Psychiatric Assessment and Fundamentals of Mental Health and Psychiatric Nursing NCLEX Quiz: 50 Questions| 2022 UPDATE | RATED A+

Psychiatric Assessment and Fundamentals of Mental Health and Psychiatric Nursing NCLEX Quiz: 50 Questions 1. 1. Question Marco approached Nurse Trisha asking for advice on how to deal with his alcohol addiction. Nurse Trisha should tell the client that the only effective treatment for alcoholism is: o A. Psychotherapy o B. Alcoholics Anonymous (A.A.) o C. Total abstinence o D. Aversion Therapy Incorrect Correct Answer: C. Total abstinence Total abstinence is the only effective treatment for alcoholism. Offering counseling on moderation may help convince some problem drinkers to seek help before they suffer painful consequences. Research into moderate or “controlled” drinking has shown that this strategy can be successful for patients who have not yet developed a pervasive pattern of alcohol abuse, or who have experienced few negative consequences from drinking. It also helps to be young, female, employed, in a stable social situation, and confident about moderating intake. The goal is to help patients set goals and drinking limits before they cross the line into dependence. • Option A: Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist, or other mental health providers. During psychotherapy, the client learns about their condition and their moods, feelings, thoughts, and behaviors. Psychotherapy helps the client learn how to take control of their life and respond to challenging situations with healthy coping skills. There are many types of psychotherapy, each with its own approach. The type of psychotherapy that’s right for each client depends on their individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy. • Option B: Alcoholics Anonymous is an international fellowship of men and women who have had a drinking problem. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to do something about their drinking problem. • Option D: Aversion therapy is a type of behavioral therapy that involves repeated pairing of unwanted behavior with discomfort. For example, a person undergoing aversion therapy to stop smoking might receive an electrical shock every time they view an image of a cigarette. The goal of the conditioning process is to make the individual associate the stimulus with unpleasant or uncomfortable sensations. 2. 2. Question Nurse Hazel is caring for a male client who experiences false sensory perceptions with no basis in reality. This perception is known as: • A. Hallucinations • B. Delusions • C. Loose associations • D. Neologisms Incorrect Correct Answer: A. Hallucinations Hallucinations are visual, auditory, gustatory, tactile or olfactory perceptions that have no basis in reality. The word “hallucination” comes from Latin and means “to wander mentally.” Hallucinations are defined as the “perception of a nonexistent object or event” and “sensory experiences that are not caused by stimulation of the relevant sensory organs.” Hallucinations occur frequently in people with psychiatric conditions, including schizophrenia and bipolar disorder, however, you don’t necessarily need to have a mental illness to experience hallucinations. • Option B: Delusions are defined as fixed, false beliefs that conflict with reality. Despite contrary evidence, a person in a delusional state can’t let go of their convictions. Delusions are often reinforced by the misinterpretation of events. Many delusions also involve some level of paranoia. For example, someone might contend that the government is controlling our every move via radio waves despite evidence to the contrary. • Option C: A thought disturbance demonstrated by speech that is disconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea. It is essentially equivalent to derailment. • Option D: In psychiatry, the term is used to describe the creation of words which only have meaning to the person who uses them. It is considered normal in children, but a symptom of thought disorder indicative of a psychotic mental illness such as schizophrenia in adults. Usage of neologisms may also be related to aphasia acquired after brain damage resulting from a stroke or head injury. 3. 3. Question Nurse Monet is caring for a female client who has suicidal tendencies. When accompanying the client to the restroom, Nurse Monet should… • A. Give her privacy. • B. Allow her to urinate. • C. Open the window and allow her to get some fresh air. • D. Observe her. Incorrect Correct Answer: D. Observe her. The nurse has a responsibility to continuously observe the acutely suicidal client. The nurse should watch for clues, such as communicating suicidal thoughts, and messages; hoarding medications and talking about death. First and foremost, the patient’s safety must be assured; this is the intervention. Intervention is based on the application of risk factors coupled with a clinical inquiry. • Option A: The individual must not be left alone. In the ED, such a recommendation is handled easily by hospital security personnel. In other settings, summon assistance quickly. In an isolated place, call 911. Involve family or friends; they can remain with the patient while treatment arrangements are made. • Option B: The suicidal patient should be treated initially in a secure, safe, and highly supervised place. Inpatient care at a hospital offers one of the best settings. Most managed care companies recognize the medical necessity of hospitalization in situations in which the suicide danger is acute. • Option C: Remove anything that the patient may use to hurt or kill him or herself. Remove sharp or potentially dangerous objects. Ask the patient for any weapon, such as knives or pills, and secure them away from the patient. A study of the association between the provision of mental health services and suicide rates found that removing ligature points (places where things like ropes could be attached to) was associated with significant reductions in the overall psychiatric inpatient suicide rate and in the rate of inpatient suicide by hanging. 4. 4. Question Nurse Maureen is developing a plan of care for a female client with anorexia nervosa. Which action should the nurse include in the plan? • A. Provide privacy during meals. • B. Set-up a strict eating plan for the client. • C. Encourage the client to exercise to reduce anxiety. • D. Restrict visits with the family. Incorrect Correct Answer: B. Set-up a strict eating plan for the client Establishing a consistent eating plan and monitoring the client’s weight are important to this disorder. Supervise the patient during mealtimes and for a specified period after meals (usually one hour). To ensure compliance with the dietary treatment program. For a hospitalized patient with anorexia, food is considered a medication. Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results. Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight. • Option A: Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games. • Option C: Monitor exercise program and set limits on physical activities. Chart activity and level of work (pacing and so on). Moderate exercise helps in maintaining muscle tone, weight and combating depression; however, the patient may exercise excessively to burn calories. • Option D: Discourage members from asking for approval from each other. Be alert to verbal or nonverbal checking with others for approval. Acknowledge the competent actions of the patient. Each individual needs to develop own internal sense of self-esteem. The individual often is living up to others’ (family’s) expectations rather than making his or her own choices. Acknowledgment provides recognition of self in positive ways. 5. 5. Question A client is experiencing an anxiety attack. The most appropriate nursing intervention should include? • A. Turning on the television. • B. Leaving the client alone. • C. Staying with the client and speaking in short sentences. • D. Ask the client to play with other clients. Incorrect Correct Answer: C. Staying with the client and speaking in short sentences Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Maintain a calm, non threatening manner while working with the client; anxiety is contagious and may be transferred from staff to client or vice versa. Use simple words and brief messages, speak calmly and clearly, to explain hospital experiences to the client; in an intensely anxious situation, the client is unable to comprehend anything but the most elementary communication. • Option A: Provide a non-stimulating environment. Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor); a stimulating environment may increase the level of anxiety. Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.) Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked. • Option B: Reassure the client of his or her safety and security; this can be conveyed by the physical presence of the nurse; do not leave the client alone at this time. Remain with the client at all times when levels of anxiety are high (severe or panic); reassure the client of his or her safety and security. The client’s safety is an utmost priority. A highly anxious client should not be left alone as his anxiety will escalate. • Option D: Encourage the client to talk about traumatic experiences under non-threatening conditions; help the client work through feelings of guilt related to the traumatic event; help the client understand that this was an event to which most people would have responded in like manner. Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation, and so forth. Relaxation exercises are effective nonchemical ways to reduce anxiety. 6. 6. Question A female client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is: • A. Being Killed. • B. Highly famous and important. • C. Responsible for an evil world. • D. Connected to the client unrelated to oneself. Incorrect Correct Answer: B. Highly famous and important Delusion of grandeur is a false belief that one is highly famous and important. A delusion of grandeur is the false belief in one’s own superiority, greatness, or intelligence. People experiencing delusions of grandeur do not just have high self-esteem; instead, they believe in their own greatness and importance even in the face of overwhelming evidence to the contrary. Someone might, for example, believe they are destined to be the leader of the world, despite having no leadership experience and difficulties in interpersonal relationships. Delusions of grandeur are characterized by their persistence. They are not just moments of fantasy or hopes for the future. • Option A: Cotard delusion is a rare condition marked by the false belief that you or your body parts are dead, dying, or don’t exist. It usually occurs with severe depression and some psychotic disorders. It can accompany other mental illnesses and neurological conditions. One of the main symptoms of Cotard delusion is nihilism. Nihilism is the belief that nothing has any value or meaning. It can also include the belief that nothing really exists. People with Cotard delusion feel as if they’re dead or rotting away. In some cases, they might feel like they’ve never existed. • Option C: A delusion is a belief that is clearly false and that indicates an abnormality in the affected person’s content of thought. The false belief is not accounted for by the person’s cultural or religious background or his or her level of intelligence. The key feature of a delusion is the degree to which the person is convinced that the belief is true. A person with a delusion will hold firmly to the belief regardless of evidence to the contrary. Delusions can be difficult to distinguish from overvalued ideas, which are unreasonable ideas that a person holds, but the affected person has at least some level of doubt as to its truthfulness. • Option D: A person with a delusion is absolutely convinced that the delusion is real. Delusions are a symptom of either a medical, neurological, or mental disorder. Delusions may be present in any of the following mental disorders: (1) Psychotic disorders, or disorders in which the affected person has a diminished or distorted sense of reality and cannot distinguish the real from the unreal, including schizophrenia, schizoaffective disorder, delusional disorder, schizophreniform disorder, shared psychotic disorder, brief psychotic disorder, and substance-induced psychotic disorder, (2) Bipolar disorder, (3) Major depressive disorder with psychotic features (4) Delirium, and (5) Dementia. 7. 7. Question A 20-year-old client was diagnosed with dependent personality disorder. Which behavior is not most likely to be evidence of ineffective individual coping? • A. Recurrent self-destructive behavior. • B. Avoiding relationships. • C. Showing interest in solitary activities. • D. Inability to make choices and decisions without advice. Incorrect Correct Answer: D. Inability to make choices and decision without advice Individuals with dependent personality disorder typically show indecisiveness, submissiveness, and clinging behavior so that others will make decisions with them. Dependent personality disorder (DPD) is a type of anxious personality disorder. People with DPD often feel helpless, submissive or incapable of taking care of themselves. They may have trouble making simple decisions. But, with help, someone with a dependent personality can learn self-confidence and self-reliance. • Option A: Self-destructive behaviors are those that are bound to harm you physically or mentally. It may be unintentional. Or, it may be that you know exactly what you’re doing, but the urge is too strong to control. It may be due to earlier life experiences. It can also be related to a mental health condition, such as depression or anxiety. Self-destructive behavior is when you do something that’s sure to cause self-harm, whether it’s emotional or physical. • Option B: People with DPD have an overwhelming need to have others take care of them. Often, a person with DPD relies on people close to them for their emotional or physical needs. Others may describe them as needy or clingy. People with DPD may believe they can’t take care of themselves. They may have trouble making everyday decisions, such as what to wear, without others’ reassurance. • Option C: Dependent personality belongs to a group of anxious or fearful disorders that also includes avoidant personality — painfully shy, inhibited, and withdrawn. But it also has characteristics in common with histrionic personality — self-dramatizing, suggestible, seductive, and constantly starved for attention. 8. 8. Question A male client is diagnosed with a schizotypal personality disorder. Which signs would this client exhibit during a social situation? • A. Paranoid thoughts • B. Emotional affect • C. Independence need • D. Aggressive behavior Incorrect Correct Answer: A. Paranoid thoughts Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. People with schizotypal personality disorder are often described as odd or eccentric and usually have few, if any, close relationships. They generally don’t understand how relationships form or the impact of their behavior on others. They may also misinterpret others’ motivations and behaviors and develop significant distrust of others. These problems may lead to severe anxiety and a tendency to avoid social situations, as the person with schizotypal personality disorder tends to hold peculiar beliefs and may have difficulty with responding appropriately to social cues. • Option B: People with schizotypal personality disorder are loners who prefer to keep their distance from others and are uncomfortable being in relationships. They sometimes exhibit odd speech or behavior, and they have a limited or flat range of emotions. This pattern begins early in adulthood and continues throughout life. Those with this disorder also tend to have markedly illogical thinking, with unusual ideas or odd beliefs that are not consistent with prevailing ideas, for example, a strong belief in extrasensory perception (ESP). They may report unusual perceptions or strange body experiences. • Option C: People with schizotypal personality disorder are loners who prefer to keep their distance from others and are uncomfortable being in relationships. They sometimes exhibit odd speech or behavior, and they have a limited or flat range of emotions. This pattern begins early in adulthood and continues throughout life. • Option D: Many people with schizotypal personality disorder have subtle difficulties with memory, learning, and attention. They usually do not have the more severe and disabling psychotic symptoms, such as delusions and hallucinations that appear in schizophrenia. However, people with a schizotypal personality disorder do sometimes develop schizophrenia. 9. 9. Question Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is? • A. Encourage to avoid food. • B. Identify anxiety-causing situations. • C. Eat only three meals a day. • D. Avoid shopping for plenty of groceries. Incorrect Correct Answer: B. Identify anxiety-causing situations Bulimia disorder generally is a maladaptive coping response to stress and underlying issues. The client should identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Assist the patient to learn strategies other than eating for dealing with feelings. Have the patient keep a diary of feelings, particularly when thinking about food. Feelings are the underlying issue, and the patient often uses food instead of dealing with feelings appropriately. The patient needs to learn to recognize feelings and how to express them clearly. • Option A: Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Be alert to choices of low-calorie foods and beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets. The patient will try to avoid taking in what is viewed as excessive calories and may go to great lengths to avoid eating. • Option C: Provide diet and snacks with substitutions of preferred foods when available. Having a variety of foods available enables the patient to have a choice of potentially enjoyable foods. Provide smaller meals and supplemental snacks, as appropriate. Gastric dilation may occur if refeeding is too rapid following a period of starvation dieting. Note: the patient may feel bloated for 3–6 weeks while the body adjusts to food intake. • Option D: Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain. 10. 10. Question Nurse Tony was caring for a 41-year-old female client. Which behavior by the client indicates adult cognitive development? • A. Generates new levels of awareness. • B. Assumes responsibility for her actions. • C. Has maximum ability to solve problems and learn new skills. • D. Her perception is based on reality. Incorrect Correct Answer: A. Generates new levels of awareness An adult age 31 to 45 generates a new level of awareness. Two forms of intelligence—crystallized and fluid—are the main focus of middle adulthood. Our crystallized intelligence is dependent upon accumulated knowledge and experience—it is the information, skills, and strategies we have gathered throughout our lifetime. This kind of intelligence tends to hold steady as we age—in fact, it may even improve. For example, adults show relatively stable to increasing scores on intelligence tests until their mid-30s to mid-50s (Bayley & Oden, 1955). Fluid intelligence, on the other hand, is more dependent on basic information-processing skills and starts to decline even prior to middle adulthood. Cognitive processing speed slows down during this stage of life, as does the ability to solve problems and divide attention. However, practical problem-solving skills tend to increase. These skills are necessary to solve real-world problems and figure out how to best achieve the desired goal. • Option B: During early adulthood, cognition begins to stabilize, reaching a peak around the age of 35. Early adulthood is a time of relativistic thinking, in which young people begin to become aware of more than simplistic views of right vs. wrong. They begin to look at ideas and concepts from multiple angles and understand that a question can have more than one right (or wrong) answer. • Option C: The need for specialization results in pragmatic thinking—using logic to solve real-world problems while accepting contradiction, imperfection, and other issues. Finally, young adults develop a sort of expertise in either education or career, which further enhances problem-solving skills and the capacity for creativity. • Option D: Since Piaget’s theory, other developmental psychologists have suggested a fifth stage of cognitive development, known as postformal operational thinking (Basseches, 1984; Commons & Bresette, 2006; Sinnott, 1998). In postformal thinking, decisions are made based on situations and circumstances, and logic is integrated with emotion as adults develop principles that depend on contexts. This kind of thinking includes the ability to think in dialectics, and differentiates between the ways in which adults and adolescents are able to cognitively handle emotionally charged situations. 11. 11. Question A neuromuscular blocking agent is administered to a client before ECT therapy. The nurse should carefully observe the client for: • A. Respiratory difficulties • B. Nausea and vomiting • C. Dizziness • D. Seizures Incorrect Correct Answer: A. Respiratory difficulties Neuromuscular Blocker, such as succinylcholine (Anectine) produces respiratory depression because it inhibits contractions of respiratory muscles. A nerve stimulator is utilized to monitor succinylcholine, a depolarizing muscle relaxant used to reduce tonic-clonic contractions during the procedure. As an alternative to EMG, a blood pressure cuff is inflated on the patient’s ankle to prevent succinylcholine from entering the foot, allowing a visual monitor of seizure activity with measurement of tonic-clonic contractions. • Option B: Physiologically, during the tonic phase of the seizure, a 15- to 20-second parasympathetic discharge occurs, which can lead to bradyarrhythmias including premature atrial and ventricular contractions, atrioventricular block, and asystole. Patients with sub convulsive seizures are at higher risk for asystole. • Option C: Paradoxically, patients with heart block or underlying arrhythmias are less likely to develop asystole. The clonic phase of the seizure correlates with a catecholamine surge that causes tachycardia and hypertension, which lasts temporally with seizure duration. Hypertension and tachycardia resolve within 10 to 20 minutes of the seizure, although some patients exhibit persistent hypertension that requires medical intervention. • Option D: The beginning and termination of a cerebral seizure is monitored via EEG, recorded from right and left frontal and mastoid positions. Seizure induction is via two electrodes placed bitemporally or a right unilateral electrode; both of which allow electrical current to pass into the scalp. A 2017 meta-analysis of numerous randomized trials of 792 patients specifically compared moderate dose bilateral ECT with high dose right unilateral ECT, and remission was comparable. Right unilateral ECT is utilized preferentially to minimize retrograde amnesia. 12. 12. Question A 75-year-old client is admitted to the hospital with the diagnosis of dementia of the Alzheimer’s type and depression. The symptom that is unrelated to depression would be? • A. Apathetic response to the environment. • B. “I don’t know” answer to questions. • C. Shallow of labile affect. • D. Neglect of personal hygiene. Incorrect Correct Answer: C. Shallow of labile affect With depression, there is little or no emotional involvement therefore little alteration in affect. The common features of all the depressive disorders are sadness, emptiness, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. • Option A: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home. • Option B: A dysphoric mood state may be expressed by patients as sadness, heaviness, numbness, or sometimes irritability and mood swings. They often report a loss of interest or pleasure in their usual activities, difficulty concentrating, or loss of energy and motivation. Their thinking is often negative, frequently with feelings of worthlessness, hopelessness, or helplessness. • Option D: Depression—also called “clinical depression” or a “depressive disorder”—is a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least 2 weeks. 13. 13. Question Nurse Trish is working in a mental health facility; the nurse’s priority nursing intervention for a newly admitted client with bulimia nervosa would be: • A. Teach the client to measure I & O. • B. Involve the client in planning daily meals. • C. Observe the client during meals. • D. Monitor the client continuously. Incorrect Correct Answer: D. Monitor client continuously These clients often hide food or force vomiting; therefore they must be carefully monitored. Supervise the patient during mealtimes and for a specified period after meals (usually one hour) to prevent vomiting during or after eating. Identify the patient’s elimination patterns to prevent self-induced vomiting. • Option A: Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results. Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight. Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. • Option B: Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situation while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain. • Option C: Provide one-to-one supervision and have a patient with bulimia remain in the day room area with no bathroom privileges for a specified period (2 hr) following eating, if contracting is unsuccessful. Prevents vomiting during and after eating. The patient may desire food and use a binge-purge syndrome to maintain weight. Note: the patient may purge for the first time in response to the establishment of a weight gain program. 14. 14. Question Nurse Patricia is aware that the major health complication associated with intractable anorexia nervosa would be: • A. Cardiac dysrhythmias resulting in cardiac arrest. • B. Glucose intolerance resulting in protracted hypoglycemia. • C. Endocrine imbalance causing cold amenorrhea. • D. Decreased metabolism causing cold intolerance. Incorrect Correct Answer: A. Cardiac dysrhythmias resulting in cardiac arrest These clients have severely depleted levels of sodium and potassium because of their starvation diet and energy expenditure, these electrolytes are necessary for cardiac functioning. Refeeding syndrome can occur following prolonged starvation. As the body utilizes glucose to produce molecules of adenosine triphosphate (ATP), it depletes the remaining stores of phosphorus. Also, glucose entry into cells is mediated by insulin and occurs rapidly following long periods without food. Both cause electrolyte abnormalities such as hypophosphatemia and hypokalemia, triggering cardiac and respiratory compromise. Patients should be followed carefully for signs of refeeding syndrome and electrolytes closely monitored. • Option B: Anorexia nervosa is a psychiatric disease in which patients restrict their food intake relative to their energy requirements through eating less, exercising more, and/or purging food through laxatives and vomiting. Despite being severely underweight, they do not recognize it and have distorted body images. They can develop complications from being underweight and purging food. • Option C: Patients will report symptoms such as amenorrhea, cold intolerance, constipation, extremity edema, fatigue, and irritability. They may describe restrictive behaviors related to food like calorie counting or portion control, and purging methods, for example, self-induced vomiting or use of diuretics or laxatives. Many exercise compulsively for extended periods of time. Patients with anorexia nervosa develop multiple complications related to prolonged starvation and purging behaviors. • Option D: Remission in anorexia nervosa varies. Three-fourths of patients treated in out-patient settings remit within five years and the same percentage experience intermediate-good outcomes, including weight gain. Relapse is more common in patients who are older with a longer duration of disease or lower body fat/weight at the end of treatment, have comorbid psychiatric disorders, or receive therapy outside of a specialized clinic. Often, patients who achieve partial remission develop another form of eating disorder like bulimia nervosa or an unspecified eating disorder. 15. 15. Question Nurse Anna can minimize agitation in a disturbed client by: • A. Increasing stimulation. • B. Limiting unnecessary interaction. • C. Increasing appropriate sensory perception. • D. Ensuring constant client and staff contact. Incorrect Correct Answer: B. Limiting unnecessary interaction Limiting unnecessary interaction will decrease stimulation and agitation. Keep immediate surroundings low in stimuli (dim lighting, few people, simple decor); a stimulating environment may increase the level of anxiety. Reassure the client of his or her safety and security; this can be conveyed by the physical presence of the nurse; do not leave the client alone at this time. • Option A: Move the client to a quiet area with minimal stimuli such as a small room or seclusion area (dim lighting, few people, and so on.) Anxious behavior escalates by external stimuli. A smaller or secluded area enhances a sense of security as compared to a large area which can make the client feel lost and panicked. • Option C: Maintain a calm, non-threatening manner while working with the client. Anxiety is contagious and may be transferred from health care provider to client or vice versa. The client develops a feeling of security in presence of a calm staff person. Avoid asking or forcing the client to make choices. The client may not make sound and appropriate decisions or may be unable to make decisions at all. • Option D: Maintain calmness in your approach to the client. The client will feel more secure if you are calm and if the client feels you are in control of the situation. Observe for increasing anxiety. Assume a calm manner, decrease environmental stimulation, and provide temporary isolation as indicated. Early detection and intervention facilitate modifying a client’s behavior by changing the environment and the client’s interaction with it, to minimize the spread of anxiety. 16. 16. Question A 39-year-old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Nurse Trish recognizes that the basis of O.C. disorder is often: • A. Problems with being too conscientious • B. Problems with anger and remorse • C. Feelings of guilt and inadequacy • D. Feeling of unworthiness and hopelessness Incorrect Correct Answer: C. Feelings of guilt and inadequacy Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior. An inability to cope with uncertainty, an increased sense of responsibility as well as magical thinking seem to predispose those to obsessive-compulsive habits. • Option A: Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others to participate; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function. • Option B: The behaviors or mental acts aim at reducing anxiety or distress or preventing some dreaded situation; however, these behaviors or mental actions do not connect in a realistic way with what they are designed to prevent or are clearly excessive. • Option D: Obsessions are defined as intrusive thoughts or urges that cause significant distress; the patient attempts to neutralize this distress by diverting thoughts or performing rituals. Compulsions are actions the patient feels pressured to do in response to the anxiety/distress producing obsessions or to prevent an uncomfortable situation from occurring. These compulsions may be illogical or excessive. 17. 17. Question Mario is complaining to other clients about not being allowed by staff to keep food in his room. Which of the following interventions would be most appropriate? • A. Allowing a snack to be kept in his room. • B. Reprimanding the client. • C. Ignoring the client's behavior. • D. Setting limits on the behavior. Incorrect Correct Answer: D. Setting limits on the behavior The nurse needs to set limits on the client’s manipulative behavior to help the client control dysfunctional behavior. A consistent approach by the staff is necessary to decrease manipulation. Interventions such as employing limit-setting techniques help reduce stress and hostility for both patients and staff. To successfully limit problem behavior, limits must be consistent and reinforced by everyone, including the family and all health care personnel. Staff working with manipulative patients are best prepared when they establish firm rules that are rigidly interpreted and consistently enforced among all members of the health care team. Frequent discussions regarding the patient’s progress can help reduce staff frustration and isolation and minimize the patient’s attempts at staff splitting. • Option A: State limits and the behavior you expect from the patient in a matter-of-fact, non-threatening tone. State the consequences if behaviors are not forthcoming. Written limits and consequences can be useful (one copy for the patient and one for the staff). Be direct and assertive, if necessary, in a neutral, factual manner, not in anger. • Option B: Anger is a natural response to being manipulated. Deal with your own feelings of anger toward the patient. Peer supervision can be useful. Assess your feelings toward patients who use manipulation, and work on being assertive in stating limits. Workshops in assertiveness can be very helpful for nurses. • Option C: Confronting unacceptable, inappropriate, or harmful behavior needs to be done immediately, and setting limits on patient behaviors is the pivotal intervention when working with manipulative patients. Clear, enforceable consequences of continuing unacceptable behaviors need to be spelled out and consistently and matter-of-factly enforced by all staff involved in the patient’s care. The most effective approach with the patient is to maintain a professional therapeutic relationship with clear boundaries. A professional relationship is based on the patient’s therapeutic needs, not on being liked or the nurse’s personal feelings. People who manipulate others need clear and firm boundaries with clear and firm consequences identified for overstepping those boundaries. 18. 18. Question Conney with borderline personality disorder who is to be discharged soon threatens to “do something” to herself if discharged. Which of the following actions by the nurse would be most important? • A. Ask a family member to stay with the client at home temporarily. • B. Discuss the meaning of the client’s statement with her. • C. Request an immediate extension for the client. • D. Ignore the client's statement because it’s a sign of manipulation. Incorrect Correct Answer: B. Discuss the meaning of the client’s statement with her. Any suicidal statement must be assessed by the nurse. The nurse should discuss the client’s statement with her to determine its meaning in terms of suicide. Determine whether the person has any thoughts of hurting him or herself. Suicidal ideation is highly linked to completed suicide. Some inexperienced clinicians have difficulty asking this question. They fear the inquiry may be too intrusive or that they may provide the person with an idea of suicide. In reality, patients appreciate the question as evidence of the clinician’s concern. A positive response requires further inquiry. • Option A: The individual must not be left alone. In the ED, such a recommendation is handled easily by hospital security personnel. In other settings, summon assistance quickly. In an isolated place, call 911. Involve family or friends; they can remain with the patient while treatment arrangements are made. • Option C: Determine what the patient believes his or her suicide would achieve. This suggests how seriously the person has been considering suicide and the reason for death. For example, some believe that their suicide would provide a way for family or friends to realize their emotional distress. Others see their death as a relief from their own psychic pain. Still others believe that their death would provide a heavenly reunion with a departed loved one. In any scenario, the clinician has another gauge of the seriousness of the planning. • Option D: A clear and complete evaluation and clinical interview provide the information upon which to base a suicide intervention. Although risk factors offer major indications of the suicide danger, nothing can substitute for a focused patient inquiry. However, although all the answers a patient gives may be inclusive, a therapist often develops a visceral sense that his or her patient is going to commit suicide. The clinician’s reaction counts and should be considered in the intervention. 19. 19. Question Joey, a client with antisocial personality disorder belches loudly. A staff member asks Joey, “Do you know why people find you repulsive?” This statement most likely would elicit which of the following client reactions? • A. Defensiveness • B. Embarrassment • C. Shame • D. Remorsefulness Incorrect Correct Answer: A. Defensiveness When the staff member asks the client if he wonders why others find him repulsive, the client is likely to feel defensive because the question is belittling. The natural tendency is to counterattack the threat to self-image. • Option B: Embarrassment is a painful but important emotional state. Most researchers believe that the purpose of embarrassment is to make people feel badly about their social or personal mistakes as a form of internal (or societal) feedback, so that they learn not to repeat the error. • Option C: Shame is an unpleasant self-conscious emotion typically associated with a negative evaluation of the self; withdrawal motivations; and feelings of distress, exposure, mistrust, powerlessness, and worthlessness. • Option D: One of the hallmarks of people with Borderline Personality Disorder or Narcissistic Personality Disorder (BP/NP) is that they often do not feel truly sorry. Even though a BP/NP may say he or she is sorry, there is often something lacking. The BP/NP may regret an action, but it is hard to see true remorse in their response. Remorse involves admitting one’s own mistakes and taking responsibility for one’s actions. It creates a sense of guilt and sorrow for hurting someone else and leads to confession and true apology. It also moves the remorseful person to avoid doing the hurtful action again. 20. 20. Question Which of the following approaches would be most appropriate to use with a client suffering from narcissistic personality disorder when discrepancies exist between what the client states and what actually exists? • A. Rationalization • B. Supportive confrontation • C. Limit setting • D. Consistency Incorrect Correct Answer: B. Supportive confrontation The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for himself. Supportive confrontation means that we are putting good energy and effort into addressing a value or principle that seems disconnected or out of alignment, using some specific skills. Over time we view this as an opportunity to deepen relationships, strengthen teams, and enhance our organizations. • Option A: Rationalization is an attempt to logically justify immoral, deviant, or generally unacceptable behavior. In Freud’s classical psychoanalytic theory, rationalization is a defense mechanism, an unconscious attempt to avoid addressing the underlying reasons for behavior. • Option C: Limit setting allows the boundaries of the therapeutic relationship to be established and provides the consumer with a clear understanding of what is and isn’t acceptable behavior and what the consequences of their actions will be. • Option D: Consistency refers to the way in which minority influence is more likely to occur if the minority members share the same belief and retain it over time. This then draws the attention of the majority to the minority. 21. 21. Question Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mmHg and pulse is 92 bpm. Which of the medications would the nurse expect to administer? • A. naloxone (Narcan) • B. benztropine (Cogentin) • C. lorazepam (Ativan) • D. haloperidol (Haldol) Incorrect Correct Answer: C. lorazepam (Ativan) The nurse would most likely administer benzodiazepine, such as lorazepam (ativan) to the client who is experiencing symptoms: The client’s experiences symptoms of withdrawal because of the rebound phenomenon when the sedation of the CNS from alcohol begins to decrease. Lorazepam binds to benzodiazepine receptors on the postsynaptic GABA-A ligand-gated chloride channel neuron at several sites within the central nervous system (CNS). It enhances the inhibitory effects of GABA, which increases the conductance of chloride ions into the cell. This shift in chloride ions results in hyperpolarization and stabilization of the cellular plasma membrane. Its inhibitory action in the amygdala helps with anxiety disorders, while its inhibitory action in the cerebral cortex helps in seizure disorders. • Option A: Naloxone is indicated for the treatment of opioid toxicity, specifically to reverse respiratory depression from opioid use. It is useful in accidental or intentional overdose and acute or chronic toxicity. Common opioid overdoses treated with naloxone include heroin, fentanyl, carfentanil, hydrocodone, oxycodone, methadone, and others. Naloxone is a pure, competitive opioid antagonist with a high affinity for the mu-opioid receptor, allowing for reversal of the effects of opioids. • Option B: Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drug). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting so that its administration can be with less frequency than diphenhydramine. It also induces less CNS stimulation effect compared to that of trihexyphenidyl, making it a preferable drug of choice for geriatric patients. • Option D: Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world. Food and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe aggressivity, mood instability, and frustration intolerance), severe childhood behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups. It is a typical antipsychotic because it works on positive symptoms of schizophrenia, such as hallucinations and delusions. 22. 22. Question Which of the following foods would the nurse Trish eliminate from the diet of a client in alcohol withdrawal? • A. Milk • B. Orange Juice • C. Soda • D. Regular Coffee Incorrect Correct Answer: D. Regular Coffee Regular coffee contains caffeine which acts as psychomotor stimulants and leads to feelings of anxiety and agitation. Serving coffee to the client may add to tremors or wakefulness. During acute alcohol intake, caffeine largely antagonizes the “unwanted” effects of alcohol by blocking A1 receptors, which mediate alcohol’s somnogenic and ataxic effects. On the other hand, an alcohol-induced increase in the extracellular concentration of adenosine can decrease the A1 receptor-mediated “unwanted” anxiogenic effects of caffeine. The mutual antagonism of “unwanted” effects gives the possibility of increasing significantly the intake of both drugs in the pursuit of the “wanted” reinforcing effects. • Option A: Calcium is important for strong bones. Dairy such as milk contains plenty of calcium (but don’t have too much, because of the fat content). Eating leafy greens like chard, spinach, and kale work wonders – why not make a kale and spinach omelet? • Option B: Potassium is very important for heart and muscular health. Bananas are very high in potassium, as are sweet and white baked potatoes, peas, beans, spinach, fish and seafood, dried fruits, and greens. • Option C: If you’re going to undertake an alcohol detox, a fundamental rule is to cut out sugary foods, especially those with processed sugars and meals that have a high-fat content. Although we all need particular carbohydrates that are high in fiber, it is also recommended that you cut down on carbs too, such as crisps, bread, and pasta. 23. 23. Question Which of the following would Nurse Hazel expect to assess for a client who is exhibiting late signs of heroin withdrawal? • A. Yawning & diaphoresis • B. Restlessness & Irritability • C. Constipation & steatorrhea • D. Vomiting and diarrhea Incorrect Correct Answer: D. Vomiting and diarrhea Vomiting and diarrhea are usually the late signs of heroin withdrawal, along with muscle spasms, fever, nausea, repetitive, abdominal cramps, and backache. Opioid withdrawal syndrome is a life-threatening condition resulting from opioid dependence. Opioids are a group of drugs used for the management of severe pain. They are also commonly used as psychoactive substances around the world. Opioids include drugs such as morphine, heroin, oxycontin, codeine, methadone, and hydromorphone hydrochloride. They produce mental relaxation, pain relief, and euphoric feelings. • Option A: Commonly co-occurring in opioid drug users and can be characterized by symptoms that occur in primary mental disorders. Such symptoms include depressed mood, persistent depressive disorder (dysthymia), and opioid-induced depressive disorder. Opioid withdrawal differs from other opioid-induced disorders because symptoms in other disorders predominate clinical presentation and warrant further diagnostic investigation. • Option B: According to Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, signs and symptoms of opioid withdrawal include lacrimation or rhinorrhea, piloerection “goose flesh,” myalgia, diarrhea, nausea/vomiting, pupillary dilation, and photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and yawning. • Option C: Sedative-hypnotic withdrawal symptoms may resemble opioid withdrawal characteristics, but opioid withdrawal is also characterized by lacrimation, rhinorrhea, and pupillary dilation. Hallucinogen and stimulant intoxication can also cause pupillary dilation, but other symptoms of opioid withdrawal-like nausea, diarrhea, vomiting, lacrimation, and rhinorrhea are usually not present. 24. 24. Question To establish an open and trusting relationship with a female client who has been hospitalized with severe anxiety, the nurse in charge should? • A. Encourage the staff to have frequent interaction with the client. • B. Share an activity with the client. • C. Give client feedback on behavior. • D. Respect client’s need for personal space. Incorrect Correct Answer: D. Respect client’s need for personal space Moving to a client’s personal space increases the feeling of threat, which increases anxiety. Lessen sensory stimuli by keeping a quiet and peaceful environment; keep “threatening” equipment out of sight. Anxiety may intensify to a panic state with excessive conversation, noise, and equipment around the patient. increasing anxiety may become frightening to the patient and others. • Option A: Interact with the patient in a peaceful manner. The nurse or health care provider can transmit his or her own anxiety to the hypersensitive patient. The patient’s feeling of stability increases in a calm and non-threatening environment. Help the patient determine precipitants of anxiety that may indicate interventions. Obtaining insight allows the patient to reevaluate the threat or identify new ways to deal with it. • Option B: Allow the patient to talk about anxious feelings and examine anxiety-provoking situations if they are identifiable. Talking about anxiety-producing situations and anxious feelings can help the patient perceive the situation realistically and recognize factors leading to the anxious feelings. • Option C: If the situational response is rational, use empathy to encourage the patient to interpret the anxiety symptoms as normal. Anxiety is a normal response to actual or perceived danger. Avoid unnecessary reassurance; this may increase undue worry. Reassurance is not helpful for the anxious individual. 25. 25. Question Nurse Monette recognizes that the focus of environmental (MILIEU) therapy is to: • A. Manipulate the environment to bring about positive changes in behavior. • B. Allow the client’s freedom to determine whether or not they will be involved in activities. • C. Role play life events to meet individual needs. • D. Use natural remedies rather than drugs to control behavior. Incorrect Correct Answer: A. Manipulate the environment to bring about positive changes in behavior Environmental (MILIEU) therapy aims at having everything in the client’s surrounding area toward helping the client. Theories of MT commonly acknowledge the role of the environment as a setting in which therapeutic change happens. According to Dincin (1975), “a great deal has been written about the importance of the milieu and the environment.?The creation of a therapeutic atmosphere is one of [its] hallmarks” (p. 134). • Option B: Milieu therapy is a form of psychotherapy that involves the use of therapeutic communities. Patients join a group of around 30, for between 9 and 18 months. During their stay, patients are encouraged to take responsibility for themselves and the others within the unit, based upon a hierarchy of collective consequences. • Option C: In milieu therapy, you spend a significant amount of time in a home-like environment, interacting with other people as you conduct ordinary activities throughout the day. You may attend group or individual therapy sessions as part of your schedule. With this treatment approach, patients have daily responsibilities that contribute to the functioning of their environment. Many programs allow people to choose the work they do every day so they feel comfortable and productive. The idea is that these activities and responsibilities will become opportunities to look at, talk about, and change ways of thinking and acting that aren’t healthy. • Option D: In milieu therapy, power is distributed in a more egalitarian way. This shared authority approach allows everyone in the program to have a greater sense of agency and responsibility. That’s because the end goal is for everyone in the program to emerge with more confidence in their ability to handle stressors in the larger society. 26. 26. Question Nurse Naomi would expect a child with a diagnosis of reactive attachment disorder to: • A. Have a more positive relationship with the father than the mother. • B. Cling to mother & cry on separation. • C. Be able to develop only superficial relationships with others. • D. Have been physically abused. Incorrect Correct Answer: C. Be able to develop only superficial relationships with the others Children who have experienced attachment difficulties with the primary caregiver are not able to trust others and therefore relate superficially. Reactive attachment disorder (RAD) is a condition in which an infant or young child does not form a secure, healthy emotional bond with his or her primary caretakers (parental figures). • Option A: Children with RAD often have trouble managing their emotions. They struggle to form meaningful connections with other people. Children with RAD rarely seek or show signs of comfort and may seem almost fearful of their caretakers, even in situations where the current parent figures seem quite loving and caring. These children are often irritable or sad, and may report feeling unsafe and/or alone. • Option B: Although there is no exact cause, researchers believe that lack of an appropriate level of loving and consistent caretaking contributes to the development of RAD. Inadequate caregiving can make a child feel abandoned, alone and uncared for – all of which can prevent that child from developing a healthy and secure emotional bond with his or her primary caretakers. • Option D: Reactive attachment disorder is most common among children between 9 months and 5 years who have experienced physical or emotional neglect or abuse. While not as common, older children can also have RAD since RAD sometimes can be misdiagnosed as other behavioral or emotional difficulties. 27. 27. Question When teaching parents about childhood depression Nurse Victoria should say? • A. It may appear acting out behavior. • B. Does not respond to conventional treatment. • C. Is short on duration & resolves easily. • D. Looks almost identical to adult depression. Incorrect Correct Answer: A. It may appear acting out behavior Children have difficulty verbally expressing their feelings, acting out behavior, such as temper tantrums, may indicate underlying depression. Early medical studies focused on “masked” depression, where a child’s depressed mood was evidenced by acting out or angry behavior. While this does occur, particularly in younger children, many children display sadness or low mood similar to adults who are depressed. The primary symptoms of depression revolve around sadness, a feeling of hopelessness, and mood changes. • Option B: Treatment options for children with depression are similar to those for adults, including psychotherapy (counseling) and medication. The child’s doctor may suggest psychotherapy first, and consider antidepressant medicine as an additional option if there is no significant improvement. The best studies to date indicate that a combination of psychotherapy and medication is most effective at treating depression. • Option C: If the symptoms of depression in a child have lasted for at least two weeks, they should schedule a visit with their doctor to make sure there are no physical reasons for the symptoms and to make sure that the child receives proper treatment. A consultation with a mental health care professional who specializes in children is also recommended. Keep in mind that the pediatrician may ask to speak with the child alone. • Option D: Although some children may continue to function reasonably well in structured environments, most kids with significant depression will suffer a noticeable change in social activities, loss of interest in school and poor academic performance, or a change in appearance. Children may also begin using drugs or alcohol, especially if they are over age 12. 28. 28. Question Nurse Perry is aware that language development in autistic child resembles: • A. Scanning speech • B. Speech lag • C. Stuttering • D. Echolalia Incorrect Correct Answer: D. Echolalia The autistic child repeats sounds or words spoken by others. Echolalia is a unique form of speech, and if the child has autism it may be one of the first ways in which the child uses speech to communicate. Thus, while it can be described as a symptom of autism, it can also be a great place for a parent or speech-language therapist to start working with the child. • Option A: Scanning speech is a type of ataxic dysarthria in which spoken words are broken up into separate syllables, often separated by a noticeable pause, and spoken with varying force. Scanning speech, like other ataxic dysarthrias, is a symptom of lesions in the cerebellum. It is a typical symptom of multiple sclerosis, and it constitutes one of the three symptoms of Charcot’s neurologic triad. • Option B: Speech delay, also known as alalia, refers to a delay in the development or use of the mechanisms that produce speech. Speech – as distinct from language – is the actual process of making sounds, using such organs and structures as the lungs, vocal cords, mouth, tongue, teeth, etc. Language delay refers to a delay in the development or use of the knowledge of language. • Option C: People who stutter may have more disfluencies and different types of disfluencies. They may repeat parts of words (repetitions), stretch a sound out for a long time (prolongations), or have a hard time getting a word out (blocks). Stuttering is more than just disfluencies. Stuttering also may include tension and negative feelings about talking. It may get in the way of how you talk to others. You may want to hide your stuttering. So, you may avoid certain words or situations. For example, you may not want to talk on the phone if that makes you stutter more. 29. 29. Question A 60-year-old female client who lives alone tells the nurse at the community health center “I really don’t need anyone to talk to”. The TV is my best friend. The nurse recognizes that the client is using the defense mechanism known as? • A. Displacement • B. Projection • C. Sublimation • D. Denial Incorrect Correct Answer: D. Denial The client statement is an example of the use of denial, a defense that blocks problems by unconscious refusing to admit they exist. Refusing to acknowledge that something is wrong is a way of coping with emotional conflict, stress, painful thoughts, threatening information and anxiety. The client can be in denial about anything that makes them feel vulnerable or threatens their sense of control, such as an illness, addiction, eating disorder, personal violence, financial problems or relationship conflicts. They can be in denial about something happening to them or to someone else. • Option A: Displacement involves taking out frustrations, feelings, and impulses on people or objects that are less threatening. Displaced aggression is a common example of this defense mechanism. Rather than express our anger in ways that could lead to negative consequences (like arguing with our boss), we instead express our anger towards a person or object that poses no threat (such as our spouse, children, or pets). • Option B: Projection is a defense mechanism that involves taking our own unacceptable qualities or feelings and ascribing them to other people. For example, if you have a strong dislike for someone, you might instead believe that they do not like you. Projection works by allowing the expression of the desire or impulse, but in a way that the ego cannot recognize, therefore reducing anxiety. • Option C: Sublimation is a defense mechanism that allows us to act out unacceptable impulses by converting these behaviors into a more acceptable form. For example, a person experiencing extreme anger might take up kick-boxing as a means of venting frustration. 30. 30. Question When working with a male client suffering phobia about black cats, Nurse Michelle should anticipate that a problem for this client would be? • A. Anxiety when discussing phobia. • B. Anger toward the feared object. • C. Denying that the phobia exists. • D. Distortion of reality when completing daily routines. Incorrect Correct Answer: A. Anxiety when discussing phobia Discussion of the feared object triggers an emotional response to the object. Patients with a specific phobia experience high levels of anxiety and panic attacks along with excessive and unreasonable fear due to either exposure or anticipation of exposure to a feared stimulus. As a result, these patients will try to avoid the anxiety-provoking stimulus to any extent possible. • Option B: The exact etiology of specific phobias is not known. However, some theories suggest that specific phobia may also develop due to an association of a specific object or situation with emotions such as fear and panic. Two theories have been proposed to show this pairing. The most common theory is when a specific event that provokes fear or anxiety is paired with an emotional experience. • Option C: Another mechanism of association is through modeling, in which a person observes a reaction in another person and internalizes that other person’s fears or warnings about the dangers of a specific object or situation. To be successful, behavioral therapy requires that the patient be committed to the treatment, there are distinctly identified problems and objectives, and there are alternative strategies for dealing with the patient’s