NURSING 301 quiz two_ LATEST,100% CORRECT

NURSING 301 quiz two_ LATEST 1. A nurse is assessing a client with chronic schizophrenia. Which effects will the client most likely exhibit? Select all that apply. Correct1 Apathy 2 Sadness Correct3 Flatness 4 Hostility 5 Happiness 6 Depression Apathy (indifference) is common among people with chronic schizophrenia because negative symptoms are more apparent. Flatness, with few extremes of emotion, is common among people with chronic schizophrenia because negative symptoms are more apparent. Extremes in emotions are not associated with chronic schizophrenia. Sadness is related more to mood disorders, such as a depressive episode of bipolar disorder or major depression. Hostility may be seen in some forms of schizophrenia, such as paranoid schizophrenia, but it is rarely seen in the chronic stages. Happiness and elation are associated with manic episodes of bipolar disorder, not chronic schizophrenia. Depression is related to mood disorders, such as a depressive episode of bipolar disorder or major depression. Test-Taking Tip: Read carefully and answer the question asked; pay attention to specific details in the question. 13%of students nationwide answered this question correctly. View Topics 2. Confidence: Pretty sure Stats Issue with this question? 2. 2. Which client characteristic is an initial concern for the nurse when caring for a client with the diagnosis of paranoid schizophrenia? 1 Continual pacing Correct2 Suspicious feelings 3 Inability to socialize with others 4 Disturbed relationship with the family The nurse must consider the client's suspicious feelings and establish basic trust to promote a therapeutic milieu. Continual pacing is not a problem because the nurse can walk back and forth with the client. Inability to socialize with others and disturbed relationship with the family may be of long-range importance but have little influence on the nurse-client relationship at this time. 67%of students nationwide answered this question correctly. View Topics 3. Confidence: Pretty sure Stats Issue with this question? 3. 3. A client has a diagnosis of schizoid personality disorder. During the assessment the nurse should expect the client's behavior to be: 1 Rigid and controlling 2 Dependent and submissive Correct3 Detached and socially distant 4 Superstitious and socially anxious Clients with the diagnosis of schizoid personality disorder neither desire nor enjoy close relationships, prefer solitary activities, and demonstrate emotional coldness, detachment, and a flattened affect. Rigid and controlling behavior is typical of clients with the diagnosis of obsessive-compulsive personality disorder. Dependent and submissive behavior is typical of clients with the diagnosis of dependent personality disorder. Superstitious and socially anxious behavior is typical of clients with the diagnosis of schizotypal personality disorder. 61%of students nationwide answered this question correctly. View Topics 4. Confidence: Pretty sure Stats Issue with this question? 4. 4. A health care provider prescribes aripiprazole (Abilify) 15 mg by mouth once a day for a client with the diagnosis of schizophrenia. The hospital pharmacy sends aripiprazole 5 mg/tablet. How many tablets should the nurse administer? Record your answer using a whole number. ___3_ tablets Solve the problem using ratio and proportion. 95%of students nationwide answered this question correctly. View Topics 5. Confidence: Pretty sure Stats Issue with this question? 5. 5. The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the client's record and finds that this client did not have an interrupted sleep pattern disorder before transfer from a private room to a four-bed room 3 days ago. What factor should the nurse identify as most likely related to the client's sleeplessness? Correct1 Fear of the other clients 2 Concern about family at home 3 Watching for an opportunity to escape 4 Trying to work out emotional problems Because the client has paranoid feelings that other people are out to do harm, assignment to a four-bed room may be threatening. Concern about family at home seems unlikely because the disruption appears to have started with the transfer to a four-bed room. Watching for an opportunity to escape is possible but unlikely; planning an escape is usually not part of a schizophrenic pattern of behavior. Trying to work out emotional problems is possible but not likely; clients with schizophrenia have difficulty solving problems. 94%of students nationwide answered this question correctly. View Topics 6. Confidence: Pretty sure Stats Issue with this question? 6. 6. When speaking with a client who has schizophrenia, the nurse notes that the client keeps interjecting sentences that have nothing to do with the main thoughts being expressed. The client asks whether the nurse understands. How should the nurse reply? 1 "You aren't making any sense; let's talk about something else." 2 "Why don't you take a rest? We can talk again later this afternoon." 3 "I'd like to understand what you're saying, but you're too confused now." Correct4 "I'd like to understand what you're saying, but I'm having trouble following you." "I'd like to understand what you're saying, but I'm having trouble following you" lets the client know that the nurse is trying to understand; it increases the client's feeling of self-esteem and points out reality. Clients with schizophrenia have problems with associative links, and these same problems will occur regardless of the topic. The statement "Why don't you take a rest? We can talk again later this afternoon" cuts off communication and tells the client that the nurse will speak only if the client's communication makes sense to the listener. "I'd like to understand what you're saying, but you're too confused now" cuts off communication and tells the client that the nurse will speak only if the client's communication makes sense to the listener. 92%of students nationwide answered this question correctly. View Topics 7. Confidence: Pretty sure Stats Issue with this question? 7. 7. A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? 1 Akathisia Correct2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia, motor restlessness, usually can be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Dystonia, impairment of muscle tonus, can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. 67%of students nationwide answered this question correctly. View Topics 8. Confidence: Pretty sure Stats Issue with this question? 8. 8. A client with the diagnosis of schizophrenia refuses to eat meals. Which nursing action is most beneficial for this client? 1 Directing the client repeatedly to eat the food 2 Explaining to the client the importance of eating 3 Waiting and allowing the client to eat whenever the client is ready Correct4 Having a staff member sit with the client in a quiet area during mealtimes By sitting with the client during mealtimes the nurse can evaluate how much the client is eating; this encourages the client to eat and begins the construction of a trusting relationship. Fewer distractions may help the client focus on eating. The client will not follow directions to eat because of the nature of the illness. Explaining the importance of eating and allowing the client to eat when ready are both unrealistic and will not ensure adequate intake. 50%of students nationwide answered this question correctly. View Topics 9. Confidence: Pretty sure Stats Issue with this question? 9. 9. A client is admitted to a psychiatric hospital with the diagnosis of schizoid personality disorder. Which initial nursing intervention is a priority for this client? 1 Helping the client enter into group recreational activities 2 Convincing the client that the hospital staff is trying to help Correct3 Helping the client learn to trust the staff through selected experiences 4 Arranging the client's contact with others so it is limited while she is in the hospital Demonstrating that the staff can be trusted is a vital initial step in the therapy program. The client is not ready to enter group activities yet and will not be until trust is established. Even proof will not convince the client with a schizoid personality that feelings of distrust are false. Arranging the client's contact with others is not realistic even if it is possible; limiting contact with other clients will not enhance trust. 76%of students nationwide answered this question correctly. View Topics 10. Confidence: Pretty sure Stats Issue with this question? 10. 10. A client with paranoid schizophrenia tells the nurse, "My neighbors are spying on me because they want to rob me and take money." While hospitalized, the client complains of being poisoned by the food and of being given the wrong medication. The nurse evaluates the client's response to medications and therapy. Which assessment finding leads the nurse to conclude that the client's reality testing has improved? Correct1 The client eats the food provided on the hospital tray. 2 The client discusses his discharge plans with the staff. 3 The client questions each medication when it is administered. 4 The client asks permission to make phone calls to the hospital administration. Because the client was admitted while complaining that the food was poisoned, eating the food on the tray indicates that the client feels safe. Discussing discharge plans with the staff does not provide adequate behavioral assessment with which the nurse can evaluate reality testing. Questioning each medication when it is administered indicates that the client still does not completely trust the staff. Asking permission to make phone calls to the hospital administration seems to indicate that the client still does not trust the staff and is attempting to intimidate the staff by calling the administration. 85%of students nationwide answered thi 11. 11. 11. What should the nurse identify as the foremost basis for the development of schizophrenia? 1 Seasonal perspective Correct2 Biological perspective 3 Immunological perspective 4 Psychoanalytical perspective The biological factors, including genetics, neuroanatomy, and abnormal neurotransmitter-endocrine interactions, prevail as the origin of schizophrenia as a result of studies conducted during the twentieth century. Psychoanalytic perspective no longer is thought of as the primary basis for schizophrenia. A seasonal or immunological perspective is not the primary basis for schizophrenia. 59%of students nationwide answered this question correctly. View Topics 12. Confidence: Pretty sure Stats Issue with this question? 12. 12. An adult with the diagnosis of schizophrenia is admitted to the psychiatric hospital. The client is ungroomed, appears to be hearing voices, is withdrawn, and has not spoken to anyone for several days. What should the nurse do during the first few hospital days? 1 See that the client bathes and changes clothes daily. 2 Wait and see whether the client approaches the staff. 3 Conduct an admission assessment interview with the client. Correct4 Seek out the client frequently to spend short periods of time together. Seeking out the client frequently to spend short periods of time together will help the nurse establish trust without unduly increasing anxiety. Seeing that the client bathes and changes clothes daily is not the priority unless the client is extremely dirty; this client is ungroomed, not dirty. A withdrawn client will usually not approach anyone. The client's history reveals a failure to speak. 54%of students nationwide answered this question correctly. View Topics 13. Confidence: Pretty sure Stats Issue with this question? 13. 13. A client with catatonic schizophrenia who is in a vegetative state is admitted to the psychiatric hospital. The nurse identifies short- and long-term outcomes in the client's clinical pathway. What is the priority short-term outcome of care that the client should be able to attain? 1 Talking with peers 2 Performing her own activities of daily living 3 Completing unit activities and assignments Correct4 Ingesting adequate fluid and food with assistance A client in a vegetative state may not eat or drink without assistance; fluids and foods are basic physiologic needs that are necessary to prevent malnutrition and starvation; therefore the intake of adequate fluid and food is a priority short-term goal. The client is in total withdrawal; talking with peers, performing activities of daily living, and completing activities and assignments are not priority outcomes at this time. 81%of students nationwide answered this question correctly. View Topics 14. Confidence: Pretty sure Stats Issue with this question? 14. 14. A 56-year-old man is admitted to the inpatient unit after family members report that he seems to be experiencing auditory hallucinations. The man has a history of schizophrenia and has had several previous admissions. Which statement indicates to the nurse that the client is experiencing auditory hallucinations? 1 "Get these horrible snakes out of my room!" Correct2 "I am not the devil! Stop calling me those names!" 3 "The food on this plate has poison in it, so take it away—I won't eat it." 4 "I did see an alien spaceship last night outside in my yard, and I've felt worse ever since." The client is responding to messages that he is hearing, which are auditory hallucinations. The responses regarding the snakes and the spaceship are examples ofvisual hallucinations because they describe what the client sees. The accusation of poisoning is the statement of a client who is suspicious and paranoid but not hallucinating. 95%of students nationwide answered this question correctly. View Topics 15. Confidence: Pretty sure Stats Issue with this question? 15. 15. A client has a diagnosis of schizoid personality disorder. During the assessment the nurse should expect the client's behavior to be: 1 Rigid and controlling 2 Dependent and submissive Correct3 Detached and socially distant 4 Superstitious and socially anxious Clients with the diagnosis of schizoid personality disorder neither desire nor enjoy close relationships, prefer solitary activities, and demonstrate emotional coldness, detachment, and a flattened affect. Rigid and controlling behavior is typical of clients with the diagnosis of obsessive-compulsive personality disorder. Dependent and submissive behavior is typical of clients with the diagnosis of dependent personality disorder. Superstitious and socially anxious behavior is typical of clients with the diagnosis of schizotypal personality disorder. 62%of students nationwide answered this question correctly. View Topics 16. Confidence: Pretty sure Stats Issue with this question? 16. 16. A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to manage the possible outcome of this behavior? 1 Providing thickened liquids to minimize the risk of aspiration 2 Documenting intake and output each shift to monitor hydration 3 Reinforcing appropriate social boundaries through staff role modeling Correct4 Passive range-of-motion exercises three times a day for effective joint health Waxy flexibility is an excessive and extended maintenance of posture that can lead to a variety of problems, including joint trauma. Passive range-of-motion exercises focus on the effective management of joint mechanics. Although aspiration precautions, documentation of intake and output, and staff role modeling may address issues experienced by a client with schizophrenia, passive range-of-motion exercises address waxy flexibility. 68%of students nationwide answered this question correctly. View Topics 17. Confidence: Pretty sure Stats Issue with this question? 17. 17. A young client is admitted to the hospital with a diagnosis of acute schizophrenia. The family reports that one day the client looked at a linen sheet on a clothesline and thought it was a ghost. What is the most appropriate conclusion to make about what the client was experiencing? Correct1 Illusion 2 Delusion 3 Hallucination 4 Confabulation An illusion is a misinterpretation of an actual sensory stimulus. A delusion is a false, fixed belief. A hallucination is a false sensory perception that occurs with no stimulus. Confabulation is a filling in of blanks in memory. 51%of students nationwide answered this question correctly. View Topics 19. Confidence: Pretty sure Stats Issue with this question? 19. 19. What defense mechanism should the nurse anticipate that a client with the diagnosis of schizophrenia, undifferentiated type, will most often exhibit? 1 Projection Correct2 Regression 3 Repression 4 Rationalization Regression is the defense mechanism that is commonly used by clients with schizophrenia, undifferentiated type, to reduce anxiety by returning to earlier behavior. Projection is an organized defense used by clients with schizophrenia, paranoid type, in which the delusional system is well systematized. Repression, or unconscious forgetting, is not a major defense used by clients with schizophrenia; if it were, they would not need to break with reality. Rationalization, in which the individual blames others for problems and attempts to justify actions, is seldom used by clients with schizophrenia. 32%of students nationwide answered this question correctly. View Topics 20. Confidence: Pretty sure Stats Issue with this question? 20. 20. On the afternoon of admission to a psychiatric unit, an adolescent boy with the diagnosis of schizophrenia exposes his genitals to a female nurse. What should the nurse's immediate therapeutic response be? 1 Ignoring the client at this time Correct2 Stating that this behavior is unacceptable 3 Moving him to his room for a short time-out 4 Telling the client to come to the office later to discuss the behavior When clients enter a new milieu, limits should be set on unacceptable behavior and acceptable behavior should be reinforced. Neither clients nor unacceptable behavior should ever be ignored. Moving the client to his room for a short time-out is punishment. Unacceptable attention-getting behavior must be addressed immediately; also, the focus should be on appropriate behavior. 83%of students nationwide answered this question correctly. View Topics 21. Confidence: Pretty sure Stats Issue with this question? 21. 21. As a nurse is assisting a client with the diagnosis of schizophrenia with morning care, the client suddenly throws off the covers and starts shouting, "My body is disintegrating! I'm being pinched." What term best describes the client's behavior? Correct1 Somatic delusion 2 Paranoid ideation 3 Loose association 4 Ideas of reference A somatic delusion is a false feeling about the physical self that is caused by a loss of reality testing. Paranoid ideations are beliefs that the individual is being singled out for unfair treatment. Loose associations are verbalizations that are difficult to understand because the links between thoughts are not apparent. Ideas of reference are false beliefs that the words and actions of others are concerned with or are directed toward the individual. 74%of students nationwide answered this question correctly. 22. What should the nurse do when a client with the diagnosis of schizophrenia talks about being controlled by others? 1 Express disbelief about the client's delusion. 2 Divert the client's attention to unit activities. Correct3 React to the feeling tone of the client's delusion. 4 Respond to the verbal content of the client's delusion. Reacting to the feeling tone of the client's delusion helps the client explore underlying feelings and allows the client to see the message that his verbalizations are communicating. Expressing disbelief about the client's delusion denies the client's feelings rather than accepting and working with them. Attempting to divert the client rather than accepting and working with him denies the client's feelings. Responding to the verbal content of the client's delusion focuses on the delusion itself rather than on the feeling that is causing the delusion. 26%of students nationwide answered this question correctly. View Topics 23. Confidence: Pretty sure Stats Issue with this question? 23. 23. A nurse is monitoring a client with the diagnosis of schizophrenia who is experiencing opposing emotions simultaneously. When providing a change-of-shift report, how should the nurse refer to this emotional experience of the client? 1 Double bind Correct2 Ambivalence 3 Loose association 4 Inappropriate affect Ambivalence is the existence of two conflicting emotions, impulses, or desires. Double bind is two conflicting messages, not emotions, in a single communication. Loose associations are not two conflicting emotions but instead the loosening of connections between thoughts. Inappropriate affect is not two conflicting emotions but instead the inappropriate expression of emotions. 38%of students nationwide answered this question correctly. View Topics 25. Confidence: Pretty sure Stats Issue with this question? 25. 25. A client with schizophrenia who was admitted involuntarily to a psychiatric facility runs away. The nurse's first action is to notify the: 1 Client's family that the client has left the hospital Correct2 Law enforcement officers of the client's elopement 3 Client's psychiatrist after discovering that the client has gone 4 Practitioner who certified the client's need for hospitalization Legally it is the responsibility of the staff to notify law enforcement officers so the client can be found and returned. The staff should notify the family, but this is not the first intervention. Although the client's psychiatrist will be notified, it is not the priority at this time. Although the practitioner may appreciate being notified, it is not the priority. 75%of students nationwide answered this question correctly. View Topics 26. Confidence: Pretty sure Stats Issue with this question? 26. 26. A client has been prescribed chlorpromazine (Thorazine) for the management of positive symptoms of schizophrenia. When the client reports difficulty sustaining an erection, the nurse: 1 Reassures him this side effect will resolve in a few weeks Correct2 Consults with his provider regarding alternative medication therapies 3 Explains that all conventional antipsychotic medications cause impotence 4 Provides additional medication education to explain the medication's side effects in detail Although erectile dysfunction can result from conventional antipsychotic medication therapy, the provider is often able to prescribe an alternative medication that will help manage the symptoms but is less likely to cause the dysfunction. Education regarding side effects is certainly appropriate, but such information will only confirm that the side effect is not likely to subside with time. 51%of students nationwide answered this question correctly. View Topics 27. Confidence: Pretty sure Stats Issue with this question? 27. 27. When a nurse enters a room to administer an oral medication to an agitated and angry client with schizophrenia, paranoid type, the client shouts, "Get out of here!" What is the most therapeutic response? 1 Stating, "You must take your medicine now." Correct2 Saying, "I'll be back in a few minutes so we can talk." 3 Explaining why it is necessary to take the medication 4 Withholding the medication before notifying the primary care practitioner Saying, "I'll be back in a few minutes so we can talk," allows the angry client time to regain self-control; announcing a plan to return will ease fears of abandonment or retribution. Staying and insisting that the client take the medication may provoke increased anger and further loss of control. Clients will not accept logical explanations when angry. Alternative nursing interventions should be attempted before withholding the medication and notifying the practitioner may become necessary. Test-Taking Tip: Survey the test before you start answering the questions. Plan how to complete the exam in the time allowed. Read the directions carefully and answer the questions you know for sure first. 62%of students nationwide answered this question correctly. View Topics 28. Confidence: Pretty sure Stats Issue with this question? 28. 28. A nurse begins a therapeutic relationship with a client with the diagnosis of schizotypal personality disorder. What is the best initial nursing action? 1 Setting limits on manipulative behavior 2 Encouraging participation in group therapy Correct3 Respecting the client's need for social isolation 4 Recognizing that seductive behavior is expected These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may foster the eventual development of a therapeutic alliance. Manipulative behavior is typical of clients with the diagnosis of antisocial personality disorder or borderline personality disorder. Group therapy will increase this client's anxiety; cognitive or behavioral therapy is more appropriate. Seductive behavior is associated with clients with the diagnosis of histrionic personality disorder. 29%of students nationwide answered this question correctly. View Topics 29. Confidence: Pretty sure Stats Issue with this question? 29. 29. An adult is found to have schizotypal personality disorder. How should a nurse describe the client's behavior? 1 Rigid and controlling 2 Submissive and immature 3 Arrogant and attention-seeking Correct4 Introverted and emotionally withdrawn These clients usually display social inadequacy and lack of emotional contact with others. Rigid and controlling behaviors reflect an obsessive-compulsive personality disorder. Submissive and immature behaviors reflect a dependent personality disorder. Arrogant and attention-seeking behaviors probably reflect a narcissistic personality disorder. 60%of students nationwide answered this question correctly. View Topics 30. Confidence: Pretty sure Stats Issue with this question? 30. 30. A client with schizophrenia, paranoid type, is delusional, withdrawn, and negativistic. The nurse should plan to: Correct1 Invite the client to play a game of cards or board game. 2 Explain to the client the benefits of joining a group activity. 3 Encourage the client to become involved in group activities. 4 Mention to the client that the psychiatrist has ordered increased activity. Activities that require limited interpersonal contact are less threatening. Individuals with schizophrenia, paranoid type, usually do not respond to an authoritarian approach because they do not trust others, particularly those who act in an aggressive manner. Group activities require interaction with other people, which is threatening to individuals with paranoid feelings. 53%of students nationwide answered this question correctly. View Topics 31. Confidence: Pretty sure Stats Issue with this question? 31. 31. A nurse is caring for a client with the diagnosis of schizophrenia, paranoid type. How should the nurse plan for the client's initial care? 1 By discussing important life events Correct2 By providing a nonthreatening environment 3 By concentrating on the content of delusions 4 By limiting topics for discussion to recent situations These clients are hypersensitive to external stimuli and respond with less anxiety to a minimally threatening environment. Discussing prominent life events is too threatening an approach and interferes with the goals of therapy. Focusing on delusional material will reinforce the delusional system. Limiting topics for discussion to recent situations is not therapeutic; it may trigger suspiciousness and hostile outbursts. 92%of students nationwide answered this question correctly. View Topics 32. Confidence: Pretty sure Stats Issue with this question? 32. 32. During a one-to-one interaction with a client with schizophrenia, paranoid type, the client says to the nurse, "I 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? 1 Nihilistic delusion Correct2 Delusion of grandeur 3 Auditory hallucination 4 Overvaluation of the self Thoughts of being pursued by some powerful agent or agents because of one's special attributes or powers are fixed false beliefs and referred to as delusions of grandeur. There is no evidence to indicate that a delusion of total or partial nonexistence is being used. There is no evidence to indicate that a sensory-perceptual disturbance is present. Delusions of grandeur are usually used to deny unconscious feelings of low self-esteem. 57%of students nationwide answered this question correctly. 33. A client with schizophrenia tells the nurse, "There are foreign agents conspiring against me; they're out to get me at every turn." How should the nurse respond? 1 "It must be scary to believe that people are out to trick you at every opportunity." 2 "Those people you call foreign agents are out to do you in. What else is happening?" 3 "What's happened to make you believe that these people you call foreign agents are after you?" Correct4 "I can understand how frightening your thoughts are to you, but there are not foreign agents out to get you." Noting how frightening the client's thoughts must seem to him but also telling the client that his thoughts do not seem factual acknowledges the client's feelings and points out reality. Although "It must be scary to believe that people are out to trick you at every opportunity" is an empathic response, it does not point out reality; the word "trick" does not have the same connotation as "do me in." The response "Those people you call foreign agents are out to do you in. What else is happening?" reinforces the client's delusional system. The response "What's happened to make you believe these people you call foreign agents are after you?" does not focus on feelings and places the client on the defensive. 54%of students nationwide answered this question correctly. View Topics 34. Confidence: Pretty sure Stats Issue with this question? 34. A client with schizophrenia who has auditory hallucinations is withdrawn and apathetic. What should the nurse say to involve this client in an activity? 1 "You'll get a reward if you go to the gym." Correct2 "Would you like to participate in the group walk today?" 3 "Those voices you hear would like it if you did a little exercise." 4 "There's a positive relationship between exercise and good mental health." "Would you like to participate in the group walk today?" is a declarative statement invites the client to walk, and the client can comply without making a verbal decision. A client with schizophrenia is often ambivalent, rendering decision-making difficult. A withdrawn, apathetic clients probably will not internalize or appreciate rationales for interventions. Saying that the voices want the client to exercise supports the client's hallucinations. 54%of students nationwide answered this question correctly. View Topics 35. Confidence: Pretty sure Stats Issue with this question? 35. One morning a client tells the nurse, "My legs are turning to rubber because I have an incurable disease called schizophrenia." The nurse identifies that this as an example of: 1 Hallucinations 2 Paranoid thinking Correct3 Depersonalization 4 Autistic verbalization The state in which the client feels unreal or believes that parts of the body are distorted is known as depersonalization or loss of personal identity. This is not an example of a hallucination; a hallucination is a sensory experience for which there is no external stimulus. The client's statement does not indicate any feelings that others are out to do harm, are responsible for what is happening, or are in control of the situation. The statement is not an example of autistic verbalization. 35%of students nationwide answered this question correctly. View Topics 36. Confidence: Pretty sure Stats Issue with this question? 36. A young client with schizophrenia says, "I'm starting to hear voices." What is the nurse's most therapeutic response? 1 "How do you feel about the voices, and what do they mean to you?" 2 "You're the only one hearing the voices. Are you sure you hear them?" 3 "The health team members will observe your behavior. We won't leave you alone." Correct4 "I understand that you're hearing voices talking to you and that the voices are very real to you. What are the voices saying to you?" Acknowledging that client is hearing voices talking to him and that the voices are very real to him validates the presence of the client's hallucinations without agreeing with them, which communicates acceptance and can form a foundation for trust; it may help the client return to reality. The nurse also needs to assess the content of the voices to determine the risk of self injury or violence against others. The client's contact with reality is too tenuous to explore what they mean. Saying that the client is the only one hearing the voices and asking whether he is sure that he is hearing demeans the client, which blocks the development of a trusting relationship and future communication. Telling the client that the health team members will observe his behavior and that he won't be left alone is condescending and may impair future communication. 86%of students nationwide answered this question correctly. View Topics 37. Confidence: Pretty sure Stats Issue with this question? 37. A nurse is caring for a client with the diagnosis of schizophrenia. What should the nurse plan to do to increase the self-esteem of this client? Correct1 Reward healthy behaviors. 2 Explain the treatment plan. 3 Identify various means of coping. 4 Encourage participation in community meetings. By realistically rewarding the healthy behaviors, the nurse provides secondary gains and encourages the continued use of healthy behaviors. Explaining the treatment plan, identifying various means of coping, and encouraging participation in community meetings are important but will do little to increase the client's self-esteem. 61%of students nationwide answered this question correctly. View Topics 38. Confidence: Pretty sure Stats Issue with this question? 38. The nurse is planning a group session for three chronically ill clients who have the diagnosis of schizophrenia. In light of the symptoms and general characteristics of schizophrenia and long-term mental illness, one of the most helpful topics for this group is: 1 Relaxation techniques 2 Rational behavior therapy 3 Assertiveness in relationships Correct4 Social skills in the group setting Chronically ill clients with schizophrenia usually have a lack of social skills, so this topic is appropriate for this group. Relaxation techniques can be helpful for anyone; however, this is not the most therapeutic focus for this group. Rational behavior therapy is helpful for clients coping with depression. Many chronically mentally ill clients have difficulty applying the concepts associated with being assertive. 45%of students nationwide answered this question correctly. View Topics 39. Confidence: Pretty sure Stats Issue with this question? 39. A client with the diagnosis of schizophrenia watches the nurse pour juice for the morning medication from an almost-empty pitcher and screams, "That juice is no good! It's poisoned." What is the most therapeutic response by the nurse? 1 Assure the client, "The juice is not poisoned." 2 Pour the client a glass of juice from a full pitcher. 3 Take a drink of the juice to show the client that it is safe. Correct4 Say, "You sound frightened. Is there something else I can give you to take your medication with?" The response "You sound frightened" reflects the client's feelings and avoids focusing on the delusion; following up with "Is there something else I can give you to take your medication with?" encourages the client to take the medication. The response "The juice is not poisoned" will not change the client's feelings because the belief is real to the client. Pouring the client a glass of juice from a full pitcher will not change the client's feelings because the other pitcher also may be perceived as poisoned. Taking a drink of the juice to show the client that it is safe will not change the client's feelings; the client will believe that the nurse was not really drinking the juice. 74%of students nationwide answered this question correctly. View Topics 40. Confidence: Pretty sure Stats Issue with this question? 40. At mealtime a client with schizophrenia moves to the counter to choose food but is unable to decide what to do next. The nurse, recognizing the client's ambivalence, assists by using: 1 Nonverbal communication Correct2 Simple declarative statements 3 Basic questions requiring simple choices 4 Rewards for each of the food items chosen Ambivalence makes decision-making difficult, if not impossible; simple, easy-to-follow declarative statements limit the choices available for the indecisive client. The client will be unable to interpret nonverbal communication and will experience increased confusion and indecision. Asking basic questions to elicit simple choices or giving a reward for each item chosen is inappropriate because the pressure to make choices may increase the client's ambivalence and discomfort. 33%of students nationwide answered this question correctly. View Topics 41. Confidence: Pretty sure Stats Issue with this question? 41. A 22-year-old male client with the diagnosis of schizophrenia has been in a mental health facility for approximately 2 weeks. After his parents visit he is seen pacing in the hall, talking loudly to himself. What should the nurse's initial intervention be? 1 Obtaining a prescription for a tranquilizer Correct2 Asking the client about the events of his day 3 Calling the parents to find out what happened 4 Assigning a nursing assistant to remain with the client A broad opening encourages communication that may elicit the client's perception of the day's events. Obtaining a prescription for a tranquilizer is premature. What is most important is the client's, not the parents', perception of what has occurred. Assigning a nursing assistant to remain with the client is premature; there are no data to indicate that the client may harm himself or others. 81%of students nationwide answered this question correctly. View Topics 43. Confidence: Pretty sure Stats Issue with this question? 43. A newly admitted male client with schizophrenia appears to be responding to internal stimuli when laughing and talking to himself. What is thebest initial response by the nurse? Correct1 Asking the client whether he is hearing voices 2 Encouraging the client to engage in unit activities 3 Telling the client that the voices he is hearing are not real 4 Giving the client his prescribed PRN antipsychotic medication Because the client is newly admitted, the nurse needs to conduct a thorough assessment before intervening. Encouraging the client to engage in unit activities may eventually be done but is not the priority. Telling the client that the voices he is hearing are not real assumes that the client is hallucinating. The client's behavior does not indicate the need for extra medication at this time. Some clients with schizophrenia have hallucinations throughout their lives. 44. What should a nurse do first when managing interpersonal relationships with a client who has schizophrenia? 1 Allow the client to be alone when desired but provide quiet activities. 2 Insist that the client join group meetings and activities with other clients. Correct3 Establish a one-on-one relationship and then bring the client into group activities. 4 Encourage dependence by the client initially but set limits on the extent of this behavior. To improve social function in clients with schizophrenia, the nurse must first work to develop a trusting one-on-one relationship. Clients with schizophrenia will build trust through one-on-one interactions. Clients need interaction to increase trust; they will not seek interactions without encouragement. If forced, these individuals will be too fearful of the group to function in it or benefit by it. Dependency is not encouraged for any capable clients. 76%of students nationwide answered this question correctly. View Topics 45. Confidence: Pretty sure Stats Issue with this question? 45. A female client with schizophrenia is going to occupational therapy for the first time. She tells the nurse that she doesn't want to go. What is themost therapeutic initial response by the nurse? 1 "It's only for an hour, and then you'll be back." 2 "Try it once. If you don't like it, you don't have to go back." Correct3 "Tell me what concerns you about going to occupational therapy." 4 "The doctor prescribed it as part of your treatment. You should go." "Tell me what concerns you about going to occupational therapy" is an open-ended statement that allows the nurse to explore the patient's concerns. If the patient would feel more comfortable having the nurse go with her to the first session, this idea may be explored next. The statement "It's only for an hour, and then you'll be back" will do nothing to allay the client's anxiety about facing a new situation. Telling the client to try it once because she won't have to go back if she doesn't like it is not true; even if the client does not like the therapy, she should be encouraged to go as part of the overall therapy program. Telling her that the provider has prescribed the therapy as part of her treatment and that she should go will do nothing to allay the client's anxiety about facing a new situation. 96%of students nationwide answered this question correctly. View Topics 46. Confidence: Pretty sure Stats Issue with this question? 46. A client with schizophrenia is taking benztropine (Cogentin) in conjunction with an antipsychotic. The client tells a nurse, "Sometimes I forget to take the Cogentin." What should the nurse teach the client to do if this happens again? 1 Take 2 pills at the next regularly scheduled dose. 2 Notify the health care provider about the missed dose immediately. Correct3 Take a dose as soon as possible, up to 2 hours before the next dose. 4 Skip the dose, then take the next regularly scheduled dose 2 hours early. Taking a dose as soon as possible is the advised intervention when a dose is missed; interruption of the medication may precipitate signs of withdrawal such as anxiety and tachycardia. Taking 2 pills at the next regularly scheduled dose will provide an excessive amount of the medication at one time. Notifying the health care provider about the missed dose immediately is unnecessary. Skipping a dose is not advised if the next regularly scheduled dose is due within 2 hours. 61%of students nationwide answered this question correctly. View Topics 47. Confidence: Pretty sure Stats Issue with this question? 47. A client with schizophrenia says to the nurse, "I've been here 5 days. There are five players on a basketball team. I like to play the piano." How should the nurse document this cognitive disorder? 1 Word salad Correct2 Loose association 3 Thought blocking 4 Delusional thinking These ideas are not well connected and there is no clear train of thought. This is an example of loose association. Word salad is incoherent expressions containing jumbled words. This client's thoughts are coherent but not connected. Thought blocking occurs when the client loses the train of thinking and ideas are not completed. Each of the client's thoughts is complete but not linked to the next thought. These statements are reality based and not reflective of delusional thinking. 72%of students nationwide answered this question correctly. View Topics 48. Confidence: Pretty sure Stats Issue with this question? 48. A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the primary nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response should the nurse give? 1 Citalopram (Celexa) Correct2 Ziprasidone (Geodon) 3 Benztropine (Cogentin) 4 Acetaminophen with hydrocodone (Lortab) Ziprasidone (Geodon) is a neuroleptic, which will reduce psychosis by affecting the action of both dopamine and serotonin. Citalopram (Celexa) is a selective serotonin reuptake inhibitor antidepressant. Benztropine (Cogentin) is an anticholinergic. Acetaminophen with hydrocodone (Lortab) is an analgesic/opioid. 49%of students nationwide answered this question correctly. View Topics 49. Confidence: Pretty sure Stats Issue with this question? 49. Schizophrenia is associated with negative symptoms. In the assessment of a client with schizophrenia, which symptoms are classified as negative symptoms? Select all that apply. Correct1 Lack of energy Correct2 Poor grooming 3 Illogical speech 4 Ideas of reference 5 Agitated behavior A lack of energy (anergy) is a negative symptom associated with schizophrenia. Inadequate grooming results from apathy and lack of energy and is a negative symptom associated with schizophrenia. Illogical speech that reflects disorganized thinking is a positive symptom of schizophrenia type 1. Ideas of reference, a thought process in which a person believes he or she is the object of environmental attention, is a positive symptom of schizophrenia. Agitated, hostile, angry, and violent behaviors are positive symptoms of schizophrenia. 38%of students nationwide answered this question correctly. View Topics 50. Confidence: Pretty sure Stats Issue with this question? 50. At times a client's anxiety level is so high that it blocks attempts at communication and the nurse is unsure of what is being said. To clarify understanding, the nurse says, "Let's see whether we mean the same thing." What communication technique is being used by the nurse? 1 Reflecting feelings 2 Making observations Correct3 Seeking consensual validation 4 Attempting to place events in sequence Seeking consensual validation is a technique that prevents misunderstanding so that both the client and the nurse can work toward a common goal in the therapeutic relationship. Reflection of feelings is used to increase client awareness but should not be used when the nurse is unsure of what the client is saying. Making observations refers more to nonverbal than to verbal communication. Placing events in a sequence helps organize content, but ideas should be clarified first by means of validation if the nurse is unsure of the meaning of what is being said. 72%of students nationwide answered this question correctly. View Topics 51. Confidence: Just a guess Stats Issue with this question? 51. A client has been on the psychiatric unit for several days. The client arouses anxiety and frustration in the staff and manipulates them so well that staff members are afraid to approach the client. One morning the client shouts at the nurse, "You've worked it so I can't go for a walk with the group today. You're as cunning as a fox. I hate you! Get out, or I'll hit you!" What is the best response by the nurse? 1 "Tell me what I did to upset you." 2 "Go ahead and try to hit me if you need to." Correct3 "I don't like hearing your threats, but tell me more about your feelings." 4 "You're being rude and your behavior is stopping me from wanting to be with you." The response "I don't like to hear your threats, but tell me more about your feelings" shows acceptance for the client and may promote expression of feelings, yet it sets firm limits on the behavior. The response "Tell me what I did to upset you" is not therapeutic because it puts the focus on the nurse rather than on what is behind the outburst. The nurse should not accept physical abuse from the client; limits must be set. Although the statement "You are being rude and your behavior is stopping me from wanting to be with you" rejects the behavior, it also rejects the client. 56%of students nationwide answered this question correctly. View Topics 52. Confidence: Pretty sure Stats Issue with this question? 52. A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) should the nurse anticipate that the health care provider may prescribe? 1 Haloperidol (Haldol) Correct2 Fluvoxamine (Luvox) 3 Imipramine (Tofranil) 4 Benztropine (Cogentin) Fluvoxamine (Luvox) inhibits central nervous system neuron uptake of serotonin but not of norepinephrine. Haloperidol (Haldol) is not an SSRI; it is an antipsychotic that blocks neurotransmission produced by dopamine at synapses. Imipramine (Tofranil) is a tricyclic antidepressant, not an SSRI. Benztropine (Cogentin) is an antiparkinsonian agent, not an SSRI. 47%of students nationwide answered this question correctly. View Topics 53. Confidence: Pretty sure Stats Issue with this question? 53. A client who was involved in a near-fatal automobile collision arrives at the mental health clinic with complaints of insomnia, anxiety, and flashbacks. The nurse determines that the client is experiencing symptoms of crisis. What is the nurse's initial intervention? Correct1 Focusing on the present 2 Identifying past stressors 3 Discussing a referral for psychotherapy 4 Exploring the client's history of mental health problems Crisis intervention deals with the here and now; the past is not important except in building on client strengths. The client is anxious and uncomfortable because of the current situation; the focus is on the present, not the past. Psychotherapy is not appropriate for crisis intervention; psychotherapy focuses on the causes of current feelings and behavior and may be provided long term. Exploring the client's history of mental health problems is not significant to crisis intervention. 57%of students nationwide answered this question correctly. View Topics 54. The nurse plans to teach a client to use healthier coping behaviors that can consciously be used to reduce anxiety. These include: 1 Eating, dissociation, fantasy 2 Sublimation, fantasy, rationalization Correct3 Exercise, talking to friends, suppression 4 Repression, intellectualization, smoking Exercise, talking to friends, and suppression are positive coping behaviors that can be used consciously to promote mental health. Eating, dissociation, and fantasy; sublimation, fantasy, and rationalization; and repression, intellectualization, and smoking are not healthy coping behaviors, and their frequent use can lead to distortions of reality. Also, they are usually not under conscious control. 86%of students nationwide answered this question correctly. View Topics 56. Confidence: Pretty sure Stats Issue with this question? 56. A client is admitted to the hospital with the diagnosis of severe anxiety. The nurse's plan of care for a client with an anxiety disorder should include: 1 Promoting the suppression of anger by the client Correct2 Supporting the verbalization of feelings by the client 3 Encouraging the client to limit anxiety-related behaviors 4 Restricting the involvement of the client's family during the acute phase Freedom to ventilate feelings serves as a safety valve to reduce anxiety. The suppression of anger may increase the client's anxiety. Encouraging the client to limit anxiety-related behaviors is not therapeutic; it may increase the anxiety that the client is feeling. Restricting the involvement of the client's family during the acute phase may or may not be helpful; the client's family may provide support to the client. 78%of students nationwide answered this question correctly. View Topics 57. Confidence: Just a guess Stats Issue with this question? 57. A client who is to begin a physical therapy regimen after orthopedic surgery expresses anxiety about starting this new therapy. The nurse responds that some of this apprehension can be an asset because it will: 1 Slow physiological function. Correct2 Increase alertness to the environment. 3 Mobilize automatic behavioral responses. 4 Promote the use of ego defense mechanisms. Mild and moderate levels of anxiety can be beneficial because they focus attention on the environment by attempting to ward off additional anxiety. Initially anxiety amplifies physiological function; function decreases after prolonged anxiety because of exhaustion. Automatic behavioral responses and ego defense mechanisms may hinder, rather than increase, an individual's awareness. 64%of students nationwide answered this question correctly. View Topics 58. Confidence: Just a guess Stats Issue with this question? 58. A client with a generalized anxiety disorder is hospitalized. The nurse determines that an environment conducive to reducing emotional stress and providing psychological safety for this client is one in which: 1 Needs are met. Correct2 Realistic limits and controls are set. 3 The client's requests are met promptly. 4 The client's environment is kept neat and orderly. Setting realistic limits and controls makes the environment as emotionally nonthreatening as is realistically possible. All needs cannot be met; the person must learn how to cope with delaying gratification. It is not possible or realistic to meet all of a person's requests. Order in the environment is of less importance; providing a nonthreatening environment is the priority action. 50%of students nationwide answered this question correctly. View Topics 59. Confidence: Just a guess Stats Issue with this question? 59. Many clients who call a crisis hotline are extremely anxious. The nurse answering the hotline phone considers that the characteristic distinguishing posttraumatic stress disorders from other anxiety disorders is: 1 Lack of interest in family and others Correct2 Reexperiencing the trauma in dreams and flashbacks 3 Avoidance of situations and activities that resemble the stress 4 Depression and a blunted affect when discussing the traumatic situation Experiencing the actual trauma in dreams or flashbacks is the major symptom that distinguishes posttraumatic stress disorders from other anxiety disorders. Lack of interest in family and others is usually not associated with anxiety disorders. Avoidance of situations and activities that resemble the stress is more common with phobic disorders. Although depression may be generated by discussion of the traumatic situation, the affect is usually exaggerated, not blunted. 89%of students nationwide answered this question correctly. View Topics 61. Confidence: Pretty sure Stats Issue with this question? 61. The nurse can identify the most commonly demonstrated comorbid disorders associated with generalized anxiety disorder (GAD) by assessing the client for which of the following? Select all that apply. 1 Obesity Correct2 Signs of alcohol withdrawal Correct3 Phobias 4 Impaired cognitive function Correct5 Suicidal ideations The most frequent comorbid conditions associated with GAD include alcohol abuse, simple phobias, and major depression. Obesity and impaired cognitive function generally are not identified as being comorbid conditions associated with GAD. 12%of students nationwide answered this question correctly. View Topics 62. Confidence: Pretty sure Stats Issue with this question? 62. What is the nurse's ultimate goal when managing the care of a client diagnosed with generalized anxiety disorder (GAD)? 1 Creating an anxiety-free environment for the client Correct2 Assisting the client with the development of healthy, adaptive coping mechanisms 3 Identifying the triggers that produce anxiety in the client 4 Providing reinforcement that the client's anxiety issues can be eliminated GAD is characterized by the maladaptive use of worrying as a coping mechanism. The ultimate goal is for the nurse to help the client replace the ineffective worrying with effective, healthy coping mechanisms. It is not possible or even desirable to create an anxiety free environment; the goal is to help the client learn to deal with anxiety in a healthy manner. While identifying triggers is an appropriate goal, it is not the ultimate/definite goal for this diagnosis. It is not appropriate to eliminate all of the client's anxiety issues, because all individuals experience anxiety. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the “old” material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don’t wait until the middle to end of the semester to try to cram information. 66%of students nationwide answered this question correctly. View Topics 63. Confidence: Pretty sure Stats Issue with this question? 63. Which nursing intervention is indicated for a client with an anxiety disorder? 1 Encouraging suppression of anger by the client Correct2 Promoting verbalization of feelings by the client 3 Limiting involvement of the client's family during the acute phase 4 Explaining why the client should accept the psychological factors that are precipitating the anxiety Freedom to express feelings serves as a safety valve to reduce anxiety. Suppression of anger or hostility may add to the client's anxiety. Limiting involvement of the client's family during the acute phase may or may not be helpful; the client's family members may provide support. Explaining why the client should accept the psychological factors that are precipitating the anxiety is not therapeutic; accepting current situational stresses may not be possible. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the “old” material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don’t wait until the middle to end of the semester to try to cram information. 92%of students nationwide answered this question correctly. View Topics 64. Confidence: Pretty sure Stats Issue with this question? 64. A student is anxious about an upcoming examination but is able to study intently and does not become distracted by a roommate's talking and loud music. What level of anxiety is demonstrated by the student's ability to shut out the distractions? Correct1 Mild 2 Panic 3 Severe 4 Moderate A person with mild anxiety has a broad perceptual field and increased problem-solving abilities. A moderately anxious person shuts out peripheral events and focuses on central concerns but has a decreased ability to problem solve. Panic is characterized by a completely disruptive perceptual field. With severe anxiety, the perceptual field is reduced, as is the ability to focus on details. 80%of students nationwide answered this question correctly. View Topics 65. Confidence: Pretty sure Stats Issue with this question? 65. A nurse is accompanying a client with a diagnosis of anxiety disorder who is pacing the halls and crying. When the client's pacing and crying worsen, the nurse suddenly feels uncomfortable and experiences a strong desire to leave. What is the most likely reason for what the nurse is experiencing? Correct1 An empathic communication of anxiety 2 A fear of the client's becoming assaultive 3 A desire to go off duty after a busy workday 4 An inability to tolerate any more bizarre behavior Because anxiety can be an interpersonal experience, it is contagious; the nurse then has a strong urge to get away. A fear of the client's becoming assaultive is possible but not probable; the client is exhibiting anxiety, not hostility, at this time. The desire to go off duty should not suddenly make the nurse uncomfortable. There is no indication that this or any other behavior encountered has been bizarre. 54%of students nationwide answered this question correctly. View Topics 66. A client who was hospitalized with severe anxiety is ready to be discharged. What priority outcome has been met? 1 Follows rules of the milieu Correct2 Maintains anxiety at a manageable level 3 Verbalizes positive aspects about the self 4 Recognizes that hallucinations can be controlled Maintenance of anxiety at a manageable level results from teaching the client to recognize situations that provoke anxiety and how to institute measures to control its development. Following the rules of the milieu and verbalizing positive aspects about himself are not priorities; the client has probably had little difficulty in these areas. No evidence was presented to indicate that the client is hallucinating. 88%of students nationwide answered this question correctly. View Topics 68. Confidence: Just a guess Stats Issue with this question? 68. When a client is expressing severe anxiety by sobbing in the fetal position on her bed, the nurse's priority is: Correct1 Ensuring a safe therapeutic milieu 2 Monitoring and documenting vital signs 3 Eliminating the cause of the client's anxiety 4 Ensuring that the client's physical needs are met Client safety is the nurse's first priority, and because the client is has not experienced any physical injuries and is not at risk, attention should be directed toward psychiatric risk, in this case crisis control. The severely stressed individual is likely to experience increased vital signs and will continue to have physiological needs such as food and water; however, these issues do not take the priority over a psychiatric crisis. The client will not be able to concentrate on therapy related to identifying the source of the anxiety until the crisis has been managed. 57%of students nationwide answered this question correctly. View Topics 69. Confidence: Pretty sure Stats Issue with this question? 69. An extremely depressed client signed the consent for electroconvulsive therapy (ECT) but continues to express anxiety about the procedure. What is most important for a nurse to emphasize when discussing ECT with the client? 1 "The procedure may c