Q&A Hero

Q: While taking care of a client at the mental health clinic, the student nurse notices scars and healing lacerations on the client's arms. The client states, "I did all of that." The student nurse knows this type of behavior is:Standard Text: Select all that apply.1. Self-destructive.2. A prank.3. A maladaptive measure.4. A coping mechanism.5. A waste of time.

Q: The nurse is learning how to handle feelings of frustration and helplessness when caring for clients with cluster B personality disorders. Which of the following statements by the nurse would reflect that learning has taken place?1. "I can just ignore my feelings and focus on the client's needs."2. "As long as my words are therapeutic, the client cannot tell what I am really thinking."3. "I need to maintain professional distance by using empathy."4. "I can talk about my feelings with my friends."

Q: A client with a diagnosis of antisocial personality disorder comes to the nurses' station at 11:00 p.m. requesting to use the phone. The client insists on consulting a lawyer immediately to discuss filing for a divorce. The unit rules prohibit phone calls after 10:00 p.m. Which of the following responses is therapeutic for this client?1. "It is after 10:00 p.m. You can call tomorrow."2. "You know better than to break the rules. I'm surprised at you."3. "You really don't want to file for a divorce, do you?"4. "You may go ahead and use the phone. I know this is hard for you."

Q: A client with borderline personality disorder approaches the nurse voicing concerns about being ignored by the nursing staff and feeling unimportant. The client blames the nursing staff for not paying attention to the client. The nurse's best therapeutic response to this client would include which of the following statements?1. "Tell me more about your feeling of being ignored."2. "That's all in your imagination."3. "You need to share your feelings with the nurses you feel are ignoring you."4. "I will bring it up at the next meeting."

Q: The nurse is planning care for an individual diagnosed with borderline personality disorder. The nurse realizes that interventions will have to be focused on which of the following behaviors?1. Desiring order and perfection2. Not being able to make decisions3. Acting out when feeling abandoned or disrespected4. Withdrawing and becoming isolative

Q: Clients with antisocial personality disorder display a lack of empathy and will put their own needs above the needs of others. Interventions for clients with antisocial personality disorder will be targeted toward which of the following behaviors?1. Displaying a great deal of responsibility toward others2. Displaying a disregard for the rights of others3. Displaying a great deal of self-control4. Displaying a great deal of anxiety

Q: Which of the following interventions would the nurse implement to address the client with feelings of abandonment?1. Assist client to suppress feelings of abandonment.2. Encourage client to never get involved in a relationship again.3. Assist client to express deep rage at the ending of the relationship.4. Assist client to verbalize feelings of abandonment in an appropriate manner.

Q: A client with a diagnosis of borderline personality disorder has had several hospitalizations for suicide attempts and self-mutilation. A priority nursing intervention for this client would include which of the following?1. Safety maintenance2. Social interaction3. Anxiety reduction4. Concrete communication

Q: The nurse and a client talk about healthy ways to meet needs. The client states, "When I am looking really good, it is not asking too much for people to acknowledge me." The nurse recognizes that this experience is indicative of:1. Affective instability.2. Splitting.3. Feelings of emptiness.4. A sense of entitlement.

Q: The client with a diagnosis of borderline personality disorder shows the nurse multiple superficial cuts to the arms that were made during the night. The client states, "I told the night staff that I was feeling alone." The nurse recognizes that the self-mutilation may be a result of:1. Manipulation.2. Anxiety.3. Splitting.4. Impulsive behavior.

Q: A student nurse is working with a client on the inpatient unit who exhibits manipulative behavior. What action should the student incorporate into interactions with this client?1. Limit setting2. No-harm contract3. Confront negative self-concepts4. Matter-of-fact approach

Q: The nursing staff is discussing boundary setting. Which of the following statements about boundary setting is inaccurate?1. "Boundaries are established by providing consistent expectations."2. "Boundaries define the therapeutic relationship."3. "Boundaries provide guidelines for self-control."4. "Boundaries are established to make the nursing staff's job easier."

Q: A client with borderline personality disorder gives written notice of intention to leave the hospital after a voluntary admission. The client tells the nurse, "I will rescind my notice if you expand my smoking privileges." The nurse should respond in a way that:1. Convinces the client to rescind the notice.2. Provides exceptions to the unit rules.3. Refers the client to the physician.4. Consistently reinforces the unit rules.

Q: The nurse is working with a client who has a history of impulsive and self-harming behavior. The nurse will need to address which of the following in the plan of care?1. Boundary setting2. Confidentiality3. Safety4. Appropriate self-disclosure

Q: A 30-year-old man is accused of sexual assault and is arrested by law enforcement. During the interview with the forensic nurse, the client uses flattery and compliments the nurse's interview skills. He asks the nurse for her phone number so his lawyer can contact her as an expert witness for his case. How should the nurse respond?1. Tell the client that she is listed in the phone book.2. In a way that establishes the boundaries of the nurse"client relationship.3. Tell the client that the nurse is working for the prosecution.4. In a way that nurtures the client's feelings.

Q: The student nurse is comparing the essential characteristics of each cluster of personality disorders. The student correctly identifies the essential characteristics of cluster C disorders as:1. Anxiety.2. Pervasive distrust.3. Impulsivity.4. Openness.

Q: The nurse admits a client who initially presents as intelligent, articulate, and superficially charming. The client claims his admission to the mental health unit is a big mistake. He states that there was a mix-up in the emergency room and he was incorrectly identified. A probable diagnosis is:1. Antisocial personality disorder.2. Avoidant personality disorder.3. Dependent personality disorder.4. Obsessive-compulsive personality disorder.

Q: A client presents with an inability to make decisions and function independently. The nurse knows these symptoms are indicative of which of the following disorders?1. Dependent personality disorder2. Paranoid personality disorder3. Schizotypal personality disorder4. Schizoid personality disorder

Q: The nurse is preparing to assess a client with a diagnosis of paranoid personality disorder. What client characteristics will the nurse expect to observe?1. Grandiosity2. Superficial charm3. Affective instability4. Suspicions and rigidity

Q: The nurse is working with a client who exhibits a pervasive, excessive, and unrealistic need to receive care. This client's behavior is a characteristic of which of the following personality disorders?1. Histrionic personality disorder2. Narcissistic personality disorder3. Dependent personality disorder4. Avoidant personality disorder

Q: The nurse is working with a client who exhibits a grandiose sense of self-importance. This characteristic is associated with which of the following personality disorders?1. Narcissistic personality disorder2. Avoidant personality disorder3. Histrionic personality disorder4. Dependent personality disorder

Q: A client with a diagnosis of paranoid personality disorder appears hypervigilant and sits alone in an isolated area of the unit. The client does not acknowledge other clients and often uses sarcasm when addressing staff. The nurse invites the client to attend a milieu group, but the client ignores the nurse's efforts. An appropriate nursing diagnosis for this client is which of the following?1. Activity Intolerance2. Fear3. Impaired Social Interaction4. Powerlessness

Q: What would the nurse expect to find when assessing a client with obsessive-compulsive personality disorder?1. Difficulty completing projects2. A sense of spontaneity3. Open expression of feelings4. Ability to tolerate mistakes

Q: Impulse control is part of the care plan for a client with borderline personality disorder. Which of the following is particularly important to include?1. A no-harm contract2. Identification of behavior patterns3. Identification of support sources4. Management of emotions

Q: The nurse is caring for a client with schizoid personality disorder. Which nursing diagnosis is most appropriate for this client with a cluster A personality disorder?1. Fear related to feelings of abandonment2. High Risk for Violence, Self-Directed, related to poor impulse control3. Social Isolation related to inadequate social skills, craving of solitude4. Ineffective Individual Coping related to high dependency needs

Q: The nurse is working with a client who has been diagnosed with a personality disorder. Which situation best describes the client's external response to stress?1. The client attends group therapy.2. The client uses meditation when upset.3. The client tries to change the environment instead of changing him- or herself.4. The client engages in self-awareness exercises.

Q: A client consistently fails to accept the consequences of his or her own behavior. The nurse identifies this behavior as characteristic of:1. Immaturity.2. A lack of structure.3. A need for medication.4. A personality disorder.

Q: In describing personality disorders to a group of consumers, which statement by the nurse is accurate?1. "People with personality disorders are unable to experience painful feelings."2. "These disorders usually develop during the toddler stage."3. "People with personality disorders view their problems as separate from themselves."4. "Behavior is sporadic with no particular pattern."

Q: A nurse is working with a client who has a diagnosis of obsessive-compulsive personality disorder. It is important for the nurse and client to discuss:1. The effect of anger on perfectionism.2. The need to feel superior.3. The link between anxiety and perfectionism.4. The need for medication.

Q: How can the nurse differentiate the client with obsessive-compulsive personality disorder from a client with perfectionist personality traits?1. Clients with obsessive-compulsive personality disorder will exhibit order in all areas of their lives.2. Clients with obsessive-compulsive personality disorder will exhibit fear, anxiety, and an excessive need for order.3. Clients with obsessive-compulsive personality disorder will exhibit the need for perfection in everyone but themselves.4. Clients with obsessive-compulsive personality disorder will exhibit order in their work lives but are able to relax when away from work.

Q: A nurse is studying personality disorders. What statement would indicate that the nurse can differentiate between personality traits and personality disorders?1. "Personality traits are persistent behavior traits that do not significantly interfere with an individual's life."2. "Personality traits are lifelong maladaptive patterns."3. "Personality traits are rigid, stereotyped behavioral patterns."4. "Personality traits are enduring and deviate from societal norms."

Q: Which of the following interventions might facilitate the nurse's understanding of how clients with eating disorders view their bodies?1. Observe the client's interactions with other clients with eating disorders.2. Assess the client's response to limit setting when eating.3. Discuss the importance of food and exercise in maintaining body image.4. Ask the clients to draw a picture of themselves as they are now and as they desire to be.

Q: An adolescent student tells the nurse, "I lost ten pounds in the last three months. I believe I have anorexia." The nurse's response should be based on the following understanding:1. Since the student is willing to talk about the issue, the student is probably not anorexic.2. The student may be anorexic if the weight loss has lead to maintenance body weight less than 85% of the expected.3. The student is not anorexic because the student's physical development has not been affected by nutritional status.4. There is cause for alarm since most adolescent females experience anorexia.

Q: The client is diagnosed with bulimia nervosa. What is the most appropriate nursing intervention that focuses on purging behaviors?1. Provide frequent small meals.2. Weigh the client after eating.3. Observe the client for at least one hour after meals.4. Have the nurse eat with the client.

Q: The client with bulimia is experiencing anxiety. What action should the nurse take to assist the client to avoid binge eating and purging in response to the anxiety?1. Assume a matter-of-fact attitude and positive expectations of the client.2. Project a calm reassuring attitude and provide a quiet non-stimulating environment.3. Contract for safety since the client is likely to engage in self-injurious behavior.4. Maintain total control of the environment and project an attitude of authority.

Q: What are suggested outcomes for the nursing diagnosis of "Ineffective Individual Coping" for a client with anorexia nervosa?Standard Text: Select all that apply.1. Actions to manage stressors that tax an individual's resources2. Ability to self-restrain altered perceptions3. Ability to self-restrain compulsive or impulsive behaviors4. Ability to acquire, organize, and use information5. Adequate nutrients taken into the body

Q: Which medication should the nurse expect to administer to the client with bulimia nervosa?1. Prozac2. Prolixin3. Benadryl4. Ritalin

Q: The client with binge-eating disorder reports a lack of involvement in activities, loss of interest in self-care activities, and oversleeping. The client's speech is filled with despondency. What nursing diagnosis is most appropriate for this client?1. Hopelessness2. Anxiety3. Social Isolation4. Knowledge Deficit

Q: Despite the fact that the patient is 5"6" and weighs 72 lbs, the patient reported feeling "fat and overweight." What is the most appropriate nursing diagnosis for this patient?1. Chronic Low Self-Esteem2. Ineffective Coping3. Altered Nutrition4. Body Image Disturbance

Q: What factor contributes to a poor outcome for clients with anorexia nervosa?1. Treatment approaches are fragmented and controversial.2. The client with anorexia nervosa actively resents or refuses treatment.3. There is no cure for anorexia nervosa.4. Changes in the client's behavior are irreversible.

Q: A client with an eating disorder is trying to develop new coping skills. The process the nurse can use to help family members as they support the client is to:1. Assist the family to explore their own coping strategies.2. Encourage the family to avoid discussing their feelings about the client's illness.3. Assist the family to challenge the client's behavior.4. Teach the family how to manipulate the client's environment to avoid problem situations.

Q: Which of the following physical findings regarding the client's weight is consistent with binge-eating disorders?1. The client is usually of normal or slightly above average weight.2. Weight tends to fluctuate but is generally low.3. All of the clients are overweight.4. The client is generally underweight.

Q: Which of the following physical findings would lead the nurse to suspect that the client has bulimia nervosa?1. A skeletal appearance2. Lanugo growth on face and extremities3. Abrasions and calluses on the knuckles4. Sunken eyes

Q: Which of the following questions would the nurse ask the client when assessing for a common condition thought to relate to the degree of stress that occurs with anorexia nervosa?1. Has your hair been falling out?2. Do you exercise after eating?3. Has your menstrual period stopped?4. Are you purging after you eat?

Q: Which of the following physical manifestations would the nurse expect in a client who is emaciated, has sunken eyes, and a skeletal appearance?1. Tachycardia, arrhythmia, dry skin2. Tachycardia, hypotension, and edema3. Bradycardia, hypotension, arrhythmia4. Bradycardia, hypertension, alopecia

Q: When assessing the client with dramatic weight loss or gain, the nurse should consider:1. The focus of the assessment must be on the psychological findings.2. There is usually a direct cause and effect.3. The focus of the assessment must be on the physical findings.4. Both can be caused by physical or mental conditions.

Q: Which of the following behaviors should the nurse anticipate in the client with anorexia nervosa?1. Positive self-image2. Constant over-eating3. Obsessive rituals4. Little anxiety regarding food

Q: The nurse is assessing a male client who is suspected of having an eating disorder. What additional information should the nurse include in her assessment of this client?1. Use of anabolic steroids2. Relationship with family3. Ethnic origin4. History of illegal substance use

Q: To which of the following information sources for the client with an eating disorder should the nurse limit exposure because of the many societal influences on perceptions of attractiveness?1. Information about coping behaviors2. Articles about eating disorders3. Programs that emphasize good nutrition4. Media that glamorizes thinness

Q: Since purging and excessive exercise are not features of binge-eating disorders, these individuals often become:1. Anorexic.2. Emaciated.3. Hungry.4. Obese.

Q: From a psychoanalytic perspective, eating disorders are related to:1. Conscious intrapersonal and interpersonal conflict.2. Learned behavior regarding the affect of food.3. Disturbance in the body system.4. Regression to pubertal conflicts and repudiation of developing sexuality.

Q: The most appropriate intervention for the nurse to use when integrating cognitive behavioral approaches into therapy for clients with bulimia nervosa is:1. Individual interventions.2. Behavior modification.3. Family groups.4. Client education.

Q: Which of the following must the nurse consider when deciding appropriate boundaries for the client with eating disorders and their family members?1. Family members of clients with anorexia become enmeshed2. Family members of clients with bulimia are overly affectionate3. Family members of individuals with bulimia tend to bond together4. Family members of clients with anorexia are usually very autonomous

Q: Which of the following neurotransmitters affect eating disorders?Standard Text: Select all that apply.1. Neuropeptide Y2. Dopamine3. Acetylcholine4. Serotonin5. Norepinephrine

Q: Which of the following groups is more accepting of the way they look which may serve as a protective factor against the development of eating disorders?1. Asian Americans2. Homosexual males3. Latino women4. African American women

Q: A client with an eating disorder is in the demographic group that represents those at highest risk for developing an eating disorder. The client is a/an:1. Male.2. Older adult.3. Child.4. Female.

Q: A client who cross-dresses is intent on keeping it a secret and not disclosing it to his partner. The nurse should:1. Offer education and support.2. Determine where cross-dressing will take place.3. Determine when cross-dressing will take place.4. Disclose the cross-dressing secret to the partner.

Q: The primary nursing goal for treatment with clients who are transsexual is to help them:1. Experience guilt for enjoying sex.2. Live and function in society in the cross-gender role.3. Internalize the negative expectations and beliefs of others about sex.4. Make a list of anxiety-producing sexual interactions.

Q: Which of the following interventions is most appropriate for the nurse to offer when helping a client with gender dysphoria?1. Focus on promoting comfort with the chosen gender role.2. Encourage living as their assigned gender.3. Avoid client discussions of hormonal treatment.4. Discourage genital reassignment surgery.

Q: Which one of the following assessment questions would the nurse use when completing a client's sensation assessment during a sexual history?1. "Does the use of fantasy increase or decrease your sexual desire?"2. "Do you experience any physical discomfort during sexual activity?"3. "What negative thoughts do you have about sex?"4. "How rigidly were gender roles enforced in your family of origin?"

Q: To complete a cognitive assessment during a sexual history, the nurse would ask:1. "How has your religion influenced your sexual values and behaviors?"2. "What are the negative aspects of your own sexual functioning?"3. "What are your partner's concerns about current or future sexual functioning?"4. "What concerns do you have about your future sexual functioning?"

Q: To complete a behavioral assessment during a sexual history, the nurse would ask:1. "In what way(s) do you experience anxiety about sex?"2. "What is your level of satisfaction with the frequency of your sexual activity?"3. "Can you describe the type of love and affection in this relationship?"4. "In what way(s) do you experience guilt about sex?"

Q: A client is being admitted to the mental health unit. When completing the affective assessment of the client's sexual history, the nurse asks:1. "When you were growing up, how did you learn about sex?"2. "With whom do you feel most intimate and connected?"3. "To what degree do you experience pleasure during sexual activity?"4. "What are the positive aspects of your own sexual functioning?"

Q: The nursing instructor is discussing theories to explain sexual dysfunction. The nurse states that behavioral theorists believe sexual dysfunction may be related to learned responses to:1. Lack of concern with sexual performance.2. Poor communication skills.3. Vast sexual experience with a variety of partners.4. Effective stimulation by a sexual partner.

Q: The nurse is discussing transsexualism with a client and family members, who raise the question of what causes the condition. The nurse knows that the etiology of the condition is:1. Intrapersonal.2. Unknown.3. Biologic.4. Sociocultural.

Q: The nurse recognizes that some groups believe their sexual values and behaviors are superior to others. This viewpoint is explained by:1. Intrapersonal theory's ethnocentrism.2. Behavioral theory's berdache.3. Sociocultural theory's ethnocentrism.4. Biologic theory's berdache.

Q: A client with gender dysphoria asks the nurse, "What caused this?" Which biopsychosocial theory would describe gender dysphoria as a problem occurring within the individual?1. Sociocultural2. Behavioral3. Biologic4. Intrapersonal

Q: Which of the following behaviors would a male client who is experiencing an adaptive sexual response most likely exhibit?1. Removing shoes from women in subways2. Gentle touching of thighs when passing people in a line3. Display of genitals to strangers4. Dressing in women's clothes

Q: The client describes being uncomfortable as a male since kindergarten. "I liked playing with dolls and playing dress-up in my mom's prom dress and high heels." The client is relating an example of:1. Cross-dressing.2. Fetishism.3. Gender dysphoria.4. Androgyny.

Q: A child is born with an intersex condition. On which of the following would the nurse instruct the family members?Standard Text: Select all that apply.1. External genital appearance2. Chromosomal gender3. Internal organs4. Nonambiguous gender role5. Gonadal gender

Q: The client's partner describes the role of the client as female and states the expectation that the client will exhibit certain female behaviors. This is an example of:1. Intersex.2. Gender identity disorder.3. Gender role stereotyping.4. Androgyny.

Q: The nurse instructs the client that a person's sense of identity as a male or female develops from which of the following?Standard Text: Select all that apply.1. Self-identity2. Biology3. Sexual reassignment surgery4. Numerous sexual partners5. Identity imposed by others

Q: The nurse addressing gender identity issues instructs the client that there are gradations called transgender. Which of the following teaching would include information on transgender biologic gradations?Standard Text: Select all that apply.1. Abnormal gender2. No gender3. Unclear gender4. Blending of gender5. Clear gender

Q: Which of the following is important for a nurse working with a client diagnosed with a sexual disorder to be self-aware and to self-assess periodically?Standard Text: Select all that apply.1. Professional standards of care about sex2. Personal practices about sex3. Educational practices about sex.4. Knowledge about sex5. Attitudes about sex

Q: The nurse is about to begin working with a client diagnosed with a sexual disorder. During the preinteraction phase of the nurse"patient relationship, it is important for the nurse to:1. Discuss the nurse's beliefs with the client.2. Agree with the client's sexual values.3. Engage in values clarification.4. Provide appropriate sexual health care.

Q: A client is being seen in the clinic for right-hand paresthesia that the client does not seem to be overly concerned about. The condition developed abruptly after being caught cheating on an exam by the teacher. The paresthesia also ended abruptly as well. Which symptom most clearly relates to la belle indiffrence?1. Being caught cheating on the exam2. Right-hand paresthesia3. Lack of concern over the paresthesia4. Paresthesia beginning and ending abruptly

Q: The nurse is presenting an in-service on dissociative disorder. The nurse knows that which of the following is most often used to explain the occurrence of dissociative disorder in psychiatric clients?1. Psychosocial theories2. Biological theories3. Genetic theories4. Physical theories

Q: The nurse finds that the client with a pain disorder has been in a physically and verbally abusive relationship. The client feels guilty and fears a loss of love. According to psychoanalytic concepts, this is believed to be a(n):1. Unconscious conflict from childhood that was reawakened in adulthood by a similar situation.2. Environmental factor.3. Stress related to relationships.4. Brain abnormality.

Q: The client states, "I was reared in a chaotic, alcoholic family situation." The nurse knows that the most useful theory for explaining the client's somatoform disorder would come from:1. Humanistic theory.2. Psychosocial theory.3. Biologic theory.4. Genetic theory.

Q: The nurse finds that the client with a somatoform disorder has physical symptoms, but there is no evidence of physiologic disease. The client may have decreased amounts of serotonin and endorphins, causing the client to experience an increased sensitivity to pain. This explanation of the client's symptoms is based in:1. Communication theory.2. Humanistic theory.3. Biologic theory.4. Genetic theory.