreased brain tissue in the frontal and temporal regions of the brain 2. The nurse reviews current literature and identifies that which of the following are included in current studies of biologic theories regarding the etiology of schizophrenia? Select all that apply. A) That there is a particular pathologic structure associated with the disease. B) That genetics is the cause of schizophrenia. C) Persons with schizophrenia have decreased brain volume and abnormal brain function in the frontal and temporal areas. D) The brain activity of persons with schizophrenia differs from people who do not have schizophrenia. E) That the etiology of schizophrenia may be related to the body's response to exposure of a virus. 3. The student nurse correctly recognizes that which one of the following findings is best supported by genetic studies in the etiology of schizophrenia? A) If a person has schizophrenia, distant relatives are also at risk. B) That there is no relationship at all between schizophrenia and genetics. C) That there is a weak correlation betweengenetics and schizophrenia. D) That schizophrenia is at least partially inherited. 4. The nurse is assessing for negative symptoms of schizophrenia in a newly admitted client. The nurse would note which behavior as indicative of a negative symptom? A) Difficulty staying on subject when responding to assessment questions B) Belief of owning a transportation device allowing for travel to the center of the Earth C) Hesitant to answer the nurse's questions during the assessment interview D) Mimicking the postural changes made by the nurse during the assessment interview 5. The client with schizophrenia believes the student nurses are there to spy on the clients. The client is suffering from which of the following symptoms? A) Hallucinations B) Delusions C) Anhedonia D) Ideas of reference 6. The client with schizophrenia makes the following statement, "I just don't know how to count. The sky turned to fire. I have a ball in my head." What term does the nurse use to document this statement? A) flight of ideas B) ideas of reference C) delusional thinking D) associative looseness 7. A person suffering from schizophrenia has little emotional expression when interacting with others. The nurse would document the client's affect as which ofthe following? Select all that apply. A) Flat B) Blunt C) Bright D) Inappropriate E) Pleasant 8. A client who has schizophrenia is having a conversation with the nurse and suddenly stops talking in the middle of a sentence. The client is experiencing which type of thought disruption? A) Thought withdrawal B) Thought insertion C) Thought blocking D) Thought broadcasting 9. During the nursing assessment, a client describes constantly hearing voices mumbling in the background. The client denies that the voices are telling him to do anything harmful. The nurse documents that the client is experiencing which of the following? A) Command hallucinations B) Auditory hallucinations C) Olfactory hallucinations D) Gustatory hallucinations 10. A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, "This person is my guide and tells me what I must do every day." The nurse would best describe this type of thinking as which of the following? A) Referential delusion B) Grandiose delusion C) Thought insertion D) Personalization11. The nurse is preparing a client with schizophrenia for discharge. The nurse asks the client, "How are you going to care for yourself at home?" The purpose of the nurse's question is to assess the client's… A) self concept. B) judgment. C) insight. D) social support system. 12. All of the following are nursing diagnoses identified for a client with schizophrenia. The student nurse correctly anticipates that which diagnosis will resolve when the client's negative symptoms improve? A) Impaired verbal communication B) Risk for other-directed violence C) Disturbed thought processes D) Social isolation 13. All of the following are included in the plan of care for a client with schizophrenia. Which nursing intervention should the nurse perform first when caring for this client? A) Observe for signs of fear or agitation. B) Maintain reality through frequent contact. C) Encourage client to participate in the treatment milieu. D) Assess community support systems. 14. A client with schizophrenia is seen sitting alone and talking out loud. Suddenly, the client stops and turns as if listening to someone. The nurse approaches and sits down beside the client. Which of the following is the best initial response by the nurse? A) "You must be pretty bored to be sitting here talking to an invisible person." B) "I don't hear or see anyone else; what are you hearing and seeing?"C) "I can tell you are hearing voices, but they are not real." D) "How long have you known the person you are talking to?" 15. A client states, "I am dead. I have come back from the dead." An appropriate response by the nurse is... A) "What is it like to feel dead?" B) "No you did not die. People don't come back from the dead." C) "Show me what you did in art therapy this morning." D) "I'll get your medicine and you'll feel better." 16. A client diagnosed with schizophrenia is laughing and talking while sitting alone. Which of the following is the best response by the nurse? A) State, "Can you share your joke with me?" B) To sit with the client quietly until the client is ready to talk C) State, "Tell me what's happening." D) State, "You look lonely here. Let's join the others in the day room." 17. A college freshman is admitted to the hospital with a diagnosis of schizophrenia. Friends reported that she had been in her room for 2 days in a trance-like state, not eating nor speaking to anyone. Which of the following is the highest priority for this client? A) Assessing fluid intake and output B) Completing an assessment of mental status C) Obtaining more data about her college experiences D) Providing for adequate rest 18. The client with schizophrenia tells thenurse that rats have started to eat his brain. The best response by the nurse would be... A) 'Have you discussed this with your physician?" B) "How could that be possible?" C) "You cannot have rats in your brain." D) "You look OK to me." 19. A client who has suspicion has been placed in a room with a roommate. The night nurse assesses the situation and reports that this client has been awake for the past three nights. The likely explanation for his wakefulness is which of the following? A) He is fearful of what his roommate might do to him while he sleeps. B) He is a light sleeper and unaccustomed to a roommate. C) He is watching for an opportunity to escape. D) He is worrying about his family problems. 20. A client with schizophrenia is reluctant to take his prescribed oral medication. The most therapeutic response by the nurse to this refusal is... A) "I can see that you're uncomfortable now, so we can wait until tomorrow." B) "If you refuse these pills, you'll have to get an injection." C) "What is it about the medicine that you don't like?" D) "You know you have to take this medicine for your own good." 21. The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning his head as if listening to another person. The nurse assesses this behavior to indicate that the client is experiencing auditory hallucinations and says...A) "Are you hearing something?" B) "It's a beautiful day, isn't it?" C) "Would you like to go to your room to talk?" D) "Would you like to take some of your PRN medication?" 22. A client with schizophrenia is admitted to the inpatient unit. He does not speak when spoken to but has been observed talking to himself on occasion. What would be the priority objective at this time? A) The client will begin talking with other clients B) The client will express his feelings freely C) The client will increase his socialization with others D) The client will increase his reality orientation 23. The nurse enters the room of a client with schizophrenia the day after he has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. The best response by the nurse would be... A) "I can see you want to be alone. I'll come back another time." B) "You don't need to talk right now. I'll just sit here for a few minutes." C) "I've got some other things I can do now. I hope you'll feel like talking later." D) "You would feel better if you would tell me what you're thinking." 24. One evening, a client with schizophrenia leaves his room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which of the following responses would be best? A) "I understand you hear a voice. You and Iare the only ones in the hall, and I don't hear a voice." B) "The voices are part of your illness, and they will leave in time." C) "This guarding responsibility can make you tired. You rest for now, and I'll guard a while." D) "You are just imagining these things. Do not pay any attention to the voices." 25. When performing discharge planning for a client who has schizophrenia, the nurse anticipates barriers to adhering to the medication regimen. The nurse assesses which of the following as improving the likelihood that the client will follow the prescribed medication regimen? Select all that apply. A) Short-term memory intact B) History of missing appointments C) Receives monthly disability checks D) Walking is primary mode of transportation E) States location of pharmacy nearest his residence 26. A client with schizophrenia is attending a follow-up appointment at the community mental health clinic. The client reports to the nurse, "I stopped taking the antipsychotic medication because I can't get an erection with my girlfriend anymore." Which of the following should the nurse recommend to enhance the client's well-being? A) "It sounds like that is a problem for you. Don't you still find her to be sexy enough?" B) "Sexual dysfunction is a temporary side effect and should get better once your body is used to the medication." C) "You should avoid having sex with your girlfriend anyway. Do you really want her to get pregnant?"D) "It is important for you to take an antipsychotic medication. You may need a different type that will be less likely to affect your sexual functioning. I would like to call your physician about this." 27. Which of the following questions would best help the nurse to evaluate the effectiveness of antipsychotic medications for a client who has schizophrenia? Select all that apply. A) Have the symptoms you were experiencing disappeared? B) If the symptoms have not disappeared, are you able to carry out your daily life despite the persistence of some psychotic symptoms? C) Are you committed to taking the medication as prescribed? D) Are you satisfied with your quality of life? E) Do you have access to community agencies that will help you to live successfully in this community? 28. A client with schizophrenia has returned to the clinic because of an increase in symptoms. The client reports he stopped taking his medication because he did not like the side effects. The nurse educates the client about managing uncomfortable side effects. Which of the following is included in the teaching plan? Select all that apply. A) Suck on hard candy as desired B) Spend at least 30 minutes outside in the sun daily C) Use stool softeners as needed D) Decrease the amount of daily fluid intake E) Maintain a balanced calorie-controlled diet 29. The nurse is working with a client who has schizophrenia, disorganized type. It istime for the client to get up and eat breakfast. Which of the following statements by the nurse would be most effective in helping the client prepare for breakfast? A) "I'll expect you in the dining room in 20 minutes." B) "It's time to put your dress on now." C) "Stay right there and I'll get your clothes for you." D) "Why don't you stay here and I'll get your tray for you." 30. The parents of a young adult male who has schizophrenia ask how they can recognize when their son is beginning to relapse. The nurse teaches the family to look for which of the following? Select all that apply. A) Excessive sleeping B) Fatigue C) Irritability D) Increased inhibition E) Negativity 31. A client asks the nurse upon discharge, "What should I do if I forget to take my medicine?" The nurse should explain to the client which of the following? A) "Just double the dose next time it is scheduled." B) "Skip that dose and resume your regular with the next dose." C) "Don't miss doses, or you will not maintain therapeutic drug levels." D) "If you remember within 3 to 4 hours later than it is due, take it then. If you remember more than 4 hours after it was due, do not take that dose." 32. Which of the following are central components of a psychiatric rehabilitation and recovery program? Select all thatapply. A) Working with clients to have an improved quality of life according to society's point of view B) Working with clients to manage their own lives C) Working with clients to make effective treatment decisions D) Working with clients to have an improved quality of life according to his or her point of view. E) Working with clients to diagnose their problem early 33. A student nurse is having a first experience in an inpatient psychiatric unit and is frightened by the behaviors of the clients with schizophrenia. The student should take which of the following actions to deal with fear? A) Express fear to the psychiatrist during rounds B) Pretend to not be afraid C) Stay in an open area while talking with the clients D) Insist that the instructor accompanies the student at all times. 34. Which of the following attitudes would be best for the nurse when the client who has schizophrenia acts as though the nurse is not trustworthy or that his or her integrity is being questioned? A) That the client is correct and the nurse is not trustworthy B) That the client wants to insult the nurse C) That the client's behavior is a part of the illness D) That the nurse's actions have failed 35. Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects?A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers 36. A client with schizophrenia is being treated with olanzapine 10 mg. daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be which of the following? A) increasing the amount of serotonin and norepinephrine in the brain B) decreasing the amount of an enzyme that breaks down neurotransmitters C) normalizing the levels of serotonin, norepinephrine, and dopamine D) blocking dopamine receptors in the brain 37. The nurse is teaching on the effects of antipsychotic medications to the client and family. Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women 38. A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes during their therapy session that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of which of the following?A) extrapyramidal side effects B) loss of voluntary muscle control C) posturing D) tardive dyskinesia 39. A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. As the nurse performs her assessment, which of these side effects would be correctly identified? A) Tardive dyskinesia B) Neuroleptic malignant syndrome C) Dystonia D) Akathisia 40. The client was conversing with the nurse when noticeable changes occurred with the client. Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? A) Opisthotonus B) Oculogyric crisis C) Torticollis D) Pseudoparkinsonism 41. The client is diagnosed with schizophrenia and the nurse is observing for effects of medication during their teaching session. Which of the following medications rarely causes extrapyramidal side effects (EPS)? A) Ziprasidone B) Chlorpromazine C) Haloperidol D) Fluphenazine 42. Which of the following increases the risk for neuroleptic malignant syndrome (NMS)? A) Overhydration B) Intake of vitamins C) DehydrationD) Vegetarian diet 43. The nurse notices the client with a shuffling gait walking in the hall. Which of the following would not be included as a symptom of drug-induced parkinsonism? A) Stooped posture B) Cogwheel rigidity C) Drooling D) Tachycardia 44. The client has been living in the community with schizophrenia. Which of the following drug classification is the primary medication treatment for schizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics 45. A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to... A) get a stat. order for a serum drug level. B) hold the client's medication until the symptoms subside. C) place an urgent call to the client's physician. D) give a PRN dose of benztropine IM. 46. One week after beginning therapy with thiothixene, the client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, andincontinence. The nurse should notify the physician because these symptoms are indicative of... A) acute dystonic reaction. B) extrapyramidal side effects. C) neuroleptic malignant syndrome. D) tardive dyskinesia. 47. For a client taking clozapine, which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivity reaction D) Sore throat and malaise 48. A nurse is working with a client that is not participating in group. The client seems to be indifferent to other people. This is considered a negative or soft symptom as well as which symptoms? Select all that apply A) caatatonia B) anhedonia C) blunted affect D) ideas of reference E) ambivalence 49. A nurse is working with a client that has been diagnosed with delusional thoughts. Which is an initial short-term outcome appropriate for this client? A) accept that the delusion is illogical B) distinguish external boundaries C) explain the basis for the delusions D) engage in reality oriented conversation 50. A client is admitted with the diagnosis of possible schizophrenia and to rule out (R/O) organic pathology. Based on thisinformation, what treatment will the nurse expect for this client? A) to see a mental health specialist for extensive psychological testing B) to be scheduled for a computerized tomography (CT) of the brain C) to have an immunologic assay performed within two days of the admission D) to participate in a dexamethasone suppression test (DST) 51. A client has a history of schizophrenia, controlled by haloperidol. During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect to be prescribed for this client? A) haloperidol B) fluphenazine deconoate C) clozapine D) benztropine mesylate 52. A nurse has been assigned a newly admitted client. The client's report notes that the client is demonstrating grandiosity. Which client statement is most consistent with this symptom? A) "I can understand why my wife is upset that I overspend." B) "I can't do anything anymore." C) "I'm the world's most astute financier." D) "I can't understand where all the money in our family goes."Answer Key 1. D 2. B, C, D, E 3. D 4. C 5. B 6. D 7. A, B, D 8. C 9. B 10. A 11. C 12. D 13. A 14. B 15. C 16. C 17. A 18. A 19. A 20. C 21. A 22. D 23. B 24. A 25. A, C, E 26. D 27. A, B, C, D 28. A, C, E 29. B 30. B, C, E 31. D 32. B, C, D 33. C 34. C 35. B 36. D 37. A, B, D 38. D 39. D 40. B 41. A 42. C43. D 44. D 45. D 46. C 47. D 48. A, B, C 49. D 50. B 51. D 52. CChapter 17 1. The client has been diagnosed with depression. He asks the nurse what imbalances influence depression. Which of the following best explains the neurochemical processes responsible for depression? A) Increased activity of dopamine B) Decreased glucocorticoid activity C) Decreased serotonin and norepinephrine activity D) Potentiating of the kindling process 2. The client has been diagnosed with depression, and asks the nurse several questions regarding depression and how it came to be diagnosed. Which of the following is a Freudian explanation of the etiology of depression? A) Depression is a reaction to a distressing life experience. B) Depression results from being raised by rejecting or unloving parents. C) Depression results from cognitive distortions. D) Depression is anger turned inward. 3. The client's family is questioning the nurse about bipolar disorder. Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply. A) Norepinephrine levels may be increased in mania. B) Manic episodes are a “defense” against underlying depression. C) Acetylcholine seems to be implicated in mania. D) The id takes over the ego and acts as an undisciplined hedonistic being (child).4. The client presents to the Emergency Department with a flat affect. The family is concerned about the lack of family involvement with the client. Which variables represent the highest risk for developing major depressive disorder? Select all that apply. A) Male gender B) Mood disorder in first-degree relatives C) Substance abuse D) Divorced E) Older adult 5. A concerned family member tells the nurse, "I am concerned about my brother. He has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder? A) Taking unnecessary risks B) Sleeping more C) Intense focus D) Showing low self-esteem 6. A client is admitted for major depression. The client has stated that nothing seems to bring him pleasure anymore. What should the nurse expect to find during assessment? A) Anhedonia, feelings of worthlessness, and difficulty focusing B) Depressed mood, guilt, and pressured speech C) Changes in sleep pattern, fatigue, and grandiose mood D) Difficulty focusing, feelings of helplessness, and flight of ideas 7. A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highestrisk for self-harm? A) Immediately after a family visit B) On the anniversary of significant life events in the client's life C) During the first few days after admission D) Approximately 2 weeks after starting antidepressant medication 8. The nurse is planning care for a client with major depression. Which is an appropriate expected outcome? A) The client will avoid causing harm to others. B) The client will be free from stress. C) The client will independently carry out activities of daily living. D) The client will not experience agitation. 9. A client who is depressed begins to cry and states, "I'm just really sick of feeling this way. Nothing ever seems to go right in my life." Which would be the most appropriate response by the nurse? A) "Don't cry. Try to look at the positive side of things." B) "You are feeling really sad right now. It's a hard time." C) "Hang in there. Your medication will start helping in a few days." D) "Nothing ever goes right?" 10. A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior? A) Administering a sedative that has been prescribed to be used PRN. B) Insisting the client take a "time-out" in his room C) Clearing the area of all other clients D) Setting limits on aggressive and intimidating behavior11. Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? A) Peanut butter sandwich, chips, cola B) Fried chicken, mashed potatoes, milk C) Ham sandwich, cheese slices, milk D) Spaghetti, garlic bread, salad, tea 12. A client who is manic states, "What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?" Which would be the most appropriate response by the nurse? A) "Please slow down. I'm not sure what you need first." B) "You will have to be quiet and have breakfast after the doctor comes." C) "Are you hungry?" D) "Your thoughts seem to be racing this morning." 13. A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time? A) Accompany the client to his or her room to get dressed. B) Put the client in seclusion for his or her own protection. C) Tell other clients to ignore the behavior because it is harmless. D) Tell the client that the behaviors have to stop right now. 14. The client with mania attempts to hit the nurse. Which is the best response by the nurse? A) "Do not swing at me again. If you cannot control yourself, we will help you."B) "If you do that one more time, you will be put in seclusion immediately." C) "Stop that. I didn't do anything to provoke an attack." D) "Why do you continue that kind of behavior? You know I won't let you do it." 15. During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse? A) "Do you think you could sit still for a few minutes so we can talk?" B) "How are you ever going to get any rest if you keep that music on?" C) "Let's go to the conference room and talk for a while." D) "Turn the radio down so we can hear ourselves talk." 16. At 1 AM, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response? A) "Go to the day room and wait while I call your psychiatrist." B) "Don't be unreasonable. I can't call the psychiatrist at this time of night." C) "I can't call the psychiatrist now, but you and I can talk about your request for a pass." D) "You must really be upset to want a pass immediately; I'll give you some medication." 17. A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse'sintervention should be based on which rationale? A) As soon as lunch is over, the client will calm down. B) Other clients need to be protected from the intrusive behavior. C) The client's behavior is not an imminent threat to anyone's physical safety. D) The client needs food and fluids in any way possible. 18. A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first? A) Decrease the client's environmental stimuli. B) Give the client feedback about his behavior. C) Introduce the client to other staff on the unit. D) Tell the client about hospital rules and policies. 19. The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, "I saw you sitting alone and thought I might keep you company." The client turns away from the nurse. Which would be the most therapeutic nursing intervention? A) Move to another chair closer to the client and say, "The staff is here to help you." B) Move to a chair a little further away and say, "We can just sit together quietly." C) Remain in place and say, "How are you feeling today?" D) Say, "I'll visit with you a little later," and leave the client alone for a while. 20. A client with depression appears lethargicand apathetic but agrees to participate in a leisure activity group. Which nursing intervention is most likely to help the client successfully participate? A) Allowing the client to direct her participation at her own pace B) Giving the client several choices of projects, so she can choose her favorite C) Staying away from the client during the session to encourage free expression D) Structuring the activity to facilitate completion of one specific task 21. A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention? A) Stating, "The effects of medications will not last forever. You will need to eventually learn to function without them." B) Stating, "Medications help your brain function better, but the therapy helps you achieve lasting behavior change." C) Stating, "Both are recommended. Since your insurance covers both that is the best plan for you." D) Asking, "Do you have reservations about going to therapy?" 22. A client who has been discharged home on citalopram calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions? A) Make an appointment to change to a different medication. B) Take the medication at night. C) Be patient while this early side effect subsides. D) Skip a dose if drowsiness is excessive.23. The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of her husband. The nurse suggests the wife implement the limit-setting skills she has learned in family therapy. In this instance, the nurse's action would be considered... A) inappropriate; the nurse should not give advice to the wife. B) inappropriate; the husband has the legal right to spend personal money. C) appropriate; the wife is responsible for the husband's actions since he has a mental illness. D) appropriate; the wife needs support in setting boundaries. 24. A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply. A) Weigh self weekly at the same time of day. B) Drink a 2-L bottle of decaffeinated fluid daily. C) Do not alter dietary salt intake. D) See the doctor if you get the flu. E) Restrict involvement in intense exercise. 25. The nurse is teaching a 70-year-old man about his depression. Which statement by the client would indicate that teaching has been effective? A) "All old people get depressed at times." B) "I'm glad I'll feel better in 2 or 3 days." C) "I never knew depression could just happen for no specific reason." D) "When I reduce the stress in my life, the depression will go away." 26. Which individual is at highest risk for committing suicide? A) A 71-year-old male, alcohol user,independent minded B) A 16-year-old female, diabetic, two best friends C) A 47-year-old male, obese, unemployed D) A 57-year-old female, depression, active in church 27. Which is a possible explanation for the increased risk of suicide in persons who have had a relative who committed suicide? A) The relative's suicide offers a sense of “permission” or acceptance of suicide as a method of escaping a difficult situation. B) Many people with depression who have suicidal ideation lack the energy to implement suicide plans, but antidepressant treatment can actually give clients with depression the energy to act on suicidal ideation. C) Suicide is more likely to occur in April when natural energy from increased sunlight may give the client the energy to act on suicidal ideation. D) The relative's suicide caused the family members to realize that suicide is emotionally harmful to the ones left behind and vow not to consider suicide. 28. Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply. A) After starting antidepressant therapy but not having reached the therapeutic level B) After having reached the therapeutic level of antidepressants and maintained it for several years C) If the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed D) If the client does not adhere to the medication regimen and takes antidepressant medications irregularlyE) Prior to initiating antidepressant therapy but before the depression results in lack of energy 29. Which client is at highest risk for carrying out a suicide plan? A) A client who has occasionally considered taking a bottle of sleeping pills. B) A client who says, “My life is over.” C) A client who has a private gun collection. D) A client who says, “I'm going to jump off the next bridge I see.” 30. A client who is depressed states, "I think my family would be better off without me. They don't need to worry." Which would be the most appropriate response by the nurse? A) "Are you planning to commit suicide?" B) "What do you think they are worried about?" C) "Where are you going?" D) "You don't mean that. Your family loves you." 31. A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of his favorite soda. Which action should the nurse take at this time? A) Confiscate the soda can as a restricted item. B) Pour the soda into a plastic cup. C) Ask the visitor to place the soda can at the nurse's desk until he or she leaves. D) Ask the visitor not to bring outside items on the unit in the future. 32. A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatricunit. Which nursing diagnosis has the highest priority? A) Hopelessness related to recent divorce B) Ineffective coping related to inadequate stress management C) Spiritual distress related to conflicting thoughts about suicide and sin D) Risk for suicide related to a highly lethal plan 33. The nursing instructor is conducting a preconference with a group of nursing students on a psychiatric unit. Which statement made by a student reflects the greatest barrier to being able to provide professional care to the client who is suicidal? A) "I just don't understand why anyone would want to kill themselves." B) "I think suicide is wrong and selfish." C) "I get frustrated when my client negates all the positives I try to point out." D) "I can see how much my client is hurting inside." 34. Which may contribute to a staff person being less effective in dealing with a person who is at increased risk for suicide? Select all that apply. A) Negative societal view of suicide B) Feeling inadequate and anxious about suicide and/or his or her own mortality C) Having personally considered suicide but decided against it and not having dealt with the associated anxiety D) Being unaware of his or her own feelings and beliefs about suicide E) Implementing nursing interventions to decrease the risk of suicide 35. A client with depression has been taking an SSRI--fluoxetine--for the last 3 months and has noticed improvement ofsymptoms. The nurse inquires about any side effects. Which of the following would the nurse expect the client to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose 36. The client suffers from Bi-Polar disorder. The client is experiencing a downward spiral. For which one of the following drugs should the nurse expect the client to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac 37. A client who is taking paroxetine reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially? A) Instruct the client to stop the medication for a few days to see if the nausea goes away. B) Reassure the client that this is an expected side effect that will improve with time. C) Suggest that the client take the medication with food. D) Tell the client to contact the physician for a change in medication. 38. The client has been diagnosed with severe depression. During the assessment of the client, the nurse is aware of which of the following is the primary consideration with clients taking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep39. A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see? A) Constipation and postural hypotension B) Fever, muscle rigidity, and disorientation C) Nausea, diarrhea, and confusion D) None; the serum level is in therapeutic range 40. A client with bipolar disorder takes lithium 300 mg three times daily. The nurse is educating on its use, side effects and need for compliance. The nurse evaluates that the dose is appropriate when the client reports which of the following? A) feeling sleepy and less energetic B) weight gain of 7 pounds in the last 6 months C) minimal mood swings D) increased feelings of self-worth 41. What is the priority nursing diagnosis for a depressed client exhibiting signs of acute mania that include agitation, insomnia, increased physical activity, and anorexia? A) chronic low self-esteem B) noncompliance C) risk for injury D) insomnia 42. An inappropriately dressed client has not slept for 3 days and has been making excessive long-distance phone calls. When the client can be heard singing loudly in the examining room, the nurse makes initial plans to focus on which of the following? A) setting strict limits on dress and behaviorB) assessing needs for food, liquids, and rest C) conducting an in-depth suicide assessment D) obtaining a complete psychosocial assessment 43. Which statement by a client would indicate the need for additional education regarding a prescribed lithium treatment regimen? A) "I will take my medications with food." B) "I will have my blood drawn on schedule." C) "I will drink 8 to 12 glasses of liquids daily." D) "I will restrict my intake of processed foods high in sodium." 44. Which outcome would be appropriate to determine an early favorable response to antidepressant medication? A) The client will establish a balance of rest, sleep, and activity. B) The client will demonstrate assertive communication skills. C) The client will describe signs and symptoms of major depression. D) The client will make plans to attend one community social activity a week. 45. What is the primary nursing concern related to a depressed client who has been taking amitriptyline 50 mg three times a day for the past 3 weeks? A) anxiety B) ineffective coping C) risk for self-injury D) chronic low self-esteemAnswer Key 1. C 2. D 3. B, D 4. B, C, D 5. A 6. A 7. D 8. C 9. B 10. D 11. C 12. A 13. A 14. A 15. C 16. C 17. B 18. A 19. B 20. D 21. B 22. B 23. D 24. B, C, D 25. C 26. A 27. A 28. A, C, D, E 29. D 30. A 31. B 32. D 33. B 34. A, B, C, D 35. B 36. C 37. C 38. C 39. C 40. C 41. C 42. B43. D 44. A 45. CChapter 18 1. Which disorder is characterized by pervasive mistrust and suspiciousness of others? A) Paranoid personality disorder B) Schizoid personality disorder C) Histrionic personality disorder D) Dependent personality disorder 2. Of the following personality disorders, which are most likely related to lack of caring about others? Select all that apply. A) Schizotypal personality disorder B) Borderline personality disorder C) Antisocial personality disorder D) Narcissistic personality disorder E) Obsessive-compulsive personality disorder 3. Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? A) Insisting that others follow the rules of the unit B) Wondering why others are being friendly to her C) Having a tantrum if not getting enough attention D) Getting others to make decisions for her 4. The staff nurse that has a student assigned to her unit today notices that the nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then displays negativity. The nursing student may be showing signs of which of the following personality disorder or behavior? A) ParanoidB) Borderline C) Narcissistic D) Passive-aggressive behavior 5. Which thought process would cause a client with antisocial personality disorder to want to do everything for himself? A) Belief in his own self-worth B) Inability to delay gratification C) Rewards for competitive behavior D) Sense of mistrust of others 6. The client states that decisions that are made by him are superior to everyone else's. Which of the following would the nurse expect to assess in a client with narcissistic personality disorder? A) Genuine concern for others B) Mistrust of others C) Grandiose and superior self-concept D) Dependence on others for decision making 7. The nurse is assessing the client who states he is a spiritual healer. Which term describes the extent to which a person considers himself to be an integral part of the universe? A) Cooperativeness B) Self-directedness C) Self-transcendence D) Character 8. A person with temperament traits of high harm avoidance would most likely suffer from which personality disorder? A) Schizoid B) Avoidant C) Narcissistic D) Antisocial9. Which of the following is a psychosocial explanation for the development of personality disorders? A) Highly self-directed people reflect uncooperativeness and intolerance. B) Cooperative people become increasingly helpless over time. C) Failure to complete a developmental task jeopardizes future personality development. D) Self-transcendence contributes to self-consciousness and materialism. 10. The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply. A) Paranoid B) Antisocial C) Schizotypal D) Narcissistic E) Avoidant 11. The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action on him. Which is the best rationale for this intervention? A) It will assist the client to start basing decisions and actions on reality. B) It will help the client understand the origins of his or her paranoid thinking. C) It will help the client learn to trust other people. D) It will teach the client to differentiate when his or her suspicions are true. 12. The nurse is teaching a client with schizoid personality to function more comfortably with others in thecommunity. Which nursing intervention would be effective to improve the client's social skills? A) Teach the client to make necessary requests in writing or over the phone. B) Accompany the client during initial interactions in the community. C) Suppress the display of any unusual behaviors in public. D) Assist in developing an explanation for bizarre behaviors to offer to others in the community. 13. The nurse explains to the client that therapy will be a long process. Which of the following is a realistic outcome for the care of a person with a personality disorder? A) Outcomes that focus on satisfaction with daily life B) Outcomes that focus on the client's perception of others C) Outcomes that focus on increased client insight D) Outcomes that focus on change in behavior 14. A client with antisocial personality disorder is begging to use the phone to call his wife, even though it is against the unit rules. The client begs, "It is just this once, and she will be so hurt if I don't call her." Which would be the most appropriate response by the nurse? A) "Only to help your wife, you can call this time." B) "I will get in trouble with my supervisor if I let you call." C) "You may not use the phone to call your wife." D) "You cannot call because you need to focus on your recovery while you are here, not your wife."15. Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality? A) The team needs to consider updating treatment recommendations as the client improves. B) Rotating team members need to be apprised of the care planned for the client. C) Staff frustrations in caring for the client need to be processed. D) Team consistency is important to prevent manipulation by the client. 16. A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse? A) "I'm glad you feel comfortable with me." B) "I'm here to help you just as all the staff members are." C) "You feel others don't understand you?" D) "I cannot be your friend. We need to be clear on that." 17. When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do? A) Aggressively confront the client about boundary violations. B) Limit interactions to 10 minutes at a time. C) Respect the client's boundaries at all times. D) Tell the client the relationship will last as long as the client wishes. 18. While observing the client the nurse notices the client's mood changes rapidly and erratically. When planning care for aclient with passive-aggressive personality disorder, the nurse will need to include interventions for which behavior? A) Avoidance of anxiety-provoking situations B) Compulsive needs for perfection and praise C) Dependence on others for decisions D) Procrastination and intentional inefficiency 19. The client often uses attention seeking behaviors. Which of the following nursing interventions are most important in a plan of care for a client with histrionic personality disorder? Select all that apply. A) Teach social skills. B) Assist the client to eliminate passive behavior. C) Provide factual feedback about behavior. D) Try to meet the client's needs for attention. E) Acceptance of the behavior. 20. A client with dependent personality disorder has a goal to increase her problem-solving skills. Which client behavior would indicate progress toward meeting that goal? A) Asking questions B) Being polite C) Controlling emotional outbursts D) Requesting assistance appropriately 21. The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful? A) "Being a loner really limits your employment opportunities." B) "Maybe your friend could see if there is a night position available at the convenience store."C) "Perhaps working part-time at a fast-food restaurant would be something you could do." D) "There is a job posting at the hospital for a file clerk in medical records." 22. The client is talking to staff members individually and attempting to manipulate them. Which of the following are important in the limit-setting technique to deal with manipulative behavior? Select all that apply. A) Stating the behavioral limit B) Identifying the consequences if the limit is exceeded C) Identifying the expected or desired behavior D) Providing choices E) Allowing flexibility 23. The nurse teaches an antisocial client to take a time-out in his room when challenged by another person instigating an argument. What is the main reason for the time-out? A) It allows time for the instigator to leave the area. B) It allows adequate space between the client and the instigating individual. C) It prevents the client from experiencing negative consequences of behavior. D) It allows an opportunity for the client to regain control of emotions. 24. A nurse is teaching a client with borderline personality disorder to reshape thinking patterns. Which is an example of a cognitive restructuring technique that would be helpful for this client? A) When negative thoughts begin, tell yourself “stop.” B) Learn to look at situations realistically rather than assuming the worst.C) Recognize negative thoughts and replace them with positive ones. D) Express needs using “I” statements. 25. Upon admission, a client with a personality disorder identified as areas of concern for which the client would like help. The nurse is aware of which of the following will most likely be addressed by the health care team? A) Psychological distress B) Self-care C) Sexual expression D) Budgeting 26. A female client with borderline personality was formerly cooperative with the treatment regimen. Suddenly, the client believes the staff is working against her and is refusing all interaction and participation in treatment. The nurse feels very frustrated by this client's behavior. What is the best action for the nurse to take regarding personal frustration with this client? A) Discuss the feelings of frustration with the client in a one-to-one interaction. B) Discuss the frustration with a colleague or supervisor in a private setting. C) Set aside the frustration and focus on reassessing the client's needs. D) Research the client's diagnosis further to better understand the client's behaviors. 27. Which challenges are posed when working with clients with personality disorders? Select all that apply. A) Clients with personality disorders are obviously unable to function more effectively. B) It can take a long time to change their behaviors, attitudes, or coping skills. C) The nurse can easily but mistakenlybelieve the client simply lacks motivation or the willingness to make changes. D) Clients with personality disorders challenge the ability of therapeutic staff to work as a team. E) Team members may have differing opinions about individual clients. 28. Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? Select all that apply. A) Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings. B) Considering the client to be a personal friend. C) Employ ongoing communication with team members to remain firm and consistent about expectations for clients. D) Solving the problems of the client. E) Understanding that behavior changes in clients with personality disorders can occur quickly. 29. A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? A) "How would you feel if someone yelled at you like that?" B) "What's the matter with you? Don't you know any better?" C) "Yelling at others is unacceptable. You need to let staff know you're upset." D) "You're still having problems controlling your anger." 30. When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care?A) risk for self-mutilation B) disturbed personal identity C) ineffective coping D) social isolation 31. Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder? A) Client talks about three failed marriages. B) Client cries loudly whenever requests are denied. C) Client fears criticism from others, including staff. D) Client shows no remorse when accidentally breaking another client's bracelet. 32. A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder? A) perceives personal behavior to be embarrassing B) believes he or she is incapable of functioning independently C) tends to exaggerate the potential dangers of ordinary situations D) demands excessive attention from others whenever in a group situation 33. A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder? A) These clients are generally experiencing chronic depression and are severely impaired socially. B) A high stimulus environment will cause the client to exhibit exacerbated behaviorsthat are loud and attention seeking. C) The client is easily intimidated and may become so withdrawn that the assessment will be difficult if not impossible to complete. D) This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened. 34. When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success? A) collaborating with the client when establishing treatment goals B) educating the client to the importance of complying with treatment interventions C) evaluating the client's understanding of the etiology of the prescribed medications D) conducting regular assessments so the treatment can be changed when necessaryAnswer Key 1. A 2. A, C, D 3. C 4. D 5. D 6. C 7. C 8. B 9. C 10. A, B, D 11. A 12. A 13. D 14. C 15. D 16. B 17. C 18. D 19. A, C 20. A 21. D 22. A, B, C 23. D 24. C 25. A 26. B 27. B, C, D, E 28. A, C 29. C 30. C 31. C 32. B 33. D 34. AChapter 19 1. A community health nurse is planning a substance abuse prevention program. Which group would be the best target audience for the nurse to plan a program? A) Teenagers in a high school health class B) School-age children in an after-school program C) Parents attending a parent–teacher association meeting D) Elementary school teachers and counselors 2. Which statements are important reasons for why the problem of substance abuse must be addressed? Select all that apply. A) Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. B) Chemical abuse results in increased violence. C) Alcohol abuse costs business and industry an estimated $223 billion annually. D) Alcohol abuse is a too frequent cause of or contributor to death. E) Substance abuse is decreasing. 3. Which of the following groups could benefit most from prevention programs? A) Children, prior to first use B) Adults who have already engaged in substance abuse C) Older adults D) Infants 4. Which of the following neurochemical influences is a probable cause of substance abuse? A) Imbalances of serotonin and norepinephrine in the brainB) Inhibition of GABA in the brain C) Excessive serotonin activity in the CNS D) Stimulation of dopamine pathways in the brain 5. The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristic would the nurse identify as the most significant risk factor? A) One parent who is an alcoholic B) Parents who practiced strict discipline C) Overprotective parents D) Being raised in an urban area 6. A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least six drinks with every episode in order to "have a good time." Which term would best describe this phenomenon? A) Dependence B) Intoxication C) Tolerance D) Withdrawal 7. The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that his relationship with the client was codependent and enabling. Which is an example of codependent behavior? A) The friend called Alcoholics Anonymous when the client expressed a need to stop drinking. B) The friend called the client every night to make sure he got home safely and went looking for him if he was not at home. C) The friend confronted the client on the effect of his drinking on their relationship. D) The friend refused to go out drinking with the client to celebrate the client's birthday.8. When interviewing the family members of a client being treated for substance abuse problems, which behavior would alert the nurse to the possibility of codependency? A) Being flexible but angry B) Blaming themselves for the client's problems C) Expressing thoughts and feelings openly D) Taking pleasure in self-accomplishments 9. The nurse is discussing the principles of 12-step programs for recovery with a client. Which statement is consistent with the principles of 12-step programs? A) The client will need to abstain from all substances for successful recovery. B) Once sober, the person can safely return to life as it was before becoming addicted. C) The prognosis for recovery is enhanced with the aid of maintenance medications. D) Recovery requires adherence to a plan of achieving long-term goals. 10. Which characteristic of the 12-step program distinguishes it from other programs? A) The philosophy that it is possible to reduce the use of substances without abstaining. B) It is a self-help group that does not necessarily use health professionals as leaders. C) Persons who use this program are independent in their sobriety. D) Infrequent attendance is usually successful. 11. Which slogans would be used in a 12-step program? Select all that apply. A) "Pull yourself together." B) "Get control of your problem." C) "One day at a time." D) "Easy does it."E) "Let go and let God." 12. The nurse is assessing the drinking history of a client with a history of alcohol abuse. The client is being admitted after being found unresponsive in a public place. Which statement would indicate the use of defense mechanisms? A) "I really need some help. My drinking is tearing my family apart." B) "I have tried so many times to stop drinking. It is so hard." C) "I don't really have a problem with alcohol. I've just been having a streak of bad luck lately." D) "I have no intention to stop drinking. I like the way it makes me feel." 13. A client in treatment for drug abuse makes the statement to some of the other clients, “I am a winner. You all are the losers because you can't beat this on your own.” What common characteristic of persons addicted to drugs is revealed in this statement? A) Realistic understanding of successful recovery of drug addiction B) Indication of an underlying personality disorder C) Brain damages resulting from chronic drug use D) Defending against a negative self-concept 14. A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse? A) "I am going to take up a new hobby. It's time to start something new." B) "I can still hang out with my old friends. I am just not going to use." C) "I'm not very comfortable with being alone yet."D) "Shooting baskets helps me not think about getting high." 15. A client is being discharged on disulfiram. Which instruction for Antabuse should the client receive? A) Take disulfiram with food to avoid stomach upset. B) Skip the daily dose of disulfiram on days when consumption of alcoholic beverages is likely. C) Read products labels carefully to avoid all products containing alcohol. D) Disulfiram will prevent the desire to drink alcoholic beverages. 16. The client asks the nurse, "What will happen if I drink while taking disulfiram?" What should be the nurse's reply? A) "You will not want to drink while taking Antabuse. It reduces the cravings." B) "You will not get any effect from the alcohol you drink." C) "Disulfiram will reverse the effects of alcohol." D) 'You will experience a severe reaction, including a throbbing headache and vomiting." 17. A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include? A) Unlike heroin, methadone is nonaddicting. B) Methadone will meet the physical need for opiates without producing cravings for more. C) Methadone will produce a high similar to heroin. D) People taking methadone run the same risks associated with IV drug use as thosetaking heroin. 18. A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The nurse assesses the client and finds the client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which of the following is typical of these symptoms? A) Alcohol withdrawal syndrome B) Continuing intoxication C) Delirium tremens D) Wernicke-Korsakoff syndrome 19. A client with alcohol dependence is admitted to the hospital with pancreatitis. Which intervention should be included in the client's plan of care? A) Fluid restriction of 1000 mL per 24 hours B) Glucometer checks b.i.d. C) High-protein diet D) Protective isolation precautions 20. A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client? A) Check the client's belongings for additional drugs. B) Pad the side rails of the bed because seizures are likely. C) Prepare a dose of ipecac, an emetic. D) Monitor respiratory function. 21. A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, "I am so ashamed." What should the nurse reply? A) "I really thought you would make it." B) "Tell me what has happened since yourlast admission." C) "You have nothing to be ashamed of." D) "Why did you start drinking again?" 22. A client has been admitted to the inpatient unit after using inhalants recently. Upon assessment the nurse finds the client with slurred speech and nystagmus. Which of the following is an antidote to treat inhalant toxicity? A) Lorazepam B) Naloxone C) Disulfiram D) There is no antidote 23. The nurse is leading a family therapy group with a client addicted to alcohol. Which of the following statements made by the wife indicates the need for additional education regarding alcoholism as a family illness? A) "I have to call in sick for my husband when he is too hung over to go to work." B) "Last time he got arrested, I just let him sit in jail." C) "We have separated our finances so that I will not go broke." D) "I take my kids with me to Al-anon meetings every week." 24. A nurse is working with a couple seeking counseling for marital discord. The history indicates the husband was treated for substance abuse four years ago and attends AA meetings occasionally. Which statement made by the recovering husband should alert the nurse for the need for further education? A) "I still need to go to AA meetings even though I have been sober for years." B) "After all these years, I just don't have the will power to stop if I started using again." C) "She gets upset when I hang out with myold buddies on the weekends." D) "I wish I could be able to handle just one beer with dinner." 25. A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit "cold turkey." What would be the best response by the nurse? A) "It is not safe to stop drinking suddenly without medicine." B) "You sound really motivated. Come in and we will help you find a treatment center." C) "After a few days of rest, you should feel much better as long as you do not drink anything." D) "You will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest, and come in if they do not get better in 3 to 5 days." 26. An unconscious client is admitted to the emergency department after a motor vehicle accident. The client's blood alcohol level upon admission was 1.7. The client's family soon arrives, reporting that the client is an uncle who is visiting from out of town. They cannot give much more history other than that he is a “social drinker.” After being transported to the unit, the client starts sweating and has elevated vital signs. What information should the nurse request of the family? A) Who is the next of kin? B) For what occasion is the uncle visiting from out of town? C) Does the uncle have a history of any sort of anxiety disorder? D) Are there other indications that the client may be a heavy drinker? 27. The nurse is leading a family therapygroup for clients and families of drug-addicted individuals. The family of a cocaine addict is angry and cannot understand why the client cannot just stop using. The nurse guides the group to discuss their understanding of the nature of addiction. Which statement would the nurse identify as an accurate understanding of the nature of addiction? Select all that apply. A) It is a medical illness that is progressive. B) The client will eventually be cured. C) Relapses and remissions are part of the illness. D) Clients can learn to get control over the substance. 28. The wife of a client who is alcoholic asks the nurse how to respond to him in a helpful way when he is disruptive in family life. Which is the nurse's best response? A) "Help him avoid embarrassment by supporting him when he makes excuses for failing to meet obligations." B) "Include him in family outings even when he is drinking." C) "Search the house regularly for alcohol." D) "Try to maintain a normal home environment for yourself and the children." 29. A client will be taking disulfiram after discharge from an alcohol treatment program. Which statement would indicate that teaching has been effective? A) "Disulfiram is safe to take with any over-the-counter cold medication." B) "Disulfiram will block my cravings for alcohol, so I'll have less desire to drink." C) "Drinking alcohol while taking disulfiram can cause dangerous symptoms." D) "If I drink while taking disulfiram, it will make me vomit before the alcohol affectsme." 30. A nurse suspects a coworker is signing out narcotics for clients and is using them herself. Which action should be taken by the nurse who has these suspicions? A) Ignore suspicions and leave it to the supervisor to intervene. B) Report the observations to the supervisor. C) Follow behind the coworker to ensure client comfort and safety. D) Confront the coworker about suspicions. 31. The nurse is observing her coworker that is having some questionable behavior. Which of the following are general warning signs of substance abuse that a nurse should be alert for in coworkers? Select all that apply. A) Poor work performance B) Frequent absenteeism C) Unusual behavior D) Slurred speech E) Isolation from peers F) Substance abuse is not a problem in health professionals 32. The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which is the best action for the nurse to take? A) Ask other nurses if they have noticed anything unusual. B) Call the manager and report the observations. C) Observe the nurse as injections are prepared and administered. D) Tell the nurse, "I know you've been stealing Valium."33. A peer reports for work looking unkempt and disheveled. Her movements are uncoordinated, and her breath smells like mouthwash. Another nurse suspects this peer is intoxicated. What should be the action of the nurse who suspects that a peer is intoxicated? A) Immediately call the supervisor to report the peer's behavior. B) Ask the peer if she feels all right and express concern. C) Give the peer some information about the hospital's employee assistance program. D) Ignore the situation until someone else validates the observations. 34. A client is readmitted to the detox unit for the fourth time in three years. The nurse states in the morning report, "Not again! Why should we keep trying to help this guy? He obviously doesn't want it." Which of the following statements is reflective of the nurse? A) The nurse lacks the self-awareness to work effectively with this addicted client. B) The nurse understands the cycle of remission and relapse characteristic of addiction. C) The nurse has repressed negative emotions from past experiences with addiction. D) The nurse is trying to conceal his or her own addictions. 35. The nurse is dealing with a difficult client. Which reasons make it necessary for the nurse to examine his or her beliefs and attitudes about substance abuse? Select all that apply. A) The nurse may be overly harsh and critical of the client. B) The nurse may unknowingly act out oldfamily roles and engage in enabling behavior. C) The nurse or close friends and family of the nurse may abuse substances. D) The nurse may have different attitudes about various substances of abuse. E) The nurse is not likely to have had any experience with substance abuse. 36. A nurse shows an understanding of the use of nursing outcomes regarding triggers for a client diagnosed with chronic alcohol abuse when making which statement? A) "Can you work on identifying three situations that cause you to abuse alcohol?" B) "I'll help you to identify three triggers for your drinking during today's session." C) "I'm pleased you've identified three situations that trigger your abuse of alcohol." D) "Do you think you will be able to avoid the three triggers that cause you to drink?" 37. A nurse is speaking to a group of expectant mothers. One person asks, "what can expectant mothers do that would prevent most of the cases of mental retardation in newborns?" Which is the best response from the nurse? A) eat balanced meals B) abstain from alcohol C) avoid being in a crowd D) rest during the day 38. An intoxicated client was admitted for trauma treatment last night at 2:00 AM (0200). When should the nurse expect to be alert for withdrawal symptoms? A) between 8:00 and 10:00 AM(0800 and 1000) today (6 to 8 hours after drinking stopped)B) about 2:00 AM (0200) tomorrow (24 hours after drinking stopped) C) about 2:00 AM (0200) of hospital day 2 (48 hours after drinking stopped) D) about 2:00 AM (0200) of hospital day 3 (72 hours after drinking stopped) 39. A client is admitted for treatment of trauma sustained in a fall. The client believes bugs are crawling on the bed. The client is anxious, agitated, diaphoretic, and has a history of chronic drinking. The nurse can anticipate that the physician will order which medication? A) benzodiazepine, such as diazepam or chlordiazepoxide B) phenothiazine, such as chlorpromazineor thioridazine C) monoamine oxidase inhibitor, such as phenelzine D) narcotic, such as codeine 40. A client asks the nurse, “What is Alcoholics Anonymous all about?” Which is the best response by the nurse? A) "It is a group that learns about drinking from a group leader." B) "It is a form of group therapy led by a psychiatrist." C) "It is a self-help group for which the norm is sobriety." D) "It is a group that advocates strong punishment for drunk drivers."Answer Key 1. B 2. A, B, C, D 3. A 4. D 5. A 6. C 7. B 8. B 9. A 10. B 11. C, D, E 12. C 13. D 14. B 15. C 16. D 17. B 18. A 19. B 20. D 21. B 22. D 23. A 24. C 25. A 26. D 27. A, C 28. D 29. C 30. B 31. A, B, C, D, E 32. B 33. B 34. A 35. A, B, C, D 36. C 37. B 38. A 39. A 40. CChapter 20 1. A 15-year-old female is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? A) Body weight less than normal for age, height, and overall physical health B) Irregular menstrual cycles C) Absence of hunger feelings D) Erosion of dental enamel 2. The nurse is assessing a client with bulimia nervosa. Which of the following symptoms would the nurse expect to find? Select all that apply. A) Cold intolerance B) Normal weight for height C) Dental erosion D) Hypotension E) Metabolic alkalosis 3. A client has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the client often purges the food or exercises excessively. Between binges, the client often eats low-calorie foods or fasts. What is the client's most likely diagnosis? A) Anorexia nervosa B) Bulimia nervosa C) Pica D) Rumination 4. When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? A) Codependence B) Control issues C) Self-discipline D) Sexual identity5. During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which would indicate to the nurse that this client might have anorexia nervosa? A) Episodes of overeating and excessive weight gain B) Expressions of a positive self-concept C) Flexible thought patterns and spontaneity D) Severe weight loss due to self-imposed dieting 6. What is the primary difference between anorexia nervosa and bulimia nervosa? A) Anorexia has a psychological basis, whereas the cause of bulimia is biologic. B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. C) Bulimia can be life threatening, whereas anorexia is seldom so. D) There is no real difference between these two types of disorders. 7. While assessing the family dynamics of a client with an eating disorder, which of the following does the nurse most likely discover? A) Multiple siblings B) Lack of interest in the client by other family members C) Supportive and encouraging relationships D) Over controlling parents 8. The nurse understands that which biologic factors may influence the development of an eating disorder? Select all that apply. A) Family history of eating disorders B) Dysfunction of the hypothalamus C) Norepinephrine imbalances D) First-degree relatives with psychotic disorderE) Decreased serotonin levels 9. Which factors may contribute to the frequency of eating disorders in adolescents? Select all that apply. A) Media portrayal of slimness as an ideal B) Body dissatisfaction in adolescent females C) Stress-free existence of adolescents D) Body image disturbance E) Seeking autonomy F) Seeking to develop a unique identity 10. Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client's distorted body image? A) Amitriptyline B) Cyproheptadine C) Olanzapine D) Fluoxetine 11. The nurse is sitting with the client at mealtime. The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which of the following statement by the nurse would be consistent with this approach? A) "Is there any way you can look at that sandwich as fuel for your body?" B) "You have to eat in moderation for good nutrition." C) "You seem to have a really hard time controlling your eating patterns." D) "Is this your way of showing your family that you can make decisions?" 12. Which may help a person to overcome an eating disorder that causes weight gain? A) Being ashamed of his or her body image B) Believing that gaining weight is an effect of unhealthy lifestyle behaviors and losingweight is an effect of healthy lifestyle behaviors C) Being reminded that every morsel of food he or she consumes will make him or her fat D) Knowing that his or her current weight is abnormal 13. The nurse is assessing a client with an eating disorder. Which of the following personality characteristic would the nurse expect to detect when interacting with the client? A) Careless B) Outspoken C) Defiant D) Eager to please 14. The nurse has just completed her admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? A) "I know I have a problem. I need help." B) "Others are just trying to keep me from looking good." C) "I know my weight is a little below normal." D) "Those weight charts are for normal people. I am not normal." 15. All of the following nursing diagnoses are appropriate for the care of a client with anorexia nervosa. Which nursing diagnosis has the highest priority? A) Activity intolerance B) Ineffective coping C) Chronic low self-esteem D) Imbalanced nutrition: less than body requirements16. Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? A) Leave the client alone to relax during meals. B) Offer liquid protein supplements if the client is unable to complete meal. C) Observe the client for 30 minutes after all meals. D) Weigh the client weekly in the same clothing at the same time of day. 17. The nurse is assisting the client with anorexia nervosa to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings? A) "Are you sad?" B) "You look anxious" C) "Tell me what you are feeling right now." D) "Tell me when you feel bad." 18. The nurse is teaching a client with bulimia to use self-monitoring techniques. Which of the following statements by the client would let the nurse know that this has been effective? A) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." B) "I am beginning to understand how my lack of self-control is hurting me." C) "I am keeping a record of everything I eat and how I am feeling every day." D) "I am getting more comfortable confronting people when I have conflict with them." 19. The nurse is helping a client with an eating disorder to accept her body image,but she must first learn effective coping skills. Which of the following statement best describes the relationship between body image and coping skills? A) Coping skills are dependent on a supportive upbringing. B) When body image is positive, the client will develop better coping skills. C) Being able to cope in healthy ways improves the ability to accept a realistic body image. D) Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills. 20. When preparing a client with bulimia for the implementation of discharge, the nurse suggests that the client and family continue with family therapy on an outpatient basis. Which of the following is the rationale for this suggestion? A) Family members often need to learn role independence and autonomy. B) Family members need to learn to monitor for signs of client relapse. C) Family relationships need to be strengthened due to a lifetime of disengagement. D) Family members often feel jealous of the attention the client has been receiving in treatment. 21. Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? A) Imbalanced nutrition—less than body requirements B) Disturbed body image C) Deficient knowledge (nutritious eating patterns) D) Social isolation 22. Which of the following interventionswould be appropriate for a client with anorexia nervosa? A) Allowing the client to eat whenever she feels hungry B) Insisting that the client sit in the dining room until all food is eaten C) Having the client in view of staff for 90 minutes after each meal D) Permitting the client to eat any food she chooses, as long as she is eating 23. Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa? A) Changing her irrational thinking about her body B) Establishing a target weight to be achieved by discharge C) Restoring nutritional status to normal D) Gaining insight into the effects of anorexia on her physical health 24. Which nursing statement is most effective in communicating a positive expectation of the client? A) "I'll give you 90 minutes to eat." B) "I will allow you space to eat in peace." C) "I will sit here quietly with you while you eat." D) "There are people who would truly appreciate this food." 25. A 16-year-old female with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome? A) The client will accept herself as having value and worth. B) The client will admit she has a fear of gaining weight. C) The client will follow a nutritionally balanced diet for her age. D) The client will identify her problems and potential alternative coping strategies.26. A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? A) Dieting helps build a positive self-image in children. B) Dieting during childhood can promote self-discipline in children who are obese. C) Dieting at an early age teaches healthy eating habits. D) Dieting at an early age may lead to the development of eating disorders. 27. The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? A) Provide the client a diet of mainly vegetables and salads. B) Encourage the entire family to engage in a balanced and regular dietary pattern. C) Encourage autonomy by allowing the client to have total control over food choices. D) Insist that the client complete all meals provided. 28. Which of the following would be most supportive for family and friends of a client with an eating disorder? A) Emotional support, love, and attention B) Focus on food intake, calories, and weight C) Unlimited access to unhealthy foods that the client enjoys D) Positive reinforcement for weight gain 29. The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement wouldindicate that teaching was effective? A) "We will eat our evening meals together with no exceptions." B) "We will negotiate resolutions to family conflicts." C) "We will spend less time discussing troublesome family members." D) "We will give her frequent encouragement for eating well and maintaining her weight." 30. The nurse has been teaching a client about bulimia. Which statement by the client indicates that the teaching has been effective? A) "I know if I eat pasta, I'll binge." B) "I'll eat small meals and snacks regularly." C) "I'll take my medication when I feel the urge to binge." D) "I'll limit my intake of carbohydrates and fats." 31. A client who has an eating disorder is becoming dependent on the nurse for direction in food choices. Which approach by the nurse would demonstrate the nurse's self-awareness? A) Approach the client with an adult-like objectivity. B) Give the support and direction that the client is seeking. C) Give approval for positive changes seen in the client. D) Take care of the needs that the client is neglecting. 32. A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? A) 5 to 10 years old B) 10 to 14 years old C) 18 to 22 years oldD) 25 to 35 years old 33. A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which nursing intervention takes priority? A) assessment of family issues and health concerns B) assessment of early disturbances in mother-daughter interactions C) assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment D) assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems 34. A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate? A) "Thanks for checking in." B) "I will accompany you to the bathroom." C) "Let me know when you get back to the dayroom." D) "I'll stand outside your door to give you privacy." 35. A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? A) "I really enjoy a large plate of spaghetti." B) "I'll weigh you after your meal." C) "I like hamburgers a lot but why do you always talk about food" D) "Let's focus on your continued improvement. You ate 80 percent of your lunch."36. A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? A) mood disorders, which often accompany the diagnosis of bulimia nervosa B) nutritional deficits, which are characteristic of bulimia nervosa C) binging, which causes abdominal discomfort D) vomiting, which may lead to dehydration and electrolyte imbalanceAnswer Key 1. A 2. B, C, E 3. B 4. B 5. D 6. B 7. D 8. A, B, C, E 9. A, B, D, E, F 10. C 11. A 12. B 13. D 14. B 15. D 16. B 17. C 18. A 19. C 20. A 21. B 22. C 23. C 24. C 25. B 26. D 27. B 28. A 29. B 30. B 31. A 32. C 33. D 34. B 35. D 36. DChapter 21 1. Psychosomatic illness refers to physical symptoms that are either created or worsened by psychic influences. Which conditions are thought to be attributed to the connection between mind and body? Select all that apply. A) Diabetes B) Arthritis C) Hypertension D) Headache E) Colitis 2. Which of the following are possible with somatization? Select all that apply. A) Real symptoms can begin. B) Real symptoms can continue. C) Real symptoms can worsen. D) Unrelated symptoms can occur. E) Clients can control these symptoms. 3. The client asks the nurse, "What does somatization mean?" What should the nurse reply? A) 'It means you're not physically sick." B) "It means that stress and/or emotions are causing your symptoms." C) "It means that you'll be well when you get your life in order." D) "It means that your symptoms are a product of your imagination." 4. Which is the primary gain associated with developing physical symptoms in response to stress? A) Accept dependency B) Decrease anxiety C) Experience attention D) Suppress anger5. A client with a somatic symptom illness asks what is causing her physical symptoms. Which would be the appropriate explanation for the nurse to offer? A) Physical symptoms can be attributed to an organic cause. B) Physical symptoms are deliberately expressed in order to benefit in some way. C) Physical symptoms are independent of the amount of the client's psychic distress. D) Physical symptoms are an involuntary way of dealing with psychic conflict. 6. The husband of a woman with a somatic symptom illness asks the nurse why the doctors cannot find anything wrong with her. Which would be the appropriate explanation for the nurse to offer? A) 'She is not really experiencing the symptoms. She is making them up to get attention." B) "There is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it." C) "She controls the symptoms when she isn't feeling much stress. It is hard to diagnose when the symptoms are intermittent." D) "There is a physical cause. It just has not been detected yet." 7. Which is the primary gain for a client with conversion disorder? A) Emotional detachment B) Emotional support from family C) Identification of anxious feelings D) Relief from emotional conflict 8. A client with somatic symptom illness tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth.Which is this evidence of? A) Dysfunctional family unit B) Primary gain C) Role reversal D) Secondary gain 9. Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders? A) Somatization B) Identification C) Internalization D) Repression 10. Which are the factors that are currently considered to be possible reasons for the increased incidence of somatization in women? Select all that apply. A) Boys in the United States are taught to be stoic and to “take it like a man,” causing them to offer fewer physical issues as adults. B) Women seek medical treatment more often than men, and it is more socially acceptable for them to do so. C) Childhood sexual abuse, which is related to somatization, happens more frequently to girls. D) Women more often receive treatment for psychiatric disorders with strong somatic components such as depression. E) Unexplained female pains result from migration of the uterus throughout the woman's body. 11. A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which mental health diagnosis is most probable for thisclient? A) Conversion disorder B) Pain disorder C) Brain cancer D) Illness anxiety disorder 12. The client reports laryngitis. Upon assessment with subjective and objective data, the nurse discovers he is an actor and has prepared extensively for his first stage production. Today, the morning of the opening of the play, the actor awakened with laryngitis. From which disorder is the actor most likely suffering? A) Acute upper respiratory infection B) Conversion disorder C) Hysteria D) Somatization disorder 13. The nurse is planning care for a client with somatic symptom illness disorder. Which should the nurse plan to reassess on a daily basis? A) Sensory deficits experienced by the client B) Character of pain reported by the client C) Frequency of generalized somatic reports D) Signs of possible neurologic disorders 14. A newly graduated nurse is scheduled to take the NCLEX-RN examination in 3 days. On awakening today, the graduate cannot see anything at all but tells fellow classmates, "Oh, don't worry; it will all work out. “The nurse is aware that this statement results from? A) La belle indifference B) Regression C) Malingering D) Undoing 15. A middle-aged client goes to the physician reporting hip pain. The friendthat brought him to the office tells the nurse that the client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis? A) Malingering B) Illness anxiety disorder C) Factitious disorder D) Factitious disorder imposed on another 16. Which of the following accurately describes how somatic symptoms are distinguished from factitious disorders and malingering? A) Munchausen's syndrome cannot be controlled by persons who have it. B) Persons who experience somatic disorders intentionally produce symptoms for some external purpose or gain. C) In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. D) People who experience somatic symptom illnesses can stop the physical symptoms as soon as they have gained what they wanted. 17. A mother rushes her infant to the ED and states "Help, my baby is unresponsive!" Which of the following terms is applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim? A) Malingering B) Factitious disorder C) Munchausen's syndrome by proxy D) Induced illness 18. The nurse is caring for a client who was in a motorcycle accident 2 months ago. Theclient says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." What condition might the nurse suspect? A) Hypochondriasis B) La belle indifference C) Conversion reaction D) Malingering 19. A client is seeking relief for undiagnosed pain. There is no history of significant physical illness. The history reveals that the client was laid off four months ago from her job. The nurse's assessment is unremarkable. Which statement made by the client would most strongly suggest a somatoform disorder? A) "I have been having a hard time lately. It's hard not working like I'm used to." B) "I seem to have more pain now that I got laid off." C) "I probably just overexerted myself working around the house. It's hard to slow down." D) "I'm sure they will figure out what is wrong with me." 20. The client presented to the ER with reports of chest pain. The nurse performs a thorough physical examination for this client with a history of a somatic symptom illness. Which of the following is the best rationale for the physical exam? A) Ease the client's mind that the nurse is looking for physical illness. B) Physical disorders underlie somatic disorders. C) Physical exams are reimbursed by third-party payers. D) Underlying pathology should be ruled out. 21. The client states, "I can't go to group today. I have a very upset stomach thismorning." Which would be the nurse's most appropriate response? A) "You have to go to group. The doctor has ordered it." B) "Okay, you can miss this time." C) "I know you don't feel well, but it's important for you to participate in therapy." D) "You aren't really feeling nauseous. It is part of your illness." 22. The client has severe headaches that are debilitating. The nurse has encouraged the client with a somatic symptom illness to keep a journal. Which if the following treatment outcomes might be met by journaling? A) The nurse will control external stressors that trigger the patient's physical symptoms. B) The nurse will assess the onset of physical symptoms. C) The client will express emotions privately. D) The client will identify the occurrence of physical symptoms when stressed. 23. The client states that his stomach pain is unbearable. The nurse is working with the client to develop emotion-focused coping strategies. Which should the nurse include as an emotion-focused coping strategy? A) Problem solving B) Assertiveness techniques C) Role-playing D) Deep breathing techniques 24. The nurse is identifying outcomes for a client with a somatic symptom illness. Which is an appropriate outcome to include in the plan of care? A) The client will verbally express his or her emotions. B) The client will be free from stress.C) The client will demonstrate alternative ways to avoid stressful situations. D) The client will verbalize acceptance of physical symptoms. 25. A client with recurrent headaches has been told by the physician that the cause is likely psychosomatic. The client reports this conversation to the nurse and says, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." Which is the nurse's best response? A) To give the client some privacy and time to calm down B) To say nothing and sit quietly with the client C) "The pain in your head is very real." D) "Well, that's not what your doctor thinks." 26. Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness? Select all that apply. A) The client will assume responsibility for self-care activities. B) The client will identify the relationship between stress and physical symptoms. C) The client will learn to vary his or her schedule. D) The client will verbally express emotional feelings. E) The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings. 27. The family members of a client with somatic symptom illness report to the nurse that every time they invite the client to join in an activity the client declines, saying things like, “I wish I could, but I feel so terrible.” Which of the following approaches should the nurse suggest toencourage activity? A) "What does your pain feel like right now?" B) "You are fine, the doctor said so. Let's go." C) "I know this is difficult, but exercise is important. It will be a short walk." D) "I'll let you rest. Let me know when you feel better." 28. The husband of a client with hypochondriasis has accompanied his wife to the follow-up doctor's visit. While waiting for the doctor, the husband expresses to the nurse his frustration with his wife's obsession about illness. He asks the nurse, "What can I do?" The best response by the nurse would be... A) "Try ignoring her reports, and they should subside." B) "Try finding an activity you enjoy doing together to help her feel better overall." C) "Try to be the client and understand that she is worried that she is sick." D) "Try to give her some sort of reward when she resists reporting her illnesses." 29. Which statement would indicate to the nurse that the client has understood somatic symptom illness? A) “As soon as my symptoms go away, I'll be my old self again.” B) “How I handle stress and emotions can affect my physical health.” C) “I have to avoid stress all my life to avoid getting sick again.” D) “Taking medication won't help my pain since it's caused by stress.” 30. The client has a somatic symptom illness. During individual therapy, the client yells at the nurse, "You are all quacks! Can't you see I am sick?" Which of thefollowing knowledge statements would help the nurse to work most effectively with this client? A) Client progress is expected to be very slow. B) Physical illness is the root of the client's problems. C) The client will never be free of somatic symptoms. D) The nurse has done everything possible to treat the client. 31. A client is diagnosed with hypochondriasis. Which assessment data validates this diagnosis? Select all that apply. A) preoccupation with disease processes and organ function B) physical symptoms are managed by using the defense mechanism of denial C) long history of doctor shopping D) social and occupational functioning may be impaired E) depression and obsessive-compulsive traits are common 32. A client diagnosed with hypochondriasis reports to the nurse that others doubt the seriousness of the client's illness. The client is angry, frustrated, and anxious. Which nursing intervention takes priority? A) Remind the client that lab tests showed no evidence of physiological problems. B) Document the client's unwillingness to accept anxiety as the source of the illness. C) Discuss with client's family ways to avoid secondary gains associated with physical issues. D) Acknowledge the client's frustrations without fostering continued focus on physical illness. 33. A client experiencing the sudden onset ofblindness is diagnosed with a conversion disorder. Which nursing intervention would be most appropriate? A) suggest to the client that this is possible malingering B) assist the client in making an appointment with an endocrinologist C) provide nursing care in a supportive but matter-of-fact manner D) provide an occupational therapy consult to address the needs of a blind person 34. A client reports severe pain during intercourse since being sexually assaulted three years ago. Which is the first step in confirming the diagnosis of a pain disorder? A) evaluating the client's understanding of a pain disorder B) asking the client to keep a journal of her feelings regarding the assault C) assessing the client for posttraumatic stress disorder D) ruling out a physical cause of pain 35. A client has a somatization disorder. Which statement by the client would indicate a need for additional client teaching? A) "I have learned that my family can be a support system." B) "I will let my therapist know if I think suicidal thoughts." C) "Nicotine makes my heart race, so I need to stop smoking." D) "Drinking strong coffee really helps me combat my fatigue."Answer Key 1. A, C, D, E 2. A, B, C, D 3. B 4. B 5. D 6. B 7. D 8. D 9. C 10. A, B, C, D 11. D 12. B 13. C 14. A 15. A 16. C 17. C 18. D 19. B 20. D 21. C 22. D 23. D 24. A 25. C 26. A, B, D, E 27. C 28. B 29. B 30. A 31. A, C, D, E 32. D 33. C 34. D 35. DChapter 22 1. The nurse is assessing a 16-month-old child during a well-baby checkup. Which of the following behaviors would be consistent with autism spectrum disorder? Select all that apply. A) The child displays little eye contact with others. B) The child thrives on changes in routine. C) The child makes few facial expressions toward others. D) The child does not like spontaneous play. E) The child answers questions verbally. 2. A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is, A) "It is recommended that you wait until the child is older to vaccinate." B) "There are safer alternative immunizations available now." C) "There has been no research to establish a relationship between vaccines and autism." D) "The risks do not outweigh the benefits of immunization against childhood diseases." 3. A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). She brings the child in to be evaluated. Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.4. The parents of a child are concerned about their child's behavior now that he has started school. The nurse assesses and evaluates the child. Which of the following symptoms are characteristic of ADHD? Select all that apply. A) Enuresis B) Inattentiveness C) Encopresis D) Overactivity E) Impulsiveness 5. The client is an adult and has been diagnosed with ADHD. The client is experiencing some additional symptoms. Which of the following are common coexisting psychiatric disorders for adults with ADHD? Select all that apply. A) Social phobia B) Bipolar disorder C) Obsessive-compulsive disorder D) Major depression E) Alcohol dependence 6. A nurse asks an assigned client diagnosed with a Tic disorder, "How are you doing today?" The client responds with "doing today, doing today, doing today." Which of the following speech pattern disturbances is this an example of? A) Reactive attachment disorder B) Stereotypic movement disorder C) Selective mutism D) Echolalia 7. The nurse is assessing the client that has been diagnosed with a Tic disorder. Which of the following terms describes the repeating of one's own words or sounds? A) Coprolalia B) PalilaliaC) Echolalia D) None of the above 8. A mother brings in her child that has speech difficulties for evaluation. Which of the following disorders involves problems with forming sounds associated with speech? A) Phonologic disorder B) Mixed receptive-expressive language disorder C) Expressive language disorder D) Stuttering 9. A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums. 10. A child with ADHD reports to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.11. The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child? A) Break tasks into small steps. B) Let the child complete tasks at his own pace. C) Offer rewards when all tasks are completed. D) Set a time limit to complete all tasks. 12. Which of the following would be important circumstances to gather assessment data for a child with ADHD? Select all that apply. A) Direct observation of the child B) Reviewing the client's record C) Interviewing the client's parents D) Interviewing the client's teachers E) Assessing the client in a group of peers 13. Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance 14. An 8-year-old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. Which should be the nurse's first step? A) "I need to talk to you." B) "Stop that right now." C) "You are going to hurt yourself." D) "Why are you jumping off the bed?" 15. The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son'sdisruptive behavior. The nurse would be most therapeutic by saying which of the following? A) "Your son is a cute child, but he needs to calm down." B) "It must be difficult to handle your son at home." C) "You need to take a firmer approach with your son." D) "Your son sure is active." 16. A child with attention deficit hyperactivity disorder is taking methylphenidate in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon? A) Increased impulsivity or hyperactive behavior B) Lack of appetite for lunch C) Sleepiness or drowsiness D) Social isolation from peers 17. The parents of an autistic child ask the nurse, “Will my child ever be normal?” Which would be the most appropriate response by the nurse? A) “You seem worried about your child's future.” B) “Autistic children can fully recover with the right treatment and education.” C) “Your child should outgrow autistic traits by adolescence.” D) “Your child will probably always have some autistic traits.” 18. The parents of a child with ADHD express to the nurse, “We get so frustrated when our son never minds us.” Which parenting strategies should the nurse discuss with the parents? Select all that apply. A) Use time-out for behavior control. B) Provide occasional rewards andconsequences for behavior. C) Give verbal reprimands for negative behavior. D) Resist giving praise until fully compliant with requests. E) Use a point system for positive and negative behavior. 19. Which one of the following statements about educating parents of a child with ADHD is true? A) It is unimportant to educate the family members about ADHD as they already know the problem too well. B) Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. C) It is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents. D) If the child receives special school services under the Individuals with Disabilities Education Act, there is no need for further services. 20. A nurse is providing education to a group of parents who have children with ADHD. Which of the following statements would be accurate and should be included in the education? Select all that apply. A) Medication alone will adequately treat children with ADHD. B) It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem. C) Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. D) ADHD is not the fault of the parents or the child, and that techniques and schoolprograms are available to help. E) Children with ADHD do not qualify for special school services under the Individuals with Disabilities Education Act. 21. When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching? A) "We'll have him do his homework at the kitchen table with his brothers and sisters." B) "We'll make sure he completes one task before going on to another." C) "We'll set up rules with specific times for eating, sleeping, and playing." D) "We'll use simple, clear directions and instructions." 22. Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? A) "We'll teach him the proper way to take the medication, so he can manage it independently." B) "We'll be sure he takes Ritalin at the same time every day, just before bedtime." C) "We're so glad that Ritalin will eliminate the problems of ADHD." D) "We'll be sure to record his weight on a weekly basis." 23. The mother of a 15-year-old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. She asks if it is healthy for a 15-year-old to be so independent. Which is valid information for the nurse to offer the mother?A) His behaviors reflect normal growth and development. B) He is overly independent. C) It sounds like he is trying to avoid her. D) She should observe for signs of substance abuse. 24. The nurse is working with a child with a mental health problem and the family must be included in the care. Which of the following is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior. D) Interpret the child's thoughts and feelings to the parent. 25. For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders? A) It is much more difficult to diagnose psychiatric disorders in children and adolescents. B) It is not necessary because psychiatric disorders do not occur in children and adolescents. C) Children and adolescents experience some of the same mental health problems as adults. D) Psychiatric disorders in children manifest themselves very quickly. 26. For which reasons is it more difficult to diagnose psychiatric disorders in children than in adults? Select all that apply. A) Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. B) Because they are constantly changing anddeveloping, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. C) Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level. D) Sometimes, children “outgrow” psychiatric disorders. E) Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults. 27. The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child. 28. When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents? A) Continue to remind the child and parents that the prognosis for improvement is very poor. B) Encourage the parents to believe that the child will recover spontaneously. C) Assist the child and the parents to develop coping mechanisms. D) Focus on their problems instead of theirstrengths and assets. 29. A nurse is teaching a family how to best help their child who has been recently diagnosed with a neurodevelopmental disorder. Which statement indicates to the nurse that teaching has been effective? A) "We will be able to do more things with our family." B) "We will be able to enjoy more structure in our home." C) "We will be able to go to the races every weekend like we used to." D) "We will be able to go on the bus tour with our church group." 30. The mother of a child with ADHD tells the school nurse that her child's teacher has called a conference. Which of the following statements is true regarding evaluation of treatments for the child with ADHD? A) often the child notices the change in treatment before anyone else B) often the change is subtle and gets noticed at the follow up visit C) often it is the siblings that notice the change in behavior first D) often the parents or teacher notice positive outcomes of treatment 31. A nurse is discussing a client's condition with the client's family. A family member states that the client has a long history of mental retardation. The nurse corrects the family member by explaining that which is the correct term for this condition? A) mental delay B) intellectual disability C) mental incapacity D) intellectual retardation32. A young client has been brought to a clinic for evaluation. The client has developed several motor tics and shouts throughout the day. The mother states this has been going on for over a year. Which disorder does the nurse suspect this to be? A) Tourette's disorder B) communication disorder C) attention deficit hyperactivity disorder D) autism spectrum disorder 33. As a child with ADHD moves into adolescence, problematic behaviors continue. A nurse is aware of these behaviors when teaching families regarding their teenagers with ADHD. Which are typical behaviors that the nurse would discuss with families that have children with ADHD? Select all that apply. A) cutting class B) getting speeding tickets C) drug usage D) attending study groups E) failed relationshipsAnswer Key 1. A, C, D 2. C 3. A 4. B, D, E 5. A, B, D, E 6. D 7. B 8. A 9. D 10. B 11. A 12. A, C, D, E 13. B 14. B 15. B 16. A 17. D 18. A, C, E 19. B 20. B, C, D 21. A 22. D 23. A 24. B 25. A 26. A, B, C 27. C 28. C 29. B 30. D 31. B 32. A 33. A, B, C, EChapter 23 1. A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling and are formulating a collaborative plan. The child is experiencing signs of which of the following disorder? A) Oppositional defiant disorder B) Asperger's syndrome C) Attention deficit hyperactivity disorder D) Conduct disorder 2. A child has been displaying behaviors associated with conduct disorder. As the nurse evaluates these behaviors she will further assess for which common risk factors seen in children with conduct disorder? Select all that apply. A) Poor family functioning B) Strict disciplinary practices C) Family history of substance abuse D) Possible child abuse E) Poverty conditions 3. The client was brought to the clinic after breaking out several windows. The nurse questions the client regarding this action. The nurse knows which disorder is exemplified by vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity? A) Intermittent explosive disorder B) Mild conduct disorder C) Oppositional defiance Disorder D) Moderate conduct disorder 4. The nurse is using limit setting with a child diagnosed with conduct disorder.Which statement reflects the most effective way for the nurse to set limits with the child? A) 'That is not allowed here. You will lose a privilege. You need to stop." B) "Stop what you are doing. Go to your room.' C) 'I would appreciate if you would not do that." D) "Why do you do these things?' 5. Which is likely to be most effective for adolescents with conduct disorder? A) Involvement with the legal system B) Focusing on the parenting education C) Incarceration D) Early intervention 6. A 14-year-old girl is being treated for conduct disorder. She refuses to attend class today, stating that yesterday the other nurse told her she did not have to go to class if she did not want to. Which would be the best response by the nurse? A) "Fine, but you're confined to your room." B) "Missing class is against the rules." C) "You and I both know you're lying." D) "Why do you keep fighting the system?" 7. The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage the parents to use? A) Provide consistent consequences for behaviors. B) Set earlier curfews than the child's peers adhere to. C) Release the child from household responsibilities until he can demonstrate dependable behavior.D) Avoid discussing feelings and expectations with the child. 8. Which are most likely included in the history of a child with conduct disorder? Select all that apply. A) Disturbed relationships with peers B) Major antisocial violations C) Aggression toward people or animals D) Destruction of property E) Serious violation of rules 9. Which steps are involved in limit setting? Select all that apply. A) State expected behavior. B) Inform clients or the rule or limit. C) Threaten incarceration. D) Explain the consequences if clients exceed the limit. E) Occasionally limit enforcement. 10. Which is true of the time-out strategy that may be used for persons with conduct disorder? A) It is a punishment. B) It should only be used as a last resort. C) Eventually, the goal is for the client to avoid time-out. D) Time-out is retreat to a neutral place, so clients can regain self-control. 11. The nurse understands that when working with a child with a disruptive behavior disorder, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior.D) Interpret the child's thoughts and feelings to the parent. 12. The nurse is assessing an adolescent client. The father is in the room and answers most of the questions, even though the questions are directed at the client. Which of the following actions from the parents of a child with conduct disorders may contribute to the problems of the child? Select all that apply. A) The parents may not behave appropriately themselves because of a lack of knowledge. B) The parents blame the school when the child causes a disturbance in school and receives detention. C) The parents engage in yelling at, hitting, or simply ignoring the behavior of their child. D) The parents make reasonable curfews that are appropriate for the age of the client. E) The parents establish household responsibilities that are appropriate for the age of the client. 13. When presenting information about conduct disorders to a community group, the nurse is asked, “Which is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?” Which would be the most appropriate reply by the nurse? A) The acute care setting B) School C) Residential treatment settings D) Jail-diversion program 14. Which is an effective way for parents to deal with problem behaviors in children and to prevent later development ofconduct disorders? A) Administering medications B) Avoiding setting limits C) Group-based parenting classes D) Being overprotective of the child 15. The nurse has been working with the family of a small child with oppositional defiant disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best nursing action at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child. 16. The adolescent client is exhibiting "bullying behaviors". Which of the following may be concerns that a nurse has when caring for clients who have conduct disorders? Select all that apply. A) Thinking that the client should be able to refrain from hostility and aggression through use of will power. B) Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude. C) Discussing feelings, fears, or frustrations with colleagues. D) Having anxiety and fears for the nurse's personal safety. E) Believing that aggression is the most productive way to deal with anger. 17. Which are important points for the nurse to consider when working with clientswith disruptive behavior disorders and their families? Select all that apply. A) Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods. B) Remember to focus on the client's strengths and assets, as well as their problems. C) Transient conduct disorders are common in all children. D) Avoid a “blaming” attitude toward clients and/or families. E) Focus on positive actions to improve situations and/or behaviors. 18. Which is the most important reason for the nurse who cares for children with conduct disorders to discuss feelings, fears, or frustrations with colleagues? A) To make the nurse feel better and avoid burnout. B) To encourage camaraderie between colleagues. C) To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. D) To ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders. 19. After being arrested for prostitution, an adolescent client has been referred to a mental health clinic by a juvenile officer. The client has a history of truancy and being physically abusive to siblings. From the history gathered during assessment, the nurse might anticipate which diagnosis? A) intermittent explosive disorder B) oppositional disorder C) conduct disorder D) childhood depressive disorder20. A client has been referred to a mental health center by a juvenile court after being arrested for vandalism. At the mental health center, the client refuses to participate in scheduled activities. The client was seen pushing another client, causing the person to fall. Which approach by nursing staff would be most therapeutic? A) neutrally permitting refusals B) coaxing to gain compliance C) offering rewards in advance D) establishing firm limits 21. A pre-teen client has been considered a neighborhood bully for several years. Peers avoid him, and the mother says she cannot believe a thing he tells her. Recently, the client was observed shooting at several dogs with a pellet gun and setting fire to a vacant lot for the first time. A nurse would assess these behaviors as being most consistent with which disorder? A) conduct disorder B) oppositional defiant disorder C) pyromania D) defiance of authority 22. A young client, diagnosed with oppositional defiant disorder, becomes angry and defiant over the rules of the day treatment program. The client is shouting at the nurse. Which action by the nurse can help defuse the situation? A) placing the client in a time out B) suggesting that the client go to the gym and shoot baskets C) calling staff to seclude the client D) providing an as-needed anxiolytic medication 23. When a young client is disruptive, thenurse responds, "You must take a time-out." What is the expectation of a client during a time-out? A) to go to his or her room until called for the next meal B) to slowly count to 20 before returning to the group C) to sit quietly on the lap of one of the staff members D) to sit in a designated place until able to regain self-control and review the episodeAnswer Key 1. D 2. A, C, D, E 3. D 4. A 5. D 6. B 7. A 8. A, C, D, E 9. A, B, D 10. D 11. B 12. A, B, C 13. C 14. C 15. C 16. A, B, D 17. B, D, E 18. C 19. C 20. D 21. A 22. B 23. DChapter 24 1. During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? A) Unable to identify a water pitcher B) Unable to transfer to sitting position C) Difficulty with verbal expression D) Disoriented to person 2. A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? A) The clients should be able to ask us for items they need. B) The clients may not recognize their family when they come to visit. C) The clients who are ambulatory can still carry out activities of daily living independently. D) The clients should know when to come to the dining room for meals. 3. Which is believed to be a risk factor specific to the development of delirium? A) Increased severity of physical illness B) Ineffective coping C) Baseline cognitive impairment D) Gradual decline in functioning 4. Which patient is most likely suffering from dementia? A) A 90-year-old male who has experiencedprogressive mental decline that started with forgetfulness B) An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff C) A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes D) A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is 5. The client is brought to the clinic with dementia and is unable to recognize ordinary objects, such as a pen or notebook. The family is upset and concerned. Upon assessment of the client, which of the following would this be a symptom of? A) Agnosia B) Amnesia C) Apraxia D) Aphasia 6. Which client would have an increased risk for delirium? A) An elderly woman with abdominal pain B) A 3-year-old child with a temperature of 103.2°F C) A middle-aged woman newly diagnosed with multiple sclerosis D) A young adult male with gastroenteritis and dehydration 7. The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate responseby the nurse? A) "You sound like you aren't ready for her to be dependent on caregivers." B) "Her confusion is a temporary complication of her physical illness and should subside when the illness gets better." C) "Symptoms of dementia gradually get worse. Unfortunately, she will not be independent again." D) "With early treatment, mild dementia can be reversed. It may be possible." 8. Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia, and is hospitalized for an acute urinary tract infection? A) "You are likely to become progressively more confused now." B) "This should be just a temporary situation." C) "Don't worry about it; everyone is confused when they are in the hospital." D) "I know things are upsetting and confusing right now, but your confusion should clear as you get better." 9. The nurse is questioning the family of a client brought in with cognitive impairment as she assesses and evaluates the client's condition. Which distinguishes delirium from dementia? A) Delirium has an acute onset and is progressive in course. B) Delirium has a gradual onset and can be resolved. C) Dementia has a gradual onset and is progressive in course. D) Dementia has an acute onset and can be resolved. 10. The nurse is performing a health historyand assessment of a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply. A) Recent alcohol use B) Dehydration C) Use of antihistamines D) Sleep disturbances E) Use of megadoses of vitamins F) Exposure to paint or gasoline 11. A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, “I'm going to take a walk outside. I'll be back in about 10 minutes.” Which is the most appropriate nursing action? A) Further assess the client's motives for wanting to walk. B) Give the client permission to go on a walk on the grounds. C) Tell the client the walk is not allowed and restrict him to the unit. D) Designate a staff member to accompany the client on the walk. 12. A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client? A) Tacrine B) Memantine C) Donepezil D) Rivastigmine 13. The nursing supervisor in an extended care facility is managing the environmentto best help the clients with dementia. Which should the nurse include in planning the living environment? A) Plan for the same caregivers to provide care to individuals as much as possible. B) Open the windows and doors to allow fresh air to circulate through the environment. C) Provide a buffet-style menu with many food choices. D) Assign peer-led exercise activates on a daily basis. 14. The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake? A) Sit with the client as long as necessary to complete the meal. B) Provide entertainment during meals such as television or music. C) Avoid between-meal snacks to encourage appetite. D) Serve meals in small, bite-size pieces. 15. The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. The nurse observes the actions of the client as she talks about the photos. Which best describes the usefulness of viewing photos when caring for the dementia client? A) Viewing photos is a form of reminiscence therapy for the client. B) Sharing photos will encourage interaction with other clients. C) This can help the children to correctly identify old photographs. D) Talking about the photos will encourage the client to live in the past. 16. The nurse is encouraging a group ofclients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation? A) Show an instructional video just prior to the activity. B) Describe the exercise immediately before performing it. C) Demonstrate the exercises while clients simultaneously perform them. D) Perform the same routine daily to avoid the need for repeated instruction. 17. A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior? A) The nurse was unsure of how to calm the client. B) The nurse was frustrated and needed to take a “time-out.” C) The nurse gave the client a chance to calm down before resuming the meal. D) The nurse stepped away to verify the safety of other clients. 18. Which is the most effective intervention for clients with delirium? A) Giving detailed explanations B) Managing environmental stimuli C) Promoting rest with PRN medications D) Providing activities for distraction 19. The client says to the nurse he is having trouble keeping up with things. The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning? A) OrientationB) Food preferences C) Recent memory D) Remote memory 20. The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation? A) "It would be best if you just took your shower now." B) "You seem anxious and upset." C) "You have plenty of time to shower before it's time to go home." D) "Why are you thinking you're going home?" 21. The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first? A) Administer an antianxiety drug such as lorazepam at these times. B) Explain the unit routine and the reasons for increased activity to the client. C) Keep unit activity to a minimum. D) Move the client to a quieter area during these times. 22. The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client? A) A card game with other clients B) An activity with the nurse C) Decorating a bulletin board with the group D) Morning stretch group with music23. The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most helpful response by the nurse? A) "Are you saying you don't want to care for your mother anymore?" B) "I know it is really hard. It takes a lot of work and you are doing such a good job." C) "Your mother really appreciates what you do for her. You are the best one to care for her." D) "Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?" 24. Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia? A) "Most people seek help when they really need it." B) "What is wrong with your family? Can't they see you need help?" C) "You should be grateful that you still have your family member around." D) "Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role." 25. A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse? A) "It's distressing when my mother forgets my name." B) "I wish my sister would come to visit more often."C) "Mother won't let anyone else do anything for her." D) "Taking care of my mother is a big responsibility." 26. A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include in her teaching as a measure most likely to prevent Alzheimer's disease and other dementias? A) Crafts B) Cooking C) Watching television D) Reading 27. The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique? A) "Let's look at what is on television." B) "If you stop yelling, I will get your dessert." C) "Don't you want to finish your meal?" D) "I don't understand what you are saying." 28. The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer? A) Ask her to explain what she did at work today that kept her busy. B) Go along with her thought of it having been a busy day, but do not refer to her work. C) Reorient her that she is at home and did not go to work.D) Give her 5 to 10 minutes of rest, and she will have no memory of the incident. 29. The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention? A) Decrease environmental misinterpretation B) Improve memory retention C) Increase frustration D) Slow the progress of the disease 30. A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, “I feel like all my work doesn't do them any good.” Which should the nurse's supervisor encourage the nurse to do? A) Cease giving instructions because the clients will not remember them anyway. B) Try to stay supportive and meet the clients' needs at the current moment. C) Seek counseling if personal feelings get in the way of client care. D) Consider transferring to a different client care specialty area. 31. Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply. A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually. B) The nurse may get little or no positive response or feedback from clients with dementia. C) It can be difficult to remain positive andsupportive to clients and family because the outcome is so bleak. D) It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses. E) The clients may seem not to hear or respond to anything the nurse does. 32. A nurse is working with a client, and family of the client, who has a diagnosis of Alzheimer's disease. The nurse explains to the client and family that the average course of the disease is how many years? A) 10 B) 15 C) 20 D) 25 33. A nurse is talking to a client recently diagnosed with Alzheimer's disease. The nurse explains that which abnormality is found to be associated with Alzheimer's disease of late onset (after 65 years of age)? A) an increase in glucose in frontal lobe areas of the brain and the spinal column B) a decrease in dopamine in the area of the amygdale C) a genetic component of chromosome 21, 14, and 19 D) dysregulation in the hypothalamic-pituitary-adrenal axis 34. A nurse is assessing client with a diagnosis of Huntington's disease (HD) in the later stages. The client has severe cognitive defects. In this case, the nurse will also likely find which classic symptom? A) blindness B) memory loss C) choreiform movementsD) ataxia 35. A nurse is caring for a client with delirium who is experiencing illusions. What environmental conditions should the nurse arrange for this client? A) provide a well-lit room without glare or shadows and limit noise B) have the client sit by the nurse's desk while awake in a room with the television on C) light the room brightly around the clock and awaken hourly to check mental status D) keep the room shadowy with soft lighting around the clock, and keep a radio on continuously 36. During morning care, a nursing assistant asks a client with dementia, "How was your night?" The client replies, "It was lovely. My husband and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client? A) The client is demonstrating a sense of humor. B) The client is using confabulation. C) The client is perseverating. D) The client is delirious.Answer Key [Show More]

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