TEST BANK for Introductory Mental Health Nursing 4th Edition BY Womble Kincheloe (All Chapters 1-19)

TEST BANK for Introductory Mental Health Nursing 4thEdition Womble Kincheloe

Chapter 1 Mental Health and Mental Illness

1.

When studying mental health and mental illness, the student nurse learns that which of the following is evidence of our mental health?

A)

Our ability to function well with others

B)

Our ability to defend what we believe

C)

Our ability to perform demanding tasks on the job

D)

Our ability to defend those weaker than we are

2.

A mental health nurse is teaching a class in anger management. She teaches the patients that recognizing what triggers their anger response allows them to do which of the following?

A)

Manipulate the situation to get what you want

B)

Stand up for ones beliefs against the cultural beliefs of a community

C)

Gives them the opportunity to gain control of their anger

D)

Control the things that trigger their anger

3.

Which of the following are factors that could be part of a persons cultural identity? (Select all that apply.)

A)

Common family customs

B)

Common language

C)

Common stressors

D)

Gender

E)

Adaptive resources

4.

What would a culturally competent nurse know that some cultural and ethnic groups feel that mental illness is caused by?

A)

Demon possession

B)

Pretense

C)

The stars

D)

Hypnosis

5.

A staff educator is discussing stress and its impact on a disease process, whether it is physical or mental. What would be the best statement about stress that the educator could give?

A)

Stress can be prostress or distress.

B)

Stress can never enhance the feeling of well-being.

C)

Stress can be either physically or emotionally exhausting, but not both.

D)

Distress is actually harmful to ones health.

6.

A patient comes to the clinic to see the Mental Health Nurse Practitioner.

The patient states, I seem to be miserable and upset all the time. My marriage is crumbling because my wife refuses to understand how I feel.

What does the nurse practitioner understand about the factors contributing to the patients stress?

A)

Internal situations often make us miserable and upset

B)

External situations often make us miserable and upset

C)

We choose to make ourselves miserable and upset

D)

We choose to live with chronic stress

7.

As a mental health nurse, you know that when a person feels insulted, mental images of resentment and animosity may be formed. These images generate what?

A)

The need to fight back

B)

The need to change their behavior

C)

The need to project blame onto the other person

D)

The need to manipulate the situation

8.

Mental health nurses know that stress management is an important part of patient care. What is one way a mental health nurse could help the patient cope with stress?

A)

Teach mentalization

B)

Teach hypnosis

C)

Teach imagination

D)

Teach visualization

9.

To help patients deal with their stress, nurses must also learn to cope with their own. Which of the following is an adaptive coping strategy that might be used by the nurse?

A)

Reframing

B)

Mediation

C)

Asset training

D)

Mental blocking

10.

A)

An 18-year-old college student is very anxious about auditioning for the schools famous chorale. Which of the following ways of dealing with this anxiety would the nurse recognize as being maladaptive?

Arranging for voice lessons

B)

Practicing the songs used in the audition

C)

Going to a concert

D)

Singing with a group of friends

11.

Several steps occur in the crisis sequence. What is one of these steps?

A)

Organization recurs

B)

Violence

C)

Autonomic response

D)

Peripheral nervous system response

12.

A 70-year-old man is admitted to the hospital in a severe state of malnutrition. The nurse learns that he lost his wife 3 months ago and is living alone in a rural area. His family lives at a great distance and rarely visits him. He is not eating for several days at a time and is not paying his bills. He is now without electricity and phone service at his home. When his son asks the nurse what is wrong with his father, what would be the nurses best response?

A)

He is grieving for his wife.

B)

He has colon cancer and is dying.

C)

He has a malabsorption disorder.

D)

He feels alone and useless.

13.

A 28-year-old woman, whose husband and two children were killed in a hurricane 3 years ago, has dated several men in the past 18 months. She has never allowed a serious relationship to develop, always finding a reason to end the relationship after a couple of months. What is a reason that this woman may not be able to form a serious, lasting relationship with a man?

A)

Unresolved grieving from a loss when she was 15 years old

B)

The patient has had multiple losses

C)

Guilt with regard to circumstances at or near the time of loss

D)

The patient has ambivalent feelings toward the lost person

14.

A new nurse has just begun work in a mental health facility. During orientation, the nurse learns about chronic sorrow. What should this nurse learn that is considered chronic sorrow?

A)

Twelve continuous months of coping with a loss

B)

Inability to complete the coping process

C)

A prolonged and intensified resolution

D)

A prolonged and intensified reaction

15.

A patient who responds to acute stress by fleeing from the situation is demonstrating the fight-or-flight response. Which of the following describes this response?

A)

A surge of adrenalin into the bloodstream in response to an immediate threat

B)

A lapse of judgment that causes a person to avoid consequences

C)

A positive response to an insulting situation

D)

A result of chronic stress

16.

The nurse is caring for a patient whose husband is dying. The patient says that the doctors caring for her husband are very good and that she knows her husband will recover. The nurse recognizes that the patient is likely in which stage of grief?

A)

Anger

B)

Denial

C)

Acceptance

D)

Bargaining

17.

As a mental health nurse, you are initiating therapeutic strategies for a patient who is in psychological crisis. You initiate therapeutic strategies that are designed to do what?

A)

Teach the person in crisis a lesson

B)

Assist in preventing future emotional states of dysfunction

C)

Assist in identifying future behaviors

D)

Teach the person in crisis how to diffuse the anger

18.

During the mental health clinical rotation, a student nurse asks what types of triggers increase stress levels. What would be the most likely answer the student nurse could get?

A)

Expected triggers

B)

One-time triggers

C)

Intense triggers

D)

Controllable triggers

19.

A patient on the medical/psychiatric unit has been seen pacing back and forth in his room. The nurse asks him what is wrong. The patient responds, I dont know. What is this an example of?

A)

Stress

B)

Anxiety

C)

Distress

D)

Grief

20.

A nurse is collecting data on a new patient in the clinic. What is the best question the nurse might ask the patient to elicit data on the patients mental health?

A)

What family members do you live with?

B)

Do you often change things in your life?

C)

How do you feel about yourself?

D)

What do you do for a living?

Answer Key

1.

A

2.

C

3.

A, B, D

4.

A

5.

D

6.

C

7.

A

8.

D

9.

A

10.

C

11.

C

12.

A

13.

B

14.

D

15.

A

16.

B

17.

B

18.

C

19.

B

20.

C

Chapter 2 The Delivery of Mental Health Care 1.

Who was the first nurse trained in mental health nursing in the United States?

A)

Florence Nightingale

B)

Linda Richards

C)

Harriet Bailey

D)

Dorothea Dix

2.

A 19th century school teacher worked to expose the conditions of patients with mental problems. Because of this person, mental hospitals that had standards of care were constructed. Who was this person?

A)

Benjamin Rush

B)

Linda Richards

C)

Harriet Bailey

D)

Dorothea Dix

3.

What act of legislation provided funds for research, advanced nursing degree programs, and improved community service for individuals with mental illness?

A)

Joint Commission on Mental Illness and Health in 1955

B)

National League for Nursing 1953

C)

National Institute of Mental Health 1949

D)

National Mental Health Act of 1946

4.

In the mid 1950s, antipsychotic drugs were introduced. As medications made caring for the mentally ill somewhat easier, what movement gained momentum?

A)

The move to deinstitutionalize mentally ill clients

B)

The move to use electric shock therapy for depressed clients

C)

The move to use antipsychotic drugs instead of restraints

D)

The move to improve the conditions in mental health hospitals

5.

Research has shown that people in minority groups do not always receive the care they need for mental illness. The barriers to accessing mental health care include what? (Mark all that apply.)

A)

High abuse rate in family

B)

Low socioeconomic status

C)

Low educational levels

D)

Limited income

E)

High physical needs of family

6.

The nurse is admitting a 36-year-old Arabic female diagnosed with severe postpartum depression to the mental health unit. The culturally sensitive nurse is aware that cultural incompetence among mental health providers and professionals is what?

A)

The reason minorities do not seek health care

B)

Nonexistent in the United States

C)

The single most pivotal barrier to equality in delivery of mental health care

D)

Rampant in third world countries

7.

When admitting a patient to a mental health setting, what does the nurse do to aid in preserving the rights of the client?

A)

Give the client the opportunity to read the Mental Health Systems Act Bill of Rights

B)

Send a copy of the Mental Health Systems Act Bill of Rights home with a family member

C)

Read the client the Mental Health Systems Act Bill of Rights

D)

Tell the client of his or her rights

8.

In the child behavioral unit on which you work with the family of a prospective patient, you are having a discussion with the mother. The mother asks you how she knows her child will not be mistreated when he misbehaves. What is the best statement in the Patient Bill of Rights to discuss with this mother regarding her childs treatment?

A)

Be treated with dignity, concern, and respect at all times

B)

Expect quality care provided by trained and competent professional providers

C)

Be treated in the least restrictive setting

D)

Receive explanations of treatment and be involved in the planning of care

9.

A client is admitted on an emergent basis to a local mental health facility after being detained by the police when he was found walking naked down the middle of a four-lane highway. The nurse knows that the client can be held for what length of time?

A)

7284 hours

B)

4872 hours

C)

3648 hours

D)

2436 hours

10.

You work in a mental health facility and are admitting a client who has been brought to the emergency department of a local hospital after being picked up while attempting to jump from the rail of a bridge. The physician feels that the patient is serious about attempting suicide and so sends the patient to you for admission. What type of admission would you document this as?

A)

Emergent

B)

Routine

C)

Voluntary

D)

Involuntary

11.

On admittance to a mental health unit, a client tells the nurse that he or she does not want anyone to know that he or she is a patient there. The next day the nurse receives a phone call requesting information about the client. The nurse refuses to acknowledge that the client is a patient on the unit. What is the best way to describe how this nurse is acting?

A)

Confidently

B)

Legally

C)

Ethically

D)

Privately

12.

What does the Health Insurance Portability and Accountability Act (HIPAA) of 1996 hold mental health care professionals legally and ethically responsible for?

A)

Portability of medical records

B)

Accurate documentation

C)

Correct billing of insurance companies

D)

Client confidentiality

13.

As a student nurse, you are accountable for the care that you provide. Where would you find the scope and minimum standard of practice for the care you provide?

A)

Student Nurses Practice act for the United States

B)

American Nurses Association website

C)

Student Nurses Association website

D)

Nurse practice act of your state

14.

While providing care to a client who has moderate to severe Alzheimer disease, a mental health nurse has what responsibility?

A)

Protecting the clients rights

B)

Disclosing information only to family members

C)

Keeping the patient on a locked unit

D)

Being within arms length of the patient at all times

15.

Federal regulations and Joint Commission standards regulate the use of seclusion and restraints by health care workers. What do these regulations mandate with regard to the use of restraints?

A)

Restraints can only be applied in the presence of a physician

B)

Restraints can be applied under the supervision of a licensed nurse

C)

Restraints can only be applied under the supervision of a registered nurse

D)

Restraints can only be applied if nursing orders are on the chart

16.

You are caring for a client who is under 24-hour suicide watch when the client becomes very aggressive and belligerent. When you are trying to talk the client down, the client hits you. What would you recommend for this client?

A)

Seclusion

B)

Restraints

C)

Time-out

D)

Demerits

17.

As a mental health nurse, your possible practice settings include what?

(Mark all that apply.)

A)

Long-term care facilities

B)

Home-health care

C)

Outpatient surgery clinics

D)

Hospital units

E)

Ophthalmic clinics

18.

As an emergency department nurse, you deal with some mentally healthy clients who are experiencing a temporary mental instability. What type of nursing would you practice in this situation?

A)

Family care nursing

B)

Crisis intervention nursing

C)

Adult health nursing

D)

Situational nursing

19.

Holistic nursing is practiced in every practice setting. Because of this, no matter what the health care setting, what should the nurse be prepared to do?

A)

Help others follow the policies of the institution they are working in

B)

Practice nursing according to Peplaus theory

C)

Be prepared to initiate interventions to address the psychosocial needs of each client

D)

Care for the physical needs of the patient exclusively

20.

What must a nurse in a correctional facility provide to a patient newly diagnosed with HIV?

A)

Compassion and strength

B)

Counseling and support

C)

Empathy and strength

D)

Sympathy and support

Answer Key

1.

B

2.

D

3.

D

4.

A

5.

B, C, D

6.

C

7.

A

8.

A

9.

B

10.

D

11.

C

12.

D

13.

D

14.

A

15.

C

16.

B

17.

A, B, D

18.

B

19.

C

20.

B

Chapter 3 Theories of Personality Development 1.

A nurse researcher is conducting a study on how a mother perceives her infant at the age of 4 months. The researcher is asking the mother to identify general prominent features, some of which are seen in all the infants behavior patterns and are most often used as descriptors of the infant. What is the best term for these features?

A)

Personality traits

B)

Secondary traits

C)

Central traits

D)

Humanistic traits

2.

What type of the following personality theories views a person as a whole?

A)

Altruistic

B)

Humanistic

C)

Theistic

D)

Allopathic

3.

Which of the following are components of an individuals personality?

(Select all that apply.)

A)

Pattern of interacting with oneself and the environment

B)

Pattern of perceiving oneself and the environment

C)

Pattern of relating to oneself and the environment

D)

Pattern of thinking about oneself and the environment

E)

Pattern of admiring oneself and the environment

4.

A)

When caring for patients, the nurse recognizes that each person has a certain disposition. How else could disposition be described?

Personality

B)

Core traits

C)

Temperament

D)

Secondary traits

5.

The nurse knows that as persons grow from childhood to adulthood, they respond to the realization that they are an autonomous being and therefore capable of controlling themselves. This realization forms what?

A)

Patterns of thinking

B)

Patterns of behavior

C)

Secondary traits

D)

Core traits

6.

The nurse reads the admission notes in the chart of a new patient. The admitting nurse mentions that the patient uses humor as a defense mechanism. If this defense mechanism is used short term, how would its use be described?

A)

Maladaptive

B)

Predetermined

C)

Patterns of conflict

D)

Adaptive

7.

Eriksons theory of psychosocial development recognizes that not everyone will be successful at each stage of development. Eriksons view emphasizes that failure in one stage of development means what for the person in later stages of development?

A)

The failure can be corrected by successes

B)

The failure can never be corrected

C)

Repetition of the previous stage until success is achieved

D)

Going back to a previous stage to work through more tasks

8.

What basic psychologic needs did William Glasser cite that determine a persons behavioral response in a given situation? (Select all that apply.)

A)

Fun

B)

Dependence

C)

Love

D)

Trust

E)

Choice

9.

Piaget theorizes that as humans grow and move from one stage to another, they seek cognitive balance. What term does Piagets theory use to describe this process of achieving cognitive balance?

A)

Equilibration

B)

Trust

C)

Assimilation

D)

Accommodation

10.

A pediatric nurse is caring for a 5-year-old female patient. When giving the child an injection preoperatively, the patient cries and states, Now everything will leak out. The nurse knows that this is an example of what?

A)

Impulsivity

B)

Fear

C)

Magical thinking

D)

Egocentrism

11.

Based on Piagets work, Kohlberg developed a theory of moral development.

According to Kohlbergs theory, each of the levels builds on the one prior with what?

A)

A chance to go back and rework the prior level

B)

A chance to be successful at prior levels

C)

A more complex view of a moral issue

D)

A less complex view of a moral issue

12.

A mental health nurse must develop what with the clients to be able to provide patient care?

A)

A personal relationship

B)

An informal relationship

C)

A social relationship

D)

A therapeutic relationship

13.

When working with a patient on the behavioral unit, a mental health nurse notes that the patient does not demonstrate an understanding of own actions or the results of those actions. Practicing Peplaus theory, the nurse sees what as a basis for therapeutic interaction with this client?

A)

Stages of developmental growth

B)

Levels of psychosocial growth

C)

Stages of interpersonal growth

D)

Levels of interactive growth

14.

A nurse working on the pediatric unit is caring for a toddler. The nurse knows that according to Peplaus theory, the child is learning what?

A)

Learning independence

B)

Delaying self-gratification

C)

Learning to cooperate

D)

Learning to behave in a way that is acceptable to others

15.

A mother and daughter are seeing a mental health advanced practice nurse.

The daughter, 15 years old, ran away a month ago and was found at a friends home 3 days later. The daughter says she ran away because her mother beat her. The mother tells the APN that she is raising her daughter the way she was raised. What theory would the mental health APN use to treat this patient dyad?

A)

Cognitive theory

B)

Psychodynamic nursing

C)

Family Systems theory

D)

Psychosocial theory

16.

Bowen, in the Family Systems theory, proposes that anxiety, an individual reaction to stress, is directly correlated to the persons what?

A)

Distancing

B)

Level of differentiation

C)

Pseudoself

D)

Solid self

17.

Peplaus theory of psychodynamic nursing purports that an individual must do what before being able to live successfully and interact as a member of society?

A)

Pass through all the developmental stages of Erikson

B)

Be a solid self

C)

Understand Piagets cognitive levels of development

D)

Learn to practice self-control

18.

The nurse caring for a child is explaining to the mother about development.

At what age would the nurse tell the mother the superego starts developing?

A)

12 years

B)

23 years

C)

34 years

D)

45 years

19.

You are working on a mental health unit that follows the theory of interpersonal development. You would know that this theorys major concepts include what?

A)

There is one solid image of self

B)

There are two images of self

C)

The person develops three images of self

D)

It is necessary to integrate four unconscious images of self

20.

The mental health APN is counseling with a family that he has identified as being made up of individuals who are predominantly a solid self. This means that the nurse is interacting with what type of family system?

A)

Open

B)

Closed

C)

Differentiated

D)

Pseudocohesive

Answer Key

1.

C

2.

B

3.

B, C, D

4.

C

5.

B

6.

D

7.

A

8.

A, C, E

9.

A

10.

C

11.

C

12.

D

13.

A

14.

B

15.

C

16.

B

17.

D

18.

C

19.

C

20.

A

Chapter 1.

4 Treatment of Mental Illness A client is admitted to the mental health unit with a diagnosis of bipolar disorder. What is the aim of this clients treatment?

A)

To allow the client to live and function in society with improved personal and interpersonal skills

B)

To allow the client to become successful in society

C)

To allow the client to mentally even out

D)

To allow the client to become used to the medication

2.

A)

The support of the nurse for the client in a therapeutic relationship encourages what from the client?

Submission and growth

B)

Change and goal setting

C)

Growth and change

D)

Interpersonal stability

3.

The parents of a 10-year-old child being admitted to the childrens behavioral unit ask the nurse what a therapeutic milieu is. What is the nurses best answer?

A)

The dayroom on our unit

B)

The school room on our unit

C)

A safe and secure structured environment

D)

A place where the client and the patients can interact

4.

A mental health nurse on an inpatient unit is often in a position to maintain the milieu as a place where there is what?

A)

Toleration of acting out

B)

A place to practice in the pool

C)

Laughter and good will

D)

Dignity and acceptance

5.

A new LVN/LPN is being oriented to the psychiatric unit at a local hospital.

At the end of the day, the new nurse asks the preceptor to explain what the RN is accountable for on the unit. What would be the preceptors best answer?

A)

Both the physical and the mental health care of the clients

B)

Everything

C)

The physical care of the client

D)

The mental health care of the client

6.

An LPN/LVN is working on a closed (locked) mental health unit. What would his or her responsibilities include?

A)

Administering medications and searching client rooms daily

B)

Observing behaviors and administering medications

C)

Documenting in the client record and preparing meals

D)

Interacting with clients and notifying insurance companies

7.

As an LVN/LPN on a mental health unit, a basic part of your nursing assessment is what?

A)

Performing the admission assessment of each client

B)

Reinforcing inappropriate behavior

C)

The observation of inappropriate behaviors

D)

Teaching the client new skills

8.

A client asks the nurse to explain what is wrong with the client. What is the nurses responsibility in this instance?

A)

Copy the diagnosis from the DSM-IV for the client

B)

Tell the client that he or she needs to speak with the physician about this

C)

Explain the diagnosis in medical terms

D)

Provide an explanation at the clients level of understanding

9.

An essential part of the nurses role in the therapeutic process is what?

A)

Unconditionally accepting the client as a person

B)

Explaining to the client why the clients behavior is inappropriate

C)

Unconditionally accepting the clients behavior

D)

Raising the clients ego

10.

As the nurse sees the situation from the clients perspective and demonstrates an empathetic positive regard for client needs, what usually improves in the client?

A)

Appropriate behaviors

B)

Compliance with treatment

C)

Regard for the nurse

D)

Clients ego

11.

A mental health APN is talking with a client and the spouse about treatment for depression. The client asks what the most common method of treatment is. What would be the APNs best answer?

A)

Inpatient treatment and medication

B)

Outpatient treatment and psychotherapy

C)

Medication and electroconvulsive therapy

D)

Psychotherapy and medication

12.

A client in psychotherapy asks the mental health practitioner what the goal of this treatment is. What would be the practitioners best response?

A)

The goal is to reduce the symptoms of the emotional disturbance.

B)

The goal is to allow clients to make choices.

C)

The goal is to help clients have the inner courage to act on their priorities.

D)

The goal is to give advice to the client.

13.

A mental health nurse is passing drugs on an inpatient unit. Clients ask why they have to take medicine. What would the nurse include in the explanation to the clients?

A)

The medicine helps you get better faster than counseling does

B)

The medicine helps you to have a manageable level of existence

C)

The medicine helps you act more inappropriately

D)

When the drugs work in your system, you can go home

14.

How do psychotropic drugs work? (Mark all that apply.)

A)

By affecting a clients psychiatric viewpoint

B)

By affecting a clients psychiatric function

C)

By affecting a clients behavior

D)

By affecting a clients experience

E)

By affecting a clients psychiatric desires

15.

What type of individual therapy is nondirective and focuses on helping the client to clarify his or her own feelings?

A)

Behavioral

B)

Cognitive therapy

C)

Group

D)

Humanistic

16.

A nurse is getting a patient ready for the first electroconvulsive therapy treatment. The clients spouse asks what the expected outcome of ECT is.

What would be the nurses best response?

A)

We expect this treatment to cause short seizures.

B)

We expect this treatment to cure the client.

C)

We expect this treatment to restore a chemical balance within the brain.

D)

We expect this treatment to make the patient sleep for a period of time.

17.

On a mental health unit, the nurse spends a great deal of time with the clients. Because of this, the nurse is seen as what?

A)

An authority figure

B)

Part of the health care team

C)

An authority on games

D)

A role model for social behaviors

18.

What type of therapy uses monitoring devices during situations that trigger specific types of anxiety?

A)

Play therapy

B)

Biofeedback

C)

Electroconvulsive therapy

D)

Agitation therapy

19.

What are the functions of a mental health technician on most mental health units? (Mark all that apply.)

A)

Assisting clients with physical and hygiene needs when needed

B)

Planning recreational activities

C)

Preparing meals and snacks

D)

Monitoring unit activities

E)

Assisting with group activities

20.

As a nurse leader in an outpatient setting, the mental health nurse maintains a therapeutic milieu by giving clients the opportunity to do what? (Select all that apply.)

A)

Improve social relationships

B)

Discuss their social plans

C)

Voice complaints

D)

Give feedback on other clients

E)

Talk about the environment in general

Answer Key

1.

A

2.

C

3.

C

4.

D

5.

A

6.

B

7.

C

8.

D

9.

A

10.

B

11.

D

12.

A

13.

B

14.

B, C, D

15.

D

16.

C

17.

D

18.

B

19.

A, D, E

20.

C, D, E

Chapter 5 Establishing and Maintaining a Therapeutic Relationship

1.

The nurse is explaining roles and boundaries to a newly admitted patient.

These actions are part of which phase of the therapeutic relationship?

A)

Preinteraction

B)

Orientation

C)

Working

D)

Termination

2.

The nurse is assisting the client to overcome his fear of public places. The nurse and the client are in which of the following phases of the therapeutic relationship?

A)

Preinteraction

B)

Orientation

C)

Working

D)

Termination

3.

When the nurse tried to perceive a situation from the clients perception, which characteristic of the nurseclient relationship is being utilized?

A)

Self-awareness

B)

Empathy

C)

Genuineness

D)

Acceptance

4.

Which of the following provides insight into how we respond to our environment and how others react to our behavior?

A)

Empathy

B)

Genuineness

C)

Self-awareness

D)

Acceptance

5.

When the nurse shows concern for a patients well-being, he or she is exhibiting which characteristic of the nurseclient relationship?

A)

Self-awareness

B)

Empathy

C)

Acceptance

D)

Genuineness

6.

Which of the following is vital to the nurseclient relationship?

A)

Confidence

B)

Trust

C)

Sympathy

D)

Adaptation

7.

The phases of the nurseclient relationship center upon which of the following?

A)

Clients attitude

B)

Clients personality

C)

Clients functional ability

D)

Clients social support

8.

To ensure confidentiality, information is shared only with which of the following persons?

A)

All persons in contact with the client

B)

Members of the treatment team as it applies to the clients well-being

C)

Persons who have known the client for several years

D)

Family members who are inquiring about the client

9.

Which of the following would be inconsistent with the characteristics of a therapeutic relationship?

A)

It is dependent on the situation and needs of the client.

B)

It focuses on identifying client problems.

C)

It is considered a social interaction.

D)

It promotes a return to independent living within societal norms.

10.

An assigned client is escalating and becoming hostile toward the nurse.

Which of the following actions should be completed by the nurse?

A)

Use touch to convey a caring demeanor.

B)

Threaten the client with action.

C)

Enter the clients room alone to decrease the clients anxiety level.

D)

Offer the client time to regain control and stop the behavior.

11.

The nurse is utilizing limit setting for a manipulative client. Which of the following is an appropriate action to apply limit-setting strategies to this client?

A)

Encourage instant gratification.

B)

Reinforce negative behavior.

C)

Recognize what the client is attempting to do.

D)

Apply firm boundaries intermittently.

12.

The nurse is teaching appropriate coping skills to a client diagnosed with an anxiety disorder. Which phase of nurseclient relationship is the nurse facilitating?

A)

Preinteraction

B)

Orientation

C)

Working

D)

Termination

13.

During the termination phase, which of the following occurs?

A)

Encouraging independence in getting along with others

B)

Planning of outcomes and goals

C)

Evaluating the effectiveness of changes

D)

Building trust and establishing roles

14.

Which of the following components of the nurseclient relationship fosters an honest and caring foundation?

A)

Trust

B)

Self-awareness

C)

Genuineness

D)

Empathy

15.

The nurse is developing a therapeutic relationship with a newly admitted client. Which of the following is an essential component for a therapeutic relationship?

A)

Family support

B)

Intelligence

C)

Explanation

D)

Dependency needs

Answer Key

1.

B

2.

C

3.

B

4.

C

5.

D

6.

B

7.

C

8.

B

9.

C

10.

D

11.

C

12.

C

13.

A

14.

C

15.

C

Chapter 6 Dynamics of Anger, Violence, and Crises

1.

A)

The nurse has been assigned to a client diagnosed with depression. Which neurotransmitter has been implicated in depression?

Dopamine

B)

Acetylcholine

C)

Serotonin

D)

GABA (gamma-aminobutyric acid)

2.

A nurse is completing discharge teaching to a client diagnosed with an anxiety disorder who has been prescribed diazepam (Valium). Which of the following would be an important component of the discharge teaching?

A)

There is no potential for addiction to the drug.

B)

The drug acts to depress the central nervous system, causing sedation.

C)

The client should monitor his or her blood pressure for increased values.

D)

The drug can cause increased appetite.

3.

The nurse is caring for a client who has been recently placed on an antidepressant. Which of the following would be a correct statement made by the nurse, regarding antidepressant drugs?

A)

The drug must be taken several weeks for a therapeutic effect to occur.

B)

Antidepressants are curative.

C)

There are no risks of suicide when taking this type of medication.

D)

The medication should be stopped when the client is feeling better.

4.

Which of the following is a priority nursing diagnosis for a client taking an antidepressant?

A)

Constipation related to side effects of the medication

B)

Self-care deficit related to low selfesteem

C)

Risk for self-directed violence related to mood dysphoria

D)

Sleep pattern disturbance related to psychologic factors

5.

A client has been prescribed lithium for mania. A therapeutic serum level for lithium would include which of the following?

A)

0.4 mEq/L

B)

0.8 mEq/L

C)

2.0 mEq/L

D)

2.5 mEq/L

6.

The nurse is teaching a client receiving a mood-stabilizing agent. Which of the following should be included in the plan of care?

A)

Limit sodium intake when perspiring heavily.

B)

Maintain fluid intake of 1,000 to 1,500 mL daily.

C)

Administer the medication with food.

D)

Monitor for the side effects of sedation and drooling.

7.

Extrapyramidal side effects block which of the following neurotransmitters that coordinate involuntary movements?

A)

Acetylcholine

B)

Serotonin

C)

Epinephrine

D)

Dopamine

8.

The nurse is assessing a client receiving antipsychotic medication. She notices that the patient is smacking his lips and has protruding tongue movements. The nurse would document this side effect as which of the following?

A)

Akathisia

B)

Tardive dyskinesia

C)

Dystonia

D)

Parkinsonism

9.

Which of the following medications is used to treat drug-induced extrapyramidal side effects associated with antipsychotic agents?

A)

Benztropine (Cogentin)

B)

Lithium carbonate (Lithane)

C)

Olanzapine (Zyprexa)

D)

Fluphenazine (Prolixin)

10.

Long-acting benzodiazepines can cause prolonged sedation and increased risk for falls in the elderly population. Which of the following is considered a long-acting benzodiazepine?

A)

Alprazolam (Xanax)

B)

Diazepam (Valium)

C)

Lorazepam (Ativan)

D)

Oxazepam (Serax)

11.

When teaching a client regarding antianxiety medications, the nurse would emphasize which of the following components?

A)

Alcohol can be consumed in moderation.

B)

The medication can be discontinued when anxiety is lifted.

C)

Smoking should be decreased to 3 cigarettes a day.

D)

Side effects include fatigue and loss of coordination.

12.

A client is being seen in the outpatient clinic for major depression. She is currently taking a monoamine oxidase inhibitor (MAOI). The nurse needs to reinforce the importance of avoiding which substance when taking an MAOI?

A)

Egg products

B)

Aspirin

C)

Tyramine

D)

Peaches

13.

The nurse is reviewing the side effects of a prescribed antipsychotic. Which of the following antipsychotic medications is associated with agranulocytosis?

A)

Fluphenazine (Prolixin)

B)

Chlorpromazine (Thorazine)

C)

Haloperidol (Haldol)

D)

Clozapine (Clozaril)

14.

The nurse is giving a seminar on the effects of psychotropic medication to a community group. Which classification of psychotropic medication can cause tolerance and addiction?

A)

MAOIs

B)

Benzodiazepines

C)

Antimanics

D)

Anticonvulsants

15.

The nurse is developing a teaching plan for a client receiving an antidepressant. Which of the following should be included in the plan?

A)

Antidepressants promote a cure to depression.

B)

There is a delayed therapeutic effect.

C)

Discontinue the medication if it is not helping.

D)

The effect of antidepressant drugs is immediate.

Answer Key

1.

C

2.

B

3.

A

4.

C

5.

B

6.

C

7.

D

8.

B

9.

A

10.

B

11.

D

12.

C

13.

D

14.

B

15.

B

Chapter 7 Communication in Mental Health Nursing 1.

The nurse states, You need to take a walk. The client responds with walk, walk, walk. This is an example of which speech pattern?

A)

Flight of ideas

B)

Echolalia

C)

Neologism

D)

Loose association

2.

A nurse is initiating a conversation with a client diagnosed with bipolar disorder. Which of the following is an example of a barrier to therapeutic communication?

A)

Clarification

B)

Validation

C)

Giving advice

D)

Using silence

3.

Which of the following would be inconsistent in conveying a sense of openness to the client?

A)

A facial expression congruent with other gestures

B)

Crossed legs and arms

C)

Respecting the physical or personal space between the client and yourself

D)

Use of touch

4.

The nurse is interviewing a client newly admitted to the inpatient unit. The client states, I am hungry. Will you buy me a car? Can we go to the movie?

The nurse understands that this is an example of which of the following speech pattern?

A)

Verbigeration

B)

Loose association

C)

Neologism

D)

5.

Flight of ideas

While completing an assessment, the nurse asks a client how he is feeling.

The client gives a lengthy and very detailed history of numerous problems.

He states, My leg is swelling, my eye is drooping, and my cologne is too strong. The nurse would document this speech pattern as which of the following?

A)

Echolalia

B)

Circumstantiality

C)

Blocking

D)

Verbigeration

6.

When interviewing a client regarding his previous health history, the nurse uses hand gestures and facial expressions when communicating. This is an example of which communication technique?

A)

Use of touch

B)

Kinesics

C)

Blocking

D)

Objectivity

7.

When interacting with a client in a professional atmosphere, for most people in U.S. culture, personal space is designated as which of the following?

A)

6 inches

B)

9 inches

C)

1 foot

D)

2 feet

8.

Which of the following is true regarding therapeutic communication?

A)

The focus is on the client.

B)

It is planned by the client.

C)

The goal is expression of the nurses feelings.

D)

It does not encompass values and beliefs.

9.

When initiating a therapeutic conversation with a client, the nurse uses which of the following therapeutic communication techniques?

A)

False reassurance

B)

Validation

C)

Giving advice

D)

Minimizing

10.

A mental health nurse is teaching a nursing student about the importance of active listening. Which of the following would be inconsistent with active listening?

A)

Giving critical attention to verbal comments

B)

Attempting to understand the clients perception of the situation

C)

Judging the client on his or her perception of the illness

D)

Reviewing client comments and behaviors prior to responding

11.

When dealing with clients diagnosed with mental illness, the nurse must use caution when using touch to convey caring with which client population?

A)

A client who is ready for discharge

B)

A depressed client

C)

A client who is diagnosed with schizophrenia

D)

A client who is sexually preoccupied

12.

When the nurse asks a client, Did I understand you correctly, the nurse is using which verbal communication technique?

A)

Validation

B)

Clarification

C)

Reflection

D)

Restating

13.

The nurse states to the client, It is time for your dinner. The client responds with For your dinner, for your dinner, for your dinner. The nurse would document this as which type of speech pattern?

A)

Neologism

B)

Echolalia

C)

Verbigeration

D)

Loose association

14.

When the client talks about a recent death of a brother, the client states, Then my sisterwhat was I saying? The nurse understands that the client is using which of the following speech patterns?

A)

Verbigeration

B)

Echolalia

C)

Blocking

D)

Flight of ideas

15.

Using silence is a nonverbal communication technique. Silence allows which of the following to occur in the conversation?

A)

The unwillingness to continue listening

B)

The nurse to stop the conversation

C)

The ability of the client to ignore the nurse

D)

The regain of control in the conversation

Answer Key

1.

B

2.

C

3.

B

4.

D

5.

B

6.

B

7.

D

8.

A

9.

B

10.

C

11.

D

12.

B

13.

C

14.

C

15.

D

Chapter

1.

8 The Nursing Process in Mental Health Nursing A nurse is teaching nursing students about the nursing process. Which of the following is a true statement regarding a nursing diagnosis?

A)

It is synonymous with a medical diagnosis.

B)

It is considered the first step in the nursing process.

C)

It only incorporates actual client problems.

D)

2.

It is the identification of a client problem based on conclusion from collected data.

The nurse is developing appropriate nursing diagnoses for a client diagnosed with major depression. Which of the following would be inconsistent with the parts of the nursing diagnosis?

A)

Actual or potential problem related to the clients problem

B)

Causative or contributing factors

C)

Nursing interventions specific to the client

D)

Behavior or symptoms that support the problem

3.

A nurse is reviewing the care plan for a client diagnosed with schizophrenia and hallucination. Which of the following would be considered a long-term outcome for this client?

A)

The client does not harm self in next 48 hours.

B)

The client reports a decrease in anxiety level within 24 hours.

C)

The client identifies environmental factors that precipitate hallucinations by discharge.

D)

The client identifies feelings associated with hallucinations with each episode.

4.

The nurse is completing a psychosocial assessment. Which of the following would be an example of a social component of the client assessment?

A)

Vital signs

B)

Behavior

C)

Affect

D)

5.

Awareness

The nurse is completing an admission physical assessment on a client diagnosed with obsessive-compulsive disorder. Which of the following would be considered objective data?

A)

Medical history

B)

Thoughts

C)

Present symptoms

D)

Client self-report

6.

A nurse is completing a psychosocial assessment on a client diagnosed with depression. Which of the following terms could be used to describe observations of a clients mood during the psychosocial assessment?

A)

Blunted

B)

Flat

C)

Euphoric

D)

Inarticulate

7.

A client has been admitted to an inpatient mental health unit following a suicide attempt. Which of the following would be considered a priority nursing diagnosis for this client?

A)

Ineffective individual coping related to life events

B)

Self-injury related to a suicide attempt

C)

Altered nutrition, less than body requirements, related to depression

D)

Body image disturbance related to scar on wrist

8.

Which of the following is a measurable and realistic goal that anticipates the improvement or stabilization of the client?

A)

Assessment

B)

Nursing diagnosis

C)

Expected outcome

D)

Evaluation

9.

The nurse is reviewing the care plan of a patient diagnosed with bipolar disorder. Which step of the nursing process focuses on helping clients rechannel their energies in a constructive manner?

A)

Assessment

B)

Nursing diagnosis

C)

Implementation

D)

Evaluation

10.

A client has been diagnosed with an anxiety disorder. Which of the following would be considered a long-term outcome?

A)

The client reports decreased anxiety within 24 hours.

B)

The client demonstrates an understanding of need for continued medication compliance by discharge.

C)

The client attends group therapy on day 2.

D)

The client reports an increased ability to concentrate within 4 hours.

11.

The nurse is completing a health assessment on a patient diagnosed with an anxiety disorder. Which of the following would be considered emotional assessment data?

A)

Family relationships

B)

Somatic complaints

C)

Self-concept

D)

Orientation

12.

The nurse is completing a mental health assessment on a client diagnosed with schizophrenia. Which of the following is descriptive of a clients affect?

A)

Apathetic

B)

Suspicious

C)

Blunted

D)

Hostile

13.

The nurse is completing an initial assessment on a client diagnosed with depression. Which of the following is an example of cognitive assessment data?

A)

Perception of current problem

B)

Employment status

C)

Current living situation

D)

Family relationships

14.

Which of the following phases of the nursing process encompasses the establishment of a baseline to formulate the care plan?

A)

Assessment

B)

Nursing diagnosis

C)

Planning

D)

Implementation

15.

Which of the following is a vital component of the therapeutic milieu in mental health treatment?

A)

Dependency

B)

Biofeedback

C)

Consistency

D)

Electroconvulsive therapy

Answer Key

1.

D

2.

C

3.

C

4.

B

5.

A

6.

C

7.

B

8.

C

9.

C

10.

B

11.

C

12.

C

13.

A

14.

A

15.

C

Chapter

1.

9 Anxiety Disorders A client has been diagnosed with obsessive-compulsive anxiety disorder.

The nurse would expect to find which of the following clinical manifestations?

A)

Avoidance

B)

Persistent unwanted thoughts

C)

Feeling of suffocation

D)

Flashbacks

2.

A client becomes very anxious when riding in an elevator, which is going to the 12th floor. This would be documented as which of the following types of phobia?

A)

Arachnophobia

B)

Acrophobia

C)

Microphobia

D)

Pyrophobia

3.

A soldier has been back from Iraq for two weeks. He is being seen in the outpatient mental health clinic due to complaints of inability to sleep, nightmares, and flashbacks. The nurse would expect the client to be diagnosed with which of the following?

A)

Generalized anxiety disorder

B)

Obsessive-compulsive disorder

C)

Posttraumatic stress disorder

D)

Social phobia

4.

A client has been diagnosed with generalized anxiety disorder. In order to establish a nurseclient relationship, which of the following steps is most important?

A)

Identify the problem

B)

Begin psychotherapy

C)

Determine social support

D)

Lower the clients anxiety level

5.

A client diagnosed with obsessive-compulsive disorder is constantly checking the oven to make sure it is off. This is an example of which type of obsessive thought content?

A)

Contamination

B)

Repeated doubts

C)

Orderliness

D)

6.

Aggressive impulses

When assessing a client diagnosed with an anxiety disorder, the nurse should use which type of questioning?

A)

Open ended

B)

Direct

C)

Matter of fact

D)

Abstract

7.

Which of the following treatment approaches has been proven to be the most beneficial for the client diagnosed with an anxiety disorder?

A)

Antianxiety medications combined with psychotherapy

B)

Antianxiety medications only

C)

Psychotherapy only

D)

Guided imagery

8.

A physiologic response to generalized anxiety includes which of the following?

A)

Narcolepsy

B)

Decreased urinary output

C)

Muscle tension

D)

Constipation

9.

Which of the following would be a sympathetic nervous system response to panic anxiety?

A)

Decreased blood pressure

B)

Increased heart rate

C)

Dry skin

D)

Pale extremities

10.

A patient diagnosed with obsessive-compulsive disorder avoids touching all doorknobs when entering the health clinic. This type of obsessive thought content would be documented as which of the following?

A)

Orderliness

B)

Contamination

C)

Repeated doubts

D)

Horrific impulses

11.

The nurse should avoid which of the following interventions when dealing with a client having a panic attack?

A)

Communicating in a nonthreatening manner

B)

Maintaining a calm environment

C)

Providing a safe place

D)

Touching the client

12.

A client who is experiencing a panic attack states, I am going to die. I feel like I am suffocating. What is the nurses best response?

A)

I will leave you alone so that you can calm down.

B)

You are having a panic attack. I will not leave you alone.

C)

Please calm down. You are not dying.

D)

Why are you having a panic attack?

13.

In order for a client to be diagnosed with an anxiety disorder, the client must have had symptoms for longer than which time frame?

A)

1 week

B)

2 weeks

C)

3 weeks

D)

14.

1 month

A client is being admitted to an inpatient clinical unit for treatment of obsessive-compulsive anxiety disorder. The nurse understands that this anxiety disorder is associated with which of the following?

A)

Feelings of terror

B)

Nightmares

C)

Persistent unwanted thoughts and ritualistic behaviors

D)

Flashbacks

15.

When reviewing a care plan of a client diagnosed with obsessivecompulsive disorder, the nurse would expect to see which of the following nursing interventions early in treatment?

A)

Set limits on the amount of time spent performing the ritual.

B)

Allow time for the client to perform the ritual.

C)

Prevent all ritualistic behaviors.

D)

Increase stimuli in the environment.

16.

A client has been diagnosed with agoraphobia. Which of the following is a manifestation of phobias?

A)

Emotional numbing

B)

Irrational fear

C)

Ritualistic behavior

D)

Insomnia

17.

A)

A client is dreading speaking in front of others during a group therapy session. This behavior is consistent with which type of anxiety?

Separation

B)

Anticipatory

C)

Free floating

D)

Uncued

18.

To be diagnosed with generalized anxiety disorder, the client experiences an increased level of anxiety and worry on most days over which time frame?

A)

1 month

B)

2 months

C)

4 months

D)

6 months

19.

Which medication classification would the nurse expect to be used in the treatment of a client diagnosed with an anxiety disorder?

A)

CNS stimulants

B)

Anxiolytics

C)

Antipsychotics

D)

Anticonvulsants

20.

A client diagnosed with agoraphobia associated with panic disorder has been scared to leave her home for 3 months, unable to go to the grocery store. In reviewing the care plan, the nurse would expect to find which goal for this client?

A)

Control her symptoms.

B)

Function effectively within the environment.

C)

Participate in psychotherapy.

D)

Perform self-care activities.

Answer Key

1.

B

2.

B

3.

C

4.

D

5.

B

6.

B

7.

A

8.

C

9.

B

10.

B

11.

D

12.

B

13.

D

14.

C

15.

B

16.

B

17.

B

18.

D

19.

B

20.

B

Chapter

1.

10 Mood Disorders A client is receiving lithium carbonate. Which of the following is a therapeutic blood level for lithium?

A)

0.2 mEq/L

B)

0.4 mEq/L

C)

1.0 mEq/L

D)

2.

1.4 mEq/L

A client diagnosed with bipolar disorder is verbalizing, The mare, doesnt care, over there, if you dare, anywhere. This is an example of which type of thought pattern?

A)

Delusions of grandiosity

B)

Auditory hallucination

C)

Clang association

D)

Flight of ideas

3.

A client diagnosed with mania is pacing back and forth. To ensure adequate nutrition for this client, which of the following would be most appropriate?

A)

Foods of clients choice

B)

Finger foods

C)

Large meals

D)

Liquid meals

4.

A nurse is caring for a client diagnosed with severe depression. The nurse understands that which neurotransmitter deficit has been implicated in depression?

A)

Norepinephrine

B)

Acetylcholine

C)

Serotonin

D)

Dopamine

5.

The nurse is caring for a client who has just undergone electroconvulsive therapy (ECT). Which of the following is an expected postprocedure manifestation of ECT?

A)

Memory deficits

B)

Severe confusion

C)

Seizures

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D)

6.

Electrolyte imbalances

A client is diagnosed with depression. When reviewing the chart of this client, the nurse notes that the client has anhedonia. The nurse would expect to note which of the following sign or symptom related to anhedonia?

A)

Exaggerated self-worth

B)

Inability to experience pleasure

C)

Anergia

D)

Mania

7.

A client states to the nurse, I want to kill myself. I dont have anything to live for. The nurse understands that this statement is an example of which of the following?

A)

Suicidal erosion

B)

Suicidal gesture

C)

Suicidal threat

D)

Suicide attempt

8.

When assessing a client taking lithium, the nurse should be aware of which of the following electrolyte levels within the clients diet?

A)

Calcium

B)

Magnesium

C)

Potassium

D)

Sodium

9.

Clients taking a monoamine oxidase inhibitor (MAOI) should avoid which of the following in their diet?

A)

Vitamin C

B)

Tyramine

C)

Fats

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D)

10.

Sodium

A client is being discharged on a tricyclic antidepressant (TCA). The nurse should include which of the following in the discharge teaching?

A)

Limit the amount of tyramine in the diet.

B)

Avoid consuming alcohol.

C)

Stop taking the medication when feeling better.

D)

Continue a sodium-restricted diet.

11.

Which of the following neurotransmitters has been implicated in mania?

A)

Serotonin

B)

Norepinephrine

C)

Acetylcholine

D)

Dopamine

12.

The nurse understands that which of the following antidepressants are fatal in overdose?

A)

MAOIs

B)

TCAs

C)

SSRIs

D)

Heterocyclics

13.

A client has failed to respond to medication therapy for depression. The physician has ordered electroconvulsive therapy (ECT). Which of the following is most important to include in the teaching plan for this client?

A)

This type of therapy will induce a seizure.

B)

ECT will cure your depression.

C)

A registered nurse will perform the procedure.

D)

There will be no memory impairment postprocedure.

14.

A client is being assessed following a suicide attempt. She continues to have suicidal thoughts. Which of the following nursing diagnoses would take priority at this time?

A)

Activity intolerance related to fatigue

B)

Anxiety related to psychological conflict

C)

Risk for violence, self-directed, related to suicidal thoughts

D)

Social isolation related to feelings of worthlessness

15.

Which of the following would be an expected outcome for a client diagnosed with depression?

A)

Utilizes self-blame to cope

B)

Internalizes feelings

C)

Limited interaction with others

D)

Identifies personal strengths

16.

The nurse is caring for a severely depressed client. The nurse should be aware of suicide warning signs. Which of the following would be inconsistent as a warning sign?

A)

Social withdrawal

B)

Increased appetite

C)

Giving away possessions

D)

Previous suicide attempt

17.

Which of the following levels of risk for suicide entails a thought that indicates the persons desire to do self-harm?

A)

Suicidal gesture

B)

Suicidal threat

C)

Suicidal ideation

D)

Suicide attempt

18.

Which of the following mood disorders is less severe than major depressive disorder but tends to be more chronic?

A)

Mania

B)

Bipolar disorder

C)

Dysthymic disorder

D)

Cyclothymic disorder

19.

A client has had five mood shifts within a year, alternating between mania and depression. The nurse would correctly document this shift as which of the following?

A)

Dysthymia

B)

Rapid cycling

C)

Cyclothymia

D)

Hypomania

20.

A client is laughing when talking about a brothers death. This type of affect would be accurately documented as which of the following?

A)

Blunted

B)

Flat

C)

Incongruent

D)

Appropriate

Answer Key

1.

C

2.

C

3.

B

4.

C

5.

A

6.

B

7.

C

8.

D

9.

B

10.

B

11.

B

12.

B

13.

A

14.

C

15.

D

16.

B

17.

C

18.

C

19.

B

20.

C

Chapter 11 Psychotic Disorders

1.

A client is hearing voices telling him to kill himself. The nurse would document this type of perceptual disturbance as which of the following?

A)

Illusion

B)

Delusion

C)

Thought insertion

D)

Hallucination

2.

A client has been diagnosed with schizophrenia. The nurse is able to move the clients arm in a certain position and it will remain in that position until it is moved again. The nurse would document this behavior alteration as which of the following?

A)

Avolition

B)

Waxy flexibility

C)

Loose association

D)

Dystonia

3.

A client states, Little green men implanting destructive asteroids in my brain. This statement is reflective of which type of thinking?

A)

Thought broadcasting

B)

Thought insertion

C)

Thought withdrawal

D)

Delusion of reference

4.

Which of the following is considered a negative symptom of schizophrenia?

A)

Autism

B)

Delusions

C)

Agitation

D)

Flat affect

5.

A client is exhibiting lip smacking, facial grimacing, and protruding tongue movements. This extrapyramidal side effect would accurately be documented as which of the following?

A)

Akathisia

B)

Tardive dyskinesia

C)

Drug-induced parkinsonism

D)

Dystonia

6.

Which drug classification is most commonly used to relieve the druginduced extrapyramidal side effects associated with antipsychotic agents?

A)

Anticonvulsants

B)

Antiparkinson

C)

Antihypertensives

D)

Anxiolytics

7.

Water intoxication is associated with schizophrenia. The possible cause is related to the effects of antipsychotic drugs on which gland of the body?

A)

Parathyroid

B)

Thyroid

C)

Pituitary

D)

Pineal

8.

Which of the following psychotic disorders is exhibited by a mood episode and active symptoms of schizophrenia that occur together, which is preceded by delusions and hallucinations?

A)

Shared psychotic disorder

B)

Brief psychotic disorder

C)

Schizophreniform disorder

D)

Schizoaffective disorder

9.

The nurse is reviewing a care plan for a patient diagnosed with schizophrenia who is receiving antipsychotic medication. The nurse would expect to find which priority outcome for this client?

A)

Decreased delusional thinking

B)

Improved communication

C)

Complies with therapeutic drug regimen

D)

Ability to meet self-care needs

10.

A client diagnosed with schizophrenia comes to the outpatient mental health clinic very disheveled, with body odor and an unkempt beard. The nurse suspects which of the following negative symptoms of schizophrenia?

A)

Anhedonia

B)

Avolition

C)

Alogia

D)

Autism

11.

A client diagnosed with schizoaffective disorder has a nursing diagnosis of impaired verbal communication. Which of the following intervention would be most appropriate?

A)

Develop alternate communication methods.

B)

Place the client in a group therapy session.

C)

Establish a one-to-one relationship.

D)

Allow the client to be alone at specific times.

12.

A client is taking haloperidol (Haldol) for chronic schizophrenia. The nursing assessment reveals muscular rigidity, hyperthermia, and an altered level of consciousness. These symptoms are consistent with which of the following?

A)

Akathisia

B)

Dystonia

C)

Neuroleptic malignant syndrome

D)

Tardive dyskinesia

13.

The client is experiencing extrapyramidal side effects from taking antipsychotic drugs. Which medication may be used to counteract these side effects?

A)

Haloperidol (Haldol)

B)

Chlorpromazine (Thorazine)

C)

Fluphenazine (Prolixin)

D)

Benztropine (Cogentin)

14.

The priority nursing intervention for a client diagnosed with catatonic schizophrenia includes which of the following?

A)

Leaving the client alone

B)

Administering the prescribed lithium carbonate (Lithane)

C)

Meeting the basic needs of the client

D)

Allowing the client to communicate feelings

15.

Which behavior is characteristic of catatonic schizophrenia?

A)

Waxy flexibility

B)

Mania

C)

Disorganized speech

D)

Silly laughter

16.

A client states, Everyone is out to get me. They are trying to get into my head. They are watching me. The nurse suspects which type of schizophrenia?

A)

Catatonic

B)

Disorganized

C)

Paranoid

D)

Undifferentiated

17.

A client is admitted to the inpatient mental health unit with paranoid schizophrenia. Which of the following assessment parameters would be most important for the nurse to observe?

A)

Hygiene

B)

Communication patterns

C)

Ability to make decisions

D)

Motor activity

18.

Which of the following is a true statement regarding schizophrenia?

A)

Early onset is more common in women than in men.

B)

It affects 10% of the general population.

C)

Women tend to experience less severe symptoms.

D)

Most symptoms are cured with antipsychotic medications.

19.

A client has been prescribed clozapine (Clozaril) for the treatment of schizophrenia. The nurse notes that this medication is associated with which of the following life-threatening side effects?

A)

Neuroleptic malignant syndrome

B)

Tardive dyskinesia

C)

Agranulocytosis

D)

Dystonia

20.

The nurse is reviewing a care plan for an assigned client diagnosed with paranoid schizophrenia. Which of the following would be a priority diagnosis for this client?

A)

Risk for self-directed violence

B)

Altered nutrition, less than body requirements

C)

Defensive coping

D)

Altered family processes

Answer Key

1.

D

2.

B

3.

B

4.

D

5.

B

6.

B

7.

C

8.

D

9.

C

10.

B

11.

C

12.

C

13.

D

14.

C

15.

A

16.

C

17.

C

18.

C

19.

C

20.

A

Chapter 12 Personality Disorders 1.

The nurse is caring for a client who is exhibiting manipulative behaviors.

The nurse would be correct in implementing which of the following?

A)

Allowing for expression of feelings by the client

B)

Negative reinforcement

C)

Limit setting

D)

Emphasis-guided imagery

2.

The nurse is interviewing a client diagnosed with avoidant personality disorder. The nurse would expect this client to exhibit which of the following behaviors?

A)

Preoccupation with details

B)

Extreme shyness

C)

Inability to make decisions

D)

Manipulation

3.

Which of the following would be listed as a cluster A personality disorder according to the DSM-IV-TR?

A)

Paranoid

B)

Obsessive-compulsive

C)

Dependent

D)

Avoidant

4.

Which of the following would be inconsistent with the diagnosis of obsessive-compulsive personality disorder?

A)

Focus on details

B)

Stubbornness

C)

Insecurity

D)

Hoarding of items

5.

A client diagnosed with borderline personality disorder who is selfmutilating has been admitted to the inpatient medical unit. Which of the following interventions would take priority for this client?

A)

Identify the triggers of acting-out behaviors.

B)

Develop a no-harm contract.

C)

Explain the rules of the unit.

D)

Encourage the client to participate in unit activities.

6.

Which of the following behaviors would the nurse expect to assess in the client diagnosed with narcissistic personality disorder?

A)

Sense of entitlement

B)

Attention-seeking behavior

C)

Unstable relationships

D)

Blood stains on clothing

7.

A client is upset with a nurse on the inpatient mental health unit. She states to another client, That nurse is mean and hates me. I want to have another nurse take care of me because that nurse is nice all the time. The client is exhibiting which manifestation of borderline personality disorder?

A)

Dissociation

B)

Impulse

C)

Manipulation

D)

Splitting

8.

A client is diagnosed with histrionic personality disorder. The interventions should focus on which of the following behaviors?

A)

Preoccupation with orderliness

B)

Fear of disapproval

C)

Dependency needs

D)

9.

Extreme egocentricity

Which of the following behaviors by the client diagnosed with dependent personality disorder would show progression toward increasing ability to problem solve?

A)

Utilizing appropriate manners

B)

Asking questions of the nurse

C)

Exhibiting a relaxed posture

D)

Gaining control over impulses

10.

When assessing a client diagnosed with antisocial personality disorder, the nurse would expect to observe which of the following?

A)

Deceit and dishonesty

B)

Grandiose view of self

C)

Inability to make self-care decisions

D)

Preoccupation with orderliness

11.

Which of the following thought patterns is consistent with the diagnosis of schizotypal personality disorder?

A)

Self-absorbed thoughts

B)

Magical thinking

C)

Egocentric

D)

Preoccupation with perfection

12.

Which cluster of personality disorders exhibits anxious and fearful types of behavior?

A)

Cluster A

B)

Cluster B

C)

Cluster C

D)

Cluster D

13.

A nurse is caring for a client diagnosed with borderline personality disorder.

The nurse would expect which priority nursing diagnosis in the care plan?

A)

Self-esteem disturbance, related to unmet dependency needs

B)

Risk for violence, self-directed, related to self-mutilating behaviors

C)

Impaired communication, related to social withdrawal

D)

Impaired social interaction, related to indifference toward others

14.

A client is being seen in the mental health clinic. When taking the health history, the nurse notes that the client has a history of vandalism, verbal assaults, and truancy. These behaviors are consistent with which of the following personality disorders?

A)

Dependent personality disorder

B)

Narcissistic personality disorder

C)

Antisocial personality disorder

D)

Borderline personality disorder

15.

Which of the following clients diagnosed with a personality disorder feels a sense of entitlement?

A)

Antisocial

B)

Narcissistic

C)

Histrionic

D)

Dependent

16.

Which personality disorder would be consistent with the nursing diagnosis of impaired social interaction, related to indifference toward others?

A)

Schizoid personality disorder

B)

Histrionic personality disorder

C)

Dependent personality disorder

D)

Antisocial personality disorder

17.

When assessing a client diagnosed with borderline personality disorder, it would be most important for the nurse to assess for which of the following?

A)

Inconsistencies between vocalizations and behaviors

B)

Scars or cuts

C)

Nonverbal behaviors

D)

Resistance to questioning

18.

A client diagnosed with antisocial personality disorder is being seen in the health clinic. Which of the following would be the most appropriate outcome for this client?

A)

Increases interactions with others

B)

Exhibits relaxed posture

C)

Decreases manipulative behaviors

D)

Gains control over impulses

19.

Which of the following clusters of personality disorders is associated with odd or eccentric behaviors?

A)

Cluster A

B)

Cluster B

C)

Cluster C

D)

Cluster D

20.

Which of the following personality disorders has an increased risk of abuse associated with it?

A)

Histrionic

B)

Dependent

C)

Schizoid

D)

Borderline

Answer Key

1.

C

2.

B

3.

A

4.

C

5.

B

6.

A

7.

D

8.

D

9.

B

10.

A

11.

B

12.

C

13.

B

14.

C

15.

B

16.

A

17.

B

18.

D

19.

A

20.

B

Chapter 13 Somatic Symptom and Related Disorders 1.

The term used to explain physical complaints and symptoms that are expressed because of psychologic stress is what?

A)

Hysteria

B)

Somatization

C)

Psychophysiologic

D)

Somatoform

2.

A 36-year-old male comes to the clinic complaining of severe headaches.

After assessing the client and reviewing test results, the physician finds no physical cause for the headaches. The physician believes that the client has a psychophysiologic syndrome. What is the client getting from the attention of the health care workers?

A)

Displacement of anxiety

B)

Primary gain

C)

Secondary gain

D)

Repression of trauma

3.

A client is seen in the outpatient clinic for the first time. When reviewing the history, the nurse notes that the client has a long history of being seen by many different doctors. The client has also had multiple exploratory surgeries with nothing found to cause the clients problem. What would the nurse suspect of this patient?

A)

A slow growing cancer

B)

Hypochondriasis

C)

A central nervous system disorder

D)

A somatoform disorder

4.

What symptoms would a client with a somatoform disorder complain of?

(Mark all that apply.)

A)

At least two gastrointestinal symptoms

B)

Severe headaches and visual problems

C)

Pain in at least four different locations

D)

A sexual or reproductive problem

E)

Flatus and diarrhea

5.

A client with somatoform disorder is commonly found to be what?

A)

Depressed

B)

Delusional

C)

Demyelinated

D)

Deceptive

6.

A client with somatoform disorder has become enraged with his coworker.

What would be a common threat for the client to make in order to manipulate his coworker into meeting his needs?

A)

Quitting his job

B)

Going on a hunger strike

C)

To kill himself

D)

To kill someone else

7.

You are researching somatoform disorder for your mental health nursing class. What ethnic populations would you find this disorder is most prevalent in?

A)

Greek and Hispanic

B)

Spanish and Puerto Rican

C)

Hispanic and Arabic

D)

Greek and Puerto Rican

8.

A)

A client with somatoform disorder has been admitted to the inpatient unit of the local hospital. The nurse would know to assess for what other personality disorder that is often seen in these clients?

Borderline

B)

Paranoid

C)

Histrionic

D)

Hypochondria

9.

A mental health nurse working with somatoform clients knows that primary care physicians are an important part of these clients treatment. Why does a trusting relationship need to be fostered between the client and the primary care physician?

A)

To provide medical input into the care plan

B)

To prevent the pattern of repeat medical treatment by a series of physicians

C)

To prevent adverse interactions in pharmacotherapy

D)

To provide support to the clients and their support system

10.

As a mental health nurse practitioner, you are treating a client with a somatoform disorder and a comorbidity of depression. You know that this patient will most likely benefit from what?

A)

Reassurance that there is no serious medical reason for the symptoms

B)

Psychotherapy

C)

An antidepressant

D)

An antianxiety agent

11.

What alternative therapies have been found helpful for some patients with somatoform disorders? (Mark all that apply.)

A)

Pharmacotherapy

B)

Massage therapy

C)

Herbal medicine

D)

Meditation

E)

12.

Group therapy

When taking a health history on a new client with a somatoform disorder, what is it that is most important to elicit?

A)

Any familial diseases

B)

Any genetic diseases

C)

Any surgical procedures

D)

Any pattern of repeated complaints

13.

When writing a care plan for a client with a somatoform disorder, what nursing diagnosis would most likely be included?

A)

Self-esteem disturbance, related to repressed unmet dependency needs and unsatisfactory interpersonal relationships

B)

Sexual dysfunction, related to an inability to feel pleasure

C)

Self-care deficit, related to loss of function

D)

Chronic pain, related to severe physical ailment

14.

You are updating a care plan for a client with a somatoform disorder. What outcome would you expect to have met before the client is discharged from the hospital?

A)

Demonstrates the use of manipulative behavior to secure attention

B)

Expresses positive feelings about self

C)

Verbalizes minor body defects and related feelings

D)

Performs self-care needs with assistance

15.

A mental health nurse practitioner has a client with a somatoform disorder.

This client is being seen on an outpatient basis. What is a realistic outcome the nurse practitioner would expect of this client near the end of the nursepatient relationship?

A)

Expresses feelings of pain and distress

B)

Verbalizes alteration in physical functioning

C)

Discusses present health problem with health care provider and family

D)

Acknowledges physical pain

16.

You are caring for a client with a conversion disorder. What would be an appropriate nursing diagnosis for this client?

A)

Sleep pattern disturbance, related to sleep apnea

B)

Self-esteem disturbance, related to repressed unmet dependency needs and unsatisfactory interpersonal relationships

C)

Body image disturbance, related to severe anxiety or low self-esteem

D)

Self-care deficit, related to perceived loss of function or paralysis of body part

17.

What would be your first nursing intervention when caring for a client with a somatoform disorder?

A)

Establishing a trusting relationship

B)

Providing a comfortable environment

C)

Identifying positive feelings that the client may have

D)

Helping the client face his or her responsibilities

18.

You are caring for a client who is exhibiting psychophysiologic behaviors.

What would be an important nursing intervention for you to use?

A)

Encourage confrontation concerning the psychologic defense nature of the symptoms.

B)

Respond to the client with understanding and patience.

C)

Identify fulfilled dependency needs of the client.

D)

Maximize time and attention given to physical symptoms.

19.

You are admitting a client to the clinic who exhibits psychophysiologic behaviors. What nursing intervention would be appropriate to use with this patient?

A)

Confront the client when he or she exhibits psychophysiologic behaviors.

B)

Recognize that the physical complaints are phantom to the client even though supportive medical evidence is lacking.

C)

Remember that the client is not consciously trying to be sick or avoid responsibilities.

D)

Observe behaviors unrelated to current illness.

20.

The mental health nurse is caring for a client with psychophysiologic behaviors. What would be an important intervention for the nurse with this client?

A)

Encourage confrontation concerning the psychologic defense nature of the symptoms.

B)

Encourage the client to use physical means to express feelings.

C)

Maximize the time and attention given to physical symptoms.

D)

Continue to monitor physical complaints to assist in ruling out any actual cause for the symptoms.

21.

When evaluating the nursing interventions used with a client exhibiting psychophysiologic behaviors, what is the nurses focus?

A)

The clients ability to recognize the underlying psychologic stress and anxiety

B)

The clients ability to decrease the manipulative behavior

C)

The clients ability to perform self-care activities independently and willingly

D)

The clients ability to verbalize the physical deficits

22.

A client diagnosed with conversion disorder may exhibit what?

A)

Severe pain

B)

Munchausen syndrome

C)

La belle indifference

D)

Physician-shopping

23.

What somatoform disorder is considered to be a chronic condition with an onset in the late teens, have intermittent reoccurrence over a lifetime, and occur with equal prevalence in both men and women?

A)

Body dysmorphic disorder

B)

Hypochondriasis

C)

Pain disorder

D)

Conversion disorder

24.

A father brings his 10-year-old daughter to see the pediatrician for complaints that lead to a differential diagnosis of somatoform disorder. The father tells the pediatrician that the childs mother was diagnosed with somatoform disorder 18 months ago. Why might this child adopt familial patterns of behavior?

A)

To be more like her mother

B)

So her daddy will love her as much as he loves her mother

C)

To gain the attention of others in the family

D)

To be loved more than her siblings

25.

An adolescent has been diagnosed with conversion disorder and is being seen in the local mental health clinic. The clients mother asks the nurse what the prognosis for this disorder is. What would be the nurses best response?

A)

Unfortunately, this disorder tends to recur in times of severe stress.

B)

Most clients recover in 2 to 4 weeks without reoccurrence.

C)

Most clients recover in 8 to 12 weeks without reoccurrence.

D)

Unfortunately, most patients never truly recover from this disorder.

26.

A client is being admitted to the psychiatric unit with a somatoform disorder. When assessing the client, what should the nurse be sure to assess?

A)

Whether the persons lifestyle has improved

B)

Previous coping skills

C)

Any behavior that indicates independence

D)

Is the client aware of events surrounding the disappearance of symptoms

27.

When assessing a client with a somatoform disorder, how would the mental health nurse assess the clients secondary gains?

A)

By asking questions concerning the type and amount of medications the client is taking

B)

By asking questions to elicit any pattern of repeated complaints by taking a history of current and past health status

C)

By asking questions concerning any previous work or activity the client used to be able to do that he or she is unable to perform as a result of the symptoms

D)

By asking questions concerning physical complaints

28.

An 18-year-old girl is diagnosed with body dysmorphic disorder. She has perceived her breasts as being too small. What symptoms would this client exhibit?

A)

A sedentary lifestyle

B)

Periods of checking and attempting to alter the defect

C)

Seeing the flaw as slight

D)

Feeling that they are one of a kind

29.

A 13-year-old boy is brought to the emergency department by his parents because he has lost the use of his right upper extremity. After medical testing, the physician tells the parents that there is no neurologic reason that can be found for the clients loss of functioning. The parents ask the nurse to explain what this means. What would be the nurses best response?

A)

The actual conversion aspect of this disorder refers to the transfer of psychologic conflict or stressors into a perceived paralysis of body parts or sensory functioning.

B)

This is not an unusual occurrence in an adolescent when there is trouble in the home.

C)

Usually there are related stress or trauma factors that have occurred concurrently with the onset of the symptoms.

D)

These types of disease processes are considered pseudoneurologic, or false neurologic.

30.

A 24-year-old female client presents at the clinic with specific complaints of a physical illness. This is the 5th time in 5 months this client has been seen.

The nurse identifies what signs and symptoms that indicate hypochondriasis? (Mark all that apply.)

A)

Concerns continue despite medical testing and reassurance that a disease does not exist

B)

Multiple symptoms that begin before age 30 and extend over a period of years

C)

Creates enough distress to cause difficulty in social or work-related functioning over a period of 6 months or more

D)

Also referred to as Briquets syndrome

E)

An excessive fear or preoccupation with having a serious illness that is based on a misinterpretation of somatic signs and symptoms

Answer Key

1.

B

2.

C

3.

D

4.

A, C, D

5.

A

6.

C

7.

D

8.

A

9.

B

10.

C

11.

B, C, D

12.

D

13.

A

14.

B

15.

C

16.

D

17.

A

18.

B

19.

C

20.

D

21.

A

22.

C

23.

A

24.

C

25.

B

26.

B

27.

C

28.

B

29.

D

30.

A, C, E

Chapter 14 Dissociative Disorders

1.

A client is brought to the emergency department by her spouse. The spouse tells the nurse that when they woke up that morning, his wife did not know who she was. The nurse knows that a differential diagnosis for this client would be what?

A)

Dissociative disorder

B)

Trauma-induced amnesia

C)

Intracranial bleed

D)

Conversion disorder

2.

When a client has a dissociative disorder, the ordinarily organized functions become disturbed. What are these functions? (Mark all that apply.)

A)

Mobility

B)

Memory

C)

Identity

D)

Conscious awareness

E)

Pain awareness

3.

After a train accident, a 19-year-old male is admitted to a local hospital unable to remember any personal information covering the entire scope of his life. What diagnosis would the nurse expect this patient to have?

A)

Depersonalization disorder

B)

Dissociative amnesia

C)

Dissociative identity disorder

D)

Dissociative fugue

4.

A client presents at the mental health clinic with complaints of experiencing a feeling of being unreal. The client is a 37-year-old female who lost her husband and two children in an automobile accident 3 months ago. The client retains insight and is aware that the experience is not real. The nurse knows that this client is displaying signs and symptoms of what?

A)

Dissociative amnesia

B)

Dissociative identity disorder

C)

Depersonalization disorder

D)

Dissociative fugue

5.

A female client, aged 27, is being seen at the clinic. The client describes her symptoms as auditory hallucinations, memory gaps, and sudden breaks in the continuity of her thought process. The nurse recognizes that the client is describing symptoms for what dissociative disorder?

A)

Dissociative amnesia

B)

Dissociative identity disorder

C)

Depersonalization disorder

D)

Dissociative fugue

6.

A 42-year-old male is brought to the emergency department by his brother.

The brother tells the nurse that the client has traveled across the country to attend the funerals of their parents who died in a car accident a week ago.

The brother tells the nurse that the client claims to be someone he is not but otherwise seems quite normal. What would the nurse suspect that this client has?

A)

Dissociative amnesia

B)

Dissociative identity disorder

C)

Depersonalization disorder

D)

Dissociative Fugue

7.

A client has a differential diagnosis of dissociative fugue. What signs and symptoms would the nurse know to assess for? (Mark all that apply.)

A)

Inability to recall relevant personal information

B)

Mood swings

C)

Flashbacks

D)

Suicidal behaviors

E)

Assumption of a new identity

8.

After a tornado flattens her home, a 65-year-old female is brought to the local clinic by her son. He tells the nurse that his mother cannot remember anything that has happened since the storm hit and has forgotten pieces of her identity such as having lived in the house she lost for 10 years. What would the nurse know is wrong with this patient?

A)

Localized amnesia

B)

Selective amnesia

C)

Generalized amnesia

D)

Continuous amnesia

9.

A client with a dissociative disorder is going through the therapeutic process. What is the ultimate goal of the therapeutic process for this patient?

A)

To identify the traumatic event that caused the dissociation

B)

To get the client in touch with his or her negative feelings about the traumatic event

C)

To assist in diagnosing which dissociative disorder the client has

D)

To integrate the fragmented personalities into one identity

10.

A client with a dissociative disorder is undergoing treatment. Why is diagnostic testing done with these clients?

A)

To determine if there are any coexisting mental health conditions

B)

To identify which dissociative disorder the client has

C)

To identify treatment methods used in integrating fragmented personalities

D)

To determine if there are any coexisting physical conditions

11.

A client with a dissociative disorder is being seen in the mental health clinic. Pharmacotherapy is being discussed with the client. What classifications of drug does the nurse know that are used to treat these disorders?

A)

Antianxiety drugs and nonnarcotic pain relievers

B)

Antianxiety drugs and antidepressants

C)

Antidepressants and antiseizure drugs

D)

NSAIDS and mood-stabilizing drugs

12.

A client has been diagnosed with a dissociative disorder. What treatments would the nurse know could be used for this client? (Mark all that apply.)

A)

Electroconvulsive therapy

B)

Seclusion therapy

C)

Hypnosis

D)

Creative art processes

E)

Cognitive techniques

13.

A)

A client has been diagnosed with dissociative fugue. What would be an appropriate nursing diagnosis for this client?

Risk for violence, related to repressed anger

B)

Altered thought processes, related to pseudoparalysis

C)

Self-care deficit, related to aimless wandering

D)

Personality identity disturbance, related to derealization

14.

You have just admitted a client to your unit diagnosed with depersonalization disorder. What would be the most appropriate nursing diagnosis for this client when developing the clients care plan?

A)

Self-care deficit, related to mechanical trance-like state or aimless wandering

B)

Sensory perceptual alteration, related to depersonalization and view of self

C)

Anxiety, related to repressed traumatic events or loss of identity

D)

Family coping ineffective, related to loss of identity

15.

A nurse working in a small rural hospital is on duty when a fire breaks out in the local movie theater. The hospital emergency department is used to triage and stabilize many of the townspeople before having them transported to trauma centers and burn units in neighboring cities. Shortly after the last client is transported, the nurse asks one of the physicians what happened to all the townspeople. She tells the physician that she remembers the hospital was notified of a fire in the movie theater and she remembered receiving four clients into the emergency department who had been injured in the fire, but she thought there should have been many more clients admitted. This nurse was exhibiting signs and symptoms of what?

A)

Localized amnesia

B)

Selective amnesia

C)

Generalized amnesia

D)

Continuous amnesia

16.

You are developing a care plan for a client diagnosed with dissociative amnesia. What nursing diagnosis would you be sure to include in this clients plan of care?

A)

Sensory perceptual alteration, related to depersonalization and view of self

B)

Self-care deficit, related to mechanical trance-like state or aimless wandering

C)

Altered thought processes, related to memory loss and repressed trauma

D)

Ineffective individual coping, related to travel away from home

17.

Which of the following would be the least likely expected outcome for a client with a diagnosis of dissociative identity disorder?

A)

Demonstrates self-control over behaviors toward self and others

B)

Performs self-care activities independently

C)

Verbalizes perceptions of environmental stimuli that are different from what others experience when faced with stressful situations

D)

Associates memory deficit with past stressful events

18.

When caring for a client with a dissociative disorder, the mental health nurse knows that the family must be included in the plan of care. What is an appropriate outcome for the family of a client with a dissociative disorder?

A)

Demonstrates unconditional support of the client and of the family unit

B)

Verbalizes realistic expectations for the clients behavior and treatment process

C)

Willingly participates in pharmacotherapy of the client

D)

Supports the client in all stages of recovery process including cure

19.

When caring for clients with dissociative disorders, the mental health nurse knows that a trusting and therapeutic relationship with the client must first be established. Why are active listening and communication techniques that encourage verbalization of feelings, conflicts, and information regarding the traumatic events that led to the current dissociative state important parts of this process?

A)

Creates a sympathetic relationship with the client

B)

Assists the client in accepting advice from the nurse

C)

Assists the client to develop personal insight

D)

Creates an atmosphere where selfdefeating and damaging behaviors are more acceptable

20.

A mental health nurse is developing a plan of care for a new client diagnosed with a dissociative disorder. A nursing intervention that is important to include in the plan of care for this client is to encourage and support the client in the achievement of control over anxiety and previous dissociative response to those situations that trigger the symptoms. Why is this intervention so important?

A)

Clients are afraid of their selfdestructive behaviors.

B)

These clients need a safe environment to protect themselves from self-injury.

C)

Use stimuli that stimulate pleasant memories and pleasurable feelings for the client.

D)

Clients are overwhelmed with fear of not knowing or being out of control.

21.

When caring for a client with a dissociative disorder, what is the best nursing intervention to aid in preventing the clients regression further into the dissociative state?

A)

Avoid flooding the client with details of past traumatic events.

B)

Use stimuli that stimulate pleasant memories and pleasurable feelings for the client.

C)

Model positive and desired behaviors.

D)

Develop a contract between the client and the staff for dealing with selfdestructive behaviors.

22.

The mental health nurse spends a great deal of time with clients diagnosed with a dissociative disorder. Because of this fact, what is it important for the nurse to do?

A)

Promote a safe environment to protect the client from self-injury or injury to others.

B)

Model positive and desired behaviors.

C)

Develop a contract between the client and the staff for dealing with selfdestructive behaviors.

D)

Decrease anxiety-producing stimuli.

23.

When engaging in a therapeutic relationship with a client diagnosed with a dissociative disorder, it is important to use stimuli that stimulate pleasant memories and pleasurable feelings for the client. Why?

A)

Stops the regression of the client into further self-destructive behaviors

B)

Develops a contract between the client and the staff for dealing with selfdestructive behaviors

C)

Assists the client to remember past experiences without the risk of precipitating increased trauma

D)

Helps the client to understand that periods of imbalance are to be expected and will decrease as the personal identity is restored

24.

A client with a dissociative identity disorder tells the nurse that he or she is having thoughts of self-injury. The nurse knows that it is important to assist the client to identify alternative actions to self-injury. What are these actions? (Mark all that apply.)

A)

Written methods of expression

B)

Describing what he or she wants to do to the nurse

C)

Physical exercise

D)

Asking for medicine to decrease anxiety

E)

Task-oriented activities

25.

When evaluating the clients progress toward identifying and demonstrating a more adaptive response to stressful stimuli, the nurse knows that this step is what?

A)

Necessary to increase the clients functioning

B)

Important to enlist the familys support in the treatment

C)

Integral in the adjustment of pharmacotherapeutic dosing

D)

Helpful in decreasing the dissociative response

26.

During the evaluation and revision process, the nurse needs to consider the clients progress toward understanding the relationship between the dissociative state and the increased anxiety that is felt as repressed past trauma is triggered by environmental factors. What would the nurse use to evaluate the clients progress toward this understanding so that revisions can be made if necessary?

A)

Ability to recall past traumatic events

B)

A decrease in self-destructive behaviors

C)

Imitation of the behaviors modeled by the nurse

D)

Acceptance by the family of the clients dissociative state

27.

You are evaluating the progress on a care plan for a client with dissociative identity disorder. What does evaluation center on for this client?

A)

The clients understanding of how the various states function as triggers to traumatic memories

B)

The clients acknowledgment of the existence of more than one personality

C)

The clients ability to control selfdestructive behaviors

D)

The clients aggressive tendencies toward others

28.

What can the nurse provide that allows the client a positive forward progression in the treatment process?

A)

A therapeutic relationship

B)

Alternative activities to thoughts of selfinjury

C)

A safe and trusting environment

D)

A sense of power and self-control

29.

The repressed memories associated with dissociative disorders are usually triggered by what?

A)

Early childhood traumas

B)

Clients inability to deal with anxiety

C)

Nonsupportive family

D)

Environmental factors

30.

What are the signs and symptoms of dissociative fugue? (Mark all that apply.)

A)

Most cases last only hours or days

B)

Recovery is typically abrupt with the client in a state of disorientation

C)

Occurs most often in adolescents

D)

Usually caused by a traumatic event that has resulted in severe psychologic stress

E)

Generally occurs during times of transition in the clients life, such as midlife crisis

Answer Key

1.

A

2.

B, C, D

3.

B

4.

C

5.

B

6.

D

7.

B, D, E

8.

A

9.

D

10.

A

11.

B

12.

C, D, E

13.

C

14.

B

15.

B

16.

C

17.

C

18.

B

19.

C

20.

D

21.

A

22.

B

23.

C

24.

A, C, E

25.

D

26.

A

27.

B

28.

C

29.

D

30.

A, B, D

Chapter 15 Substance-Related Disorders

1.

A client calls the mental health clinic and asks to speak with the nurse. The client explains that he or she has recently been diagnosed with a substance problem and the way it was explained is that it has dependence. The client asks if the nurse can explain what that means. What should be the nurses response?

A)

Substance dependence means physiologic and psychologic dependence on alcohol or other drugs that affect the central nervous system in such a way that withdrawal symptoms are experienced when the substance is discontinued.

B)

I am sorry, I cant give you any information. You will have to ask your physician.

C)

Substance dependence means the person has a maladaptive pattern of use that shows physiologic, cognitive, and behavioral indications that the person continues to use the substance despite the resulting negative effects.

D)

Substance dependence means that you depend on alcohol or drug use to get through your normal daily activities.

2.

A mental health nurse is providing an educational event for the parent organization of one of the local high schools. The nurse is speaking on substance abuse. What is one of the topics the nurse knows should be included in this educational event?

A)

The violence associated with the drug cartels in other countries

B)

Why marijuana should not be legalized

C)

Research results on the medical use of marijuana

D)

The burden on society by drug-related criminal behaviors that involve both the participation in usage and the sale of drugs

3.

The staff educator is orienting new nurses at the local substance abuse clinic. Today she is discussing the need for treatment by the population that abuses alcohol and drugs. What percentage of those requiring treatment would the staff educator cite who actually receive treatment?

A)

10%

B)

11%

C)

12%

D)

13%

4.

During adolescence, what etiologic factor contributing to substance abuse is at its highest?

A)

Family history

B)

Genetics

C)

Peer pressure

D)

Gang violence

5.

Research has shown that social learning involves imitation, the effects of modeling, and identification behaviors. What is the best explanation of the results of this research in the etiology of substance abuse?

A)

Children of substance-abusing parents are at a greater risk for substance abuse.

B)

Social learning begins at an early age.

C)

Genetics plays a part in substance abuse.

D)

Children of substance-abusing parents have more subsequent problems from their behaviors.

6.

Personality characteristics cannot be discounted in the etiology of substance abuse. Which of these personality characteristics have been identified as part of the etiology of substance abuse? (Mark all that apply.)

A)

Difficulty expressing feelings

B)

Feelings of emotional isolation

C)

Gregariousness

D)

Timidity

E)

Low frustration tolerance

7.

When a member of a family has a substance abuse problem, how may this affect family members?

A)

They may exhibit fearful behaviors when the drug user is not around.

B)

They may display defensive actions to excuse the behavior of the drug user.

C)

They may intentionally increase the likelihood that the abusive pattern will continue.

D)

They may intentionally provoke physical abuse in an attempt to normalize the behavior of the drug user.

8.

The spouse of an alcoholic is attending their first Al-anon meeting. They ask what codependency means. What would be the best answer they could receive?

A)

A tacit agreement among family members that suppressed anger and emotional pain are a normal way of life

B)

A set of behaviors that make the family members feel safe and secure

C)

A multigenerational pattern of coping mechanisms that lead to self-defeating behaviors evolving from family dynamics that discourage a member from feeling or expressing needs

D)

An unconscious supporting of the abusers behavior as normal

9.

Codependent people internalize a form of guilt for the behavior of the abuser. What does this result in for them?

A)

Physiologic symptoms such as coronary syndromes

B)

The ability to recognize the detrimental effects of their codependency

C)

Mental health problems such as dissociative disorders

D)

Behaviors aimed at sustaining the relationship

10.

The nurses efforts in the reaching of treatment goals toward long-term sobriety are directed at what?

A)

To assist the client in living a substancefree full and productive life as a member of society

B)

To assist the client and family in healing family differences

C)

To assist the client in setting long-term life goals

D)

To assist the client and family in functioning outside the previous codependent behaviors

11.

What approach to substance abuse theorizes that substance abuse is a disease where family members are either drug users or codependent?

A)

Family therapy model

B)

Cognitive relationship model

C)

Family systems model

D)

Humanistic model

12.

An expected outcome toward long-term sobriety is what?

A)

Prevent seizures

B)

Decrease anxiety and promote relaxation

C)

Demonstrates willingness to participate in a group recovery treatment program

D)

Promote and maintain fluid and electrolyte balance

13.

You have admitted a client diagnosed with substance abuse intoxication to your unit. What will your nursing assessment be directed toward first?

A)

Data regarding genetic factors

B)

Data regarding the clients perception of the admitting problem

C)

Data regarding drug use

D)

Data regarding family history of substance abuse

14.

The mental health nurse is conducting an assessment interview with a new client. What should this initial assessment be directed toward? (Mark all that apply.)

A)

What substance was first used

B)

Type of substance being used

C)

Amount and frequency of use

D)

Method of administration

E)

Length of time between uses

15.

Nurses on your unit often use the CAGE questionnaire when screening for what?

A)

Use of physical violence

B)

The clients perception of current problem

C)

Knowledge of substance abuse

D)

Alcohol dependency

16.

An intoxicated client is admitted through the emergency department after being found passed out on the sidewalk in a temperature of 33C. What would be an appropriate nursing diagnosis for this client?

A)

Risk for injury

B)

Ineffective family coping

C)

Excessive and ineffective denial of problem

D)

Sleep pattern disturbance

17.

When developing a plan of care for a client identified with substance abuse issues, the nurse selects appropriate nursing diagnoses resulting from what?

A)

Problems affecting the clients dependence on codependent family behaviors

B)

Problems affecting the clients ability to function in ADLs

C)

Problems affecting the clients knowledge of the current problem

D)

Problems affecting the clients desire to discontinue the use of the substance

18.

An intoxicated client is admitted to your unit and standard orders are instituted including a banana bag of IV fluids and a nutritional assessment.

Based on these standard orders, what nursing diagnosis would be most appropriate for this client?

A)

Fluid volume deficit

B)

Altered nutrition

C)

Altered health maintenance

D)

Ineffective individual coping

19.

What is an appropriate expected outcome for a client in the recovery phase of substance abuse?

A)

Recognizes that problems may occur with the use of the substance

B)

Recognizes that external factors are not always the cause for substance use

C)

Identifies codependent behaviors in the immediate family

D)

Identifies the drug as a problem and takes ownership of the problem

20.

The nurse is talking with a client who has a diagnosis of substance abuse.

The client states, I dont know what to do to handle the stress in my life that makes me want to take drugs. Based on the clients statement, what expected outcome would the nurse identify when updating the clients plan of care?

A)

Identifies alternative coping mechanisms

B)

Verbalizes understanding of substance abuse

C)

Demonstrates increased feelings of selfworth

D)

Demonstrates efforts at positive change

21.

Your client is in the recovery phase of the substance abuse treatment. What outcome would you assess for?

A)

Decrease anxiety and promote relaxation

B)

Begins to develop or reestablish a support system with family, employer, and nonsubstance-using friends

C)

Promote a restful sleep pattern

D)

Prevent seizures

22.

In the detoxification phase of a clients treatment for alcohol abuse, multivitamin therapy and thiamine replacement therapy are used to prevent what?

A)

Cirrhosis

B)

Esophageal varices

C)

Wernicke-Korsakoff syndrome

D)

Zollinger-Ellison syndrome

23.

In a detoxification setting, what drug minimizes opiate withdrawal symptoms?

A)

Antabuse

B)

Narcan

C)

Dilantin

D)

Catapres

24.

You are caring for a client during acute substance withdrawal. What is considered the nursing standard of care for monitoring vital signs?

A)

Every 12 hours during the first 34 days of withdrawal

B)

Every 24 hours during the first 34 days of withdrawal

C)

Every 8 hours during the first 34 days of withdrawal

D)

Every shift during the first 34 days of withdrawal

25.

When caring for a client with substance abuse issues, what will the evaluation process used by the nurse depend on?

A)

Whether the client has relapsed

B)

The anticipated outcome

C)

Whether the client recognizes his or her responsibilities

D)

The phase of the treatment process

26.

What are the criteria for evaluating outcomes during the acute withdrawal phase as achieved? (Mark all that apply.)

A)

The client has not relapsed.

B)

The client has recognized the problem and taken ownership of it.

C)

The client exhibits no signs or symptoms of substance intoxication.

D)

The client has sustained no injuries during the detoxification period.

E)

The client exhibits no signs or symptoms of substance withdrawal.

27.

When evaluating outcomes for a client with substance abuse problems, what must the nurse remember?

A)

Ownership of the problem is not necessary.

B)

Abstinence is not necessary with all clients.

C)

Recovery is an ongoing process of commitment toward a goal of abstinence.

D)

Recovery is achieved when a client has not used a drug in 5 years.

28.

Nursing interventions toward preventing injury to the client during acute substance withdrawal may include what?

A)

Perform seizure precautions every 15 minutes.

B)

Perform seizure precautions every 30 minutes.

C)

Perform seizure precautions every 1 hour.

D)

Perform seizure precautions every shift.

29.

Codependent families establish a pattern of helping the abusers maladaptive behavior to continue. What is this referred to as?

A)

Enabling

B)

Abetting

C)

Encouraging

D)

Co-opting

30.

When learning about caring for clients with substance abuse, the nurse learns that what is considered a major factor in the onset and continued use of alcohol and other drugs?

A)

Weak character

B)

High anxiety level

C)

Addiction

D)

Stress

Answer Key

1.

C

2.

D

3.

B

4.

C

5.

A

6.

A, B, E

7.

B

8.

C

9.

D

10.

A

11.

C

12.

C

13.

C

14.

B, C, D

15.

D

16.

A

17.

B

18.

C

19.

D

20.

A

21.

B

22.

C

23.

D

24.

A

25.

B

26.

C, D, E

27.

C

28.

A

29.

A

30.

D

Chapter 16 Eating Disorders 1.

A 12-year-old girl is brought to the pediatrician for her annual physical examination. The nurse notes that the girl has lost 15 pounds over the past 6 months when she was last seen for bronchitis. The nurse asks the child if she has been dieting and the girl proudly responds yes. What would the nurse suspect of this child?

A)

She has anorexia nervosa, restricting subtype.

B)

She has anorexia nervosa, binge eating/ purging subtype.

C)

She has bulimia nervosa.

D)

She has type I diabetes mellitus

2.

How does the DSM-IV-TR define binge eating?

A)

Eating a great deal of food in a short period of time and then returning to normal intake.

B)

Eating in a discrete period of time (usually less than 2 hours) an amount of food that is definitely larger than most people would eat under similar circumstances.

C)

Eating an overabundance of a specific type of food (sweets, fruits, vegetables) in a short period of time.

D)

Periodically overindulging in a specific type of food (usually sweets or fast food) in a short period of time and then returning to normal dietary intake.

3.

Binge eating in anorexia nervosa is usually followed by purging. A mental health nurse knows that purging is defined as what?

A)

Use of laxatives on a daily basis

B)

Evacuation of the digestive tract by eating until you vomit

C)

Overuse of diuretics until fluid volume depletion occurs

D)

Evacuation of the digestive tract by selfinduced vomiting or excessive use of laxatives and diuretics

4.

A 14-year-old girl is brought to the clinic by her mother. Her mother tells the nurse that on several occasions, she has found her daughter during the night eating things like a whole pizza or a carton of ice cream. The nurse asks the girl about this behavior and the girl begins to cry. The nurse knows that this behavior is a symptom of what?

A)

Anorexia nervosa, restricting subtype

B)

Anorexia nervosa, binge eating/purging subtype

C)

Bulimia nervosa

D)

Type I diabetes mellitus

5.

When learning about bulimia nervosa, what would the student nurse learn is the second primary symptom of this disease?

A)

Daily use of laxatives or diuretics

B)

Vomiting until an electrolyte imbalance is induced

C)

Shame and guilt over binging

D)

Repeated use of inappropriate and risky methods of preventing weight gain

6.

The nurse is explaining the etiology of bulimia nervosa to the mother of a preteen newly diagnosed with the disorder. What would the nurse tell the mother the behaviors center on?

A)

A dissatisfaction with body size and shape

B)

An outward preoccupation with dieting

C)

Limiting food intake with little or no alteration in weight or appearance

D)

The shame and guilt of the behaviors

7.

A 12-year-old boy is diagnosed with bulimia nervosa. When providing client education to the parents of the client, the nurse points out that what is common in clients afflicted with bulimia nervosa?

A)

Inpatient hospital treatment

B)

Physical ailments related to extreme weight loss

C)

Substance abuse

D)

Aggression and violence

8.

A 24-year-old male client presents at the mental health clinic telling the nurse, I just cant seem to maintain any interpersonal relationships. On assessment, the nurse notes that the clients social skills appear inadequate.

The client is subsequently diagnosed with bulimia nervosa. Knowing what you do about this disease process, why would the inadequate social skills and interpersonal relationship problems occur in this patient?

A)

Because of the clients need to control

B)

Because of the clients lying and hidden behaviors

C)

Because of the clients obsession with the weight

D)

Because of the clients binging and purging behaviors

9.

A male client in his late 20s is diagnosed with binge-eating disorder. What etiologic factors does the nurse know most individuals with this disorder have? (Mark all that apply.)

A)

The client has maladaptive social skills.

B)

The client is generally considered a loner.

C)

The client is overweight at a young age.

D)

The client has low self-image.

E)

The client has impulsive behaviors.

10.

The etiology of anorexia nervosa begins before adolescence. Evidence usually reveals what in these clients?

A)

The child is pushed to be independent.

B)

They are raised to believe that looks are everything.

C)

Unresolved family conflicts with inconsistent patterns of overprotective and rigid parenting.

D)

Decisions are usually made with parents.

11.

As a nurse who works with clients diagnosed with eating disorders, you know that to elicit unbiased data from the client it is important for you to do what?

A)

Confront the clients when you believe they are lying

B)

Elicit data on how the clients view their body

C)

Encourage the clients to discuss their needs with their families

D)

Examine your own feelings about food, dieting, and body image

12.

When assessing a client, what data should be collected? (Mark all that apply.)

A)

Intolerance to heat

B)

Reports of insomnia

C)

Intolerance to cold temperatures

D)

Decreased fatigue

E)

Increased anxiety level

13.

You are assessing clients on the eating disorder unit. You know that it is important to assess changes in bowel elimination or decreased urine output because they relate to what?

A)

Multisystem organ failure related to excessive weight loss

B)

Laxative or diuretic use

C)

An acute physiologic response to the disease process

D)

Kidney failure brought on by starvation

14.

You are the nurse in a pediatric clinic who is caring for a 16-year-old female client. When conducting the assessment, you note what signs that would indicate to you a possible eating disorder? (Mark all that apply.)

A)

Normal skin turgor

B)

Eroded tooth enamel

C)

Weight/height WNL

D)

Brittle dry nails

E)

Decreased hair growth

15.

You are assessing a new client on the unit who has been admitted for observation after a motor vehicle accident. The client is a female, aged 22 years, appearing well nourished. Vital signs are WNL. Weight:height ratio is WNL. During your assessment, you note abrasions on the back of the clients hands. What would this indicate to you?

A)

Possible recent fist fight

B)

The client has a cat

C)

Recent gardening work

D)

Possible induced purging

16.

A client is admitted to the eating disorder unit. During the assessment, the client tells the nurse about having difficulties with constipation. What would be an appropriate nursing diagnosis for this client?

A)

Fluid volume deficit

B)

Body image disturbance

C)

Anxiety

D)

Altered bowel elimination

17.

A client newly admitted to the eating disorder unit is obsessed with exercise. What would be the most appropriate expected outcome for this client?

A)

Participates in activity level appropriate for health maintenance

B)

Participates in activity level appropriate for weight loss

C)

Participates in activity level appropriate for steady weight gain

D)

Participates in activity level appropriate for current intake level

18.

You are developing a plan of care for a client with a diagnosis of binge eating. What would be an appropriate outcome for this client?

A)

Discusses present health problem with no one

B)

Exhibits no self-destructive behaviors

C)

Identifies ways to maintain the current means of weight control

D)

Discusses the unimportance of appropriate eating pattern

19.

A client with an eating disorder is found to have altered oral mucous membranes. The mental health nurse would know that this is related to what?

A)

Altered nutritional status

B)

Periodontal disease

C)

Frequent vomiting

D)

Damage from induced purging

20.

Clients with eating disorders usually discover the onset of the disease to be triggered by childhood events. Based on this knowledge, which of the following are appropriate nursing diagnoses for these clients? (Mark all that apply.)

A)

Body image disturbance

B)

Powerfulness

C)

Anxiety

D)

Posttrauma response

E)

Social gregarity

21.

When working with clients who have eating disorders, what roles may a nurse fill? (Mark all that apply.)

A)

Meeting the physiologic needs of the client

B)

Teaching

C)

Being a group leader

D)

Psychotherapist

E)

Adjusting pharmacotherapeutic interventions

22.

A)

The mental health nurse knows that an effective intervention for a client with an eating disorder is what?

Weigh the client daily, before breakfast, using the same scale.

B)

Discuss the initiation of a behavior modification program that the client does not want.

C)

Restrict time for meals to 15 minutes to reduce focus on food and eating.

D)

Use a firm and supportive approach to all behaviors.

23.

A client on an eating disorder unit is scheduled to have a family therapy session tomorrow. The goal of the scheduled session is to educate the family. The family calls and tells the nurse that they cannot make it to the scheduled session. What is the most appropriate intervention for the nurse at this time?

A)

Comfort the client.

B)

Encourage the family to participate in education about the clients disorder and family processes.

C)

Tell the family that they are impeding the clients recovery process.

D)

Call the social worker to enlist his or her help with the family.

24.

A client with anorexia nervosa is talking with the nurse. The client states, How do I learn to be a normal person? When updating the clients plan of care, what would be the most important nursing action to include?

A)

Use a firm and supportive approach to eating and related behaviors.

B)

Provide ways to reinforce the clients strengths and positive attributes.

C)

Assist the client in setting practical limits on expectations for self-standards.

D)

Avoid discussions that focus on food and weight.

25.

Clients with eating disorders are generally not aware of how much or how little they are eating because of their altered perception of their bodys size and shape. What intervention by the nurse can assist these clients in recognizing what they are actually eating?

A)

Initiate a behavior modification plan with privileges and restrictions based on food intake and weight gain.

B)

Remind the client that tube feeding may be employed if nutritional status deteriorates.

C)

Monitor vital signs on a regular basis.

D)

Maintain a strict intake and output log.

26.

What outcome demonstrates a successful health status for a client with an eating disorder?

A)

Absence of previous abnormal physical findings

B)

The client embracing a realistic selfimage

C)

Ability to confront environmental stressors

D)

Positive family interactions

27.

The evaluation process for a client with an eating disorder should include what?

A)

Progress of the client toward a broader knowledge base

B)

Progress of the client toward autonomy

C)

Progress of the client toward dependent decision making

D)

Progress of the client toward interacting with the family

28.

What would the nurse consider evaluation criteria for psychotherapeutic progress in the client with an eating disorder?

A)

The client demonstrates a stable selfimage.

B)

The client demonstrates stable coping skills.

C)

The client embraces a realistic selfimage.

D)

The client demonstrates an improved sense of dependence.

29.

You are caring for a client with anorexia nervosa, restricting subtype. As you evaluate the plan of care, you note that the client is now able to recognize the relationship between food, eating patterns, and the ill-fated journey of the disorder. You know that for the client to reach this goal, what had to happen?

A)

Family relationships have been mended.

B)

Reasonable expectations have been met.

C)

An understanding of the disease process has been achieved.

D)

Guilt and shame over previous behavior have been released.

30.

You are discharging a client home from the eating disorder unit and you provide the client with a referral to a support group. Why is the referral helpful to this client?

A)

Aids in the prevention of a relapse

B)

Provides support during the easy times

C)

Aids in the reinforcement of treatment goals

D)

Prevents a return to adaptive eating habits

Answer Key

1.

A

2.

B

3.

D

4.

C

5.

D

6.

A

7.

C

8.

B

9.

C, D, E

10.

C

11.

D

12.

B, C, E

13.

B

14.

B, D, E

15.

D

16.

D

17.

A

18.

B

19.

C

20.

A, C, D

21.

A, B, C

22.

A

23.

B

24.

C

25.

D

26.

A

27.

B

28.

C

29.

D

30.

A

Chapter 17 Sexual Disorders

1.

The definition of sexuality includes the blend of what? (Mark all that apply.)

A)

Psychologic functioning

B)

Chemical functioning

C)

Interpersonal functioning

D)

Genetic functioning

E)

Physical functioning

2.

The school nurse is presenting a class on sexual health for the 8th grade students at the middle school. How would the nurse explain sexual orientation?

A)

The desire for intimacy

B)

A sexual attraction

C)

A desire to be touched

D)

The need for the opposite sex

3.

A student asks the school nurse what the term bisexual means. What would be the nurses best response?

A)

Bisexual means a sexual preference for members of the same sex as you are.

B)

Bisexual means a sexual preference for members of the opposite sex as you are.

C)

Bisexual means a sexual attraction for members of both sexes.

D)

Bisexual means not having a sexual preference.

4.

A 37-year-old male patient presents at the clinic for his annual physical examination. When talking with the nurse, he mentions that he seems to have lost his interest in sex. The nurse suspects the client may have hypoactive sexual desire disorder. How would the nurse assess for this sexual disorder?

A)

Ask the client how many times he has sex in a month.

B)

Ask the client if the lack of desire bothers his sexual partner.

C)

Ask the client what his sexual orientation is.

D)

Ask the client if he has sexual fantasies.

5.

A 42-year-old male patient calls the clinic to speak to the nurse. He tells the nurse that he needs to see a physician because he cannot complete the sexual act any more. The nurse asks the client if he can explain a little more.

In response to the nurses statement, the man says, I cant keep an erection long enough to finish. What would the nurse know this man suffers from?

A)

A sexual arousal disorder

B)

A sexual desire disorder

C)

An orgasmic disorder

D)

A sexual pain disorder

6.

A young girl confides to the nurse at the free clinic that she has recently become sexually active but that having sex doesnt feel good. What would the nurse suspect is involved in this clients lack of pleasure in the sexual act?

A)

Hypoactive sexual desire disorder

B)

A sexual orgasmic disorder

C)

A sexual arousal disorder

D)

7.

A sexual pain disorder

A man diagnosed with premature ejaculation has what kind of sexual disorder?

A)

A sexual aversion disorders

B)

A hypoactive sexual desire disorder

C)

An orgasmic disorder

D)

A sexual arousal disorder

8.

A 32-year-old woman confides to the nurse at her gynecologists office that she does not want any more children and no longer desires to have sex. The nurse explains to the client that sexual desire is a mind and body process and that a persons arousal and response cycle can be sabotaged by what?

A)

Unrealistic expectations

B)

Deep physiologic fears

C)

A low pleasure response

D)

Past experiences

9.

In what group of people is sexual dysfunction seen more commonly?

A)

People who use alcohol and drugs

B)

People who smoke

C)

People with seizure disorders

D)

People with heart disease

10.

A 48-year-old female client has come to the clinic for her annual physical examination. She tells the nurse that she is no longer sexually active, even though she is married. She says, My husband wonders what is wrong with me. The nurse tells the client that at the age she is, studies show that most sexual dysfunction is related to what?

A)

Sexual aversion disorder

B)

Arousal problems in women

C)

Orgasmic dysfunction in women

D)

Pain disorders in women

11.

A young woman, aged 25, has come to the clinic for a premarital physical examination. She tells the nurse that she is a virgin and really does not want to have sex. The client says that she has always been taught that sex is dirty and nice girls did not do things like that. She wonders what she will do after her wedding. What nursing diagnosis would the nurse use when writing this clients care plan?

A)

Anxiety, related to sexual inadequacy and/or physiological problem affecting sexual performance

B)

Family processes, altered, related to marital or family discord

C)

Sexuality patterns, altered, related to physiological or psychological issues

D)

Coping ineffective, individual, related to ones sexuality

12.

Those who commit sexual offenses have been found to have what values?

(Mark all that apply.)

A)

Sexually hyperactive

B)

Self-centered

C)

Patriarchal

D)

Sadistic

E)

Power oriented

13.

A pedophile has been ordered into treatment by the court. What will the treatment most likely consist of?

A)

Humanistic therapy

B)

Cognitive-behavioral therapy

C)

Testosterone

D)

14.

Focus groups

The parents of a 10-year-old boy with gender identity disorder ask the nurse how they can help their son. What treatment would the nurse suggest?

A)

Physiologic treatment

B)

A sex-change operation

C)

Psychological treatment

D)

Hormonal treatment

15.

When conducting a psychosocial assessment of a client diagnosed with a sexual disorder, what questions would the nurse most likely ask? (Mark all that apply.)

A)

What changes do you think might help your sexual relationships?

B)

Do you experience any difficulty with sexual arousal?

C)

What is your sexual orientation?

D)

Are you comfortable in your own body?

E)

How long has this been a problem for you?

16.

A new client presents at the mental health clinic. During the assessment interview, the client makes references to being unhappy with his or her sex life. What can the nurse do that will be most effective in eliciting data so that appropriate information and treatment can be provided?

A)

Provide a quiet environment for the assessment.

B)

Promise confidentiality.

C)

Respect the private content of the issues being discussed.

D)

Encourage the client to share feelings and concerns.

17.

A 37-year-old male is ordered to treatment by the court after being arrested for rubbing his genitals against the buttocks of several women in the elevator of his work place. What is this client being treated for?

A)

Fetishism

B)

Sexual masochism

C)

Frotteurism

D)

Exhibitionism

18.

A client is being treated under court order for a sexual offense. What outcome would the nurse most likely include in the clients plan of care?

A)

Confronts and resolves traumatic developmental issues

B)

Expresses anger and shame in an appropriate manner

C)

Participates and cooperates in a treatment plan to change behavior

D)

Develops healthy interpersonal and sexual relationships

19.

A mother brings her daughter to the clinic for her preschool physical examination. The 10-year-old girl tells the nurse that she wants to be called Charlie even though her name is Suzanne. The nurse notes that the girl has a short, boyish style haircut and is dressed in jeans and a hoodie. The mother tells the nurse that she can never get her daughter to dress like a girl, and she only has boy friends that she plays with. What would the nurse suspect that the little girl has?

A)

A history of sexual abuse

B)

An obsession with the opposite sex

C)

Four older brothers

D)

Gender identity disorder

20.

A sexual behavior that involves unusual objects and that may cause clinically significant problems in social areas of functioning is called what?

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A)

A scatologia

B)

A paraphilia

C)

A fetish

D)

A frotteurism

21.

A sexual offender has just been released from prison. He becomes ill and presents at a local clinic. He mentions to the nurse that it is good to talk to a real person and that since being paroled, he has not trusted himself and so he has not made any social contacts. What nursing diagnosis would be appropriate for this client?

A)

Social isolation, related to sexual beliefs and practices

B)

Coping ineffective, individual, related to ones sexuality

C)

Anxiety, related to sexual inadequacy and/or physiological problem affecting sexual performance

D)

Self-esteem, chronic situational low, related to feelings of failure

22.

A female client, aged 48, is being seen at the clinic for sexual aversion disorder. What would be an appropriate outcome for this client?

A)

Develops healthy interpersonal and sexual relationships

B)

Refrains from deviant sexual behavior by conscious control of arousal and sexual impulses

C)

Develops insight into the effect that deviant behavior has on the victim

D)

Develops an awareness of the feelings and rights of others

23.

A pedophile is going through treatment in an attempt to change the sexual arousal patterns. What type of treatment would this client undergo? https://www.facebook.com/testbankmagic/

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A)

Trauma-based therapy

B)

Cognitive-behavioral therapy

C)

Support group

D)

Behavioral reconditioning

24.

When developing a plan of care for a client with a sexual disorder, the nurse would know that the nursing interventions would include what as the first step toward rehabilitation?

A)

Collaboration with the mental health team

B)

Reporting of any knowledge of sexual offenses or abuse to appropriate authorities

C)

Encouraging group and self-help activities with referrals that support rehabilitation

D)

Developing self-awareness regarding feelings about own sexuality and relationships

25.

A client diagnosed with a paraphilia disorder is in a rehabilitation program.

The nurse tells the client that the client will have to do what every day?

A)

Collaborate with the mental health care team

B)

Take a daily inventory of thought processes

C)

Attend a daily support group

D)

Participate in a 12-step program

26.

The nurse in the clinic is evaluating outcomes on care plans for a group of clients with sexual disorders. The nurse knows that because of the chronic nature of many sexual disorders, criteria for positive progress in the plan of care include a measure of what?

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A)

Shamelessness

B)

Guiltlessness

C)

Self-control

D)

Self-worth

27.

When evaluating the outcomes on a plan of care for a client with a sexual disorder, what would the nurse know to use as an indicator of positive progress?

A)

A verbalized improvement in self-worth

B)

The clients statement that the client is having sex more frequently

C)

A verbalized improvement in ego

D)

The clients statement that sex is less pleasurable

28.

The nurse is beginning the assessment process on a client with a sexual disorder. The client asks what is involved in being assessed. What would be the nurses best response?

A)

The assessment is mainly a psychiatric evaluation.

B)

The doctor will order some psychosexual testing.

C)

I will take a social and sexual history and then the doctor will decide what else might be needed.

D)

I will take a social and sexual history.

You will have psychosexual and psychologic testing and physiologic studies of sexual arousal patterns done.

A psychiatric evaluation may also be performed.

29.

What type of sexual dysfunction can be caused by substance abuse? (Mark all that apply.) https://www.facebook.com/testbankmagic/

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A)

A sexual arousal disorder

B)

A sexual desire disorder

C)

An orgasmic disorder

D)

A sexual pain disorder

E)

A sexual aversion disorder

30.

When studying human sexuality, the nurse would learn the phases of the response cycle. What are these phases? (Mark all that apply.)

A)

Objective changes

B)

Resetting

C)

Desire

D)

Orgasm

E)

Release

Answer Key

1.

A, B, E

2.

B

3.

C

4.

D

5.

A

6.

B

7.

C

8.

D

9.

A

10.

B

11.

D

12.

B, E

13.

B https://www.facebook.com/testbankmagic/

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14.

C

15.

A, B, E

16.

D

17.

C

18.

C

19.

D

20.

B

21.

A

22.

A

23.

D

24.

A

25.

B

26.

C

27.

A

28.

D

29.

A, B, C, D

30.

C, D, E

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Chapter

1.

18 Disorders and Issues of Children and Adolescents Which of the following signs and symptoms would be inconsistent with the diagnosis of dyslexia?

A)

Low self-esteem

B)

Adequate social skills

C)

Delayed language development

D)

Discouragement

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2.

A parent comes to the health clinic with her child. The mother states, Emily doesnt want to be held. She starts rocking and banging her head when strangers come in the room. The nurse would suspect which of the following developmental disorders?

A)

Mental retardation

B)

Psychosis

C)

Autistic disorder

D)

Dyslexia

3.

The nurse is reviewing a plan of care for a child diagnosed with conduct disorder. When reviewing the care plan, the nurse would expect to see which nursing diagnosis?

A)

Personal identity disturbance, related to inability to recognize self as separate being

B)

Sleep pattern disturbance, related to fears of separation

C)

Risk for violence, directed at others, related to poor impulse control

D)

Impaired verbal communication, related to inability to form words or sentences

4.

A child diagnosed with oppositional-defiant disorder refuses to conform to curfew rules set by his parents. The nurse would be correct to teach the parents which intervention?

A)

Enable the child to make his or her own decisions

B)

Limit setting

C)

Ignore the behavior for awhile

D)

Limit praise for positive behavior

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5.

A 7-year-old child diagnosed with phonologic disorder is being seen in the health clinic. The nurse would expect this client to exhibit which of the following behaviors?

A)

Lack of responsiveness

B)

Bullying-type behavior

C)

Hyperactivity

D)

Stuttering

6.

In completing nursing care for a child exhibiting suicidal ideations, which of the following interventions would take priority for this client?

A)

Establish a trusting relationship.

B)

Maintain consistency of caregivers.

C)

Maintain a safe environment.

D)

Establish a consistent pattern of reward for positive behavior.

7.

A child is exhibiting signs and symptoms of separation anxiety following his parents divorce. Which of the following behaviors would the nurse expect to assess in the client diagnosed with separation anxiety?

A)

Repetitive routines

B)

Truancy

C)

Somatic complaints

D)

Willful defiance of rules

8.

When assessing an adolescent for warning signs of suicide risk, the nurse would expect to observe which of the following?

A)

Improved schoolwork

B)

Elevated mood

C)

Giving away prized possessions

D)

Increased energy level

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9.

A nurse is caring for a child diagnosed with oppositional-defiant disorder.

The nurse would expect which priority nursing diagnosis in the care plan?

A)

Altered growth and development, related to genetic factors

B)

Risk for injury, related to neurologic deficits

C)

Noncompliance, related to low frustration level

D)

Sleep pattern disturbance, related to fear of separation

10.

When assessing a client diagnosed with Tourettes disorder, it would be most important for the nurse to assess for which of the following?

A)

Inattention to detail

B)

Verbal outbursts

C)

Willful defiance of rules

D)

Somatic complaints

11.

A client is diagnosed with mental retardation and has an IQ of 28. The nurse would correctly identify this IQ as being which level of mental retardation?

A)

Mild

B)

Moderate

C)

Severe

D)

Profound

12.

An 8-year-old child has been started on medication to treat attention deficit hyperactivity disorder (ADHD). Which drug classification is most commonly used to treat ADHD?

A)

CNS stimulants

B)

Antimanic agents

C)

Anticonvulsants

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D)

13.

Antipsychotics

The nurse is reviewing a care plan for a patient diagnosed with attention deficit hyperactivity disorder (ADHD) who is receiving stimulant medication. The nurse would expect to find which priority medication outcome for this client?

A)

Increased attention on homework

B)

Ability to tolerate overnight separation periods

C)

Decreased somatic complaints

D)

Remains free of self-harm

14.

A child diagnosed with expressive language disorder has a nursing diagnosis of impaired verbal communication. Which of the following nursing interventions would be most appropriate?

A)

Maintain consistency of caregivers.

B)

Allow the child ample time to communicate.

C)

Identify capabilities of the child related to self-care.

D)

Establish a consistent pattern of reward for positive behavior.

15.

A client is admitted to the inpatient mental health unit with Aspergers syndrome. Which of the following assessment parameters would be most important for the nurse to observe?

A)

Clumsiness in motor activities

B)

Hallucinations and delusions

C)

Letter reversal

D)

Lack of interest in peer relationships

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16.

A child is brought to the pediatric clinic. The parent states that the child has been withdrawn and does not make eye contact when spoken to. The nurse suspects autistic disorder. The nurse knows that these symptoms related to this disorder usually appear before which age?

A)

3 years

B)

5 years

C)

7 years

D)

9 years

17.

A child is being seen by a psychologist. The childs IQ is 38. The nurse understands that this IQ level is considered to be classified as which type of mental retardation?

A)

Mild

B)

Moderate

C)

Severe

D)

Profound

18.

Which medication classification would the nurse expect to administer in the treatment plan for a child diagnosed with a pervasive developmental disorder?

A)

Antipsychotic

B)

CNS stimulant

C)

Antidepressant

D)

Antimanic

19.

Which of the following is the most prevalent contributing factor toward the incidence of mental disorders in the child?

A)

Financial

B)

Parental divorce

C)

Environmental

D)

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20.

Which of the following clinical manifestations would the nurse expect to find in the history of a child diagnosed with oppositional-defiant disorder?

A)

A stuttering problem

B)

Early difficulty with temperament

C)

Difficulty in written expression

D)

Letter reversal

21.

Stuttering is a common characteristic of which communication disorder?

A)

Phonologic disorder

B)

Dyslexia

C)

Expressive language disorder

D)

Psychosis

22.

Which of the following is a predisposing factor for the development of oppositional-defiant disorder in children?

A)

Educational level of family members

B)

Family income

C)

Parental rejection

D)

Developmental delays

23.

A mother is concerned about her 14-year-old son who has been put in detention at school for being aggressive and using a knife to cut a fellow classmate in the arm. This adolescent is more than likely exhibiting signs and symptoms of which mental health disorder?

A)

Attention deficit hyperactivity disorder

B)

Conduct disorder

C)

Oppositional-defiant disorder

D)

Separation anxiety disorder

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24.

A child diagnosed with phonologic disorder asks the nurse about the disorder. The most appropriate response by the nurse is which of the following?

A)

Symptoms of the disorder may not occur when singing or reading aloud.

B)

Phonologic problems tend to occur more frequently in girls.

C)

Development of stuttering is typically seen by age 1.

D)

Phonologic disorder tends to be severe when diagnosed.

25.

A child is being seen in the community health clinic. The most appropriate nursing intervention for the child with separation anxiety would include which of the following?

A)

Identify suicide risk.

B)

Intervene to prevent injury from aggression.

C)

Provide a familiar security object, such as blanket.

D)

Use a slow approach when introducing tactile stimuli.

26.

Which of the following would be inconsistent with behaviors of conduct disorder?

A)

Truancy from school

B)

Sexual promiscuity

C)

Vandalism

D)

Inattentiveness

27.

A parent is concerned that her child is having bowel movements in the trash can. The nurse would be correct in identifying this disorder as which of the following? https://www.facebook.com/testbankmagic/

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A)

Encopresis

B)

Enuresis

C)

Dyslexia

D)

Copropraxia

28.

Which of the following would be inconsistent with the diagnosis of enuresis?

A)

The child must be at least 5 years of age.

B)

Symptoms occur at least once a month over a period of at least 3 months.

C)

Symptoms occur at least twice a week for at least 3 months.

D)

The child has control over urine incontinence.

29.

A 7-year-old child is having difficulty in school with correct grammar. This would be documented as which type of language problem?

A)

Echopraxia

B)

Stuttering

C)

Syntax

D)

Dyslexia

30.

A child diagnosed with Tourettes disorder is yelling obscenities during a nursing assessment. The nurse would correctly document this behavior as which of the following?

A)

Echopraxia

B)

Copropraxia

C)

Dyslexia

D)

Enuresis

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31.

A child has been diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following would be the most evaluative for a child diagnosed with ADHD?

A)

Consistent decrease in disruptive and dangerous behaviors

B)

Decrease in impulsive behaviors

C)

Improvement in satisfying relationships

D)

Decrease in harm toward others

Answer Key

1.

B

2.

C

3.

C

4.

B

5.

D

6.

C

7.

C

8.

C

9.

C

10.

B

11.

C

12.

A

13.

A

14.

B

15.

D

16.

A

17.

B

18.

C

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19.

D

20.

B

21.

A

22.

C

23.

B

24.

A

25.

C

26.

D

27.

A

28.

B

29.

C

30.

B

31.

A

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Chapter

1.

19 Disorders and Issues of the Older Adult A patient diagnosed with Alzheimers disease is having difficulty finding the right words when communicating. This difficulty would be described as which of the following?

A)

Agnosia

B)

Apraxia

C)

Amnesia

D)

Anomia

2.

Which of the following would be inconsistent as a diagnostic manifestation of Alzheimers disease?

A)

Neurofibrillary tangles

B)

Reduced brain activity

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C)

Neuritic plaques in the brain

D)

Increased synaptic nerve transmission

3.

The nurse is reviewing a plan of care for an older person diagnosed with Lewy body dementia. When reviewing the care plan, the nurse would expect to see which nursing diagnosis specific to Lewy body dementia?

A)

Risk for violence, related to agitation

B)

Self-esteem disturbance, related to hopelessness

C)

Altered mobility, related to shuffling gait

D)

Altered thought processes, related to delusions

4.

An elderly man diagnosed with Alzheimers disease is being seen in the health clinic. The nurse observes the man brushing his hair with a toothbrush. This inability to process information would be documented as which of the following?

A)

Anomia

B)

Agnosia

C)

Aphasia

D)

Apraxia

5.

In completing nursing care for an older person diagnosed with dementia, which of the following interventions would take priority for this person?

A)

Provide excessive stimuli to keep the persons attention.

B)

Use simple one-step commands.

C)

Provide higher level needs.

D)

Provide various environments to keep the person engaged in activity.

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6.

An older adult is exhibiting signs and symptoms of delirium. Which of the following behaviors would the nurse expect to assess in the client diagnosed with delirium?

A)

Confabulation

B)

Gait disturbances

C)

Decreased level of consciousness with impaired thinking

D)

Visual hallucinations of colors

7.

When assessing an older adult diagnosed with an amnestic disorder, the nurse would expect to observe which of the following?

A)

Personality changes

B)

Disorientation to person

C)

Impairment in abstract thinking

D)

Difficulty in learning new information

8.

The nurse is reviewing a care plan for a patient diagnosed with Alzheimers dementia who is receiving antipsychotic medication. The nurse would expect to find which priority medication outcome for this client?

A)

Decrease in muscle rigidity

B)

Decrease in hallucinations

C)

Increase in the ability to acquire new information

D)

Increase in mobility

9.

A client is admitted to the inpatient mental health unit with Lewy body dementia. Which of the following assessment parameters would be most important for the nurse to observe?

A)

Hemiplegia

B)

Parkinson-like symptoms

C)

Increased psychomotor activity

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D)

10.

Confabulation

An older adult diagnosed with dementia is receiving risperidone (Risperdal).

This medication is classified as which of the following?

A)

Parkinsons drug

B)

Antipsychotic

C)

NMDA receptor antagonist

D)

Cholinesterase inhibitor

11.

Although not categorized as a cognitive disorder, studies show that which of the following is the most prevalent mental disorder in older adults?

A)

Anxiety

B)

Substance use

C)

Depression

D)

Psychosis

12.

Which of the following areas of the brain is impaired when the older adult diagnosed with Alzheimers dementia starts to have language and judgment impairment?

A)

Hippocampus

B)

Cerebral cortex

C)

Temporal lobe

D)

Basal ganglia

13.

The nurse is reviewing a care plan for a patient diagnosed with dementia who is receiving haloperidol (Haldol). The nurse would expect to find which priority outcome for this client?

A)

Decreased Parkinson-like symptoms

B)

Decreased depressive symptoms

C)

Decreased physical aggression

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D)

14.

Decreased blood sugar levels

The priority nursing intervention for clients diagnosed with delirium includes which of the following?

A)

Reduce environmental noise.

B)

Initiate safety precautions.

C)

Reorient the client to date, time, and place.

D)

Explain all procedures and what is happening to the client.

15.

A client is admitted to the Alzheimers unit. Which of the following assessment parameters is consistent with severe Alzheimers disease?

A)

Poor short-term memory

B)

Mild anomia

C)

Wandering or pacing

D)

Total loss of speech

16.

Which of the following would be considered an effect of secondary aging?

A)

Stature

B)

Race

C)

Life experiences

D)

Intelligence

17.

Which of the following is a medical condition related to the cause of delirium in older adults?

A)

Anxiolytics

B)

Medication toxicity

C)

Renal disease

D)

Alcohol

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18.

A person diagnosed with delirium is hearing voices that tell him to kill his daughter. The nurse would correctly document this behavior as which of the following?

A)

Hallucination

B)

Delusion

C)

Illusion

D)

Echolalia

19.

Which of the following would be an inconsistent reason that often decreases the chance that the older adult will seek treatment?

A)

Mental health care costs

B)

Limited income

C)

Existing medical costs

D)

Ability to maintain self-care

20.

A person is receiving treatment for dementia. Which of the following medications is most effective when treatment is begun in the early stages?

A)

Haloperidol (Haldol)

B)

Donepexil (Aricept)

C)

Selegiline (Eldepryl)

D)

Risperidone (Risperdal)

Answer Key

1.

D

2.

D

3.

C

4.

B

5.

B

6.

C https://www.facebook.com/testbankmagic/

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7.

D

8.

B

9.

B

10.

B

11.

C

12.

B

13.

C

14.

B

15.

D

16.

C

17.

C

18.

A

19.

D

20.

B

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