RN mental health disorders and addictions EAQ
A nurse in an outpatient mental health setting has been assigned to care for a new
client who has been found to have an antisocial personality disorder. What does the
nurse expect to observe in the client during the assessment?
1
Pays great attention to detail and demonstrates a high level of anxiety
2
Has scars from self-mutilation and a history of many negative relationships
3
Displays charm, has an above-average intelligence, and tends to manipulate others
4
Demonstrates suspiciousness, avoids eye contact, and engages in limited
conversation - ANSWER: 3
A client with an antisocial personality disorder is charming on first contact, but this
charm is a manipulative ploy. These clients usually are bright and use their
intelligence for self-gain. Paying great attention to detail and demonstrating a high
level of anxiety are traits of an individual with an obsessive-compulsive personality
disorder. The client with a borderline personality disorder self-mutilates when under
stress; there is a fear of abandonment so that any relationship is better than no
relationship. Demonstrating suspiciousness, avoiding eye contact, and engaging in
limited conversation resembles the behavior of an individual with a paranoid
personality, which includes suspiciousness and lack of trust.
While caring for an older adult client, what symptom requires an immediate
reassessment of the client's needs and plan of care?
1
Memory loss or confusion
2
Neglect of self-care
3
Increased daily fatigue
4
Withdrawal from usual activities - ANSWER: 1
All are common signs of depression due to the aging process, however, memory loss
or confusion may require immediate intervention. The development of confusion
indicates that the client's ability to maintain equilibrium has not been achieved and
that further disequilibrium is occurring, setting the client up for safety issues.
Confusion may also be related to more serious physical conditions that can occur
which require medical intervention.
What does the nurse recall is the major defense mechanism used by an individual
with a phobic disorder?
1
Splitting
,2
Regression
3
Avoidance
4
Conversion - ANSWER: 3
The person transfers anxieties to activities or objects, usually inanimate objects,
which are then avoided to decrease anxiety. Splitting is the compartmentalization of
opposite affective states and the inability to integrate the positive and negative
aspects of others or self. Regression, the return to an earlier, more comfortable level
of development, is not the defense mechanism used by someone with a phobia.
Conversion, the transfer of a mental conflict to a physical symptom, is not the
defense mechanism used by someone with a phobia.
A mental health nurse is admitting a client with anorexia nervosa. When obtaining
the history and physical assessment, the nurse expects the client's condition to
reveal which symptom?
1
Edema
2
Diarrhea
3
Amenorrhea
4
Hypertension - ANSWER: 3
Amenorrhea results from endocrine imbalances that occur when fat stores are
depleted. The client is dehydrated; edema is not expected. Constipation, not
diarrhea, may occur because of lack of fiber in the diet. Hypotension, not
hypertension, may occur because of dehydration.
A nurse is caring for a client with an obsessive-compulsive personality disorder that
involves rituals. What should the nurse conclude about the ritual?
1
It has a purpose but is useless.
2
It is performed after long urging.
3
It appears to be performed willingly.
4
It seems illogical but is needed by the person. - ANSWER: 4
The client's exact adherence to the compulsive ritual relieves anxiety, at least
temporarily. Furthermore, it meets a need and is necessary to the client. The
compulsive act is purposeless repetition and useful only in that it temporarily eases
the client's anxiety. Urging has no effect getting the the client to start or stop the
, ritualistic behavior. The person cannot stop the activity; it is not under his voluntary
control.
A 3-year-old child is found to have a pervasive developmental disorder not otherwise
specified. What should the nurse consider most unusual for the child to
demonstrate?
1
Interest in music
2
Ritualistic behavior
3
Attachment to odd objects
4
Responsiveness to the parents - ANSWER: 4
One of the symptoms that an autistic child displays is lack of responsiveness to
others; there is little or no extension to the external environment. Music is
nonthreatening, comforting, and soothing. Repetitive behavior provides comfort.
Repetitive visual stimuli, such as a spinning top, are nonthreatening and soothing.
During a one-on-one interaction with a client with paranoid-type schizophrenia, the
client says to the nurse, "I've figured out how foreign agents have infiltrated the
news media. They want to shut me up before I spill the beans." How should the
nurse describe this statement when documenting this client's response?
1
Nihilistic delusion
2
Delusions of persecution
3
Delusions of control
4
Delusions of grandeur - ANSWER: 2
Thoughts of being pursued by powerful agents because of one's special attributes or
powers are fixed false beliefs and are referred to as delusions of persecution. There
is no evidence to indicate that there are nihilistic delusions of total or partial
nonexistence. There is also no evidence to support that external forces are
controlling the client (delusions of control) or that the client has false beliefs of being
a famous figure (delusions of grandeur).
For which clinical indication should a nurse observe a child in whom autism is
suspected?
1
Lack of eye contact
2
Crying for attention
3
A nurse in an outpatient mental health setting has been assigned to care for a new
client who has been found to have an antisocial personality disorder. What does the
nurse expect to observe in the client during the assessment?
1
Pays great attention to detail and demonstrates a high level of anxiety
2
Has scars from self-mutilation and a history of many negative relationships
3
Displays charm, has an above-average intelligence, and tends to manipulate others
4
Demonstrates suspiciousness, avoids eye contact, and engages in limited
conversation - ANSWER: 3
A client with an antisocial personality disorder is charming on first contact, but this
charm is a manipulative ploy. These clients usually are bright and use their
intelligence for self-gain. Paying great attention to detail and demonstrating a high
level of anxiety are traits of an individual with an obsessive-compulsive personality
disorder. The client with a borderline personality disorder self-mutilates when under
stress; there is a fear of abandonment so that any relationship is better than no
relationship. Demonstrating suspiciousness, avoiding eye contact, and engaging in
limited conversation resembles the behavior of an individual with a paranoid
personality, which includes suspiciousness and lack of trust.
While caring for an older adult client, what symptom requires an immediate
reassessment of the client's needs and plan of care?
1
Memory loss or confusion
2
Neglect of self-care
3
Increased daily fatigue
4
Withdrawal from usual activities - ANSWER: 1
All are common signs of depression due to the aging process, however, memory loss
or confusion may require immediate intervention. The development of confusion
indicates that the client's ability to maintain equilibrium has not been achieved and
that further disequilibrium is occurring, setting the client up for safety issues.
Confusion may also be related to more serious physical conditions that can occur
which require medical intervention.
What does the nurse recall is the major defense mechanism used by an individual
with a phobic disorder?
1
Splitting
,2
Regression
3
Avoidance
4
Conversion - ANSWER: 3
The person transfers anxieties to activities or objects, usually inanimate objects,
which are then avoided to decrease anxiety. Splitting is the compartmentalization of
opposite affective states and the inability to integrate the positive and negative
aspects of others or self. Regression, the return to an earlier, more comfortable level
of development, is not the defense mechanism used by someone with a phobia.
Conversion, the transfer of a mental conflict to a physical symptom, is not the
defense mechanism used by someone with a phobia.
A mental health nurse is admitting a client with anorexia nervosa. When obtaining
the history and physical assessment, the nurse expects the client's condition to
reveal which symptom?
1
Edema
2
Diarrhea
3
Amenorrhea
4
Hypertension - ANSWER: 3
Amenorrhea results from endocrine imbalances that occur when fat stores are
depleted. The client is dehydrated; edema is not expected. Constipation, not
diarrhea, may occur because of lack of fiber in the diet. Hypotension, not
hypertension, may occur because of dehydration.
A nurse is caring for a client with an obsessive-compulsive personality disorder that
involves rituals. What should the nurse conclude about the ritual?
1
It has a purpose but is useless.
2
It is performed after long urging.
3
It appears to be performed willingly.
4
It seems illogical but is needed by the person. - ANSWER: 4
The client's exact adherence to the compulsive ritual relieves anxiety, at least
temporarily. Furthermore, it meets a need and is necessary to the client. The
compulsive act is purposeless repetition and useful only in that it temporarily eases
the client's anxiety. Urging has no effect getting the the client to start or stop the
, ritualistic behavior. The person cannot stop the activity; it is not under his voluntary
control.
A 3-year-old child is found to have a pervasive developmental disorder not otherwise
specified. What should the nurse consider most unusual for the child to
demonstrate?
1
Interest in music
2
Ritualistic behavior
3
Attachment to odd objects
4
Responsiveness to the parents - ANSWER: 4
One of the symptoms that an autistic child displays is lack of responsiveness to
others; there is little or no extension to the external environment. Music is
nonthreatening, comforting, and soothing. Repetitive behavior provides comfort.
Repetitive visual stimuli, such as a spinning top, are nonthreatening and soothing.
During a one-on-one interaction with a client with paranoid-type schizophrenia, the
client says to the nurse, "I've figured out how foreign agents have infiltrated the
news media. They want to shut me up before I spill the beans." How should the
nurse describe this statement when documenting this client's response?
1
Nihilistic delusion
2
Delusions of persecution
3
Delusions of control
4
Delusions of grandeur - ANSWER: 2
Thoughts of being pursued by powerful agents because of one's special attributes or
powers are fixed false beliefs and are referred to as delusions of persecution. There
is no evidence to indicate that there are nihilistic delusions of total or partial
nonexistence. There is also no evidence to support that external forces are
controlling the client (delusions of control) or that the client has false beliefs of being
a famous figure (delusions of grandeur).
For which clinical indication should a nurse observe a child in whom autism is
suspected?
1
Lack of eye contact
2
Crying for attention
3
