final exam 22-26

Question 1

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?

Answer 1

The home environment is overprotective and demands perfection.

Question 2

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 problem?

Answer 2

The client will perceive personal ideal body weight and shape as normal.

Question 3

A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide?

Answer 3

The emesis produced during purging is acidic and corrodes the tooth enamel.

Question 4

A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice?

Answer 4

It allows clients to maintain control.

Question 5

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?

Answer 5

“I am angry at my mother. I can only get her approval when I win competitions.”

Question 6

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?

Answer 6

“Eating disorders have been correlated to certain familial patterns; without addressing these, your child’s condition will not improve.”

Question 7

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?

Answer 7

The client demonstrated healthy coping mechanisms that decreased anxiety.

Question 8

The nurse is working with a client diagnosed with binge eating disorder. Which medication should the nurse expect to teach the client about?

Answer 8

Lisdexamfetamine (Vyvanse)

Question 9

A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders?

Answer 9

Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.

Question 10

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?

Answer 10

Altered family processes

Question 11

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.)

1. Binge eating with a diagnosis of obesity
2. Bingeing and purging with a diagnosis of bulimia nervosa
3. Weight loss with a diagnosis of anorexia nervosa
4. Amenorrhea with a diagnosis of anorexia nervosa
5. Emaciation with a diagnosis of bulimia nervosa

Answer 11

1,2

Question 12

A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.)

1. “In this disorder, binge eating occurs exclusively during the course of bulimia nervosa.”
2. “In this disorder, binge eating occurs, on average, at least once a week for three months.”
3. “In this disorder, binge eating occurs, on average, at least two days a week for six months.”
4. “In this disorder, distress regarding binge eating is present.”
5. “In this disorder, distress regarding binge eating is absent.”

Answer 12

1,3,5

Question 13

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?

Answer 13

“I understand that you are angry, but this behavior will not be tolerated.”

Question 14

At 11 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate?

Answer 14

“It is after the 10 p.m. phone curfew. You will be able to call tomorrow.”

Question 15

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

Answer 15

Use clear, calm statements and a confident physical stance.

Question 16

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?

Answer 16

Maintain consistency of care by open communication to avoid staff manipulation.

Question 17

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder (BPD)?

Answer 17

Being firm, consistent, and empathic, while addressing specific client behaviors

Question 18

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

Answer 18

A physically healthy client who lives with parents and depends on public transportation.

Question 19

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

Answer 19

Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged.

Question 20

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

Answer 20

Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.

Question 21

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

Answer 21

Social isolation R/T inability to relate to others

Question 22

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?

Answer 22

Histrionic personality disorder

Question 23

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

Answer 23

The use of suicidal gestures to elicit a rescue response from others

Question 24

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?

Answer 24

“You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”

Question 25

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

Answer 25

Being grateful for the compliment but fearing later rejection and humiliation

Question 26

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

Answer 26

Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis

Question 27

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

Answer 27

The client experiences inflexibility and lack of spontaneity when dealing with others.

Question 28

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

Answer 28

A client diagnosed with borderline personality disorder.

Question 29

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

Answer 29

to reduce personality trait inflexibility that interferes with functioning and relationships

Question 30

Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder?

Answer 30

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.”

Question 31

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

Answer 31

Risk for violence: directed toward others R/T paranoid thinking

Question 32

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

Answer 32

Contract with the client to reinforce positive behaviors with unit privileges.

Question 33

A highly emotional client presents at an outpatient clinic appointment and states, “My dead husband returned to me during a séance.” Which personality disorder should a nurse associate with this behavior?

Answer 33

Schizotypal personality disorder

Question 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?

Answer 34

“Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.”

Question 35

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

Answer 35

“I am getting a message from the beyond that we have been involved with each other in a previous life.”

Question 36

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

Answer 36

Social isolation R/T inability to relate to others

Question 37

A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.) 1. The client has been diagnosed with sickle cell anemia. 2. The client has an inflated self-appraisal and feels a sense of entitlement. 3. The client has a history of a substance use disorder. 4. The client is odd and eccentric but not delusional. 5. The client has an intellectual developmental disorder.

Answer 37

1,3,5

Question 38

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) 1. The client will relate one empathetic statement to another client in group by day two. 2. The client will identify one personal limitation by day one. 3. The client will acknowledge one strength that another client possesses by day two. 4. The client will list four personal strengths by day three. 5. The client will list two lifetime achievements by discharge.

Answer 38

1,2,3

Question 39

A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client’s care? (Select all that apply.) 1. This client has personality traits that are deeply ingrained and difficult to modify. 2. This client needs medication to treat the underlying physiological pathology. 3. This client uses manipulation, making the implementation of treatment problematic. 4. This client has poor impulse control that hinders compliance with a plan of care. 5. This client is likely to have secondary diagnoses of substance abuse and depression.

Answer 39

1,3,4,5

Question 40

A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Ego-centrism and goal setting based on personal gratification. 2. Incapacity for mutually intimate relationships. 3. Frequent feelings of being down, miserable, or hopeless. 4. Disregard for and failure to honor financial and other obligations. 5. Intense feelings of nervousness, tenseness, or panic.

Answer 40

1,2,4

Question 41

_______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.

Answer 41

schizoid

Question 42

_____________________ personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people.

Answer 42

histrionic

Question 43

________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

Answer 43

dependant

Question 44

_____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.

Answer 44

paranoid

Question 45

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder (IDD)?

Answer 45

The client communicates wants and needs by “acting out” behaviors.

Question 46

Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate IDD?

Answer 46

Providing simple directions and praising client’s independent self-care efforts

Question 47

A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, “I’m such a terrible mother. What did I do to cause this?” Which nursing response is most appropriate?

Answer 47

“Poor parenting doesn’t cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control.”

Question 48

In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome?

Answer 48

The client will establish trust with at least one caregiver by day five.

Question 49

After an adolescent diagnosed with attention deficit/hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss?

Answer 49

The pharmacological action of Ritalin causes a decrease in appetite.

Question 50

A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data?

Answer 50

Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.

Question 51

1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.

Answer 51

The child’s mother is diagnosed with an anxiety disorder.

Question 52

A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the child’s mother?

Answer 52

Children with mild IDD develop academic skills up to a sixth-grade level.

Question 53

A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate IDD. Which student statement indicates that further instruction is needed?

Answer 53

“These clients can successfully complete elementary school.”

Question 54

A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client’s plan of care?

Answer 54

Provide consistent caregivers.

Question 55

A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate?

Answer 55

Hold client’s head steady and apply a helmet.

Question 56

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette’s syndrome?

Answer 56

Neuroleptic medications

Question 57

Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders?

Answer 57

Reinforcing positive actions to encourage repetition of desirable behaviors

Question 58

A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis?

Answer 58

The client will name own body parts as separate from others by day five.

Question 59

A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child’s behavior. Which student response indicates an appropriate evaluation of the situation?

Answer 59

“This child’s behavior must be evaluated according to developmental norms.”

Question 60

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD?

Answer 60

Altered social interaction R/T nonadherence to social convention

Question 61

A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents?

Answer 61

Convey unconditional acceptance and positive regard.

Question 62

Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? (Select all that apply.) 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

Answer 62

1,2,3

Question 63

Which of the following findings should a nurse identify that would contribute to a client’s development of ADHD? (Select all that apply.) 1. The client’s father was a smoker. 2. The client had a low birth weight. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

Answer 63

2,4

Question 64

The DSM-5 criteria for ODD specifies that: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least ______________ months

Answer 64

6

Question 65

Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder?

Answer 65

Recognize escalating aggressive behavior and intervene before violence occurs.

Question 66

A mother questions the decreased effectiveness of methylphenidate (Ritalin) prescribed for her child’s ADHD. Which nursing response best addresses the mother’s concern?

Answer 66

“Your child has probably developed a tolerance to Ritalin and may need a higher dosage.”

Question 67

After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize?

Answer 67

Arguing with authority figures for more than 6 months

Question 68

A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living. Which nursing intervention is most appropriate to maintain the client’s self-esteem?

Answer 68

Allow client to choose between two different outfits when dressing for the day.

Question 69

A son, who recently brought his extremely confused parent to a nursing home for admission, reports feelings of guilt. Which is the appropriate nursing response?

Answer 69

“Support groups are held here on Mondays for children of residents in similar situations.”

Question 70

A family asks why their father is attending activity groups at the long-term care facility. The son states, “My father worked hard all of his life. He just needs some rest at this point.” Which is the appropriate nursing response?

Answer 70

“The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation.”

Question 71

A couple resides in a long-term care facility. The husband is admitted to the psychiatric unit after physically abusing his wife. He states, “My wife is having an affair with a young man, and I want it investigated.” Which is the appropriate nursing response?

Answer 71

“I understand that you are upset. We will talk about it.”

Question 72

A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred?

Answer 72

“Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution

Question 73

A student nurse asks the instructor, “Which psychiatric disorder is most likely initially diagnosed in the elderly?” Which instructor response gives the student accurate information?

Answer 73

“Major depressive disorder is most likely diagnosed later in life.”

Question 74

An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention?

Answer 74

Advocate for a complete physical exam.

Question 75

An older client who lives with a caregiver is admitted to an emergency department with a fractured arm. The client is soaked in urine and has dried fecal matter on lower extremities. The client is 6 feet tall and weighs 120 pounds. Which condition should the nurse suspect?

Answer 75

Abuse and/or neglect

Question 76

An older, emaciated client is brought to an emergency department by the client’s caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate?

Answer 76

The client may deny or minimize the injuries.

Question 77

A client in the middle stage of Alzheimer’s disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication?

Answer 77

Verbalize the nurse’s perception of the implied communication.

Question 78

An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime?

Answer 78

Altered liver and kidney functioning

Question 79

An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client?

Answer 79

Electroconvulsive therapy (ECT)

Question 80

A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client?

Answer 80

The nurse should document using the term elderly.

Question 81

Which individual is most likely to be below the poverty level in the United States?

Answer 81

A 70-year-old Hispanic woman living alone

Question 82

A nurse is listening to a lecture on the environmental theory. Which statement(s) by the nurse indicates that teaching has been effective?(Select all that apply.) 1. “Personality characteristics in old age are correlated with early life characteristics.” 2. “Carcinogens can affect aging.” 3. “Trauma can affect the aging process.” 4. “The effects of sunlight can have an effect on the aging process.” 5. “Decline in the immune system can affect the aging process.”

Answer 82

2,3,4

Question 83

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?

Answer 83

The child shrinks at the approach of adults.

Question 84

A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect?

Answer 84

The woman may be a victim of incest.

Question 85

A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included?

Answer 85

Power and control are central to the dynamic of domestic violence.

Question 86

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

Answer 86

Remain nonjudgmental while actively listening to the client’s description of the violent rape event.

Question 87

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

Answer 87

The client may be demonstrating a controlled response pattern.

Question 88

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?

Answer 88

“These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.”

Question 89

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 will kill me.” Which is the appropriate nursing response?

Answer 89

“Let’s talk about your options so that you don’t have to go home.”

Question 90

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?

Answer 90

“I know that it was not my fault.”

Question 91

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

Answer 91

“To terrorize and subdue the victim”

Question 92

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.” This client is in which phase of the cycle of battering?

Answer 92

Phase III: The honeymoon phase

Question 93

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

Answer 93

Have ready access to the number of a safe house for battered women.

Question 94

A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense?

Answer 94

Expressed response pattern

Question 95

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

Answer 95

The child is often absent from school and seems apathetic and tired.

Question 96

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?

Answer 96

Possible history of childhood incest

Question 97

In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (Select all that apply.) 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by abuse between their parents. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay.

Answer 97

1,2,4

Question 98

Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.) 1. Low self-esteem 2. Powerlessness 3. Disturbed personal identity 4. Knowledge deficit 5. Nonadherence

Answer 98

1,2

Question 99

A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.) 1. “Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner.” 2. “Intimate partner violence is used to gain power and control over the other intimate partner.” 3. “Fifty-one percent of victims of intimate violence are women.” 4. “Women ages 25 to 34 experience the highest per capita rates of intimate violence.” 5. “Victims are typically young married women who are dependent housewives.”

Answer 99

1,2,4

Question 100

Order the description of the progressive phases of Walker’s model of the “cycle of battering.” ________ This phase is the most violent and the shortest, usually lasting up to 24 hours. ________ In this phase, the man’s tolerance for frustration is declining. ________ In this phase, the batterer becomes extremely loving, kind, and contrite.

Answer 100

2 1 3

Question 101

A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed ______________________.

Answer 101

battering

Question 102

Physical ________________ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision

Answer 102

neglect