Answer and Rationale Psychiatric Nursing

ANSWER AND RATIONALEMENTAL HEALTH AND PSYCHIATRIC

NURSINGLevel II-Comprehensive Review

November 2008

1. A client with depression who attempted suicide says to the nurse, “I should have died, I’ve always been a failure. Nothing ever goes right for me.” The most therapeutic response by the nurse is:a. “I don’t see you as a failure.”b. “Feeling like this is part of being ill.”c. “You’ve been feeling like a failure for a

while?”d. “You have everything to live for”

2. A client state to the nurse, “I haven’t slept at all last couple of nights.” The most therapeutic response by the nurse is:a. “Go on…..”b. “Sleeping?”c. “The last couple of nights?”d. “You’re having difficulty sleeping?”

3. A nurse is assigned to care for a client who is experiencing altered thought processes. The nurse is told that the client believes that the food is being poisoned. Which communication technique does the nurse plan to use to encourage the client to eat:a. Open ended questions and silenceb. Offering opinions about the necessity of

adequate nutritionc. Identifying the reasons that the client may

not want to eatd. Focusing on self disclosure regarding food

preferences

4. A client who has just been sexually assaulted is very quiet and calm. The nurse identifies this behavior as indicative of which defense mechanism:a. Denial c. Rationalizationb. Projection d. Intellectualization

5. A client is admitted to a psychiatric clinic for treatment of psychotic behavior. The client is at the locked exit door, and is shouting, “Let me out. There’s nothing wrong with me. I don’t belong here.” The nurse identifies this behavior as:a. Projection c. Regressionb. Denial d. Rationalization

1. Answer C Responding to the feelings expressed by the client is an effective therapeutic communication technique. The coorect option is an example of the use of restating. Options A,B and D block communication because they minimize the client’s experience and do not facilitate exploration of the client’s expressed feelings.

2. Answer D Option D identifies the therapeutic communication technique of restatement. Although it is a technique that has aprompting component to it, it repeats the client’s major theme and provides the perception of the problem form the client’s perspective. Option A allows the client to direct the discussion when it needs to be more focused at this point. Option B uses reflection that simply repeats the client’s last words to prompt further discussion. Option C focuses on the number of nights rather than the specific problem of sleep.

3. Answer A Open ended questions and silence are strategies used to encourage clients to discuss their problem. Option B and C do not encourage the client to express their feelings. The nurse should not offer opinions and should encouarge the client to identify the reasons for the behavior. Option D is not a client center intervention.

4. Answer A Denial is a response of a victim of child abuse. It is described as an adaptive and protective reaction. Projection is blaming or “scapegoating” rationalization is justifying the unacceptable attributes about himself or herself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful stimuli.

5. Answer B Denial is refusal to admit painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other people, objects, or situations. In regression, the client returns to an earlier, more comforting, although less mature way of behaving. Rationalization is justifying the unacceptable attributes about oneself.

St. Louis Review Center, Inc-Davao Tel. no. (082) 224-2515 or 222-8732 1

6. A client says to the nurse, “I’m going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this! After all I’m the one who’s dying.” The most therapeutic response by the nurse is:a. “You’re feeling angry that your family

continues to hope for you to be cured”b. “I think we should talk more about your

anger with your family”c. “Well, it sounds like you’re being pretty

pessimistic. After all, years ago people died of pneumonia.”

d. “Have you shared your feelings with your family?"

7. A nurse is caring for a client who is scheduled for electroconvulsive therapy. The nurse notes an informed consent has not been obtained for the procedure. On review of the record, the nurse notes that the admission was an involuntary hospitalization. Based on this information, the nurse determines that:a. An informed consent does not need to be

obtainedb. An informed consent should be obtained

from the familyc. An informed consent needs to be obtained

from the clientd. The physician will obtain the informed

consent

8. A nurse is preparing a client for the termination phase of the nurse client relationship. Which of the following nursing tasks would the nurse appropriately plan for this phase:a. Identify expected outcomesb. Plan short term goalsc. Assist in making appropriate referralsd. Assist in developing realistic solutions

9. During the termination phase of the nurse-client relationship, the clinic nurse observes that the client continuously demonstrates bursts of anger. The most appropriate interpretation of the behavior is that the client:a. Requires further treatment and is not ready

to be dischargedb. Is displaying behaviors that can occur during

terminationc. Needs to be admitted to the hospitald. Needs to be referred to a psychiatrist as soon

as possible

6. Answer AReflection is the therapeutic communication technique that redirects the client’s feelings back in order to validate what the client is saying. In option B, the nurse attempts to use focusing, but the attempt to discuss central issues seems premature. In option C, the nurse makes a judgment and is non therapeutic in the one-on-one relationships. In option D, the nurse is attempting to asses the clien’s ability to openly discuss feelings with family members. Although thismay be appropriate, the timing is somewhat premature and closes off the client’s facilitation of the client’s feelings.

7. Answer CClient’s who are involuntarily admitted do not lose their right to informed consent. The informed consent needs to be obtained from the client. Options A, B and D are incorrect.

8. Answer C Task of the termination phase include evaluating client’s performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals, and dealing with the common behaviors associated with termination. Options A,B and D identify task of the working phase of the relationship.

9. Answer BIn the termination phase of the relationship, it is normal for the client to demonstrate a number of regressive behaviors. Typical behaviors include return of symptoms, anger, withdrawal and minimizing the relationship. The anger that the client is experiencing is normal behavior during the termination phase and does not necessarily indicate the need for hospitalization or treatment.


10. Milieu therapy is prescribed for a client. The nurse understands that this type of therapy can best be described as which of the following:a. A form of behavior modification therapyb. A cognitive approach in changing behaviorc. The client is involved in setting goalsd. A behavioral approach to changing behavior

11. Disulfiram (Antabuse) is prescribed for a client with a problem related to alcohol. The nurse understands that this medication works on the principle of which of the following therapies?a. Desensitizationb. Self-control therapyc. Milieu therapyd. Aversion therapy

12. A client with eating disorder is attending group meetings with overeaters anonymous. Which of the following is not a characteristic of this form of self-help group?a. People who have a similar problem are able

to help othersb. It is designed to serve people who have a

common problemc. The members provide support to each otherd. The leader is a nurse or a psychiatrist

13. A nurse collects data on a client with an admitting diagnosis of bipolar affective disorder-mania. The symptom presentation that requires the nurse’s immediate intervention is:a. The client’s outlandish behaviors and

inappropriate dressb. The client’s grandiose delusions of being a

royal descendent of King Arthurc. The client’s non stop physical activity and

poor nutritional intaked. The client’s constant, incessant talking that

includes sexual innuendoes and teasing the staff

14. A nurse reviews the activity scheduled for the day and determines that the best activity that a manic client could participate in is:a. A brown bag luncheon and a book reviewb. Tetherballc. A paint-by-number activityd. A deep breathing and progressive relaxation

group

10. Answer C Milieu thearpy provides a safe environment that is adapted to the individual client’s needs and also provides greater comfort and freedom of expression that has been experinced in the past by the client. All members contribute to the planning and functioning of the setting.

11. Answer D Aversion therapy, also known as aversion conditioning or negative reinforcement, is a technique use to change behavior. In this theraoy, a stimulus (alcohol) attractive to the client is paired with an unpleasant event in hopes of instituting the stimulus with negative properties. Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus with a weaker and milder form. Milieu therapy provides positive environmental manipulation, both physical and social, to affect a positive change in the client. Self control therapy combines cognitive and behavioral approaches and is useful to deal with stress.

12. Answer D The sponsor of the self help group is an experienced member of the group. A nurse or a psychiatrist may be ask by the group to serve as a resource but would not be the leader of the group. Options A, B and C are characteristics of a self help group.

13. Answer C Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep and impaired ability to concentrate or complete a single train of thought. It is a period when the mood is predominantly elevated, expansive or irritable. Option C identifies a physiological need requiring immediate intervention.

14. Answer B A person who is experiencing mania is overactive, full of energy, lacks concentration and has poor impulse control. The client needs an activity that will allow him or her to use excess energy, yet not endanger others during the process. Options A, C and D are relatively sedate activities that require concentration, a quality that is lacking in the manic state. Such activities may lead to increased frustrations and anxiety for the client. Tetherball is an exercise that uses the large muscle groups of the body and is a great way to expend the increased energy this client is experiencing.


15. A woman comes into the emergency room in a severe state of anxiety after a car accident. The most important nursing intervention is to:a. Remain with the clientb. Put the client in a quiet roomc. Teach the client deep breathingd. Encourage the client to talk about her

Feelings and concerns

16. A male client with delirium becomes agitated and confused in his room at night. The best initial intervention by the nurse is to:a. Use a night light and turn off the televisionb. Keep the television and a soft light on during

the nightc. Move the client next to the nurse stationd. Play soft music during the night, and maintain

a well lit room

17. A nurse is collecting data on a client who is actively hallucinating. Which of the following nursing statements would be most therapeutic at this time?a. “I talked to the voices you’re hearing and

they wont hurt you now”b. “I can hear the voice and she wants you to

come to dinner”c. “sometimes people hear things or voices

other can’t hear”d. “I know you feel ‘they are out to get you’ but

it’s not true

18. A nurse is caring for a client who has been treated with long term anti-psychotic medication. As part of the nursing care plan, the nurse monitors for tardive dyskinesia (TD). In the event that TD occurs, the nurse would most likely to observe:a. Abnormal movements and involuntary

movements of the mouth, tongue and faceb. Abnormal breathing through the nostrilsc. Severe headache, flushing, tremor and ataxiad. Severe hypertension, migraine headache, and

“marbles in the mouth” syndrome

15. Answer AIf a client is left alone with severe anxiety, he or she may feel abandoned and become overwhelmed. Placing the client in a quiet room is also indicated, but the nurse must stay with the client. It is not possible to teach the client deep breathing until a the anxiety decreases. Encouraging the client to discuss concerns and feelings would not take place until the anxiety has increased.

16. Answer AIt is important to provide a consistent daily routine and a low stimulating environment when the client is agitated and confused. Noise levels including a radio and televisionmay add to the confusion and disorientation. Moving the client next to the nurses’ station is not the initial action.

17. Answer CIt is important to the nurse to reinforce reality with the client. Options A, B and D do not reinforce reality but rather the hallucination that the voices are real.

18. Answer ATardive dyskinesia is a severe reaction associated with the long term use of antipsychotic medication. The clinical manifestation are abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue and face. In its more severe form, tardive dyskinesia involves the fingers, arms, trunk and respiratory muscles. When this occurs, the medication is discontinued.


19. A nurse is caring for a female client who has recently admitted for anorexia nervosa. The nurse enters the client’s room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate:a. Allow the client to complete her exercise

programb. Tell the client that she is not allowed to

exercise rigorouslyc. Interrupt the client and offer to take her for a

walkd. Interrupt the client and weigh immediately

20. A nurse is caring for a client with anorexia nervosa. The nurse monitoring the client’s behavior understands that the client with anorexia nervosa manages anxiety by:a. Always reinforcing self approvalb. Having the need to always make the right

decisionc. Engaging in immoral actsd. Observing rigid rules and regulations

21. A nurse is developing a plan of care for the hospitalized client with bulimia nervosa. Which of the following would not be included in the plan of care:a. Monitoring intake and outputb. Monitoring electrolyte levelsc. Observing for excessive exercised. Checking for the presence of laxatives and

diuretics in the client’s belongings

22. A nurse is caring for a client who abuses alcohol for signs of alcohol withdrawal. Which of the following will alert the nurse to the potential for delirium tremors (DT)?a. Hypertension, changes in the levels of

consciousness, hallucinationsb. Hypotension, ataxia, vomitingc. Stupor, agitation, muscular rigidityd. Hypotension, coarse hand tremor, agitation

19. Answer CClients with anorexia nervosa are frequently preoccupied with rigorous exercise and push themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise as well as place limits on rigorous activities. Options A, B and D are inappropriate nursing actions.

20. Answer DClients with anorexia nervosa have the desire to please others. Their need to be correct of perfect interferes with rational delusion-making processes. These clients are moralistic. Rules and rituals help these clients manage their anxiety.

21. Answer CExcessive exercise is a characteristic of anorexia nervosa, not a characteristic of client with bulimia. Frequent vomiting, in addition to the laxative and diuretic abuse, may lead to dehydration and electrolyte imbalance. Assessing for dehydration and electrolyte imbalance are important nursing actions. Option C is the only option that is not a characteristics of bulimia.

22. Answer AThe symptoms associated with DTs typically are anxiety, insomia, anorexia, hypertension, disorientation, visual or tactile hallucinations, changes in the level of consciousness, agitation, fever and delusions.


23. A spouse of a client admitted for alcohol withdrawal says to the nurse “ I should get out of this bad situation” The most helpful response by the nurse would be:a. “I agree with you. You should get out of this

situation”b. “What do you find difficult about this

situation”c. “Why don’t you tell your husband about this”d. “This is not the best time to make the

decision.”

24. A nurse is caring for a client who is suspected to be dependent on drugs. Which of the following questions would be most appropriate for the nurse to ask when collecting data from the client regarding the drug abuse?a. “Why did you get started on these drugs?”b. “How long did you think you could take these

drugs without someone finding it”c. “How much do you use and what effect does

it have on to you”d. The nurse does not ask any questions in fear

that the client is in denial and will throw the nurse out of the room

25. The nurse is assigned to care for a client at risk for alcohol withdrawal. The nurse monitors the client knowing that the early signs of withdrawal will develop within how much time after the cessation or reduction of alcohol intake?a. Within a few hours c. In 1 weekb. After several hours d. In 2 to 3 weeks

26. A nurse is collecting data from the client with a diagnosis of bulimia nervosa. The nurse understands that which of the following is not a characteristic finding in this disorder?a. Enlarged parotid glandsb. Dental erosionsc. Electrolyte imbalanced. Body weight well below the ideal range

27. A nurse is reviewing the health care record of a client admitted to the psychiatric unit. The nurse notes that the admission nurse has documented that the client is experiencing anxiety as a result of a situational crisis. The nurse would determine that this type of crisis could be caused by:a. A fire that destroy the client’s homeb. A recent rape episode experienced by the

clientc. The death of a loved oned. Witnessing a murder

23. Answer BThe most helpful response is the one that encourages the client to problem solve. Giving advice implies that the nurse knows what is best and can also foster dependency. The nurse should not agree with the client, nor should the nurse request that the client provide explanations.

24. Answer CWhenever the nurse performs an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to ellicit information by being non judgmental and direct. Option A is incorrect because it is judgmental, off focus, and reflects the nurses’ bias. Option B is incorrect because it is judgmental, insensitive and aggressive, which is non therapeutic. Option D is incorrect because it indicated passivity on the part of the nurse and uses rationalization to avoid the therapeutic nursing intervention.

25. Answer A Early signs of alcohol withdrawal develop within a few hours after the cessation or reduction of alcohol and peaks after 24 to 48 hours.

26. Answer DClients with bulimia nervosa may not initially appears to be physically and emotionally ill. They are ofetn or slightly below ideal body weight. On further inspection, the client demonstrates enlargement of the parotid glands with dental erosion and caries if the client is inducing vomiting. Electrolyte imbalances are present.

27. Answer CA situational crisis arises from external rather than internal sources. External situations that could precipitate crisis include loss of or change of a job, the death of a loved one, abortion, a change in financial status, divirce, the addition of a new family members, pregnancy and severe illness. Options A,B and D identify adventitious crisis. An adventitious crisis is not part of everyday life, is unplanned and accidental.


28. A nurse is gathering a data from a crisis. When determining the client’s perception of the precipitating event that led on the crisis, the most appropriate question to ask is:a. “What leads you to seek help now?”b. “Who is available to help you?”c. “What do you usually do to feel better?”d. “With whom do you live?”

29. A nurse is assisting in developing a plan of care for the client in crisis state. When developing plan, the nurse will consider which of the following?a. Presenting symptoms in a crisis situation are

similar for all individuals experiencing a crisisb. A crisis states indicates that the individual is

suffering from emotional illnessc. A crisis state indicates that the individual is

suffering from a mental illnessd. A client’s response to a crisis for one person

may not constitute a crisis for another person

30. A nurse observes that the client with a potential for violence is agitated, pacing up and down the hallway, and is making aggressive belligerent gestures at the other clients. Which of the following statements would be the most appropriate to make to this client?a. “What is causing you to become agitated?”b. “You need to stop that behavior now!”c. “You will need to be restrained if you don’t

change your behavior”d. “You will need to place in seclusion”

31. A nurse is planning care for a client who is being hospitalized because the client has been displaying violent behavio and is at risk for potential harm to others. Which of the following would not be a component of the plan of care?a. Keep the door to the client’s room open

when with the clientb. Assign the client to a room at the end of the

hallc. Face the client when providing cared. Ensure that the security officer is within the

immediate area

28. Answer AA nurse’s initial task when gathering data from a client in crisis is to assess the individual or family and the problem. The more clearly the problem can be defined, the better the chance a solution can be found. Option A will assist in determining data related to the precipitating event that led on the crisis. Option B and D identify situational supports. Option C identifies personal coping skills.

29. Answer DAlthough each crisis response can be described in similar terms as far as presenting symptoms are concerned, what constitutes a crisis from one person may not constitute a crisis for another person because each is a unique individual. Being in crisis state does not mean that the client is suffering from an emotional or mental illness.

30. Answer AThe best statement is to ask the client what is causing the agitation. This will assist the client to become aware of the behavior and will assist the nurse in planning appropriate interventions for the client. Option B is demanding behavior, which could cause increased agitation to the client. Options C and D are threats to the client and are inappropriate.

31. Answer BThe client should be placed in a room near the nurses station and not at the end of a long, relatively unprotected corridor. The nurse should not isolate self with a potentially violent client. The door to the client’s room should be kept open, and the nurse should never turn away from the client. A security officer or male aide should be within immediate call if there is a suspicion that an act of violence is imminent.


32. Which behaviors observed by the nurse might lead to the suspicion that a depressed female adolescent client may be suicidal?a. The client becomes angry while speaking on

the telephone and slams the receiver down on the hook

b. The client runs out of the therapy group swearing at the group leader and runs to her room

c. The clients gets angry with her roommate when the room mate borrows the client’s clothes without asking

d. The client gives away a prized CD and a cherished autograph picture of the performer

33. The police arrive at the emergency room with a client who has seriously lacerated both wrists. The initial nursing action is to:a. Examine and treat the wound siteb. Secure and record a detailed historyc. Encourage and assist the client to ventilate

feelingsd. Administer an antianxiety agent

34. A nurse receives a telephone call from a male client who states that he wants to kill himself and has a bottle of sleeping pills in front of him. The best nursing action is to:a. Insist that the client give you his name and

address so that you can get the police there immediately

b. Keep the client talking and allow the client to ventilate feelings

c. Use therapeutic communications, especially the reflection of feeling

d. Keep the client talking, signal to another staff member to trace the call so that appropriate help can be sent

35. The activity that would be the least therapeutic for severely depressed clients would be:a. Specific, simple instructions to be allowedb. Simple, easily completed, short term projectsc. Monotonous, repetitive projects and

activitiesd. Allowing the clients to plan their own

activities

32. Answer DA depressed suicidal client often “gives” away that which is of value as a way of saying “goodbye” and wanting to be remembered. Options A, B and C identify acting out behaviors.

33. Answer AThe initial nursing action is to examine and treat the self inflicted injuries. Injuries from the lacerated wrist can lead to a life threatening situation. Other interventions may follow after the client has been treated medically.

34. Answer DIn a crisis, the nurse must take an authoitative,active role to promote the client’s safety. A bottle of sleeping pills in front of the client who verbalizes he wants to kill himself is a crisis. The client safety is of prime concern. Keeping the client on the phone and getting help to the client is the best intervention. The word “insist” may anger the client anf he may hang up. Option B lacks the authoritative action stance of securing the client’s safety. Usingtherapeutic communication is important, but overuse of “reflection” may sound uncaring or superficial and is lacking direction/solutions to the immediate problem of the clients safety.

35. Answer DSeverely depressed clients are not motivated to take action or to plan ahead. They are unable to direct their energy on the environment. A. This would be helpful to a severely

depressed client, whose attention span is limited.

B. This would be helpful to a severely depressed client because it requires little thought and provides gratification and satisfaction.

C. This would be helpful for a person with depression as well as for the cognitively impaired.


36. When caring for the extremely depressed client, the staff should set specific goals directed toward helping the client:a. Set realistic life goalsb. Develop trust in othersc. Express hostile feelingsd. Get involved in activities

37. When developing a nursing care plan for a depressed client, the approach that would be most therapeutic would be:a. Allowing time for the client’s slowness when

planning activitiesb. Helping the client focus on family strengths

and support systemsc. Encouraging the client to perform menial

tasks to meet the need for punishmentd. Repeating again and again that the staff views

the client as worthwhile and important

38. The activity that would be most appropriate for a depressed client during the early part of hospitalization would be a:a. Game of trivial pursuitb. Project involving drawingc. Small dance-therapy groupd. Card game with three other clients

39. A withdrawn client refuses to go out of bed and becomes upset. It would be most therapeutic for the nurse to:a. Require the client to get out of bed at onceb. Stay with the client until the client calms

downc. Give the client the PRN neuroleptic that is

orderedd. Allow the client to stay in bed for the present

without company

40. A client is place on suicide precautions. The most therapeutic way to provide these precautions would be to:a. Remove all sharp and cutting objectsb. Not allow the client to leave his/her roomc. Give the client the opportunity to ventilate

feelingsd. Assign a staff member to be with the client at

all times

36. Answer C Depressed clients find it difficult to express anger and hostility because they have internalized these feelings and turned them on themselves.A. There is nothing to indicate that the client

has unrealistic goals.B. This would develop in time; it is not really

a goal of therapy.D. This would be part of the intervention,

not a goal.37. Answer A Routines should be kept simple and

no demands should be made that the client cannot meet. The client is depressed and all actions are slow. Putting pressure on the client will only increase anxiety and feelings of worthlessness.B. The client will have to focus on personbal

strenghts, not on family strenghts.C. This would feed into the client’s feelings

of unwothiness and frustrations.D. Feelings of worth must come from within

the individual; the nurse must reassure the client through actions, not words.

38. Answer B An art-type project that could be worked on successfully at one’s own pace would be important.A. This would require too much

concentration and increase the client’s feelings of despair.

C. This is used mostly for severely regressed clients, and at this point it may not be appropriate for this client.

D. Same as Answer A39. Answer B This provides support and security

without rejecting the client or placing value judgments on behavior.A. Limits will have to be set in giving care but

staying with the client and showing acceptance are immediate nursing actions.

C. This would only calm the client down; it does not try to deal with the problem

D. This would be ignoring the problem; isolation would imply punishment.

40. Answer D Emotional support and close surveillance can demonstrate the staff’s caring and their attempt to preventing acting out of suicidal ideation.A. This would be routinely done; by itself it is

not necessarily therapeuticB. This would be a punishment for the client

who may still find a way to carry out a suicide attempt in a room.

C. This is not a suicide precaution.


41. An elderly client, depressed client frequently paces the halls, becoming physically tired from the activity. To help the client reduce this activity, the nurse should:a. Supply the client with simple monotonous

tasksb. Request a sedative order from the client’s

physicianc. Restrain the client in a chair, reducing the

opportunity to paced. Place the client in a single room, thus limiting

pacing on a smaller area

42. A long term therapy goal for a female client hospitalized for a major depressive episode should be that the client will be:a. Able to talk about her depressed feelingsb. Able to develop new defense mechanismsc. More realistic in accepting herself and othersd. Aware of the unconscious source of her anger

43. The action by the nurse that would be most therapeutic when a depressed client states, “ I am no good. I’m better off dead.” Would be:a. Stating, “ I think you’re good; you should

think of livingb. Stating, “I will always stay with you until you

are less depressed.”c. Alerting the staff to provide 24 hour

observation of the clientd. Unobtrusively removing those articles that

could be used in suicide attempts

44. A positive nursing action when caring for a middle-aged, depressed client is to:a. Play a game of chess with the clientb. Allow the client to make personal decisionsc. Sit down next to the client as often as

possibled. Provide the client with frequent periods of

thinking time

41. Answer AThese clinets can be usually fairly easily distracted by planned involvement in repetitious simple tasks.B. This should be employed only if the

client’s restlessness cannot be controlled with other measures and physical exhaustion creates a danger for the client.

C. This would be abusive treatment for the client with a need to pace and would reinforce the client’s belief that punishment was required for redemption.

D. The client may perceive this isolation as a punishment, and it would not allow observation for the staff.

42. Answer CA major part of depression involves an inability to accept the self as it is, which leads to making demands on others to meet unrealistic needs.A. A short term goal would be to talk about

the client’s depressed feelings; a long term goal would be to look at what is causing those feelings.

B. Developing new defense mechanisms would not the the priority because they tend to help the client avoid reality.

D. This is not important or crucial to the client’s recovery.

43. Answer CThis is the most therapeutic approach. The staff member also provides special attention to help the client meets dependency needs and reduce a self defeating attitude.A. This response negates client’s feelings and

cuts off further communication.B. This is unrealistic because the nurse

cannot be with the client constantly until the depression lifts.

D. The priority 24 hour observation of the client; removing articles that could provide a means for suicide would also be done.

44. Answer CThis gives the client the nonverbal message that someone cares and views the client as being worthy of attention and concern.A. The concentration required for chess is

too much for the client at thisn time.B. The client is incapable of making decisions

at this time.D. Depressed clients often too much thinking

time.


45. A client is admitted to the hospital following a week long period of complete inability to function and aimless activity. During the assessment, the nurse notes the client is pacing the floor, weeping and wringing the hands. The nurse would expect the physician to order an:a. Antimanic medicationb. Antianxiety medicationc. Antipsychotic medicationd. Antidepressive medication

46. On the second day after admission, a suicidal client asks the nurse, “Why am I being observed around the clock and why is my freedom to move around the unit restricted?’ the nurse most appropriate reply would be:a. “Why do you think we are observing you?”b. “What makes you think that we are observing

you?”c. “We are concerned that you might try to

harm yourself”d. Your doctor has ordered it and is the one you

should ask about it.”

47. One day, while shaving, a male client with a diagnosis of bipolar disorder states to the nurse, “I have hidden a razor blade and tonight I am going to kill myself.” The nurse’s best reply would be to:a. “You’re going to kill yourself?’b. “Things can really be that bad”c. ‘I’m sure you don’t really mean that.”d. “You’d better finish shaving; it’s time for

lunch.”

48. The treatment plan for a client admitted with a severe, persistent, intractable depression and suicidal ideation would probably include:a. Electroconvulsive therapy b. Short term psychoanalysisc. Nondirective psychotherapyd. High doses of anxiolytic drugs

45. Answer DThese behaviors are signs of clinical depression and need to be treated with antidepressives such as SSRI’s, tricyclic antidepressants, and MAOI’s which stimulates purposeful activity.A. These behaviors indicates agitated

depression, not mania.B. Theses behaviors are signs of agitated

depression, not anxiety.C. Antipsychotic medications such as the

phenothiazine group, haloperidol, and clozapine are used to treat the manic phase of bipolar disorder, not for any depression.

46. Answer CThis statement helps the client realize that staff members care and feel that the client is worthy of care.A. This is a response that places the client on

the defensiveB. This is inppropriate response to a rather

obvious situation.D. This is an evasive tactic by the nurse

47. Answer AThe clients is asking for help to prevent suicide. This response focuses on feelings and does not challenge or deny them.B. This response negates the client’s feelings

and interprets the situation for the client.C. This response denies the client’s feelings

and does not follow through on what the client is saying.

D. This response ignores the client’s cry for help and that does not follow through on what the client is expressing.

48. Answer A Electoconvulsive therapy, which interrupts established patterns of behavior, helps relieves symptoms and limits possible suicide attempts in clients with severe, intractable depressions that do not reapond to antidepressant medications.B. The client’s depressed mood would

greatly limit participation in psychotherapy; feelings precipitated by therapy may lead to suicidal acting out.

C. Psychotherapy is directed toward helping the person learn new coping mechanisms and better ways of dealing with problems, the depressed client needs direction to accomplish this.

D. These are antianxiety medications that would not ordinarily be used for the clients with depression.


49. A severely depressed client is to have an electroconvulsive therapy (ECT). When discussing this therapy, the nurse should tell the client that:a. Sleep will be induced and treatment will not

cause painb. With new methods of administration,

treatment is totally safec. It is better not to talk about it, but you can

ask any question you liked. There may be some permanent memory loss

as a result of the treatment

50. A side effect of electroconvulsive therapy that a client may experience is:a. Loss of appetiteb. Postural hypotensionc. Confusion for a time after treatmentd. Complete loss of memory for a time

51. A 46 year old male client has just awakened from his first scheduled ECT treatment. The most appropriate nursing intervention would be to:a. Arrange for the dietary staff to bring the

client a lunch trayb. Orient the client to the time and place and

tell him that he has just had a treatmentc. Get the client up and out of bed as soon as

possible and back into the unit’s routined. Take the blood pressure and pulse every 15

minutes until the client is fully awake

52. During the orientation tour for three new staff members, a young, hyperactive, manic client greets them by saying, “Welcome to the funny farm. I’m Jo-Jo, the head yo-yo.” This comment might mean that the client is:a. Trying to fill the “life-of-the-party” roleb. Looking for attention from the new staffc. Unable to distinguish fantasy from realityd. Anxious over the arrival of the new staff

members

49. Answer AClients fear this therapy because of the expected pain. If they will be reassured that they will be asleep and have no pain, ther will be less anxiety and more cooperation.B. No treatment requiring anesthesia is

totally safe.C. Client’s may not realize their own fears

and not know what questions to ask; this statement cuts off future communication.

D. Temporary, not permanent, loss occurs.

50. Answer CThe electrical energy passing through the cerebral cortex during ECT results in temporary state of confusion after treatment.A. This is not a usual or expected side effectB. Same as Answer AD. Same as Answer A

51. Answer BClients are confused whewn they are awaken after ECT. They have a loss of recent memory, so it is imporatnt to orient them to time, place and situation.A. This would be a later action, if the client

asked for food.C. This would not be appropriate for a client

who has just awakened after a treatment.D. This is not necessary.

52. Answer D The client’s behavior demonstrates increased anxiety. Since it was directed toward the new staff, it was probably precipitated by their arrival.A. The client is not filling the “life-of-the-

party” role; the client is rsulting to previous coping behavior in the face of extreme stress.

B. This is possible, but the remark is more indicative of increased anxiety.

C. The client is aware of what is going on and who everyone is at this time.


53. When the language of a client in the manic phase of a bipolar disorder becomes vulgar and profane, the nurse should:a. State, “We do not like that king of talk around

here.”b. Ignore it, since the client is using it only to get

attentionc. Recognize the language as part of the illness,

but set limits on itd. State, “When you can talk in an acceptable

way, we will talk to you.”

54. The nurse is assigned to care for a 39-year-old, hyperactive, manic client who exhibits flight of ideas. The client is not eating. The nurse recognizes this may be because the client:a. Feels undeserving of the foodb. Is too busy to take the time to eatc. Wishes to avoid the clients in the dining roomd. Believes that at this time there is no need for

food

55. The nurse recognizes that an excellent indicator of improvement in a client with the diagnosis of generalized anxiety disorder is when the client:a. Learns to avoid anxietyb. Participates in activitiesc. Takes medications as prescribedd. Identifies when anxiety is developing

56. When caring for a client with generalized anxiety disorder, the nurse should be aware that one of the best indicators of the client’s present condition is the client’s:a. Memory c. Judgmentb. Behavior d. Responsiveness

57. An obviously distraught client arrives at the mental health clinic. The client is disheveled, is agitated and demands that someone”do something to end this feeling.” The nurse recognizes that the client has:a. Feelings of panicb. Suicidal tendenciesc. Narcissistic behaviord. A demanding personality

53. Answer C Recognizing the language as part of the illness makes it easier to tolearte, but limits must be set for the benefit of the staff and other clients. Setting limits also shows the client that the nucrse care enough to stop the behavior.A. This statement shows little understanding

or tolerance of the illness.B. Ignoring the behavior is a form of

rejection; the client is not using the behavior for attention.

D. This statement demonstrate a rejection of the client and little understanding of the illness.

54. Answer B Hyperactive cleints frequuently will not take the time to eat because they are overinvolved in everything that is going on.A. This is indicative of depressive episodeC. The client is unable to sit long enough

with the other clients to eat a meal; this is not conscious avoidance.

D. The client probably gives no thought to food because of overinvolvement of activities in the enviroment.

55. Answer D Recognition of anxiety or symptoms of increasing anxiety are an indication that the client is improving.A. Avoidance of anxiety is not a good

indication of improvement, the is no guarantee that the anxiety can always be avoided.

B. This does not indicate improvement or recognition of feelings; the client may just be doing what others expect.

C. Same as Answer B56. Answer B The client current behavior is the

best indicator of the client’s current level of functioning; all behavior has meaning.A. This is important and should be assesed,

but it is not the best indicator of the current level of functioning.

C. Same as Answer AD. Same as Answer A

57. Answer A The client can no longer control or tolerate feelings and attempts to disregard reality as a means of avoiding it.B. The client has not indicated plans for self

harm;the client is asking others to do something to help relieve the feeling.

C. The client is experiencing panic and is crying for help; this behavior is not typical of a narcissistic personality.

D. The client is in a state of panic and is crying for help; this behavior does not indicate a demanding personality.


58. The nurse is aware that as anxiety increases, one’s concept of reality alters. Therefore when caring for a client with generalized anxiety disorder, the nurse’s first intervention would be to:a. Have the client verbalize feelings of anxietyb. Administer the PRN medication ordered by

the physicianc. Remove as many stimuli from the client’s

environment as possibled. Have the client list the relief behaviors that

are used to reduce anxiety

59. A phobic reaction will rarely occur unless the person:a. Thinks about the feared objectb. Absolves the guilt of the feared objectc. Introjects the feared object into the bodyd. Comes into contact with the feared object

60. The nurse, when exploring the modalities available for the treatment of phobias, should inform the client that the treatment having the biggest success rate of people with phobias is:a. Systematic desensitization using relaxation

techniquesb. Insight therapy to determine the origin of the

anxiety and fearc. Psychotherapy aimed at rearranging

maladaptive thought processesd. Psychoanalytic exploration of repressed

conflicts of an earlier developmental phase

61. When speaking with the client who has just experienced a panic attack, the nurse can address the client’s concerns most therapeutically by stating:a. “You must have been really upset”b. “You are concern that this might happen

again”c. “Episodes like this can be upsetting, but they

do end.”d. “Your family was concerned that you were

having heart attack.”

58. Answer CRemoving as many external stimuli as possible helps reduce the client’s anxiety by limiting the factorsthat must be dealt with; decreasing stimuli usually decreases anxiety.A. This may not decrease anxiety and may in

fact increase it.B. This may or may not be necessary; not the

first intervention until an assessment is completed.

D. The anxiety level must be decreased before this intervention can be implemented.

59. Answer DIn phobias the individual transfers anxiety to a rather safe inanimate object. Therefore the anxiety and resulting feelings will inly be precipitated when in direct contact with the object.A. It is not thinking about the feared object

that causes anxiety; it is the possibility of having to come into contact with it.

B. It is the guilt or the fear within the person, not the object, that nust be dealt with.

C. It is not possible to introject the feared object into the body.

60. Answer AThe most successful therapy for clients with phobias involves behavior modification techniques using desensitization.B. Insight into the origin of the phobia will

not necessarily help the client overcome the problem.

C. May increase understanding of the phobia but may not help the client to deal with the fear; there is no maladaptive thought processes associated with phobia.

D. Psychoanalysis may increase the understanding of the phobia , but may not help the client deal successfully with the unreasonable fear.

61. Answer BRecurrence of attacks is a common concern.A. This is not therapeuticC. Although this response initially focuses on

feelings it then cuts off communication.D. The client will be focused on won needs,

not what the family says.


62. Unsatisfied needs create anxiety that motivates an individual to action. This action is brought about mainly to:a. Reduce tensionb. Deny the situationc. Remove the problemd. Relieve physical discomfort

63. The most appropriate way to decrease a client’s anxiety is by:a. Avoiding unpleasant objects and eventsb. Prolonged exposure to fearful situationsc. Acquiring skills with which to face stressful

eventsd. Introducing an element of pleasure into

fearful situations

64. A young client is admitted with a severe anxiety disorder. The client is crying, wringing the hands and pacing. The first nursing intervention should be to:a. Stay physically close to the clientb. Gently ask what is bothering the clientc. Tell the client to sit down and try to relaxd. Get the client involve in nonthreatening

activity

65. The nurse could most appropriately begin to help an extremely anxious client with a sleep problem, who has been assigned to a four-bed room since admission, by saying:a. “You seem unable to sleep at night.”b. “I’m going to move you on a private room.”c. “Don’t worry, you’ll sleep when you are

tired.”d. “I’ll give you the sedative your doctor ordered

66. To give effective nursing care to a client who is using ritualistic behavior, the nurse must first recognize that the client:a. Should be prevented from performing the

ritualsb. Need to realize that the rituals has no

purposec. Must immediately be diverted when

performing the rituald. Does not want to repeat the ritual, but feels

compelled to do so

62. Answer AWhen tension is reduced, anxiety diminishes and the person feels more comfortable, safe and secure.B. Ther would be less anxiety if the person

were able to deny the situation.C. When anxiety is high the client is unable

to focus on the problem.D. This action would have an effect on

psychologic rather than physical discomfort.

63. Answer CLearning a variety of coping mechanisms help rduce anxiety in stressful situations.A. A person must learn to cope with

unpleasant objects and events.B. Prolonged exposure will increase anxiety

to possibly uncontrollable levels.D. Fearful situations can never be viewed as

pleasurable.64. Answer A

By staying physically close, the nurse conveys to the client the message that someone cares enough to be there and that the client is a person worth caring for.B. The client is incapable of telling anyone

what the problem isC. Sitting still will increase the tension the

client is experiencingD. This would not be an initial nursing

intervention.

65. Answer BThe client is too anxious to sleep in four bedroom and should be simply be moved to a private room.A. Just talking about the problem will not

improve it; quietly moving the client to a private room would be better intervention at this time.

C. This is false reassuranceD. This probably would not help since it

would not relieve the client’s anxiety.

66. Answer DThe repeated thought or act defends the client against even higher, more severe levels of anxiety.A. To deny the client the ritual may

precipitate panic levels of anxiety.B. The client already recognizes that the

ritual serves little purpose.C. Same as Answer A


67. The nursing diagnosis that would be most appropriate for a 22-year-old client who uses ritualistic behavior would be:a. Ineffective copingb. Impaired judgmentc. Personal identity disturbanced. Sensory/perceptual alterations

68. The priority discharge criteria for a female client who has been using ritualistic behaviors would have to include that the client should be able to:a. Verbalize positive aspects about herselfb. Follow the rules and regulations of the milieu c. Recognize that her hallucinations occur at

times of extreme anxiety and can be controlled

d. Verbalize signs and symptoms of increasing anxiety and intervene to maintain it at a manageable level

69. The nurse allows the client to use ritualistic behavior ample time for the performance of the ritual because:a. Without consistency of limit setting, change

will not occurb. To deny the client this activity may

precipitate panic levels of anxietyc. This behavior is viewed as a result of anger

turned inward on the selfd. Successful performance of independent

activities enhances self esteem

70. One day a male client with the diagnoses of borderline personality disorder describes a situation that happened at work when his immediate supervisor reprimanded him for not completing an assignment. He explains that it was not his fault and states, “People get angry and take it out on me.” The nurse recognizes that the client is using the defense mechanism called:a. Denial c. Displacementb. Projection d. Intellectualization

67. Answer AIneffective coping is the impairment of the persons adaptive behaviors and problem sloving abilities in mmeting life’s demands; ritualistic behavior fits under this category as a definign charateristics.B. Not enough information is available to

use this nursing diagnosis in this situationC. Same as Answer AD. Same as Answer A

68. Answer DThis outcome would result from teaching the client to recognize situations that provoke ritualistic behavior and the client’s learning how to interrupt the pattern.A. Not a priority; the client probably had

littlt difficulty in this area.B. Same as Answer AC. No evidence is presented to indicate the

client was hallucinating.

69. Answer BThe repeated thought or act defends the client against severe anxiety; the client doies not want to perform the ritual but feels compelled to do so to keep anxiety at a controllable level.A. No limits are being set by the nurse’s

actionC. This causes depression and is unrelated to

ritualistic behaviorD. Rituals are not activities that enhances

self-esteem; they control anxiety.

70. Answer BAttributing unacceptable feelings or attributes to others is the mechanism known as projection;the data demonstrate use of this defense mechanism.A. Denial is the unconscious refusal to

recognize the reality of an anxiety producing situation; the data do not demonstrate use of this defense mechanism.

C. Displacement is the shifting of feelings from an emotionally charged situation to a substitute person or object; the date do not demonstrate the use of this defense mechanism.

D. Intellectualization is the use of reasoning to avoid confronting an objectionable


impulse; the data do no demonstrate the use of these defense mechanism

71. When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in:a. Controlling anxietyb. Terminating the session on timec. Accepting the psychiatric diagnosisd. Setting mutual goals for the relationship

72. The main personality problem for clients who need props to blur reality is usually:a. Mistrust c.Dependencyb. Ego ideal d. Role blurring

73. Many people control anxiety by ritualistic behavior. When taking care of these individuals it is important for the nurse to:a. Avoid mentioning the ritualb. Explain the meaning of the ritualc. Allow them time to carry out the rituald. Prevent them from carrying out the ritual

74. A person who habitually expresses anxiety through physical symptoms is using:a. Projection c. Conversionb. Regression d. Hypochondriasis

75. The client with an antisocial personality disorder;a. Suffers from great deal of anxietyb. Is generally unable to postpone gratificationc. Rapidly learns by experience and punishmentd. Has a great sense of responsibility toward

others

71. Answer D Clients with borderline personality disorders frequently demonstrate a patter or unstable interpersonal relationships, impulsiveness, affective instability, and frasntic efforts to avoid abandonment; these beahviors create great difficulty in establishing mutual goals.A. The client with a borderline personality

disorder usually would not have difficulty in this area.

B. Same as Answer A c. Same as Answer A72. Answer C When props are needed to blur

reality, the individual is not able to rely on the self to test out situations, and therefore dependence on others or props increases.A. The person who mistrusts, has not

learned to trust the environment; however, the person does not necessarily needs props.

B. The person with an ego ideal would not need props to blur reality.

D. Role blurring is not a problem requiring prop.

73. Answer C Clients prevented from using ritualistic behavior to control anxiety will be deprived of a defense and have no way of relieving tension.A. The client’s behavior should never be

ignored; it is important to accept and support these clients during this time.

B. This would not decrease the ritualistic behavior

D. Preventing ritualistic behavior will only increase anxiety.

74. Answer C The development of physical symptoms without a physical cause is an anxiety reducing mechanism known as conversion.A. Blaming others for the environment for failure and

mistakes is not converting anxiety into physical symptoms.

B. Going back to an earlier state when one felt safer and more secure is not converting anxiety into physical symptoms

D. This is a continued concern about health characterized by anxiety and an unrealistic interpretation of real or imaginary symptoms as indication of serious illness.

75. Answer B Individuals with personality disorder tend to be self centered and impulsive. They lack judgment and self control and do not profit from their mistakes.A. Generally, just the opposite is trueC. These people never learn from their

mistakes, experiences and punishment.D. These people are too self centered to

have a sense of responsibilty to anyone.


76. A person with an antisocial personality disorder has difficulty relating to others because of never having learned to:a. Count on othersb. Empathize with othersc. Be dependent on othersd. Communicate with others socially

77. A person who deliberately pretends an illness is usually thought to be:a. Neuroticb. Malingeringc. Out of contact with realityd. Using conversion defenses

78. The basic difference between psychophysiologic disorders and somatoform disorders is that in psychophysiologic disorders there is:a. A feeling of illnessb. An emotional causec. A restriction of activitiesd. An actual tissue change

79. A frequent finding in clients with paraphiliac sexual disorders is that they have:a. Other covert or overt emotional disordersb. Gonadal and pituitary hormone deficienciesc. An inadequate physical development of the

sexual organsd. A poor adjustment due to association of the

society’s fringe groups

80. Following an automobile accident involving a fatality and a subsequent arrest for speeding, a client has amnesia for the events surrounding the accident. This is an example of the defense mechanism known as:a. Projection c. Dissociationb. Repression d. Suppression

76. Answer BThe lack of superego control allows the ego and the id to control the behavior. Self motivation and self satisfaction are of paramount concern.A. They count on others to extricate them

from the problems they find themselves faced with.

C. These people are extremely dependent on others

D. These people are usually charming on the surface and can easily “con” people into doing what they want.

77. Answer BWhen the individual consciously pretends an illness with no physical basis, it is called malingering.A. People using neurotic defense really

believe they are sick.C. A person out of contact with reality is

unable to pretend an illnessD. The use of conversion defenses is not a

conscious act.78. Answer D

The psychophysiologic responses (hyperfunction or hypofunction)creates actual tissue change. Somatoform disorders are unrelated to organic changes.A. There is a feeling of illness in both

instancesB. There is an emotional component in both

instancesC. There may be a restriction of activities in

both instances.79. Answer A

Clients with these sexual disorders usually have many other emotional problems that may be overt or covert in nature.B. There is no proof of deficiency of these

hormonesC. There is normal development of sexual

oragns in individuals with paraphiliac sexual disorders.

D. This has no basis in fact.80. Answer C

Dissociation is defined as handling emotional conflicts, or internal or external stressors by a temporary alteration of consciousness or identity.A. Projection is attributing one’s own

unacceptable feelings and thoughts to others.

B. Repression is unconsciously keeping unaaceptable feelings out of awareness.


D. Suppression is consciously keeping unacceptable feelings and thoughts out of awareness

81. The nurse is aware that the approach to be used during crisis intervention should be:a. Passive and reflectiveb. Active and goal directedc. Interpretative and analyticald. Future oriented and passive

82. The outcome that is unrelated to a crisis state is:a. Learning more constructive coping skillsb. Decompensation to a lower level of

functioningc. Adaptation an a return to a prior level of

functioningd. A high level of anxiety continuing for more

than 3 months.

83. The most important assessment data for the nurse to gather from the client in crisis would be:a. The client’s work habitsb. Any significant physical health datac. A history of any emotional problems in the

familyd. The specific circumstances surrounding the

“percieved” crisis situation

84. The best example of the nurse’s use of crisis interention would be:a. “Tell me what you have done to help

yourself”b. “Can you ell me about what is bothering

you?.”c. “I understand in the past you have had

problems.”d. “I will be here for you to help you figure

things out.”

85. A client, admitted 5 days ago for chronic abuse of drugs and alcohol, appears to have extreme difficulty in participating in an art therapy group project. The priority assessment the nurse needs to make after the group therapy is to determine if the client is experiencing a peiod of:a. Crisis c. Confabulation

b. Disorientation d. Hallucinations

81. Answer BDuring crisis intervention the nurse should be goal directive and active in assessing the current situation and handle the interview with authority.A. These are not appropriate; the client

cannot move without direction.C. This approach might be more appropriate

for long term therapy.D. These are not appropriate to crisis

intervention.

82. Answer DThis is not an accepted outcome of a crisis because by definition a crisis would be resolved in 6 weeks.A. This is a desirable outcome of a crisis

situationB. Although this is not the most ideal

outcome for a crisis situation, it is a possible outcome.

C. This is a desirable outcome of a crisis situation.

83. Answer DThis assessment assists the nurse in determining what the situation means to the client.A. This is not as important but should be

inclided in a later assessment.B. Same as Answer AC. Same as Answer A

84. Answer DClients in crisis need assistance with coping; the nurse must be involve with problem solving.A. Although a positive interview statement,

it does not focus on the nurses involvement with problem solving.

B. Same as Answer AC. Same as Answer A

85. Answer AThe clients behavior indicates that the peoblem is occuring in response to the therapy group. The nurse should assess whether participating in the group is creating a crisis for the client.B. There is no data to suggest the client is

disoriented


C. There is no data to suggest the client is using confabulation

D. There is not data to suggest the client is hallucinating

86. When applying mental health principles to the care of any person with children, the nurse should be aware that:a. It is easier to adjust to the first child than to

later one’sb. It is pathologic to feel anger and resentment

towards a childc. Every parent has inborn feelings of love and

acceptance for childrend. Many parents experience feelings of

resentment towards their children

87. Strict toilet training before a child is ready will cause problems in personality development because at this age a child is learning to:a. Satisfy own needsb. Identify own needsc. Satisfy parents’ needsd. Live up to society’s expectations

88. A child in the first grade is murdered and counseling is planned for the children in the school. To understand a child’s response to a crisis, the nurse must initially identify the:a. Child’s developmental levelb. Family communication patternsc. Quality of the child’s peer relationshipsd. Child’s perception of the crisis situation

89. An infant in an newborn nursery is suspected of having cerebral palsy. When the parents are told, the mother cries, “What did we do to deserve this?” The nurse’s most therapeutic response would be:a. “ Let’s sit down and have a cup of coffee.”b. “Why do you feel you are being punished?”c. “I know you must be upset, but it’s too early

to telld. “You didn’t do anything; let me tell you about

this disorder”

90. A young single woman delivers a chiuld with a severe cleft palate. The nurse recognizes the fairly typical response to a baby with a visible birth defect when the woman states:a. “I’m unhappy. I guess I’m being punished”b. “No, you must have brought me the wrong

baby”

c. “What will my parents say? What could have happened?”

d. I shouldn’t have had this baby. Now my boyfriend will never marry me”

86. Answer DFeelings of resentment toward children by parents is a normal response. To relieve feelings of guilt and shame, it is vital to help parents realize this.A. The first child causes the greatest amount

of adjustment in one’s lifeB. These are normal findingsC. This is an untrue generalization.

87. Answer BToddlers struggle to identify their own needs. Too early and too strict toilet training results in ambivalence because toddler’s needs and physical abilities are in conflict with parental demands. Toddlers are faced with giving up these needs or risking parental disapproval.A. Children are involved from birth in

satisfying their own needs.C. Children are involved from birth in

satisfying their parents’ needs, but toilet training is really the first time a conflict develops.

D. A child has no interests in society’s expectations.

88. Answer ADevelopmental level is essential to understanding a child’s response to a crisis situation.B. This is not an initial assessmentC. Same as Answer BD. This is important to assess after the

developmental level as been ascertained.89. Answer A

Sitting down shows the client that the nurse cares enough to spend time. It also opens up channels of communication.B. The nurse sets dimensions on the

mother’s feelings; this does not promote free expression of feelings

C. This statement provides false hope; the possibility of the diagnosis has been introduced.

D. This statement ignores the mother’s need to express feelings; it takes a cognitive approach to the problem.

90. Answer BDenial or disbeleif and shock are considered initial responses of greiving. There is a feeling of guilt and inadequacy when a child is born with a defect or abnormality


A. It would be unusual for a client initially to verbalize feelings of punishment or guilt so directly.

C. A sense of shame and guilt is voiced later; afetr denial, disbelief and shock.

D. It would be unusual for the client to use rationalization and voice it so obviously.

91. According to psychosexual theory, the primary emergence of the personality is demonstrated around the age of:a. 6 months c. 24 monthsb. 9 months d. 48 months

92. Personality is unique in every individual because it is the result of the person’s:a. Intellectual capacity, race and socioeconomic

statusb. Genetic background, placement in the family,

and autoimmunityc. Biologic constitution, psychologic

development and cultural settingd. Childhood experiences, intellectual capacity

and socioeconomic status

93. The basic emotional task for the toddler is:a. Trust c. Identificationb. Industry d.Independence

94. The stage of growth and development basically concerned with role identification is the:a. Oral stage c.Oedipal stageb. Genital stage d.Latency stage

95. Play for the preschool age child is necessary for the emotional development of:a. Projection c. Competition

b. Introjection d.Independence

91. Answer CBefore this age the infant has been developed before ego strength to have an identity or personality.A. This is too early; the child has not

developed enough ego strength to have a personality.

B. Self concept is nonexistentD. The primary emergence of the personality

has already occurred.92. Answer C

The parameters set by birth, physiologic experiences and the environment make each individual unique. Although other factors impinge to a slight degree, these factors form the personality.A. These are not inclusive, they are limited

to only some aspects of personality dvelopment; race plays no part.

B. Autoimmunity plays no part in personality development.

D. These are not inclusive; they are limited to only some aspects of personality development.

93. Answer DTesting the self both physically and psychologically occurs during the toddler stage after trust has been achieved.A. Task is the task of infancyB. This task is accomplished between the

ages of 6 to 12.C. Between the ages of 3 and 6, a child starts

to identify with the parent of the same sex.

94. Answer CThe child resolves oedipal conflicts by learning to identify with the parent of the opposite sex and becomes jealous of the parent of the same sex. These thoughts results in feelings of guilt, anxiety, fear and hate toward the parent of the same sex which are repressed.A. Ambivalence does not occur in the

oedipal stage of developmentB. The child loves the parent of the opposite

sex and hates the parent of the same sex.D. Same as Answer B

95. Answer BValues and beliefs from parents and society are expressed through the child’s play world.


These values becomes part of the child’s system through the process of internalization.A. If this happened, children would learn to

blame others for their own faults.C. This would occur at a later stage.D. The environment and others in it, rather

than play, influence independence.96. Resolution of the oedipal complex takes place

when the child:a. Rejects the parent of the same sexb. Introjects behavior of both parentsc. Identifies with the parent of the same sexd. Identifies with the parent of the opposite sex

97. Evidence of the existence of the unconsciousis best demonstrated by:a. The ease of recall c. Déjà vu experiencesb. Slips of the tongue d. Free floating anxiety

98. The level of anxiety that best enhances an individual’s power of perception is:a. Mild c. Severeb. Panic d. Moderate

99. A person’s seeing a design on the wallpaper perceives it is an animal. This is an example of:a. An illusion c. A hallucinationb. A delusion d. An idea of reference

100. Autism can be usually diagnosed when the child is about:

a. 2 years of age c. 6 months of ageb. 6 years of age d. 1 to 3 months of age

96. Answer CThe child realizes that the parent of the same sex cannot be tested in a struggle for the affection of the parent of the opposite sex. The role and behavior of the same sex parent are therefore assumed by the child to attract the parent of the opposite sex.A. This would be a conflict,; not a resolution.B. Doing this would give rise to greater

conflict and leave a fragmented self.D. This would be in conflict with

heterosexual drives.97. Answer B

Slips of the tongue, also called “freudian slips” are material from the unconscious` that slips out in unguarded moments.A. Material in the unconscious cannot

deliberately be brought back to awareness.

C. There is no evidence linking these experiences to the unconscious.

D. Free floating anxiety is linked to the unconscious, but the best evidence of the unconscious is slips of the tongue.

98. Answer AMild anxiety motivates one to action, such as learning emotional changes. Higher levels of anxiety tend to blur the individual’s peceptions and interfere with functioning.B. Attention is severely reduced by panic.C. The perceptual field is greatly reduced

with severe anxiety.D. The perceptual field is narrowed with

moderate anxiety.99. Answer A

An illusion is an misinterpretation or misperception of the actual external stimuli.B. This is a false belief that cannot be

changed even by evidence; it is a fixedfalse belief.

C. This would deal with imaginary, not real stimuli.

D. A belief that others are talking about the person is not a visual distortion; but rather an idea of reference.

100. Answer ABy 2 years of age, the child should demonstrate an interest in others, communicate verbally, and possess the ability


to learn from the environment. Before these skills develop, autism is difficult to diagnose.B. Autism can be diagnosed long before this

age.C. Infantile autism can occur at this age but

difficult to diagnose.D. Same as Answer C.


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Answer and Rationale Psychiatric Nursing