Part III Questions & Answers
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Part III Questions & answers 13 Essentials of psychiatric nursing 14 Somatoform & sleep disorders 15 Anxiety & mood disorders 16 Cognitive disorders 17 Personality disorders 18 Schizophrenic & delusional disorders 19 Substance-related disorders 20 Dissociative disorders 21 Sexual disorders 22 Eating disorders 3. A newly admitted client is extremely hostile toward a staff member he has just met, without apparent reason. According to Freudian theory, the nurse should suspect that the client is exhibiting which phenomena? 1. Intellectualization 2. Transference 3. Triangulation 4. Splitting 4. Which intervention would be typical of a nurse using a cognitive-behavioral approach 1. A 50-year-old client is scheduled for electroconvulsive therapy (ECT). ECT is most to a client experiencing low self-esteem? commonly prescribed for which condition? 1. Use of unconditional positive regard 1. Major depression 2. Analysis of free associations 2. Antisocial personality disorder 3. Classical conditioning 3. Chronic schizophrenia 4. Examination of negative thought patterns 4. Somatoform disorder 5. During group therapy, a client listening to another client's description of an abusive incident that occurred during childhood says, “I didn't think anyone else felt like I did as a child.” The nurse recognizes this statement as a reflection of which curative factor of group therapy, as identified by Yalom? 2. A patient with bipolar disorder becomes verbally aggressive in a group therapy session. 1. Altruism Which response by the nurse would be best? 2. Universality 3. Catharsis 1. “You're behaving in an unacceptable manner, and you need to control yourself.” 4. Existential factors 2. “If you continue to talk like that, no one will want to be around you.” 3. “You're frightening everyone in the group. Leave the room immediately.” 4. “Other people are disturbed by your profanity. I'll walk with you down the hall to help release some of that energy.” 6. Which statement best describes the key advantage of using groups in psychotherapy? 1. Decreases the focus on the individual 2. Fosters the physician–client relationship 3. Confronts individuals with their shortcomings 4. Fosters a new learning environment 9. After telling a nurse to “pray for me,” a client gives away personal possessions and shows a sudden calmness. The nurse recognizes that this behavior may signal which 7. A client who has recently lost his wife and children in a car collision is being treated at condition? the outpatient psychiatric clinic. Which therapy should be most effective with this client? 1. Major depression 1. Electroconvulsive therapy (ECT) 2. Panic attack 2. Group therapy 3. Suicidal ideation 3. Hypnotherapy 4. Severe anxiety 4. Individual therapy 10. A client recently lost his spouse. Which of the following behaviors indicates that the 8. During a group therapy session, a teenage girl says that she's fat and ugly and that client is going through a normal stage of grieving? everybody makes fun of her. This statement reflects which common adolescent fear or anxiety? 1. The client starts using chemicals. 2. The client becomes an overachiever. 1. Fear of the unknown 3. The client shows signs of hyperactivity. 2. Fear of loss of respect, love, and emerging self-esteem 4. The client shows a loss of warmth when interacting with others. 3. Anxiety related to guilt 4. Anxiety about body image and changes in physical appearance 11. Two 16-year-old clients are being treated in an adolescent unit. During a recreational activity, they begin to physically fight. How should the nurse intervene? 1. Remove the teenagers to separate areas and set limits. 2. Remind the teenagers of the unit rules. 3. Obtain an order to place the teenagers in seclusion. 4. Obtain an order to place the teenagers in restrains. 12. A client is prescribed sertraline (Zoloft), a selective serotonin reuptake inhibitor. Which information about this drug's adverse effects should the nurse include when creating a medication teaching plan? Select all that apply: 5. Provide the client with hard candy. 6. Monitor for signs and symptoms of urticaria. 1. Agitation 2. Agranulocytosis 1. 1. ECT is most commonly used for the treatment of major depression in clients who 3. Sleep disturbance haven't responded to antidepressants or who have medical problems that contraindicate the use 4. Intermittent tachycardia of antidepressants. ECT isn't commonly used for treatment of personality disorders. ECT 5. Dry mouth doesn't appear to be of value to individuals with chronic schizophrenia and isn't the treatment 6. Seizures of choice for clients with somatoform disorders. CN: Psychosocial integrity; CNS: None; CL: Application 13. A physician prescribes lithium for a client diagnosed with bipolar disorder. The nurse needs to provide appropriate education for the client on this drug. Which topics should the 2. 4. This response informs the client that, although the behavior is unacceptable, the client nurse cover? Select all that apply: is still worthy of help. The other responses are nontherapeutic and blaming. CN: Safe, effective care environment; CNS: Management of care; CL: Application 1. The potential for addiction 2. Signs and symptoms of drug toxicity 3. 2. Transference is the unconscious assignment of negative or positive feelings evoked 3. The potential for tardive dyskinesia by a significant person in the client's past to another person. Intellectualization is a defense 4. A low-tyramine diet mechanism in which the client avoids dealing with emotions by focusing on facts. 5. The need to consistently monitor blood levels Triangulation refers to conflicts involving three family members. Splitting is a defense 6. The expected time frame for noticing improvements in mood mechanism commonly seen in clients with personality disorders in which the world is perceived as all good or all bad. CN: Psychosocial integrity; CNS: None; CL: Analysis 4. 4. Popular cognitive-behavioral approaches examine the validity of habitual patterns of thinking and belief systems that influence feelings and behaviors. “Unconditional positive regard” is a phrase from Carl Rogers's client-centered therapy and describes a supportive, nonjudgmental, neutral approach by a therapist. Analysis of free associations is characteristic of Freudian psychoanalysis. Classical conditioning is characteristic of a pure behavioral intervention. CN: Psychosocial integrity; CNS: None; CL: Application 5. 2. One of the 11 curative factors of group y therapy identified by Yalom is universality, which assists group participants in recognizing common experiences and responses. This action helps reduce anxiety and allows other group members to provide support and understanding. Altruism, catharsis, and existential factors are other curative factors Yalom described, but they don't describe this particular incident. Atruism refers to finding meaning through helping others; catharsis is an open expression of previously suppressed feelings; and existential factors describe the recognition that one has control over the quality of one's life. CN: Psychosocial integrity; CNS: None; CL: Application 14. A physician starts a client on the antipsychotic medication haloperidol (Haldol). The 6. 4. In a group, the individual has the opportunity to learn that others have the same nurse is aware that this medication has extrapyramidal adverse effects. Which measures should problems and needs. The group can also provide an arena where new methods of relating to the nurse take during haloperidol administration? Select all that apply: others can be tried. Decreasing focus on the individual isn't a key advantage (and sometimes 1. Review subcutaneous injection technique. isn't an advantage at all). Groups don't, by themselves, foster the physician–client relationship, 2. Closely monitor vital signs, especially temperature. and they aren't always used to confront individuals. CN: Psychosocial integrity; CNS: None; CL: Analysis 3. Provide the client with the opportunity to pace. 4. Monitor blood glucose levels. 7. 2. The client history strongly suggests post-traumatic stress disorder. Group therapy has been especially effective with this diagnosis. ECT, hypnotherapy, and individual therapy may a dry mouth. Providing the client with hard candy to suck on can help with this problem. be useful to this client, but these therapies aren't as strongly advocated as group therapy. Haloperidol isn't given subcutaneously and doesn't affect blood glucose levels. Urticaria isn't CN: Psychosocial integrity; CNS: None; CL: Analysis usually associated with haloperidol administration. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies; CL: Analysis 8. 4. Anxiety about body image and changes in physical appearance is a common fear of adolescents. Fear of the unknown is associated with toddlerhood. Fear of loss of respect, love, and emerging self-esteem is associated with the school-age developmental phase. Anxiety related to guilt is also associated with the school-age developmental phase. CN: Psychosocial integrity; CNS: None; CL: Application 9. 3. Verbal clues to suicidal ideation include such statements as “Pray for me,” and “I won't be here when you get back.” Nonverbal clues include giving away personal possessions, a sudden calmness, and risk-taking behaviors. The nurse should recognize the combination of these signs as indicating suicidal ideation —not depression, panic, or anxiety. Clients with major depression generally don't exhibit suicidal behavior until their outlook on their