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1.

A male client with dementia often assaults the nursing staff, and the staff decides to
develop a plan that will make this client’s personal care less of a problem. The plan should
include:

• Limiting staff time with the client.


• An outline of the consequences for uncooperative behavior.
• Identification of nursing staff members whom the client prefers.
• The client’s likes and dislikes for use as a reward or punishment.

The type of care needed by the client requires trust in the caregiver; trust develops more
rapidly when there is a cooperative relationship.

2. Nurse Chris recognizes that a father’s sexual abuse of a 13-year-old daughter was
probably motivated by his:

• Need to control
• Feelings of anger
• Unfulfilled sexual need
• Unmet emotional needs

Sexually abusing fathers usually are emotionally dependent and have feelings of inferiority;
the child represents a less threatening sex object.

3. According to Erikson, an individual who fails to master the maturational crisis of


adolescence will most often:

• Rebel at parental orders


• Experience role confusion
• Be interpersonally isolated
• Use drugs and alcohol to escape

According to Erikson, adolescents are struggling with identity versus role confusion.

4. The psychotherapeutic theory that uses hypnosis, dream interpretation, and free
association as methods to release repressed feelings is the:

• Behaviorist model
• Psychoanalytic model
• Psychobiologic model
• Social-interpersonal model

The psychoanalytic model studies the unconscious and uses the strategies of hypnosis,
dream interpretation, and free association as a means of releasing repressed feelings.

5. It would be most helpful for the nurse to deal with a male client with severe anxiety by:

• Give specific instructions using speak in concise statements.


• Ask the client to identify the cause of her anxiety.
• Explain in detail the plan of care developed
• Urge the client to focus on what the nurse is saying

The client has narrowed perceptual field. Lengthy explanations cannot be followed by the
client. B. The client will not be able to identify the cause of anxiety C and D. The client has
difficulty concentrating and will not be able to focus.

6. A 30 year old client newly diagnosed with breast cancer is pacing, with rapid speech
headache and inability to focus with what the doctor was saying. The nurse assesses the
level of anxiety as:

• Mild
• Moderate
• Severe
• Panic

The client’s manifestations indicate severe anxiety. A Mild anxiety is manifested by slight
muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem
solving. B. Moderate muscle tension, increased vital signs, periodic slow pacing, increased
rate of speech and difficulty in concentrating are noted in moderate anxiety. D. Panic level
of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and
disorganization

7. During the initial care of rape victims the following are to be considered EXCEPT:

• Assure privacy.
• Touch the client to show acceptance and empathy
• Accompany the client in the examination room.
• Maintain a non-judgmental approach.

The client finds touch intrusive and therefore should be avoided. A. Privacy is one of the
rights of a victim of rape. C.The client is anxious. Accompanying the client in a quiet room
ensures safety and offers emotional support. D. Guilt feeling is common among rape
victims. They should not be blamed.

8. An 17 year old female was sexually attacked while on her way home from work. She is
brought to the hospital by her mother. Rape is an example of which type of crisis:

• Situational
• Adventitious
• Developmental
• Internal

Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life. A.
Situational crisis is from an external source that upset ones psychological equilibrium C and
D. Are the same. They are transitional or developmental periods in life
9. The male client on Haldol has pill rolling tremors and muscle rigidity. He is likely
manifesting:

• tardive dyskinesia
• Pseudoparkinsonism
• akinesia
• dystonia

Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like


facies, pill rolling tremors, muscle rigidity A. Tardive dyskinesia is manifested by lip
smacking, wormlike movement of the tongue C. Akinesia is characterized by feeling of
weakness and muscle fatigue D. Dystonia is manifested by torticollis and rolling back of the
eyes

10. A female client who are suspicious primarily use projection for which purpose:

• deny reality
• to deal with feelings and thoughts that are not acceptable
• to show resentment towards others
• manipulate others

Projection is a defense mechanism where one attributes ones feelings and inadequacies to
others to reduce anxiety. A. This is not true in all instances of projection C and D. This
focuses on the self rather than others

11. A 43 year old male client, is admitted in the ward because of bizarre behaviors. He is
given a diagnosis of schizophrenia paranoid type. The client should have achieved the
developmental task of:

• Trust vs. mistrust


• Industry vs. inferiority
• Generativity vs. stagnation
• Ego integrity vs. despair

The client belongs to the middle adulthood stage (30 to 65 yrs.) The developmental task
generativity is characterized by concern and care for others. It is a productive and creative
stage. (A) Infancy stage (0 – 18 mos.) is concerned with gratification of oral needs (B)
School Age child (6 – 12 yrs.) is characterized by acquisition of school competencies and
social skills (C) Late adulthood ( 60 and above) Concerned with reflection on the past and
his contributions to others and face the future.

12. A teenage girl is diagnosed to have borderline personality disorder. Which


manifestations support the diagnosis?

• Lack of self esteem, strong dependency needs and impulsive behavior


• Social withdrawal, inadequacy, sensitivity to rejection and criticism
• Suspicious, hypervigilance and coldness
• Preoccupation with perfectionism, orderliness and need for control

These are the characteristics of client with borderline personality. B. This describes the
avoidant personality. C. These are the characteristics of a client with paranoid personality
D. This describes the obsessive compulsive personality

13. The female client joins a support group and frequently preaches against abuse, is
demonstrating the use of:

• denial
• reaction formation
• rationalization
• projection

Reaction formation is the adoption of behavior or feelings that are exactly opposite of one’s
true emotions. A. Denial is refusal to accept a painful reality. C. Rationalization is
attempting to justify one’s behavior by presenting reasons that sounds logical. D. Projection
is attributing of one’s behaviors and feelings to another person.

14. A female client jumps up and throws a chair out of the window. He was restrained
after his behavior can no longer be controlled by the staff. Which of these documentations
indicates the safeguarding of the patient’s rights?

• There was a doctor’s order for restraints/seclusion


• There was a doctor’s order for restraints/seclusion
• The staff observed confidentiality
• The staff carried out less restrictive measures but were unsuccessful.

This documentation indicates that the client has been placed on restraints after the least
restrictive measures failed in containing the client’s violent behavior.

15. Nurse Joy closely observes the client who has been displaying aggressive behavior.
She observes that the client’s anger is escalating. Which approach is least helpful for the
client at this time?

• Acknowledge the client’s behavior


• Maintain a safe distance from the client
• Assist the client to an area that is quiet
• Initiate confinement measures

The proper procedure for dealing with harmful behavior is to first try to calm patient
verbally. . When verbal and psychopharmacologic interventions are not adequate to handle
the aggressiveness, seclusion or restraints may be applicable. A, B and C are appropriate
approaches during the escalation phase of aggression.

16. Nurse Percy ensures a therapeutic environment for the client. Which of the following
best describes a therapeutic milieu?
• A therapy that rewards adaptive behavior
• A cognitive approach to change behavior
• A living, learning or working environment.
• A permissive and congenial environment

A therapeutic milieu refers to a broad conceptual approach in which all aspects of the
environment are channeled to provide a therapeutic environment for the client. The six
environmental elements include structure, safety, norms, limit setting, balance and unit
modification. A. Behavioral approach in psychiatric care is based on the premise that
behavior can be learned or unlearned through the use of reward and punishment. B.
Cognitive approach to change behavior is done by correcting distorted perceptions and
irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic
milieu.

17. A male client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse
does one of the following:

• Agree on a consistent approach among the staff assigned to the client.


• Suggest that the client take a leading role in the social activities
• Provide the client with extra time for one on one sessions
• Allow the client to negotiate the plan of care

A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of


exploiting the weakness in others or create conflicts among the staff. Bargaining should not
be allowed. B. This is not therapeutic because the client tends to control and dominate
others. C. Limits are set for interaction time. D. Allowing the client to negotiate may
reinforce manipulative behavior.

Situation: A 28 year old writer is admitted for the second time accompanied by his wife. He
is demanding, arrogant talked fast and hyperactive. (18-19). 18. Initially the nurse Trizz
should plan this for a manic client:

• set realistic limits to the client’s behavior


• repeat verbal instructions as often as needed
• allow the client to get out feelings to relieve tension
• assign a staff to be with the client at all times to help maintain control

The manic client is hyperactive and may engage in injurious activities. A quiet environment
and consistent and firm limits should be set to ensure safety. B. Clear, concise directions
are given because of the distractibility of the client but this is not the priority. C. The manic
client tend to externalize hostile feelings, however only non-destructive methods of
expression should be allowed D. Nurses set limit as needed. Assigning a staff to be with
the client at all times is not realistic.

19. An activity appropriate for the client is:

• table tennis
• painting
• chess
• cleaning

The client’s excess energy can be rechanelled through physical activities that are not
competitive like cleaning. This is also a way to dissipate tension. A. Tennis is a competitive
activity which can stimulate the client.

20. Malingering is different from somatoform disorder because the former:

• Has evidence of an organic basis.


• It is a deliberate effort to handle upsetting events
• Gratification from the environment are obtained.
• Stress is expressed through physical symptoms.

Malingering is a conscious simulation of an illness while somatoform disorder occurs


unconscious. A. Both disorders do not have an organic or structural basis. C. Both have
primary gains. D. This is a characteristic of somatoform disorder.

21. Nurse Reese refers a client with severe anxiety to a psychiatrist for medication
evaluation. The physician is most likely to prescribe which psychotropic drug regimen on a
short-term basis?

• diazepam (Valium), 5 mg orally three times per day


• benztropine (Cogentin), 2 mg orally twice per day
• chlorpromazine (Thorazine), 25 mg orally three times per day
• clozapine (Clozaril), 200 mg orally twice per day

Diazepam is the most appropriate medication for this client because of its antianxiety
properties. Benztropine is an antiparkinsonian agent used to control the extrapyramidal
effects of such antipsychotic agents as chlorpromazine hydrochloride and thioridazine
hydrochloride. Chlorpromazine is used to control the severe symptoms (hallucinations,
thought disorders, and agitation) seen in clients with psychosis. Clozapine is used to
manage symptoms of schizophrenia in clients who don't respond to other antipsychotic
drugs.

22. After seeking help at an outpatient mental health clinic, a client who was raped while
walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months
later, the client returns to the clinic, complaining of fear, loss of control, and helpless
feelings. Which nursing intervention is most appropriate for this client?

• Exploring the meaning of the traumatic event with the client


• Allowing the client time to heal
• Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle
• Recommending a high-protein, low-fat diet
The client with PTSD needs encouragement to examine and understand the meaning of
the traumatic event and consequent losses. Otherwise, symptoms may worsen and the
client may become depressed or engage in self-destructive behavior such as substance
abuse. The client must explore the meaning of the event and won't heal without this, no
matter how much time passes. Behavioral techniques, such as relaxation therapy, may help
decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety
agents or antidepressants cautiously to avoid dependence; sleep medication is rarely
appropriate. A special diet isn't indicated unless the client also has an eating disorder or a
nutritional problem.

23. Which of the following drugs have been known to be effective in treating obsessive-
compulsive disorder (OCD)?

• benztropine (Cogentin) and diphenhydramine (Benadryl)


• chlordiazepoxide (Librium) and diazepam (Valium)
• fluvoxamine (Luvox) and clomipramine (Anafranil)
• divalproex (Depakote) and lithium (Lithobid)

The antidepressants fluvoxamine and clomipramine have been effective in the treatment of
OCD. Librium and Valium may be helpful in treating anxiety related to OCD but aren't drugs
of choice to treat the illness. The other medications mentioned aren't effective in the
treatment of OCD.

24. A young man brought to the emergency department by a police officer states, "I don't
know who or where I am." He has no identification but appears to be in good physical
health. Physical examination reveals no evidence of trauma or other abnormal findings. He
is admitted to the psychiatric unit for further evaluation and treatment. Nurse Irish
anticipates that the client will react to his inability to recall his identity by exhibiting:

• an intense preoccupation with discovering who he is.


• depression.
• anger and frustration.
• complacency.

Because a client with psychogenic amnesia is successfully blocking a traumatic or severe


anxiety-producing event, he is likely to react to his inability to recall his identity with
complacency. He won't have an intense desire to discover who he is because learning his
identity would force him to remember the event and confront the anxiety. For the same
reason, he won't exhibit depression or anger, both of which are associated with anxiety-
producing events.

25. Before eating a meal, a female client with obsessive-compulsive disorder (OCD) must
wash his hands for 18 minutes, comb his hair 555 strokes, and switch the bathroom light on
and off 55 times. What is the most appropriate goal of care for this client?

• Omit one unacceptable behavior each day.


• Increase the client's acceptance of therapeutic drug use.
• Allow ample time for the client to complete all rituals before each meal.
• Systematically decrease the number of repetitions of rituals and the amount of time
spent performing them.

When caring for a client with OCD, the goal is to systematically decrease the undesirable
behavior. (Therapy may not completely extinguish certain behaviors.) Expecting to omit one
behavior each day is unrealistic because the client may have used ritualistic behaviors to
reduce anxiety for a long time. Drugs may become a source of obsession and must be
used with caution. Allowing time for rituals would perpetuate the undesirable behaviors.

26. Before the nurse Gio administers the first dose of lithium carbonate (Lithonate) to a
client, she reviews information about the drug. Which statement accurately describes the
metabolism and excretion of lithium?

• It's metabolized in the liver and excreted in the feces.


• It's metabolized and excreted by the kidneys.
• It isn't metabolized and is excreted unchanged by the kidneys.
• It's metabolized in the liver and excreted by the kidneys.

Lithium isn't metabolized and is excreted unchanged by the kidneys.

27. A female client chronically complains of being unappreciated and misunderstood by


others. She is argumentative and sullen. She always blames others for her failure to
complete work assignments. She expresses feelings of envy toward people she perceives
as more fortunate. She voices exaggerated complaints of personal misfortune. The client
most likely suffers from which of the following personality disorders?

• Dependent personality
• Passive-aggressive personality
• Avoidant personality disorder
• Obsessive-compulsive disorder

The client with passive-aggressive personality disorder displays a pervasive pattern of


negative attitudes, chronic complaints, and passive resistance to demands for adequate
social and occupational performance. The client with a dependent personality is unable to
make everyday decisions and allows others to make important decisions. In addition, the
client with a dependent personality often volunteers to do things that are unpleasant so that
others will like him. The obsessive-compulsive personality displays a pervasive pattern of
perfectionism and inflexibility. The avoidant personality displays a pervasive pattern of
social discomfort, fear of negative evaluation, and timidity.

28. The nurse is aware that the most appropriate nursing diagnosis for a grieving family?

• Interrupted family processes


• Powerlessness
• Spiritual distress
• Ineffective coping
Spiritual distress related to experienced loss most accurately describes the problem;
therefore, nursing care should be based on this diagnosis. Families may not have altered
family process or suffer from ineffective coping. Although the family may feel powerless,
this isn't the most accurate diagnosis.

29. An extremely agitated female client is brought to the psychiatric unit by her husband.
He reports that she has been hospitalized several times for treatment of bipolar disorder
and has spent thousands of dollars in the past week. The psychiatrist admits her to the unit
for exacerbation of the manic phase of bipolar disorder. Which approach by nurse Noel
would best promote a therapeutic relationship with this client?

• Confronting the client about her inappropriate behavior


• Using reflection and open-ended questions to promote communication
• Maintaining a firm but nonthreatening manner
• Helping the client gain insight into her behavior

The nurse must maintain a firm but nonthreatening approach to avoid provoking anger in
this agitated client. Because the client can't control her behavior, confronting her would be
pointless. Her agitated state makes successful communication virtually impossible; instead
of using reflection and open-ended questions to try to develop a therapeutic relationship,
the nurse should provide emotional support and maintain a calm environment. Also,
reflective communication and open-ended questions may anger the client, who has been
hospitalized before and is accustomed to "therapeutic talk." This client is too agitated to
gain insight into her behavior.

30. Nurse Lyka is caring for a client diagnosed with antisocial personality disorder. The
client has a history of fighting, cruelty to animals, and stealing. Which of the following traits
would the nurse be most likely to uncover during assessment?

• History of gainful employment


• Frequent expression of guilt regarding antisocial behavior
• Demonstrated ability to maintain close, stable relationships
• A low tolerance for frustration

Clients with an antisocial personality disorder exhibit a low tolerance for frustration,
emotional immaturity, and a lack of impulse control. They commonly have a history of
unemployment, miss work repeatedly, and quit work without other plans for employment.
They don't feel guilt about their behavior and commonly perceive themselves as victims.
They also display a lack of responsibility for the outcome of their actions. Because of a lack
of trust in others, clients with antisocial personality disorder commonly have difficulty
developing stable, close relationships.

31. A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity
caused by antipsychotic medication by:

• blocking dopamine receptors in the central nervous system (CNS).


• blocking acetylcholine in the CNS.
• activating norepinephrine in the CNS.
• activating dopamine receptors in the CNS.

Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are
caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine
receptors and thereby reduce rigidity. They don't affect norepinephrine or acetylcholine.

32. Nurse Myrna is preparing for the discharge of a client who has been hospitalized for
paranoid schizophrenia. The client's husband expresses concern over whether his wife will
continue to take her daily prescribed medication. The nurse should inform him that:

• his concern is valid but his wife is an adult and has the right to make her own
decisions.
• he can easily mix the medication in his wife's food if she stops taking it.
• his wife can be given a long-acting medication that is administered every 1 to 4
weeks.
• his wife knows she must take her medication as prescribed to avoid future
hospitalizations.

Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks.


These agents are useful for noncompliant clients because the client receives the injection
at the outpatient clinic. A client has the right to refuse medication, but this issue isn't the
focus of discussion at this time. Medication should never be hidden in food or drink to trick
the client into taking it; besides destroying the client's trust, doing so would place the client
at risk for overmedication or undermedication because the amount administered is hard to
determine. Assuming the client knows she must take the medication to avoid future
hospitalizations would be unrealistic.

33. Which nonantipsychotic medication is used to treat some clients with schizoaffective
disorder?

• phenelzine (Nardil)
• chlordiazepoxide (Librium)
• lithium carbonate (Lithane)
• imipramine (Tofranil)

Lithium carbonate, an antimania drug, is used to treat clients with cyclical schizoaffective
disorder, a psychotic disorder once classified under schizophrenia that causes affective
symptoms, including maniclike activity. Lithium helps control the affective component of this
disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't
respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an
antianxiety agent, generally is contraindicated in psychotic clients. Imipramine, primarily
considered an antidepressant agent, is also used to treat clients with agoraphobia and
those undergoing cocaine detoxification.
34. Nurse Britney is providing care for a female client with a history of schizophrenia
who's experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol)
orally or I.M. every 4 hours as needed. What is the nurse's best action?

• Administer the haloperidol orally if the client agrees to take it.


• Call the physician to clarify whether the haloperidol should be given orally or I.M.
• Call the physician to clarify the order because the dosage is too high.
• Withhold haloperidol because it may worsen hallucinations.

The dosage is too high (normal dosage ranges from 5 to 10 mg daily). Options A and B
may lead to an overdose. Option D is incorrect because haloperidol helps with symptoms of
hallucinations.

35. Nurse Jasmine is providing care to a client with a catatonic type of schizophrenia who
exhibits extreme negativism. To help the client meet his basic needs, the nurse should:

• ask the client which activity he would prefer to do first.


• negotiate a time when the client will perform activities.
• tell the client specifically and concisely what needs to be done.
• prepare the client ahead of time for the activity.

The client needs to be informed of the activity and when it will be done. Giving the client
choices isn't desirable because he can be manipulative or refuse to do anything.
Negotiating and preparing the client ahead of time also isn't therapeutic with this type of
client because he may not want to perform the activity.

36. Victims of domestic violence should be assessed for what important information?

• Reasons they stay in the abusive relationship (for example, lack of financial
autonomy and isolation)
• Readiness to leave the perpetrator and knowledge of resources
• Use of drugs or alcohol
• History of previous victimization

Victims of domestic violence must be assessed for their readiness to leave the perpetrator
and their knowledge of the resources available to them. Nurses can then provide the
victims with information and options to enable them to leave when they are ready. The
reasons they stay in the relationship are complex and can be explored at a later time. The
use of drugs or alcohol is irrelevant. There is no evidence to suggest that previous
victimization results in a person's seeking or causing abusive relationships.

37. Nurse Lissa is caring for an adolescent female who reports amenorrhea, weight loss,
and depression. Which additional assessment finding would suggest that the woman has
an eating disorder?

• Wearing tight-fitting clothing


• Increased blood pressure
• Oily skin
• Excessive and ritualized exercise

A client with an eating disorder will normally exercise to excess in an effort to burn as many
calories as possible. The client will usually wear loose-fitting clothing to hide what she
considers to be a fat body. Skin and nails become dry and brittle and blood pressure and
body temperature drop from excessive weight loss.

38. Tourette syndrome is characterized by the presence of multiple motor and vocal tics.
A vocal tic that involves repeating one's own sounds or words is known as:

• echolalia.
• palilalia.
• apraxia.
• aphonia.

Palilalia is defined as the repetition of sounds and words. Echolalia is the act of repeating
the words of others. Apraxia is the inability to carry out motor activities, and aphonia is the
inability to speak.

39. Which outcome criteria would be appropriate for a child diagnosed with oppositional
defiant disorder?

• Accept responsibility for own behaviors


• Be able to verbalize own needs and assert rights.
• Set firm and consistent limits with the client.
• Allow the child to establish his own limits and boundaries.

Children with oppositional defiant disorder frequently violate the rights of others. They are
defiant, disobedient, and blame others for their actions. Accountability for their actions
would demonstrate progress for the oppositional child. Options C and D aren't outcome
criteria but interventions. Option B is incorrect as the oppositional child usually focuses on
his own needs.

40. A male client is admitted for detoxification after a cocaine overdose. The client tells
the nurse that he frequently uses cocaine but he can control his use if he chooses. Which
coping mechanism is he using?

• Withdrawal
• Logical thinking
• Repression
• Denial

Denial is an unconscious defense mechanism in which emotional conflict and anxiety are
avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are
consciously intolerable. Withdrawal is a common response to stress, characterized by
apathy. Logical thinking IS the ability to think rationally and make responsible decisions,
which would lead the client to admitting the problem and seeking help. Repression is
suppressing past events from the consciousness because of guilty association.

41. Nurse Ron should know that the most common side effects of regular cocaine use
include:

• Nausea, fatigue, and extreme hunger


• Anxiety, dysphoria, and suspiciousness
• Seizures, hoarseness, and electrolyte imbalance
• Lethargy, sexual arousal, and hormone imbalance

Stimulating the central nervous system with cocaine most commonly causes these
response, which can progress to fear, hallucinations, paranoid delusions, and violent
behavior.

42. To increase the self-esteem of a client with schizophrenia, Nurse Michael should plan
to:

• Reward healthy behaviors


• Identify various means of coping
• Encourage good hygiene and grooming
• Explain the diagnosis and treatment plan

By realistically rewarding the healthy behaviors, the nurse provides secondary gains and
encourages their continued use.

43. The desensitization method that has been used successfully with clients experiencing
phobias focuses on:

• Imagery
• Role-playing
• Assertiveness training
• Modeling or imitation

Imagery is a therapeutic approach used to facilitate positive self-talk; mental pictures under
the control of and initiated by the client may correct faulty cognitions.

44. A female client, who is clinically depressed, reports that she has not experienced
sexual orgasm in the past 3 years. Nurse Rhea is aware that this common condition is best
described as:

• Diminished libido
• Dysfunctional hypo-orgasmia
• Primary orgasmic dysfunction
• Situational orgasmic dysfunction

This is the correct description; the client had attained orgasm previously.
45. When caring for a client with a major depression, Nurse Melinda usually has the most
difficulty dealing with the:

• Client’s lack of energy


• Negative nonverbal responses
• Client’s psychomotor retardation
• Pervasive quality of the depression

Depression is “contagious”; it affects the nurse as well as the client.

46. An adolescent, age 16, rarely expresses feelings and usually remains passive.
However, when angry, her face becomes flushed and her blood pressure rises to 170/100
mm Hg. Her parents are passive and easygoing. The adolescent may be using which
defense mechanism to handle anger?

• Displacement
• Introjection
• Projection
• Sublimation

The adolescent may be introjecting (assuming as her own) her parents' belief that anger
shouldn't be outwardly expressed. She may also be holding and somatizing in her angry
feelings, as evidenced by her increased blood pressure. (A blood pressure rise is a
common physiological reaction to the fight-or-flight response that may be brought on by
strong emotions. Habitual failure to express anger may contribute to hypertension.)
Displacement is the discharge of negative feelings onto another person or an object.
Projection is the attribution of one's own thoughts or impulses to another person.
Sublimation is the channeling of unbearable or socially unacceptable behaviors into more
socially acceptable outlets.

47. Which psychological or personality factor is most likely to predispose an individual to


medication abuse?

• Low self-esteem and unresolved rage


• Desire to inflict pain upon one's self
• Dependent personality disorder
• Antisocial personality disorder

Low self-esteem and repressed rage as well as depression can predispose an individual to
search for solace in addictive medications. Usually, medications are used to minimize or
blot out pain, rather than inflict additional pain. Personality disorders don't predispose a
client to medication abuse; however, personality disorders, especially the antisocial ones,
may be intensified by abuse.

48. A 21-year-old male client diagnosed with antisocial personality disorder asks the
nurse if he can have an additional smoke break because he's anxious. Which of the
following responses would be best?
• "Well okay, I have a few minutes. I'll take you."
• "I'm sorry but I can't take you. I'm busy."
• "Smoking is harmful to your health. I don't want to contribute to your bad habits."
• "Clients are permitted to smoke at designated times. You'll have to follow the rules."

Consistency is essential when dealing with antisocial clients. They disregard social norms
and don't believe the rules apply to them. Option A would be detrimental to the client
because it reinforces the client's acting-out behaviors. Option B avoids the client's attempt
to manipulate. Option C is inappropriate because the nurse is lecturing the client.

49. A female client changes topics quickly while relating past psychiatric history. This
client's pattern of thinking is called:

• looseness of association.
• flight of ideas.
• tangential thinking.
• circumstantial thinking.

Flight of ideas describes a thought pattern in which a client moves rapidly from one topic to
the next with some connection. Looseness of association describes a pattern in which
ideas lack an apparent logical connection to one another. Tangential thoughts seem to be
related but miss the point. A client who talks around the subject and includes a lot of
unnecessary information is exhibiting circumstantial thinking.

50. What is a generally accepted criterion of mental health?

• Absence of anxiety
• Self-acceptance
• Ability to control others
• Happiness

Self-acceptance is a generally accepted criterion of mental health and serves as the basis
for healthy relationships with others. Some degree of anxiety is necessary to stimulate
growth and adaptation. Self-control and self-direction — not the ability to control others —
indicate mental health. Happiness, though desirable, isn't an effective indicator of mental
health because even mentally healthy people may be unhappy when faced with such
events as illness, loss, and death.