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Flashcards in Final - Ch 20-25 Deck (60):
1

A client diagnosed with somatization disorder is most likely to exhibit which personality disorder characteristic?

A.
Experiences intense and chaotic relationships with fluctuating attitudes toward others.
B.
Socially irresponsible, exploitative, guiltless, and disregards rights of others.
C.
Self-dramatizing, attention seeking, overly gregarious, and seductive.
D.
Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange.

C

2

A nurse is working with a client diagnosed with somatization disorder. What criteria would differentiate this diagnosis from a somatoform pain disorder?

A.
The client diagnosed with somatization disorder experiences at least four pain symptoms in various body systems.
B.
The client diagnosed with somatization disorder experiences a change in the quality of self-awareness.
C.
The client diagnosed with somatization disorder has a perceived disturbance in body image or appearance.
D.
The client diagnosed with somatization disorder experiences severe and prolonged pain that’s etiology is psychological in nature.

A

3

Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with somatization disorder?

A.
The client will admit to fabricating physical symptoms to gain benefits by day 3.
B.
The client will list three potential adaptive coping strategies to deal with stress by day 2.
C.
The client will comply with medical treatments for physical symptoms by day 3.
D.
The client will openly discuss physical symptoms with staff by day 4.

B

4

Which are examples of primary and secondary gains that clients diagnosed with pain disorders may experience?

A.
Primary: chooses to seek a new doctor. Secondary: euphoric feeling from new medications.
B.
Primary: euphoric feeling from new medications. Secondary: chooses to seek a new doctor.
C.
Primary: receives get-well messages. Secondary: pain prevents attendance at family reunion.
D.
Primary: pain prevents attendance at family reunion. Secondary: receives get-well messages.

D

5

A nursing instructor is teaching about the etiology of hypochondriasis from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred?

A.
“They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems.”
B.
“When the sick role relieves them from stressful situations, their physical symptoms are reinforced.”
C.
“They misinterpret and cognitively distort their physical symptoms.”
D.
“They tend to have a familial predisposition to this disorder.”

A

6

An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming for severe childhood sexual abuse. Which nursing intervention takes priority?

A.
Encourage exploration of sexual abuse.
B.
Encourage guided imagery.
C.
Establish trust and rapport.
D.
Administer antianxiety medications.

C

7

A client diagnosed with dissociative identity disorder (DID) switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function?

A.
It is a means to attain secondary gain.
B.
It is a means to explore feelings of excessive and inappropriate guilt.
C.
It serves to isolate painful events so that the primary self is protected.
D.
It serves to establish personality boundaries and limit inappropriate impulses.

C

8

A client is diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client?

A.
To recover memories and improve thinking patterns.
B.
To prevent social isolation.
C.
To decrease anxiety and need for secondary gain.
D.
To collaborate among sub-personalities to improve functioning.

D

9

What symptom differentiates dissociative fugue from dissociative amnesia?

A.
Clients diagnosed with dissociative fugue experience symptoms that are precipitated by extreme stress, and clients diagnosed with dissociative amnesia do not.
B.
Clients diagnosed with dissociative fugue are unaware of their memory loss, whereas clients diagnosed with dissociative amnesia are aware of their forgetfulness.
C.
Clients diagnosed with dissociative amnesia assume a new identity, and clients diagnosed with dissociative fugue do not.
D.
Clients diagnosed with dissociative amnesia usually recover completely, whereas clients diagnosed with dissociative fugue display residual effects.

B

10

Which is an example of systematized amnesia?

A.
A client cannot relate any lifetime memories, including personal identity.
B.
A client can relate family memories but has no recollection of a particular brother.
C.
A client cannot remember events surrounding a fatal car accident.
D.
A client whose home was destroyed by a tornado only remembers waking up in the hospital.

B

11

Neurological tests have ruled out pathology in a client’s sudden lower-extremity paralysis. Which nursing care should be included for this client?

A.
Deal with physical symptoms in a detached manner.
B.
Challenge the validity of physical symptoms.
C.
Meet dependency needs until the physical limitations subside.
D.
Encourage a discussion of feelings about the lower-extremity problem.

A

12

Which symptom exhibited by a client diagnosed with a conversion disorder would predict the poorest prognosis?

A.
Seizures
B.
Blindness
C.
Aphonia
D.
Paralysis

A

13

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client’s home environment should a nurse associate with the development of anorexia nervosa?

A.
The home environment maintains loose personal boundaries.
B.
The home environment places an overemphasis on food.
C.
The home environment is overprotective and demands perfection.
D.
The home environment condones corporal punishment.

C

14

A client’s altered body image is evidenced by claims of “feeling fat” even though the client is emaciated. Which is the appropriate outcome criterion for this client’s disorder?

A.
The client will consume adequate calories to sustain normal weight.
B.
The client will cease strenuous exercise programs.
C.
The client will perceive personal ideal body weight and shape as normal.
D.
The client will not express a preoccupation with food.

C

15

When counseling a client diagnosed with bulimia nervosa, a nurse explains that the client’s teeth will deteriorate because:

A.
The emesis produced during purging is acidic and corrodes the tooth enamel.
B.
Purging causes the depletion of dietary calcium.
C.
Food is rapidly ingested without proper mastication.
D.
Poor dental and oral hygiene leads to dental caries.

A

16

A nurse should explain to a client diagnosed with an eating disorder that behavior-modification programs are the treatment of choice because these programs:

A.
Help the client correct a distorted body image.
B.
Address the underlying client anger.
C.
Manage the client’s uncontrollable behaviors.
D.
Allow clients to maintain control.

D

17

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. Her treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice?

A.
This therapy will increase the client’s motivation to gain weight.
B.
This therapy will reward the client for perfectionist achievements.
C.
This therapy will provide the client with control over behavioral choices.
D.
This therapy will protect the client from parental overindulgence.

C

18

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder?

A.
“Skaters need to be thin to improve their daily performance.”
B.
“All the skaters on the team are following an approved 1,200-calorie diet.”
C.
“The exercise of skating reduces my appetite but improves my energy level.”
D.
“I am angry at my mother. I can only get her approval when I win competitions.”

D

19

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response?

A.
“Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions.”
B.
“Eating disorders have been correlated to certain familial patterns; without addressing these, your child’s condition will not improve.”
C.
“Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support.”
D.
“Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed.”

B

20

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change?

A.
The client gained 2 pounds in 1 week.
B.
The client focused conversations on nutritious food.
C.
The client demonstrated healthy coping mechanisms that decreased anxiety.
D.
The client verbalized an understanding of the etiology of the disorder.

C

21

A morbidly obese client is prescribed an anorexiant medication. About which medication should a nurse teach the client?

A.
Diazepam (Valium)
B.
Dexfenfluramine (Redux)
C.
Sibutramine (Meridia)
D.
Pemoline (Cylert)

C

22

A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement should the nurse identify as correct?

A.
Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.
B.
Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not.
C.
Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not.
D.
Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

A

23

A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, “My parents watch me like a hawk and never let me out of their sight.” Which nursing diagnosis would take priority at this time?

A.
Altered nutrition less than body requirements
B.
Altered social interaction
C.
Impaired verbal communication
D.
Altered family processes

D

24

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior?

A.
“You are very disrespectful. You need to learn to control yourself.”
B.
“I understand that you are angry, but this behavior will not be tolerated.”
C.
“What behaviors could you modify to improve this situation?”
D.
“What anti-personality disorder medications have helped you in the past?”

B

25

A client diagnosed with antisocial personality disorder comes to a nurses’ station at 11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing response is most appropriate?

A.
“Go ahead and use the phone. I know this pending divorce is stressful.”
B.
“You know better than to break the rules. I’m surprised at you.”
C.
“It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow.”
D.
“The decision to divorce should not be considered until you have had a good night’s sleep.”

C

26

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?

A.
Provide objective evidence that reasons for violence are unwarranted.
B.
Initially restrain the client to maintain safety.
C.
Use clear, calm statements and a confident physical stance.
D.
Empathize with the client’s paranoid perceptions.

C

27

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this behavior?

A.
Compulsive personality disorder.
B.
Schizotypal personality disorder.
C.
Histrionic personality disorder.
D.
Manic personality disorder.

C

28

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?

A.
Allow the clients to apply the democratic process when developing unit rules.
B.
Maintain consistency of care by open communication to avoid staff manipulation.
C.
Allow the client spokesman to verbalize concerns during a unit staff meeting.
D.
Maintain unit order by the application of autocratic leadership.

B

29

Which nursing approach should be utilized to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder?

A.
Being firm, consistent, and empathic, while addressing specific client behaviors.
B.
Promoting client self-expression by implementing laissez-faire leadership.
C.
Using authoritative leadership to help clients learn to conform to society norms.
D.
Overlooking inappropriate behaviors to avoid providing secondary gains.

A

30

Which adult client should a nurse identify as exhibiting the characteristics of a dependant personality disorder?

A.
A physically healthy client who is dependant on meeting social needs by contact with 15 cats.
B.
A physically healthy client who has a history of depending on intense relationships to meet basic needs.
C.
A physically healthy client who lives with parents and depends on public transportation.
D.
A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security.

C

31

A pessimistic female client expressing low self-worth has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of “suffering” in silence. Which statement by an instructor to a student best explains the etiology of this client’s personality disorder?

A.
Nurturance is provided from many sources, and independent behaviors are encouraged.
B.
Nurturance is provided exclusively from one source, and independent behaviors are discouraged.
C.
Nurturance is provided exclusively from one source, and independent behaviors are encouraged.
D.
Nurturance is provided from many sources, and independent behaviors are discouraged.

B

32

Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response?

A.
“Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.”
B.
“Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, while clients diagnosed with avoidant personality disorder do not.”
C.
“Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant.”
D.
“Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, while clients diagnosed with avoidant personality disorder remain based in reality.”

A

33

During an interview, which client statement to a nurse should indicate a potential diagnosis of schizotypal personality disorder?

A.
“I really don’t have a problem. My family is inflexible, and every relative is out to get me.”
B.
“I am so excited about working with you. Have you noticed my new nail polish: ‘Ruby Red Roses’?”
C.
“I spend all my time tending my bees. I know a whole lot of information about bees.”
D.
“I am getting a message from the beyond that we have been involved with each other in a previous life.”

D

34

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred?

A.
“Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling.”
B.
“Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.”
C.
“They tend to develop few relationships because they are strongly independent but generally maintain deep affection.”
D.
“They pay particular attention to details, which can frustrate the development of relationships.”

B

35

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?

A.
Altered thought processes R/T increased stress.
B.
Risk for suicide R/T loneliness.
C.
Risk for violence: directed toward others R/T paranoid thinking.
D.
Social isolation R/T inability to relate to others.

D

36

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?

A.
The use of highly lethal methods to commit suicide.
B.
The use of suicidal gestures to elicit a rescue response from others.
C.
The use of isolation and starvation as suicidal methods.
D.
The use of self-mutilation to decrease endorphins in the body.

B

37

Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder?

A.
As the day shift nurse leaves the unit, the client suddenly hugs the nurse’s arm and whispers, “The night nurse is evil. You have to stay.”
B.
As the day shift nurse leaves the unit, the client suddenly hugs the nurse’s arm and states, “I will be up all night if you don’t stay with me.”
C.
As the day shift nurse leaves the unit, the client suddenly hugs the nurse’s arm, yelling, “Please don’t go! I can’t sleep without you being here.”
D.
As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, “I cut myself because you are leaving me.”

D

38

Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder?

A.
Risk for violence: directed toward others R/T paranoid thinking.
B.
Risk for suicide R/T altered thought.
C.
Altered sensory perception R/T increased levels of anxiety.
D.
Social isolation R/T inability to relate to others.

A

39

From a behavioral perspective, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder?

A.
Seclude the client when inappropriate behaviors are exhibited.
B.
Contract with the client to reinforce positive behaviors with unit privileges.
C.
Teach the purpose of antianxiety medications to improve medication compliance.
D.
Encourage the client to journal feelings to improve awareness of abandonment issues.

B

40

A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?

A.
“You really don’t have to go by that schedule. I’d just stay home sick.”
B.
“There has got to be a hidden agenda behind this schedule change.”
C.
“Who do you think you are? I expect to interact with the same nurse every Saturday.”
D.
“You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”

D

41

Looking at a slightly bleeding paper cut, the client screams, “Somebody help me, quick! I’m bleeding. Call 911!” A nurse should identify this behavior as characteristic of which personality disorder?

A.
Schizoid personality disorder.
B.
Obsessive-compulsive personality disorder.
C.
Histrionic personality disorder.
D.
Paranoid personality disorder.

C

42

Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?

A.
Interpreting the compliment as a secret code used to increase personal power.
B.
Feeling the compliment was well deserved.
C.
Being grateful for the compliment but fearing later rejection and humiliation.
D.
Wondering what deep meaning and purpose is attached to the compliment.

C

43

Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder (SPD)?

A.
Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with SPD need medications to treat the pathology of their disorder.
B.
Clients diagnosed with SPD experience increased anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety.
C.
Clients diagnosed with social phobia would avoid attending birthday parties, whereas clients diagnosed with SPD would isolate themselves on a continual basis.
D.
Clients diagnosed with SPD would avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate themselves on a continual basis.

C

44

Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder?

A.
The client experiences unwanted, intrusive, and persistent thoughts.
B.
The client experiences unwanted, repetitive behavior patterns.
C.
The client experiences inflexibility and lack of spontaneity when dealing with others.
D.
The client experiences obsessive thoughts that are externally imposed.

C

45

Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors?

A.
A client diagnosed with antisocial personality disorder.
B.
A client diagnosed with borderline personality disorder.
C.
A client diagnosed with schizoid personality disorder.
D.
A client diagnosed with paranoid personality disorder.

B

46

When planning care for clients diagnosed with personality disorders, what should be the goal of treatment?

A.
To stabilize pathology with the correct combination of medications.
B.
To change the characteristics of the dysfunctional personality.
C.
To reduce inflexibility of personality traits that interfere with functioning and relationships.
D.
To decrease the prevalence of neurotransmitters at receptor sites.

C

47

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child’s face and arms. What other symptom should indicate to the nurse that the child may have been physically abused?

A.
The child shrinks at the approach of adults.
B.
The child begs or steals food or money.
C.
The child is frequently absent from school.
D.
The child is delayed in physical and emotional development.

A

48

A woman describes a history of physical and emotional abuse in intimate relationships. Which additional factor should a nurse suspect?

A.
The woman may be exhibiting a controlled response pattern.
B.
The woman may have a history of childhood neglect.
C.
The woman may be exhibiting co-dependent characteristics.
D.
The woman may be a victim of incest.

D

49

Which statement made by an emergency department nurse to a graduate nurse communicates accurate knowledge of domestic violence?

A.
“Power and control are central to the dynamic of domestic violence.”
B.
“Poor communication and social isolation are central to the dynamic of domestic violence.”
C.
“Erratic relationships and vulnerability are central to the dynamic of domestic violence.”
D.
“Emotional injury and learned helplessness are central to the dynamic of domestic violence.”

A

50

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate?

A.
Discourage the client from discussing the event, as this may lead to further emotional trauma.
B.
Remain nonjudgmental and actively listen to the client’s description of the event.
C.
Meet the client’s self-care needs by assisting with showering and perineal care.
D.
Provide leads, based on police information, to encourage further description of the event.

B

51

A raped client answers a nurse’s questions in a monotone with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this client’s responses?

A.
The client may be lying about the incident.
B.
The client may be experiencing a silent rape reaction.
C.
The client may be demonstrating a controlled response pattern.
D.
The client may be having a compounded rape reaction.

C

52

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, “Why doesn’t she just leave him?” Which is the nursing supervisor’s most appropriate response?

A.
“These clients don’t know life any other way, and change is not an option until they have improved insight.”
B.
“These clients have limited cognitive skills and few vocational abilities to be able to make it on their own.”
C.
“These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation.”
D.
“These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.”

D

53

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, “The beatings have been getting worse, and I’m afraid next time he may kill me.” Which is the appropriate nursing response?

A.
“Leopards don’t change their spots, and neither will he.”
B.
“There are things you can do to prevent him from losing control.”
C.
“Let’s talk about your options so that you don’t have to go home.”
D.
“Why don’t we call the police so that they can confront your husband with his behavior?”

C

54

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner?

A.
“I know that it was not my fault.”
B.
“My boyfriend has trouble controlling his sexual urges.”
C.
“If I don’t put myself in a dating situation, I won’t be at risk.”
D.
“Next time I will think twice about wearing a sexy dress.”

A

55

A client asks, “Why does a rapist use a weapon during the act of rape?” Which nursing rationale is most accurate?

A.
To decrease the victimizer’s insecurity.
B.
To inflict physical harm with the weapon.
C.
To terrorize and subdue the victim.
D.
To mirror learned family behavior patterns related to weapons.

C

56

When questioned about bruises, a woman states, “It was an accident. My husband just had a bad day at work. He’s being so gentle now and even brought me flowers. He’s going to get a new job, so it won’t happen again.” In which phase of the cycle of battering is this client?

A.
Phase I: The tension-building phase.
B.
Phase II: The acute battering incident phase.
C.
Phase III: The honeymoon phase.
D.
Phase IV: The resolution and reorganization phase.

C

57

Which teaching should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse?

A.
Have ready access to a gun and learn how to use it.
B.
Research lawyers that can aid in divorce proceedings.
C.
File charges of assault and battery.
D.
Have ready access to the number of a safe house for battered women.

D

58

A client in an emergency department, who has been raped, is crying, pacing, and cursing her attacker. Which behavioral defense should a nurse recognize?

A.
Controlled response pattern
B.
Compounded rape reaction
C.
Expressed response pattern
D.
Silent rape reaction

C

59

Which assessment data should a school nurse recognize as a sign of physical neglect?

A.
The child is often absent from school and seems apathetic and tired.
B.
The child is very insecure and has poor self-esteem.
C.
The child has multiple bruises on various body parts.
D.
The child has sophisticated knowledge of sexual behaviors.

A

60

A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, “My father has recently moved back to town.” What should the nurse suspect?

A.
Possible major depressive disorder.
B.
Possible history of childhood incest.
C.
Possible histrionic personality disorder.
D.
Possible history of childhood physical abuse.

B