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Which reason would be likely for a client's anger and acting out when the nurse interrupts the
hand-washing ritual of a client with obsessive-compulsive disorder?
A. Has overwhelming feelings of anxiety
B. Resents the nurse's authoritarian manner
C. Is clashing with the nurse's personality
D. Reflects and aggressive characteristic - ANSWER-A. Has overwhelming feelings of anxiety
Which response would the nurse make to a client who says, 'I feel so guilty. None of this makes
any sense. Everyone must really think I'm crazy,' after performing a complex ritual?
A. 'Your behavior is bizarre, but it serves a useful purpose.'
B. 'You're concerned about what other people are thinking about you.'
C. 'I am sure people understand that you can't help this behavior right now.'
D. 'Guilt serves no useful purpose. It just helps you stay stuck where you are.' - ANSWER-B.
'You're concerned about what other people are thinking about you.'
Which characteristic of clients with antisocial personality disorder would the nurse consider
when planning care?
A. Engages in many rituals
B. Is a perfectionist
C. Exhibits lack of empathy for others
D. Possesses limited communication skills - ANSWER-C. Exhibits lack of empathy for others
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At which stage of Kohlberg's theory does an individual want to fulfill the expectations of one's
immediate group?
A. Good boy-nice orientation
B. Society-maintaining orientation
C. Instrumental relativist orientation
D. Universal ethical principle orientation - ANSWER-A. Good boy-nice orientation
The good boy-good girl orientation stage involves an individual who wants to win the approval
and maintain the expectations of one's immediate group. During the society-maintaining
orientation stage, an individual expands focus from a relationship with others to societal
concerns. The instrumental relativist orientation stage involves a child who wants to follow
parental rules. the universal ethical principle orientation stage defines "right" by the decision of
conscience according to self-chosen ethical principles.
Which side effect would the nurse monitor for in a severely depressed client who received
electroconvulsive therapy (ECT)?
A. Loss of appetite
B. Postural hypotension
C. Total memory loss
D. Confusion immediately after the treatment - ANSWER-D. Confusion immediately after the
treatment
A client is diagnosed with Alzheimer disease and is exhibiting hyperorality. Which parameter
would the nurse closely monitor to keep this client safe?
A. For choking at meal times
B. For the presence of mouth ulcers
C. For injuries from touching hot foods
D. For attempts at eating inedible objects - ANSWER-D. For attempts at eating inedible objects
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Which period of Piaget's theory covers the prevalence of egocentrism in adolescents?
A. Sensorimotor
B. Preoperational
C. Formal operations
D. Concrete operations - ANSWER-C. Formal operations
Which explanation, when providing a change-of-shift report, would the nurse use to describe a
client diagnosed with schizophrenia who is experiencing opposing emotions simultaneously?
A. Double bind
B. Ambivalence
C. Loose association
D. Inappropriate affect - ANSWER-B. Ambivalence
Which response would the nurse use when a client diagnosed with acquired immunodeficiency
syndrome (AIDS) states, "I'm not worried because they have a cure for AIDS"?
A. "Repeated phlebotomies may be able to rid you of the virus."
B. "You may be cured for AIDS after prolonged pharmacological therapy."
C. "Perhaps you should have worn condoms to prevent contracting the virus."
D. "There is no cure for AIDS, but there are medications that can slow down the virus." -
ANSWER-D. "There is no cure for AIDS, but there are medications that can slow down the virus."
Which type of group is Alcoholics Anonymous (AA)?
A. Social group
B. Self-help group
C. Resocialization group
D. Psychotherapeutic group - ANSWER-B. Self-help group
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Which type of delusion would the nurse chart about a client who says, 'I've figured out how
foreign agents have infiltrated the news media. Now they want to shut me up'?
A. Nihilistic
B. Persecution
C. Control
D. Grandeur - ANSWER-B. Persecution
When planning for a client's care during the detoxification phase of early alcohol withdrawal,
which action would the nurse take?
A. Check on the client frequently.
B. Keep the client's room lights dim
C. Address the client in a loud, clear voice
D. Restrain the client during periods of agitation - ANSWER-A. Check on the client frequently.
Which rationale explains why the client who is displaying hyperactive and manic behaviors with
flights of ideas is not eating?
A. Feels undeserving of the food
B. Is too busy to take time to eat
C. Wishes to avoid others in the dining area
D. Believes that the food is poisoned - ANSWER-B. Is too busy to take time to eat
The parent of a child with a terminal illness appears overwhelmed and anxious. Which is the
best response by the nurse?
A. Explaining the diagnosis in a variety of ways
B. Encouraging the parent to express their feelings
C. Recommending that the parent talk with other parents
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