NURS 413: Nursing Management of Maladaptive Behavior

Week 9-15

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially in attempting to help the patient de-escalate the anxiety?

a. “Do you know what will help you manage your anxiety?”

b. “Do you need help to manage your anxiety?”

c. “Can you identify what was happening when your anxiety began to increase?”

d. “Are you feeling anxious right now?”

C

Which patient is at increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply.

a. Exacerbation of asthma signs and symptoms

b. History of peanut and strawberry allergies

c. History of chronic obstructive pulmonary disease

d. Current treatment for unstable angina pectoris

e. History of a traumatic brain injury

A C D E

Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks?

a. Alprazolam (Xanax)

b. Fluoxetine (Prozac)

c. Clonazepam (Klonopin)

d. Venlafaxine (Effexor)

B

Which statement or statements made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply.

a. “Relaxation therapy’s main goal is to prevent exhaustion by removing muscle tension.”

b. ”Muscle relaxation promotes the relaxation response.”

c. “Show me how you learned to deep breathe in yesterday’s therapy session.”

d. “You’ve said that going to group makes you nervous, so let’s start relaxing now.”

e. “I’ve given you written descriptions of the various relaxation exercises for you to review.”

B C D E

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has recently been prescribed an antianxiety medication?

a. Eating high-­protein foods.

b. Using acetaminophen without first discussing it with a healthcare provider

c. Taking medications after eating dinner or while having a bedtime snack

d. Buying a large coffee with sugar and extra cream each morning on the way to work

D

In a parent-­ teacher conference, the school nurse meets with the parents of a profoundly shy 8-­ year-­ old girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognizes that the child is most likely exposed to parental modeling and

a. The inherited shyness trait

b. A lack of affection in the home

c. Severe punishment by the parents

d. Is afraid to say something foolish

A

Isabel is a straight-­ A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states the following:

a. “I would like to try a benzodiazepine for my anxiety.”

b. “If I study harder, my anxiety level will go down.”

c. “Mild anxiety is okay because it helps me to focus.”

d. “I have fear that I will fail at college.”

C

The activity of gamma-­ aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitate the action of GABA?

a. Benzodiazepines

b. Antihistamines

c. Anticonvulsants

d. Noradrenergics

A

Samantha is a new patient at the mental health clinic and is seeking assistance for what she describes as “severe anxiety.” In addition to daily self-­ medicating with alcohol, Samantha describes long-­ term use of herbal kava. The nurse practitioner knows that kava is associated with inhibiting P450 and orders which of the following tests?

a. Electrocardiogram

b. Liver enzymes

c. Glomerular filtration rate

d. Complete blood count

B

A homebound patient diagnosed with agoraphobia has been receiving therapy at home. The nurse recognizes effective teaching when the patient states the following:

a. “I may never leave the house again.”

b. “Having groceries delivered is very convenient.”

c. “My risk for agoraphobia is increased by my family history.”

d. “I will go out again someday, just not today.”

C

Nick, a construction worker, is on duty when a nearly completed wall suddenly falls, crushing a number of his co-workers. Although badly shaken initially, he seemed to be coping well. About 2 weeks after the tragedy, he begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate?

a. Nick has acute stress disorder and will benefit from anti-anxiety medications.

b. Nick is experiencing posttraumatic stress disorder (PTSD) and should be referred for outpatient treatment.

c. Nick is experiencing anxiety and grief and should be monitored for PTSD symptoms.

d. Nick is experiencing mild anxiety and a normal grief reaction; no intervention is needed.

A

You are caring for Susannah, a 29-­ year-­ old who has been diagnosed with dissociative identity disorder. She was recently hospitalized after coming to the emergency department with deep cuts on her arms with no memory of how this occurred. The priority nursing intervention for Susannah is:

a. Assist in recovering memories of abuse.

b. Maintain 1:1 observation.

c. Teach coping skills and stress-­ management strategies.

d. Refer for integrative therapy.

B

You are caring for Connor, an 8-­ year-­ old boy who has been diagnosed with reactive attachment disorder. Which of the following nursing outcomes would be the most appropriate to achieve?

a. Increases ability to self-­ control and decreases impulsive behaviors.

b. Avoids situations that trigger conflicts.

c. Expresses complex thoughts.

d. Writes or draws feelings in a journal.

D

Ashley is a 21-­ year-­ old college student who was sexually assaulted at a party. She was seen in the local emergency department and referred for counseling after being diagnosed by the provider on call as having acute stress disorder. Which of the following treatment modalities would you expect to see used in therapy with Ashley?

a. Aversion therapy

b. Stress-­ reduction therapy

c. Cognitive ­ behavioral therapy

d. Short-­ term classical analysis therapy

C

Jamie, age 24, has been diagnosed with a dissociative disorder following a traumatic event. Jamie’s mother asks you, “Does this mean my daughter is now crazy?” Your best response would be:

a. “People with dissociative disorders are out of touch with reality, so in that way, your daughter is now mentally ill. Don’t worry. Treatment is available.”

b. “Jamie will most likely need long-­ term intensive inpatient treatment to deal with her traumatic memories as well as to work through her delusions.”

c. “Most mental health providers are skeptical about dissociative disorders and aren’t sure they truly exist. Jamie may be making up her symptoms as a cry for help.”

d. “Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With treatment, she can get back to her previous level of functioning.”

D

A young child is found wandering alone at a mall. A male store employee approaches and asks where her parents are. She responds, “I don’t know. Maybe you will take me home with you?” This sort of response in children may be due to:

a. A lack of bonding as an infant

b. A healthy confidence in the child

c. Adequate parental bonding

d. Normal parenting

A

During a routine health screening, a grieving widow whose husband died 15 months ago reports emptiness, a loss of self, difficulty thinking of the future, and anger at her dead husband. The nurse suggests bereavement counseling. The widow is most likely suffering from:

a. Major depression

b. Normal grieving

c. Adjustment disorder

d. Posttraumatic stress disorder

C

Maggie, a child in protective custody, is found to have an imaginary friend, Holly. The foster family shares this information with the nurse. The nurse teaches the family members about children who have suffered trauma and knows her teaching was effective when the foster mother states:

a. “I understand that imaginary friends are abnormal.”

b. “I understand that imaginary friends are a maladaptive behavior.”

c. “I understand that imaginary friends are a coping mechanism.”

d. “I understand that we should tell the child that imaginary friends are unacceptable.

C

The school nurse has been alerted to the fact that an 8-­ year-­ old boy routinely play acts as a police officer, “locking up” other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of:

a. The need to dominate others

b. Inventing traumatic events

c. A need to develop close relationships

d. A potential symptom of traumatization

D

A pregnant woman is in a relationship with a male who routinely abuses her. Her unborn child may engage in high-risk behavior as a teen as a result of:

a. Maternal stress

b. Parental nurturing

c. Appropriate stress responses in the brain

d. Memories of the abuse

A

The care plan of a patient diagnosed with a somatic disorder includes the nursing diagnosis impaired coping. Which patient behavior demonstrates a successful outcome for that nursing diagnosis?

a. Showers and dresses in clean clothes daily

b. Calls a friend to talk when feeling lonely

c. Spends more time talking about pain in her abdomen

d. Maintains focus and concentration

B

Which patient is at greatest risk for developing a stress-induced myocardial infarction?

a. A patient who lost a child in an accidental shooting 24 hours ago

b. A woman who has begun experiencing early signs of menopause

c. A patient who has spent years trying to sustain a successful business

d. A patient who was diagnosed with chronic major depressive disorder 10 years ago

D

What precipitating emotional factor has been associated with an increased incidence of cancers? Select all that apply.

a. Anxiety

b. Job-­ related stress

c. Acute grief

d. Feelings of hopelessness and despair from depression

e. Prolonged, intense stress

D E

You are caring for Aaron, a 38-­ year-­ old patient diagnosed with somatic symptom disorder. When interacting with you, Aaron continues to focus on his severe headaches. In planning care for Aaron, which of the following interventions would be appropriate?

a. Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis.

b. Educate Aaron on alternative therapies to deal with pain.

c. Improve reality testing by telling Aaron that you do not believe that the headaches are real.

d. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.

D

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that:

a. Once lower-­ level needs are satisfied, no further growth feels necessary.

b. Self-­ actualization is easier to achieve with financial stability.

c. Esteem is more highly valued than safety.

d. Focusing on materialism reduces interests in love, belonging, and family.

D

Diane, a 63-­ year-­ old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over finances. Ever since, Diane has been complaining of “a severe pain in my neck.” She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that:

a. Showing concern for Diane’s pain will increase her obsessional thinking.

b. Diane’s symptoms are manipulative and under conscious control.

c. Diane believes there is a physical cause for the pain and will resist a psychological explanation.

d. Diane is trying to make her son feel bad about the argument.

C

Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause of conversion disorder. Which statement is true?

a. People with conversion disorder are extremely upset about often dramatic symptoms.

b. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder.

c. An organic cause is usually found in most cases of conversion disorder.

d. Symptoms can be turned off and on depending on the patient’s choice.

B

Melanie is a 38-­ year-­ old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may:

a. Consciously be trying to maintain her role of a sick patient.

b. Not recognize her unmet needs to be cared for.

c. Protect her child from illness.

d. Recognize physical symptoms as a coping mechanism

A

You are caring for Yolanda, a 67-­ year-­ old patient who has been receiving hemodialysis for 3 months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to:

a. Organic changes in Yolanda’s brain.

b. A flaw in Yolanda’s personality.

c. A normal response to grief and loss.

d. Denial of the reality of a poor prognosis.

C

Lucas is a nurse on a medical floor caring for Kelly, a 48-­ year-­ old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient’s adjustment to her new diagnosis. What problem has the most potential to arise?

a. Development of agoraphobia

b. Treatment nonadherence

c. Frequent hypoglycemic reactions

d. Sleeping rather than checking blood sugar

B

Which statement made by the primary caregiver of a person with dementia demonstrates an accurate understanding of providing the person with a safe environment?

a. “The local police know that he has wandered off before.”

b. “I keep the noise level low in the house.”

c. “We’ve installed locks on all the outside doors.”

d. “Our telephone number is always attached to the inside of his shirt pocket.”

C

Which statement made by a family member tends to support a diagnosis of delirium rather than dementia?

a. “She was fine last night but this morning she was confused.”

b. “Dad doesn’t seem to recognize us anymore.”

c. “She’s convinced that snakes come into her room at night.”

d. He can’t remember when to take his pills or whether he’s bathed.”

A

In terms of the pathophysiology responsible for both delirium and dementia, which intervention would be appropriate for delirium specifically?

a. Assisting with needs related to nutrition, elimination, hydration, and personal hygiene

b. Monitoring neurological status on an ongoing basis

c. Placing an identification bracelet on patient

d. Giving one simple direction at a time in a respectful tone of voice

B

What side effects should the nurse monitor for while caring for a patient taking donepezil (Aricept)? Select all that apply.

a. Insomnia

b. Constipation

c. Bradycardia

d. Signs of dizziness

e. Reports of headache

A C D E

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day?

a. It increases input throughout the day

b. The person may be anorexic

c. It helps with the monitoring of food intake

d. It helps to prevent constipation

A

Ophelia, a 69-­ year-­ old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia’s distress and “introduces” Ophelia to those attending. The nurse practitioner understands that Ophelia seems to have a deficit in her

a. Lower-­ level cognitive domain

b. Delirium threshold

c. Executive function

d. Social cognition ability

D

After talking with her 85-­ year-­ old mother, Nancy became concerned enough to drive to her home and check on her. Her mother’s appearance was disheveled, her words were nonsensical, she smelled strongly of urine, and there was a stain on her dressing gown. Because she is a nurse, Nancy recognizes that her mother’s condition is likely due to

a. Early-­ onset dementia

b. A mild cognitive disorder

c. A urinary tract infection

d. Having skipped breakfast

C

Lucia, 70 years old, recently underwent a major orthopedic surgical procedure. On postoperative day 3, she responds to the nurse who has been caring for her with affection. At other times, however, she tells the nurse to leave because she does not recognize her and asks to have another nurse care for her, specifically naming the nurse as the “nice one.” The most likely reason for Lucia’s behavior is that she is

a. Attention-­ seeking and manipulative

b. Showing signs of early dementia

c. Experiencing an acute delirium

d. Playing one staff member off against another

C

Since his wife’s death 2 months earlier, Aaron, 90 years of age and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating, disrupted sleep, and lacks energy. His family has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which of the following responses would be most appropriate?

a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him.

b. Meet with the family and support them to accept, anticipate, and prepare for the progression of his stage 2 dementia.

c. Avoid touch and proximity. These are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented.

d. Arrange for an appointment with a mental health professional for the evaluation and treatment of suspected major depressive disorder.

D

Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse stress, as well as which of the following? Select all that apply.

a. Expressing emotions by journaling

b. Describing stressful events on Facebook

c. Engaging in exercise and relaxation activities

d. Having realistic patient expectations

e. Participating in a happy hour after work to blow off steam

A C D

Which patient statement acknowledges the characteristic behavior associated with a diagnosis of pica?

a. “Nothing could make me drink milk.”

b. “I’m ashamed of it, but I eat my hair.”

c. “I haven’t eaten a green vegetable since I was 3 years old.”

d. “I regurgitate and rechew my food after almost every meal”

B

In evaluating an eating disorder, what physical criterion for hospital admission would you consider?

a. A daytime heart rate of less than 50 beats per minute

b. An oral temperature of 100°F or more

c. 90% of ideal body weight

d. Systolic blood pressure greater than 130 mm Hg

A

In considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply.

a. Provide scheduled portion-­ controlled meals and snacks.

b. Congratulate patients for weight gain and behaviors that promote weight gain.

c. Limit time spent in the bathroom during periods when the patient is not under direct supervision.

d. Promote exercise as a method to increase appetite.

e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

A C E

Which intervention will promote independence in a patient being treated for bulimia nervosa?

a. Have the patient monitor daily caloric intake and intake and output of fluids.

b. Encourage the patient to use behavior modification techniques to promote weight gain behaviors.

c. Ask the patient to use a daily log to record feelings and circumstances related to urges to purge.

d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.

D

Which patient statement supports the diagnosis of anorexia nervosa?

a. “I’m terrified of gaining weight.”

b. “I wish I had a good friend to talk to.”

c. “I’ve been told that I drink way too much alcohol.”

d. “I don’t get much pleasure out of life anymore.”

A

Obesity can be the end result of a binge-­ eating disorder. The nurse understands that the best treatment option in persons with a binge-­ eating disorder is

a. Bariatric surgery

b. Coping strategies

c. Avoidance of public eating

d. Appetite suppression medications

B

Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina of the following:

a. “I need to go through the belongings you have brought with you.”

b. “You can use the scale in the back room when you need to.”

c. “You will be eating five times a day here.”

d. “The daily structure is based around your desire to eat.”

A

Safety measures are of concern in treating eating disorders. Patients with anorexia nervosa are supervised closely to monitor the following: Select all that apply.

a. Foods that are eaten

b. Attempts at self-­ induced vomiting

c. Relationships with other patients

d. Weight

A B D

Malika has been overweight all her life. Now an adult, she has health problems related to excessive weight. Seeking weight-­ loss assistance at a primary care facility, Malika is surprised when the nurse practitioner suggests the following:

a. A trial of SSRI antidepressant therapy

b. Mild exercise to start, increasing in intensity over time

c. Removing snack foods from the home

d. Medication treatment for hypertension

A

Malika agrees to try losing weight according to the nurse practitioner’s outlined plan. Additional teaching is warranted when Malika states that

a. “I am willing to admit that I am depressed.”

b. “Psychotherapy will be a part of my treatment.”

c. “I prefer to have a gastric bypass rather than use this plan.”

d. “My comorbid conditions may improve with weight loss.

C

Which individuals are most at risk for displaying aggressive behavior? Select all that apply.

a. An adolescent embarrassed in front of friends.

b. A young male who feels rejected by the social group.

c. A young adult depressed after the death of a friend.

d. A middle-­ aged adult who feels that concerns are going unheard.

e. A patient who was discovered telling a lie.

A B D E

A newly admitted male patient has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more information about the use of restraint?

a. “If his behavior warrants restraints, someone will stay with him the entire time he’s restrained.”

b. “I’ll call the primary provider and get an as needed (prn) seclusion/restraint order.”

c. “If he is restrained, be sure he is offered food and fluids regularly.”

d. “Remember that physical restraints are our last resort.”

B

Which intervention(s) should the nurse implement when helping a patient who expresses anger in an inappropriate manner? Select all that apply.

a. Approach the patient in a calm, reassuring manner.

b. Provide suggestions regarding acceptable ways of communicating anger.

c. Warn the patient that being angry is not a healthy emotional state.

d. Set limits on the angry behavior that will be tolerated.

e. Allow any expression of anger as long as no one is hurt.

A B D

Which guidelines should direct nursing care when deescalating an angry patient? Select all that apply.

a. Intervene as quickly as possible.

b. Identify the trigger for the anger.

c. Behave calmly and respectfully.

d. Recognize the patient’s need for increased personal space.

e. Demands are agreed to as long as they will not result in harm to anyone.

A B C D

Which comorbid condition would result in cautious use of an SSRI for a patient with chronic aggression?

a. Asthma

b. Anxiety disorder

c. Glaucoma

d. Bipolar disorder

D

Patrick is a widower with four daughters. He enjoyed a healthy relationship with each of them until they reached puberty. As the girls began to mature physically, he acted in an aggressive manner, often beating them without provocation. Patrick is most likely acting on:

a. Self-­ protective measures

b. Stress of raising four daughters

c. Frustration of unhealthy desire

d. Motivating his daughters to be chaste

C

A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression?

a. “I need to be aware of patients who are withdrawn and sitting alone.”

b. “An obvious change in behavior is a risk factor for aggression.”

c. ”Patients who seek constant attention are more likely to be violent.”

d. “Patients who talk to themselves are the most dangerous.”

B

An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through:

a. A casual authoritative demeanor

b. Keeping patients busy

c. Brief, frequent, nonthreatening encounters

d. Threats of seclusion or punishment

C

A 24-­ hour observation is a good choice for restraint in which of the following patients?

a. An inmate with suicidal ideation on hospice care

b. A sex offender in the psychiatric intensive care unit

c. An aggressive female with antisocial personality disorder

d. An inmate diagnosed with paranoid schizophrenia

A

Chronic obstructive pulmonary disease, spinal injury, seizure disorder, and pregnancy are conditions that:

a. Frequently result in out of control behavior.

b. Respond well to therapeutic holding.

c. Necessitate the use of only two-­ point restraint.

d. Contraindicate restraint and seclusion.

D

Which statement made by a new mother should be explored further by the nurse?

a. “I have three children, that’s enough.”

b. “I think the baby cries just to make me angry.”

c. “I wish my husband could help more with the baby.”

d. “Babies are a blessing, but they are a lot of work.”

B

Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply.

a. Phobias

b. Low self-­ esteem

c. Major depressive disorder

d. Narcissistic personality disorder

e. Posttraumatic stress disorder

A B C E

What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver?

a. The caregiver is a single male relative.

b. The caregiver was neglected as a child.

c. The caregiver is under the age of 30.

d. The caregiver has little experience with older adults.

B

What safety-­ related responsibility does the nurse have in any situation of suspected abuse?

a. Protect the patient from future abuse by the abuser.

b. Inform the suspected abuser that the authorities have been notified.

c. Arrange for counseling for all involved parties, but especially the patient.

d. Report suspected abuse to the proper authorities.

D

The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply.

a. The police department

b. An abuse hotline

c. A responsible friend or family member

d. A domestic violence shelter

e. The hospital emergency department

A B C D

Secondary effects of abuse often manifest as arrested development in children due to the fact that:

a.Coping is easier than emotional growth

b. Energy for development is diverted to coping

c. Children cannot differentiate love from abuse

d. Abuse fosters a sense of belonging, even if dysfunctional

B

The use of a patient-­ centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and:

a. Establish trust and rapport

b. Ask lots of questions

c. Interrupt the patients’ story to allow for decompression

d. Utilize closed-­ ended questions

A

The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to:

a. The love they have for parents or children.

b. Their limited options.

c. The need to feel safe at home.

d. Other relatives do not want them.

B

An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be:

a. A decrease in family interaction so there are fewer opportunities for abuse to occur.

b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.

c. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy.

d. A triad of treatment modalities, including medication, counseling, and role-­ playing opportunities.

B

Perpetrators of domestic violence tend to: Select all that apply.

a. Have relatively poor social skills and have grown up with poor role models.

b. Believe they, if male, should be dominant and in charge in relationships.

c. Force their mates to work and expect them to handle the financial decisions.

d. Be controlling and willing to use force to maintain their power in relationships.

e. Prevent their mates from having relationships and activities outside the family.

A B D E

Which statement made by the psychiatric nurse demonstrates an accurate understanding of the factors that affect an individual’s personality?

a. “Therapy will help her identify that her problems are personality related.”

b. “I’ll need to learn more about this patient’s cultural beliefs.”

c. “It’s encouraging to know that personality disorders respond well to treatment.”

d. “A person’s personality is fluid and adjusts to current social situations.”

B

When assessing a patient diagnosed with a borderline personality disorder, which statement by the patient warrants immediate attention?

a. “My mother died ten years ago.”

b. “I haven’t needed medication in weeks.”

c. “My dad never loved me.”

d. “I’d really like to hurt her for hurting me.”

D

What is the current accepted professional view of the effect of culture on the development of a personality disorder?

a. There are not enough studies to confirm the role that ethnicity and race have on the prevalence of personality disorders.

b. The North American and Australian cultures produce higher incidences of personality disorders within their populations.

c. Neither culture nor ethnic background is generally considered in the development of personality disorders.

d. Personality disorders have been found to be primarily the products of genetic factors, not cultural factors.

A

Which personality disorders are generally associated with behaviors described as “odd or eccentric”? Select all that apply.

a. Paranoid

b. Schizoid

c. Histrionic

d. Obsessive-­ compulsive

e. Avoidant

A B

Which behaviors are examples of a primitive defense mechanism often relied upon by those diagnosed with a personality disorder? Select all that apply.

a. Regularly attempts to split the staff

b. Attempts to undo feelings of anger by offering to do favors

c. Regresses to rocking and humming to sooth self when fearful

d. Lashes out verbally when confronted with criticism

e. Destroys another person’s belongings when angry

A B C

Personality disorders often co-­ occur with mood and eating disorders. A young woman is undergoing treatment at an eating disorders clinic and her nurse suspects that she may also have a cluster B personality disorder because of her

a. Desire to avoid eating

b. Dramatic response to frustration

c. Excessive exercise routine

d. Morose personality traits

B

Larry is from a small town and began displaying aggressive and manipulative traits while still a teenager. Now 40 years old, Larry is serving a life sentence for the murders of his wife and her brother. John, the prison psychiatric nurse practitioner, recognizes that Larry’s treatment will most likely

a. Transform Larry to a model prisoner

b. Not improve Larry’s coping skills

c. Reaffirm Larry’s high-­ risk behaviors

d. Manifest as small incremental changes

D

Connor is a 28-­ year-­ old student, referred by his university for a psychiatric evaluation. He reports that he has no friends at the university and that people call him a loner. Connor has recently been "giving lectures" to pigeons at the university fountains. He is diagnosed as schizotypal, which differs from schizophrenia in that persons diagnosed as schizotypal

a. Can be made aware of their delusions

b. Are far more delusional than schizophrenics

c. Have a greater need for socialization

d. Do not usually respond to antipsychotic medications

A

Garret’s wife of 8 years is divorcing him because their marriage never developed a warm or loving atmosphere. Garrett states in therapy, “I have always been a loner,” and says that he was never concerned about what others think. The nurse practitioner suggests that Garrett try a trial of bupropion (Wellbutrin) to

a. Improve his flat emotions

b. Help him to get a good night’s sleep

c. Increase the pleasure of living

d. Prepare Garrett for group therapy

C

Josie, a 27-­ year-­ old patient, complains that most of the staff do not like her. She says she can tell whether you are a caring person. Josie is unsure of what she wants to do with her life and her “mixed-­ up feelings” about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it “makes the numbness stop.” Given this presentation, which personality disorder would you suspect?

a. Obsessive-­ compulsive

b. Borderline

c. Antisocial

d. Schizotypal

B

Which patient statement supports a diagnosis of narcolepsy?

a. “My wife tells me I snore at night.”

b. “I sleepwalk several nights a week.”

c. “I have no control over when I fall asleep.”

d. “My legs feel funny, and that keeps me awake.”

C

Madelyn, a 29-­ year-­ old patient recently diagnosed with major depressive disorder, comes to the mental health clinic complaining of continued difficulty sleeping. One week ago, she was started on a selective serotonin reuptake inhibitor (SSRI), fluoxetine (Prozac), for her depressive symptoms. When educating Madelyn, your response is guided by the knowledge that:

a. SSRIs such as fluoxetine more commonly cause hypersomnolence as opposed to difficulty sleeping.

b. The sleep problem is caused by the depression and is unrelated to the medication.

c. The neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted by many psychiatric medications and may be affecting her sleep.

d. The medication should be discontinued since sleep is the most important element to her recovery

C

Which behaviors will the nurse encourage a patient diagnosed with insomnia disorder to adopt? Select all that apply.

a. Avoiding exercising at bedtime

b. Avoiding napping during the day

c. Eating a hearty snack at bedtime

d. Getting up at the same time each day

e. Moving the clock so it is not visible from the bed

A B D E

Which treatment is typically prescribed for primary insomnia? Select all that apply.

a. Cognitive behavioral therapy–insomnia (CBT-­ I)

b. Intravenous medication for sedation

c. Stimulus control

d. Sleep restriction

e. Sleep hygiene measures

A C D E

Light projected into the retina is believed to trigger changes in sleep patterns and quality of sleep. Therefore, the nurse should suggest:

a. Not reading within an hour of bedtime.

b. Exercising before bedtime in a darkened environment.

c. Limiting use of electronic devices in the hour before bedtime.

d. Dimming the screen on cellphones and computers in the evening.

C

Sleep disturbances are often overlooked or undiagnosed due to:

a. A lack of formal nurse and physician training in sleep disturbances.

b. Patients not often accurately describing sleep disturbance patterns.

c. The belief that sleep disturbance is a necessary part of hospitalization.

d. Patients hiding the fact that they have issues with sleep.

A

Many people allow life circumstances to dictate their amount of sleep instead of recognizing sleep as a priority. Which statement will the nurse recognize as progress in the patient’s sleep hygiene program?

a. ”I go to bed even if I am not sleepy, hoping I will fall asleep.”

b. “I have one glass of red wine at bedtime each night.”

c. “I take a nap each day to ‘catch up’ on my sleep deficit.”

d. “I have removed the television from my bedroom.”

D

Larry is a 50-­ year-­ old man who works about 60 hours per week. He arrives at the clinic seeking assistance with a weight gain of 50 pounds over the past year. Larry admits to sleeping 4 to 5 hours a night. The nurse recognizes that the weight gain may be related to:

a. A new onset of diabetes.

b. Suspected cardiovascular disease.

c. Dysregulation of hormones that influence appetite.

d. Comorbidity of depression with obesity.

C

Sleep deprivation is considered a safety issue that results in loss of life and property. Psychomotor impairments of sleep deprivation are similar to symptoms caused by:

a. Sleeping in excess of 10 hours.

a. Misuse of caffeine products.

c. Alcohol consumption.

d. Working more than 40 hours per week.

C

The stage of sleep known as rapid eye movement or REM sleep is characterized by atonia and myoclonic twitches in addition to the actual rapid movement of the eyes. Atonia is thought to be a protective mechanism as it:

a. Limits physical movements.

b. Prevents nightmares.

c. Enhances the dream state.

d. Regulates the autonomic nervous system.

A

Which patient statement suggests a concern over one’s ability to perform sexually?

a. “My partner and I aren’t as close as we once were.”

b. “I’m not as desirable as I once was.”

c. “My personal life has changed a lot.”

d. “I’m not the partner I used to be.”

D

The nurse should plan to educate male patients who are taking selective serotonin reuptake inhibitors (SSRIs) on the possible development of which common side effect?

a. Impotence

b. Gynecomastia

c. Decreased libido

d. Premature ejaculation

C

Which medications are currently approved for the treatment of male erectile disorder? Select all that apply.

a. Sildenafil (Viagra)

b. Flibanserin (Addyi)

c. Tadalafil (Cialis)

d. Vardenafil (Levitra)

e. Avanafil (Stendra)

A C D E

Which statement describes a common sexual side effect of diazepam (Valium)?

a. “I’m just not interested in sex as much.”

b. “I’m experiencing vaginal dryness.”

c. “I am having prolonged erections.”

d. “My breasts have gotten larger.”

A

Obtaining a sexual history can be embarrassing for the patient and practitioner. Experience with addressing the topic can help, as can which of the following?

a. Using informal language familiar to the patient’s age group

b. Avoiding specifics and focusing the interview on general topics

c. Avoiding eye contact

d. Using a professional tone of voice and a relaxed posture

D

Which patient has the greatest risk for suicide?

a. A patient who expresses the inability to stop searching the internet for child pornography.

b. A patient who reports having lost interest in having a sexual relationship with his wife.

c. A patient with a history of exposing himself to female strangers on the bus.

d. A patient whose attraction to prepubescent girls has increased.

A

When Melissa was a small child, she insisted that she was a boy, refused to wear dresses, and wanted to be called Mitch. As Melissa reached puberty, she no longer displayed a desire to be male. This change in identity is considered

a. Gender dysphoria

b. Reaction formation

c. Normal

d. Early transgender syndrome

C

Phillip, a 63-­ year-­ old male, has exposed his genitals in public for all of his adult life, but the act has lost some of the former thrill. A rationale for this change in his experience may be

a. An increasing sense of shame

b. Disgust over his lack of control

c. Desire waning with age

d. Progression into actual assault

C

A male arrested for inappropriate sexual contact in a subway car denies the allegation. On interviewing the man, the nurse suspects frotteuristic disorder due to his

a. Lack of relationships

b. Overall aggressive nature

c. Criminal history including robbery

d. Intense hatred of women

A

Pedophilic disorder is the most common paraphilic disorder where adults who have a primary or exclusive sexual preference for prepubescent children. A subset of this disorder is termed hebephilia and is defined as attraction to

a. Infants

b. Pubescent individuals

c. Teens between the ages of 15 and 19

d. Males only

B