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NCLEX Psychiatric Nursing questions & answers part 5
401. A client receiving EMDR therapy says, “After only
two sessions of my therapy, I am feeling great. Now I can stop and get on with
my life.” Which of the following nursing responses is most appropriate?
1. “I am thrilled that you have responded so rapidly
to EMDR.”
2. “To achieve lasting results, all eight phases of
EMDR must be completed.”
3. “If I were you, I would complete the EMDR and
comply with doctor’s orders.”
4. “How do you feel about continuing the therapy?”
ANS: 2
Rationale: Clients often feel relief quite rapidly
with EMDR. However, to achieve lasting results, it is important that each of
the eight phases be completed. The nurse’s most appropriate response should be
to give information to correct the client’s misconceptions about the therapy.
In answer 3 the nurse is subjectively giving advice rather than providing
objective information.
402. A nurse would recognize which treatment as most
commonly used for AD and its appropriate rationale?
1. Psychotherapy; to examine the stressor and confront
unresolved issues
2. Fluoxetine (Prozac); to stabilize mood and resolve
symptoms
3. Eye movement desensitization therapy; to reprocess
traumatic events
4. Lorazepam (Ativan); a first-line treatment to
address symptoms of anxiety
ANS: 1
Rationale: Psychotherapy is the most common treatment
used for AD. AD is not commonly treated with medications. Anxiolytic and
antidepressant medications may be prescribed as adjuncts to psychotherapy but
should not be given as the first line of treatment. Eye movement
desensitization and reprocessing therapy is not used to treat adjustment
disorders.
403. A nurse has been caring for a client diagnosed
with PTSD. Which realistic goal should be included in this client’s plan of
care?
1. The client will have no flashbacks.
2. The client will be able to feel a full range of
emotions by discharge.
3. The client will not require zolpidem (Ambien) to
obtain adequate sleep by discharge.
4. The client will refrain from discussing the
traumatic event.
ANS: 3
Rationale: Obtaining adequate sleep without zolpidem
by discharge is a goal that should be included in the client’s plan of care.
Having no flashbacks and experiencing a full range of emotions by discharge are
unrealistic goals. Clients are encouraged, not discouraged, to discuss the
traumatic event.
404. A client diagnosed with PTSD is receiving
paliperidone (Invega). Which symptoms should a nurse identify that would
warrant the need for this medication?
1. Flat affect and anhedonia
2. Persistent anorexia and 10 lb weight loss in 3
weeks
3. Flashbacks of killing the enemy
4. Distant and guarded in relationships
ANS: 3
Rationale: The nurse should identify that a client who
has flashbacks of killing the enemy may need paliperidone. Paliperidone is an
antipsychotic medication that will address the symptoms of psychosis.
405. A client, who recently delivered a stillborn
baby, has a diagnosis of adjustment disorder unspecified. The nurse case
manager should expect which client presentation that is characteristic of this
diagnosis?
1. The client worries continually and appears nervous
and jittery.
2. The client complains of a depressed mood, is tearful,
and feels hopeless.
3. The client is belligerent, violates others’ rights,
and defaults on legal responsibilities.
4. The client complains of many physical ailments,
refuses to socialize, and quits her job.
ANS: 4
Rationale: The diagnosis of adjustment disorder
unspecified is assigned when the maladaptive reaction is not consistent with
any of the other categories. Manifestations may include physical complaints,
social withdrawal, or work or academic inhibition, without significant
depressed or anxious mood.
406. A client has been extremely nervous ever since a
person died as a result of the client’s drunk driving. When assessing for the
diagnosis of AD, within what time frame should the nurse expect the client to
exhibit symptoms?
1. To meet the DSM-5 criteria for adjustment disorder,
the client should exhibit symptoms within one year of the accident.
2. To meet the DSM-5 criteria for adjustment disorder,
the client should exhibit symptoms within three months of the accident.
3. To meet the DSM-5 criteria for adjustment disorder,
the client should exhibit symptoms within six months of the accident.
4. To meet the DSM-5 criteria for adjustment disorder,
the client should exhibit symptoms within nine months of the accident.
ANS: 2
Rationale: According to the DSM-5 diagnostic criteria
for adjustment disorders, the development of emotional or behavioral symptoms
in response to an identifiable stressor occurs within three months of the onset
of the stressor.
407. A 20-year-old client and a 60-year-old client
have had drunk driving accidents and are both experiencing extreme anxiety.
From a psychosocial theory perspective, which of these clients would be
predisposed to the diagnosis of adjustment disorder?
1. The 60-year-old, because of memory deficits.
2. The 60-year-old, because of decreased cognitive
processing ability.
3. The 20-year-old, because of limited cognitive
experiences.
4. The 20-year-old, because of lack of developmental
maturity.
ANS: 4
Rationale: Research indicates that there is a
predisposition to the diagnosis of adjustment disorder when there is limited
developmental maturity. By comparison, the 20-year-old does not have the
developmental maturity, life experiences, and coping mechanisms that the
60-year-old might possess.
408. A client diagnosed with an adjustment disorder
says to the nurse, “Tell me about medications that will cure this problem.”
Which of the following are appropriate nursing responses? (Select all that
apply.)
1. “Medications can interfere with your ability to
find a more permanent problem solution.”
2. “Medications may mask the real problem at the root
of this diagnosis.”
3. “Adjustment disorders are not commonly treated with
medications.”
4. “Psychoactive drugs carry the potential for
physiological and psychological dependence.”
5. “Psychoactive drugs will be prescribed only if your
problems persist for more than three months.”
ANS: 1, 2, 3, 4
Rationale: Adjustment disorders are not commonly
treated with medications because of temporary effects, masking the real problem,
interfering with finding a permanent solution, and the potential for addiction.
409. A nurse is admitting a client who has been
diagnosed with PTSD. Which of the following symptoms might the nurse expect to
assess? (Select all that apply.)
1. Feelings of guilt that precipitate social isolation
2. Aggressive behavior that affects job performance
3. Relationship problems
4. High levels of anxiety
5. Escalating symptoms lasting less than one month
ANS: 1, 2, 3, 4
Rationale: Characteristic symptoms of PTSD include
re-experiencing the traumatic event, a sustained high level of anxiety or
arousal, general numbing of responsiveness, nightmares, inability to remember
certain aspects of the traumatic event, depression, guilt feelings, substance
abuse, anger, and aggressive behaviors. The full-symptom picture must present
for more than one month and cause significant interference with social,
occupational, and other areas of functioning.
410. A family asks the nurse why their son was
diagnosed with PTSD and others in the accident were not. Which of the following
information should the nurse offer? (Select all that apply.)
1. An individual’s religious affiliation can affect
response to trauma.
2. Responses are affected by how an individual handled
previous trauma.
3. Protectiveness of family and friends can help an
individual deal with trauma.
4. Control over the possibility of recurrence can
affect the response to trauma.
5. The time in which the trauma occurred can affect
the individual’s response.
ANS: 2, 3, 4, 5
Rationale: Variables that affect whether an individual
exposed to massive trauma develops trauma-related disorders are grouped into
characteristics of (1) the traumatic experience, (2) the individual, and (3)
the recovery environment. All information presented falls under one of these
groups. Spiritual beliefs, which can be considered a cultural influence, can
affect the individual’s response, however, an individual’s specific religious
affiliation should have no bearing or influence.
411. A nurse would recognize which of the following as
the best predictors of PTSD in Vietnam veterans? (Select all that apply.)
1. The severity of the stressor
2. The degree of ego strength
3. The degree of psychosocial isolation in the
recovery environment
4. The attitudes of society regarding the experience
5. The presence of preexisting psychopathology
ANS: 1, 3
Rationale: In research with Vietnam veterans, it was
shown that the best predictors of PTSD were the severity of the stressor and
the degree of psychosocial isolation in the recovery environment.
412. A client diagnosed with PTSD states, “Why did my
doctor prescribe an antidepressant rather than an antianxiety drug for me?”
Which of the following are the most appropriate nursing responses? (Select all
that apply.)
1. “I’m not sure, because antianxiety drugs have been
approved by the FDA for PTSD.”
2. “Antidepressants are now considered first-line
treatment choice for PTSD.”
3. “Many people have adverse reactions to antianxiety
drugs.”
4. “Because of their addictive properties, antianxiety
drugs are less desirable.”
5. “There have been no controlled studies on the
effect of antianxiety drugs on PTSD.”
ANS: 2, 4, 5
Rationale: Antidepressants are now considered the
first-line treatment of choice for PTSD. There has been an absence of
controlled studies demonstrating the efficacy of benzodiazepines for the
treatment of PTSD. Their addictive properties make them less desirable than
other medications used in the treatment of PTSD. Paroxetine and sertraline
(antidepressant drugs), not antianxiety drugs, have been approved by the FDA
for the treatment of PTSD. Adverse reactions can occur with the use of
anxiolytic drugs, but these reactions are not common.
413. A client diagnosed with somatic symptom disorder
(SSD) is most likely to exhibit which personality disorder characteristics?
1. Experiences intense and chaotic relationships with
fluctuating attitudes toward others.
2. Socially irresponsible, exploitative, guiltless,
and disregards rights of others.
3. Self-dramatizing, attention seeking, overly
gregarious, and seductive.
4. Uncomfortable in social situations, perceived as
timid, withdrawn, cold, and strange.
ANS: 3
Rationale: The nurse should anticipate that a client
diagnosed with SSD would be self-dramatizing, attention seeking, and overly
gregarious. It has been suggested that, in somatic symptom disorder, there may
be some overlapping of personality characteristics and features associated with
histrionic personality disorder. These symptoms include heightened emotionality,
impressionistic thought and speech, seductiveness, strong dependency needs, and
a preoccupation with symptoms and oneself.
414. A nurse is working with a client diagnosed with
SSD. What criteria would differentiate this diagnosis from illness anxiety
disorder (IAD)?
1. The client diagnosed with SSD experiences physical
symptoms in various body systems, and the client diagnosed with IAD does not.
2. The client diagnosed with SSD experiences a change
in the quality of self-awareness, and the client diagnosed with IAD does not.
3. The client diagnosed with SSD disorder has a
perceived disturbance in body image or appearance, and the client diagnosed
with IAD does not.
4. The client diagnosed with SSD only experiences
anxiety about the possibility of illness, and the client diagnosed with IAD
does not.
ANS: 1
Rationale: Individuals experiencing somatic symptoms
without corroborating pathology are considered to have SSD, and those with
minimal or no somatic symptoms would be diagnosed with IAD, a diagnosis new to
the DSM-5. Clients diagnosed with IAD have minimal or no somatic complaints,
but present with intense anxiety and suspiciousness of the presence of an
undiagnosed, serious medical illness.
Cognitive Level: Analysis
Integrated Process: Assessment
415. Which would be considered an appropriate outcome
when planning care for an inpatient client diagnosed with SSD?
1. The client will admit to fabricating physical
symptoms to gain benefits by day three.
2. The client will list three potential adaptive
coping strategies to deal with stress by day two.
3. The client will comply with medical treatments for
physical symptoms by day three.
4. The client will openly discuss physical symptoms
with staff by day four.
ANS: 2
Rationale: The nurse should determine that an
appropriate outcome for a client diagnosed with SSD would be for the client to
list three potential adaptive coping strategies to deal with stress by day two.
Because the symptoms of SSD are associated with psychosocial distress,
increased coping skills may help the client reduce symptoms.
416. Which are examples of primary and secondary gains
that clients diagnosed with SSD: predominately pain, may experience?
1. Primary: chooses to seek a new doctor; Secondary:
euphoric feeling from new medications
2. Primary: euphoric feeling from new medications;
Secondary: chooses to seek a new doctor
3. Primary: receives get-well cards; Secondary: pain
prevents attending stressful family reunion
4. Primary: pain prevents attending stressful family
reunion; Secondary: receives get-well cards
ANS: 4
Rationale: The nurse should identify that primary
gains are those that allow the client to avoid an unpleasant activity
(stressful family reunion) and that secondary gains are those in which the
client receives emotional support or attention (get-well cards).
417. A nursing instructor is teaching about the
etiology of IAD from a psychoanalytical perspective. What student statement
about clients diagnosed with this disorder indicates that learning has
occurred?
1. “They tend to have a familial predisposition to
this disorder.”
2. “When the sick role relieves them from stressful
situations, their physical symptoms are reinforced.”
3. “They misinterpret and cognitively distort their
physical symptoms.”
4. “They express personal worthlessness through
physical symptoms, because physical problems are more acceptable than
psychological problems.”
ANS: 4
Rationale: The nurse should understand that from a
psychoanalytical perspective, IAD occurs because physical problems are more
acceptable than psychological problems. Psychodynamicists view IAD as a defense
mechanism.
418. An inpatient client is newly diagnosed with
dissociative identity disorder (DID) stemming from severe childhood sexual
abuse. Which nursing intervention takes priority?
1. Encourage exploration of sexual abuse.
2. Encourage guided imagery.
3. Establish trust and rapport.
4. Administer antianxiety medications.
ANS: 3
Rationale: The nurse should prioritize establishing
trust and rapport when beginning to work with a client diagnosed with DID. DID
was formerly called multiple personality disorder. Trust is the basis of every
therapeutic relationship. Each personality views itself as a separate entity
and must be treated as such to establish rapport.
419. A client diagnosed with DID switches
personalities when confronted with destructive behavior. The nurse recognizes
that this dissociation serves which function?
1. It is a means to attain secondary gain.
2. It is a means to explore feelings of excessive and
inappropriate guilt.
3. It serves to isolate painful events so that the
primary self is protected.
4. It serves to establish personality boundaries and
limit inappropriate impulses.
ANS: 3
Rationale: The nurse should anticipate that a client
who switches personalities when confronted with destructive behavior is
dissociating in order to isolate painful events so that the primary self is
protected. The transition between personalities is usually sudden, dramatic,
and precipitated by stress.
420. A client is diagnosed with DID. What is the
primary goal of therapy for this client?
1. To recover memories and improve thinking patterns.
2. To prevent social isolation.
3. To decrease anxiety and need for secondary gain.
4. To collaborate among sub-personalities to improve
functioning.
ANS: 4
Rationale: The nurse should anticipate that the
primary therapeutic goal for a client diagnosed with DID is to collaborate
among sub-personalities to improve functioning. Some clients choose to pursue a
lengthy therapeutic regimen to achieve integration, a blending of all the
personalities into one. The goal is to optimize the client’s functioning and
potential.
421. According to the DSM-5 diagnostic criteria for
dissociative amnesia (DA), what symptom would be essential to meet the criteria
for the subcategory of dissociative fugue?
1. An inability to recall important autobiographical
information
2. Clinically significant distress in social and
occupational functioning
3. Sudden unexpected travel or bewildered wandering
4. “Blackouts” related to alcohol toxicity
ANS: 3
Rationale: An inability to recall important
autobiographical information and clinically significant distress in social and
occupational functioning are basic criteria for the diagnosis of DA. A specific
subtype of dissociative amnesia is with dissociative fugue. Dissociative fugue
is characterized by a sudden, unexpected travel away from customary place of
daily activities, or by bewildered wandering, with the inability to recall some
or all of one’s past. The DSM-5 also states that symptoms cannot be
attributable to the direct physiological effects of a substance (e.g., alcohol,
a drug of abuse, a medication).
422. Which situation is an example of selective
amnesia?
1. A client cannot relate any lifetime memories.
2. A client can describe driving to Ohio but cannot
remember the car accident that occurred.
3. A client often wanders aimlessly after sunset.
4. A client cannot provide personal demographic
information during admission assessment.
ANS: 2
Rationale: Three types of disturbance in recall are
identified in the DSM-5: localized, selective, and generalized. Localized and
selective amnesia are related to a specific stressful event that has occurred.
In selective amnesia, the individual can recall only certain incidents
associated with a stressful event for a specific period after the event. In the
generalized type, the individual has amnesia for his or her identity and total
life history.
423. Neurological tests have ruled out pathology in a
client’s sudden lower-extremity paralysis. Which nursing care should be
included for this client?
1. Deal with physical symptoms in a detached manner.
2. Challenge the validity of physical symptoms.
3. Meet dependency needs until the physical
limitations subside.
4. Encourage a discussion of feelings about the
lower-extremity problem.
ANS: 1
Rationale: The nurse should assist the client in
dealing with physical symptoms in a detached manner. This client should be
diagnosed with a conversion disorder in which symptoms affect voluntary motor
or sensory functioning with or without apparent impairment of consciousness.
Examples include paralysis, aphonia, seizures, coordination disturbance,
difficulty swallowing, urinary retention, akinesia, blindness, deafness, double
vision, anosmia, and hallucinations.
424. Which combination of diagnoses and appropriate
pharmacological treatments are correctly matched?
1. SSD: predominantly pain; treated with venlafaxine
(Effexor)
2. IAD; treated with cefadroxil (Duricef)
3. Conversion disorder; treated with cyclobenzaprine
(Flexeril)
4. Depersonalization-derealization disorder; treated
with mometasone (Elocom)
ANS: 1
Rationale: The nurse should anticipate that the
diagnosis of SSD: predominantly pain can be effectively treated with venlafaxine.
Antidepressants are often used with somatic symptom disorder when the
predominant symptom is pain. They have been shown to be effective in relieving
pain, independent of influences on mood.
425. A nurse is reviewing progress notes on a newly
admitted client. One progress note reveals that the client purposefully
inserted a contaminated catheter into urethra, leading to a urinary tract
infection. The nurse recognizes this behavior as characteristic of which mental
disorder?
1. Illness anxiety disorder
2. Factitious disorder
3. Functional neurological symptom disorder
4. Depersonalization-derealization disorder
ANS: 2
Rationale: Factitious disorders involve conscious,
intentional feigning of physical or psychological symptoms. Individuals with
factitious disorder pretend to be ill in order to receive emotional care and
support commonly associated with the role of “patient.” Individuals become very
inventive in their quest to produce symptoms. Examples include self-inflicted
wounds, injection or insertion of contaminated substances, manipulating a
thermometer to feign a fever, urinary tract manipulation, and surreptitious use
of medications.
426. A nursing instructor is teaching about the DSM-5
diagnosis of depersonalization-derealization disorder (D-DD). Which student
statement indicates a need for further instruction?
1. “Clients with this disorder can experience
emotional and/or physical numbing and a distorted sense of time.”
2. “Clients with this disorder can experience
unreality or detachment with respect to their surroundings.”
3. “During the course of this disorder, individuals or
objects are experienced as dreamlike, foggy, lifeless, or visually distorted.”
4. “During the course of this disorder, the client is
out of touch with reality and is impaired in social, occupational, or other
areas of functioning.”
ANS: 4
Rationale: D-DD is characterized by a temporary change
in the quality of self-awareness, which often takes the form of feelings of
unreality, changes in body image, feelings of detachment from the environment,
or a sense of observing oneself from outside the body. Depersonalization (a
disturbance in the perception of oneself) is differentiated from derealization,
which describes an alteration in the perception of the external environment.
The DSM-5 states that during the depersonalization and/or derealization
experiences, reality testing remains intact. This student statement indicates a
need for further instruction.
427. A client is diagnosed with IAD. Which of the
following symptoms is the client most likely to exhibit? (Select all that
apply.)
1. Obsessive-compulsive behaviors
2. Pseudocyesis
3. Anxiety
4. Flat affect
5. Depression
ANS: 1, 3, 5
Rationale: The nurse should expect that a client
diagnosed with IAD would exhibit obsessive-compulsive behaviors, anxiety, and
depression. Hypochondriasis involves an unrealistic or inaccurate
interpretation of physical symptoms or sensations that can lead to
preoccupation and fear of having a serious disease.
428. A client is diagnosed with functional
neurological symptom disorder (FNSD). Which of the following symptoms is the
client most likely to exhibit? (Select all that apply.)
1. Anosmia
2. Anhedonia
3. Akinesia
4. Aphonia
5. Amnesia
ANS: 1, 3, 4
Rationale: FNSD can also be termed conversion
disorder. Conversion symptoms affect voluntary motor or sensory functioning
suggestive of neurological disease. Examples include paralysis, aphonia,
seizures, coordination disturbance, difficulty swallowing, urinary retention,
akinesia, blindness, deafness, double vision, anosmia, loss of pain sensation,
and hallucinations.
429. A client is exhibiting symptoms of generalized
amnesia. Which of the following questions should the nurse ask to confirm this
diagnosis? (Select all that apply.)
1. “Have you taken any new medications recently?”
2. “Have you recently traveled away from home?”
3. “Have you recently experienced any traumatic
event?”
4. “Have you ever felt detached from your
environment?”
5. “Have you had any history of memory problems?”
ANS: 1, 3, 5
Rationale: The nurse should assess the client for
possible causes of amnesia, which may include side effects of new medications,
experiencing a traumatic event, or having a history of memory problems. Three
types of disturbance in recall are identified in the DSM-5: localized,
selective, and generalized. In the generalized type, the individual has amnesia
for his or her identity and total life history.
430. A 52-year-old client states, “My husband is upset
because I don’t enjoy sex as much as I used to.” Which priority client data
should a nurse initially collect?
1. History of hysterectomy
2. Date of last menstrual cycle
3. Use of birth control methods
4. History of thought disorder
ANS: 2
Rationale: The nurse should assess the client’s last
menstrual cycle to determine if the client is experiencing the onset of
menopause. Menopause usually occurs around the age of 50. The decrease in
estrogen can result in multiple symptoms, including a decrease in biological
drives and sexual activity.
431. In the course of an assessment interview, a
female client reveals a history of bisexual orientation. Which action should
the nurse initially implement when working with this client?
1. Self-assess personal attitudes toward
homosexuality.
2. Review client’s possible childhood sexual abuse
history.
3. Encourage discussion of aversion to heterosexual
relationships.
4. Explore client’s family history of homosexuality.
ANS: 1
Rationale: The nurse should initially self-assess
personal attitudes toward homosexuality. The nurse must be able to recognize
when negative feelings compromise care. Unconditional acceptance of each
individual is an essential component of compassionate nursing.
432. A widower reports a fear of intimacy because of
an inability to achieve and sustain an erection. He has become isolative, has
difficulty sleeping, and has lost weight over the past year. Which nursing
diagnosis should be a priority for this client?
1. Risk for situational low self-esteem AEB inability
to achieve an erection
2. Sexual dysfunction R/T dysfunctional grieving AEB
inability to experience orgasm
3. Social isolation R/T low self-esteem AEB refusing
to engage in dating activities
4. Disturbed body image R/T penile flaccidity AEB
client statements
ANS: 2
Rationale: The nurse should prioritize the nursing
diagnosis sexual dysfunction R/T dysfunctional grieving AEB inability to
experience orgasm. The nurse should assess the client’s mood and level of
energy, because depression and fatigue can decrease desire for participation in
sexual activity.
433. A nurse is assessing a client diagnosed with
pedophilic disorder. What would differentiate this sexual disorder from a
sexual dysfunction?
1. Symptoms of sexual dysfunction include
inappropriate sexual behaviors, whereas symptoms of a sexual disorder include
impairment in normal sexual response.
2. Symptoms of a sexual disorder include inappropriate
sexual behaviors, whereas symptoms of sexual dysfunction include impairment in
normal sexual response.
3. Sexual dysfunction can be caused by increased
levels of circulating androgens, whereas levels of circulating androgens do not
affect sexual disorders.
4. Sexual disorders can be caused by decreased levels
of circulating androgens, whereas levels of circulating androgens do not affect
sexual dysfunction.
ANS: 2
Rationale: The nurse should identify that pedophilic
disorder is a sexual disorder in which individuals partake in inappropriate
sexual behaviors. Sexual dysfunction involves impairment in normal sexual
response. Pedophilic disorder involves having sexual urges, behaviors, or
sexually arousing fantasies involving sexual activity with a prepubescent
child.
434. A female client on an inpatient unit enters the
common area for visiting hours dressed in a see-through blouse. Which intervention
should be a nurse’s first priority?
1. Discuss with the client the inappropriateness of
her attire.
2. Avoid addressing her attention-seeking behavior.
3. Lead the client back to her room and assist her
with a change of clothing.
4. Restrict client to room until visiting hours are
over.
ANS: 3
Rationale: The most appropriate intervention by the
nurse is to lead the client back to her room and assist her with a change of
clothing. The client could be exhibiting symptoms of exhibitionistic disorder,
which is characterized by urges to expose oneself to unsuspecting strangers.
435. A nurse is working with a client diagnosed with
pedophilic disorder. Which client outcome is appropriate for the nurse to
expect during the first week of hospitalization?
1. The client will verbalize an understanding of the
importance of follow-up care.
2. The client will implement several
relapse-prevention strategies.
3. The client will identify triggers for inappropriate
behaviors.
4. The client will attend aversion therapy groups.
ANS: 3
Rationale: During the first week of hospitalization,
identifying triggers for inappropriate behaviors is an appropriate outcome for
a client diagnosed with pedophilic disorder. Pedophilic disorder involves
intense sexual urges, behaviors, or fantasies involving sexual activity with a
prepubescent child.
436. When planning care for a client diagnosed with
female sexual interest/arousal disorder, what should a nurse document as an
expected outcome of senate focus exercises?
1. To initiate immediate orgasm
2. To reduce anxiety by eliminating physical touch
3. To focus on touching breasts and genitals
4. To reduce goal-oriented demands of intercourse
ANS: 4
Rationale: Female sexual interest/arousal disorder is
characterized by a reduced or absent frequency or intensity of interest or
pleasure in sexual activity. Senate focus exercises are highly structured
touching activities designed to help overcome performance anxiety and increase
comfort with physical intimacy. The expected outcome of senate focus exercises
is to reduce goal-oriented demands of intercourse. The reduction in demands
reduces performance pressures and anxiety associated with possible failure.
437. A newly married woman comes to a gynecology
clinic reporting anorexia, insomnia, and extreme pain during intercourse that
has affected her intimate relationship. What initial intervention should the
nurse expect a physician to implement?
1. A thorough physical, including gynecological
examination
2. Referral to a sex therapist
3. Assessment of sexual history and previous
satisfaction with sexual relationships
4. Referral to the recreational therapist for
relaxation therapy
ANS: 1
Rationale: The nurse should expect the physician to
implement a thorough physical, including a gynecological examination to assess
for any physiological causes of the client’s symptoms. If no pathology exists
the client may be diagnosed with genito-pelvic pain/penetration disorder. In
this disorder, the individual experiences considerable difficulty with vaginal
intercourse and attempts at penetration. Pain is felt in the vagina, around the
vaginal entrance and clitoris, or deep in the pelvis. There is fear and anxiety
associated with anticipation of pain or vaginal penetration. A tensing and
tightening of the pelvic floor muscles occurs during attempted vaginal
penetration.
438. A nurse is instructing a client diagnosed with
sexual female sexual interest/arousal disorder. Which symptom and treatment of
this disorder should the nurse describe to the client?
1. Avoidance of all genital sexual contact treated by
sensate focus exercises
2. Avoidance of all genital sexual contact treated by
medicating with tadalafil (Cialis)
3. Anorgasmia treated by vardenafil (Levitra)
4. Anorgasmia treated by systematic desensitization
ANS: 1
Rationale: The nurse should explain to the client that
female sexual interest/arousal disorder is characterized by a reduced or absent
frequency or intensity of interest or pleasure in sexual activity. Senate focus
exercises are highly structured touching activities designed to help overcome
performance anxiety and increase comfort with physical intimacy.
439. A psychiatric nursing instructor is teaching
about the psychological effects of the diagnosis of a sexually transmitted
disease (STD). Which student statement indicates that further instruction is
needed?
1. “STDs carry strong connotations of illicit sex and
considerable social stigma.”
2. “STDs can cause insanity.”
3. “AIDS can generate hopelessness and helplessness.”
4. “Antibiotics administered in the early stages can
cure all STDs.”
ANS: 4
Rationale: The instructor should identify the need for
further instruction if a student states that antibiotics can cure all STDs.
STDs refer to infections that are contracted primarily through sexual
activities or intimate contact. Antibiotics are ineffective in the treatment of
the STD human immunodeficiency virus (HIV).
440. A nurse is counseling a client diagnosed with
gender dysphoria. What criteria would differentiate this disorder from a transvestic
disorder?
1. Clients diagnosed with transvestic disorder are
dissatisfied with their gender, whereas clients diagnosed with gender dysphoria
are not.
2. Clients diagnosed with gender dysphoria are
dissatisfied with their gender, whereas clients diagnosed with transvestic
disorder are not.
3. Clients diagnosed with gender dysphoria avoid all
forms of sexual intercourse, whereas clients diagnosed with transvestic
disorder do not.
4. Clients diagnosed with transvestic disorder avoid
all forms of sexual intercourse, whereas clients diagnosed with gender
dysphoria do not.
ANS: 2
Rationale: The nurse should identify that clients
diagnosed with gender dysphoria are dissatisfied with their gender, whereas
clients diagnosed with transvestic disorder experience intense sexual arousal
from dressing in the clothes of the opposite gender but are not dissatisfied
with their gender. Clients diagnosed with either of these disorders do not
avoid all forms of sexual intercourse.
441. A nurse is assessing a client diagnosed with
sexual masochistic disorder. What would differentiate this paraphilic disorder
from sexual sadistic disorder?
1. Symptoms of sexual masochistic disorder are chronic
acts of humiliation, whereas symptoms of sexual sadistic disorder are acute.
2. Symptoms of sexual sadistic disorder are chronic
acts of humiliation, whereas symptoms of sexual masochistic disorder are acute.
3. Masochistic acts can be performed alone, whereas
sadistic acts must have a consenting or non-consenting partner.
4. Sadistic acts can be performed alone, whereas
mascochistic acts must have a consenting or non-consenting partner.
ANS: 3
Rationale: The identifying feature of sexual
masochistic disorder is recurrent and intense sexual arousal when being
humiliated, beaten, bound, or otherwise made to suffer. These masochistic
activities may be fantasized and may be performed alone (e.g., self-inflicted
pain) or with a partner. The identifying feature of sexual sadistic disorder is
the recurrent and intense sexual arousal from the physical or psychological
suffering of another individual. Both sexual masochistic and sadistic disorders
are chronic in nature.
442. A nurse is assessing a client diagnosed with
fetishistic disorder. What would differentiate this paraphilic disorder from
frotteuristic disorder?
1. To derive sexual excitement, fetishistic disorder
involves the use of nonliving objects, whereas frotteuristic disorder involves
touching and rubbing against non-consenting people.
2. To derive sexual excitement, frotteuristic disorder
involves the use of nonliving objects, whereas fetishistic disorder involves
touching and rubbing against non-consenting people.
3. Clients diagnosed with frotteuristic disorder are
heterosexual cross-dressing males, whereas Clients diagnosed with fetishistic
disorder are homosexual cross-dressing males.
4. Clients diagnosed with fetishistic disorder are
heterosexual cross-dressing males, whereas Clients diagnosed with frotteuristic
disorder are homosexual cross-dressing males.
ANS: 1
Rationale: Fetishistic disorder involves recurrent and
intense sexual arousal from the use of either nonliving objects or specific
nongenital body part(s). Frotteuristic disorder is the recurrent and intense
sexual arousal involving touching and rubbing against a non-consenting person.
Transvestic disorder involves recurrent and intense sexual arousal from
dressing in the clothes of the opposite gender.
443. Which of the following characteristics should a
nurse identify as “normal” in the development of human sexuality for an
11-year-old child? (Select all that apply.)
1. The child experiments with masturbation.
2. The child may experience homosexual play.
3. The child shows little interest in the opposite
sex.
4. The child shows little concern about physical attractiveness.
5. The child is unlikely to want to undress in front
of others.
ANS: 1, 2, 5
Rationale: The nurse should identify that
experimenting with masturbation and homosexual play and not wanting to undress
in front of others are characteristics that are normal in the development of
human sexuality in an 11-year-old child. Interest in the opposite sex usually
increases, and children often become self-conscious about their bodies.
444. A nursing instructor is teaching about the
various categories of paraphilic disorders. Which categories are correctly
matched with expected behaviors? (Select all that apply.)
1. Exhibitionistic disorder: Mary models lingerie for
a company that specializes in home parties.
2. Voyeuristic disorder: John is arrested for peering
in a neighbor’s bathroom window.
3. Frotteuristic disorder: Peter enjoys subway
rush-hour female contact that results in arousal.
4. Pedophilic disorder: George can experience an
orgasm by holding and feeling shoes.
5. Fetishistic disorder: Henry masturbates into his
wife’s silk panties.
ANS: 2, 3, 5
Rationale: Categories of paraphilic disorders include
voyeuristic disorder (observing unsuspecting people, who are naked, dressing,
or engaged in sexual activity), frotteuristic disorder (touching or rubbing
against a non-consenting person), and fetishistic disorder (using nonliving
objects in sexual ways). Exhibitionistic disorder is a paraphilic disorder but
involves the urge to show one’s genitals to unsuspecting strangers. Other
categories include sexual masochism disorder, sexual sadism disorder, and
transvestic disorder.
445. A client is diagnosed with erectile disorder.
Which of the following medications would address this condition, and what is
the therapeutic action of the drug? (Select all that apply.)
1. Phentolamine (Oraverse); increases blood flow to
the penis.
2. Apomorphine (Apokyn); acts directly on the dopamine
receptors in the brain.
3. Vardenafil (Levitra); blocks the action of
phosphodiesterase-5 (PDE5).
4. Goserelin (Zoladex); inhibits the production of
gonadotropins.
5. Sildenafil (Viagra); blocks the action of
phosphodiesterase-5 (PDE5).
ANS: 1, 2, 3, 5
Rationale: Sildenafil (Viagra), tadalafil (Cialis),
and vardenafil (Levitra) have been approved by the FDA for the treatment of
erectile disorder. These newer impotence agents block the action of
phosphodiesterase-5 (PDE5), an enzyme that breaks down cyclic guanosine
monophosphate (cGMP), a compound that is required to produce an erection.
Phentolamine has been used in combination with papaverine in an injectable form
that increases blood flow to the penis, resulting in an erection. Apomorphine
acts directly on the dopamine receptors in the brain. This mode of stimulating
dopamine in the brain is thought to enhance the sexual response. Zoladex is a
treatment for prostate cancer, not erectile dysfunction.
446. A nurse is planning care for a child diagnosed
with gender dysphoria. Which of the following nursing diagnoses could
potentially document this client’s problems? (Select all that apply.)
1. Low self-esteem R/T rejection by peers
2. Self-care deficit R/T isolative behaviors
3. Disturbed personal identity R/T parenting patterns
4. Impaired social interactions R/T socially
unacceptable behaviors
5. Activity intolerance R/T fatigue
ANS: 1, 3, 4
Rationale: Based on the data collected during a
nursing assessment, possible nursing diagnoses for the child with gender
dysphoria may include the following: Disturbed personal identity related to
biological factors or parenting patterns that encourage culturally unacceptable
behaviors for assigned gender, impaired social interaction related to socially
and culturally unacceptable behaviors, and low self-esteem related to rejection
by peers. Self-care deficit and activity intolerance do not address the typical
problems of clients diagnosed with gender dysphoria.
447. During an assessment interview, a client
diagnosed with antisocial personality disorder spits, curses, and refuses to
answer questions. Which is the appropriate nursing response to this behavior?
1. “You are very disrespectful. You need to learn to
control yourself.”
2. “I understand that you are angry, but this behavior
will not be tolerated.”
3. “What behaviors could you modify to improve this
situation?”
4. “What anti-personality disorder medications have
helped you in the past?”
ANS: 2
Rationale: The appropriate nursing response is to
reflect the client’s feeling while setting firm limits on behavior. Clients
diagnosed with antisocial personality disorder have a low tolerance for frustration,
see themselves as victims, and use projection as a primary ego defense
mechanism.
448. At 11:00 p.m. a client diagnosed with antisocial
personality disorder demands to phone a lawyer to file for a divorce. Unit
rules state that no phone calls are permitted after 10:00 p.m. Which nursing
response is most appropriate?
1. “Go ahead and use the phone. I know this pending
divorce is stressful.”
2. “You know better than to break the rules. I’m
surprised at you.”
3. “It is after the 10:00 p.m. phone curfew. You will
be able to call tomorrow.”
4. “A divorce shouldn’t be considered until you have
had a good night’s sleep.”
ANS: 3
Rationale: The most appropriate response by the staff
is to restate the unit rules in a calm, assertive manner. The nurse can encourage
the client to verbalize frustration while maintaining an accepting attitude.
The nurse may also help the client to identify the true source of frustration.
449. A client diagnosed with paranoid personality
disorder becomes violent on a unit. Which nursing intervention is most
appropriate?
1. Provide objective evidence that reasons for
violence are unwarranted.
2. Initially restrain the client to maintain safety.
3. Use clear, calm statements and a confident physical
stance.
4. Empathize with the client’s paranoid perceptions.
ANS: 3
Rationale: The most appropriate nursing intervention
is to use clear, calm statements and to assume a confident physical stance. A
calm attitude provides the client with a feeling of safety and security. It may
also be beneficial to have sufficient staff on hand to present a show of
strength.
450. A client diagnosed with borderline personality
disorder brings up a conflict with the staff in a community meeting and
develops a following of clients who unreasonably demand modification of unit
rules. How can the nursing staff best handle this situation?
1. Allow the clients to apply the democratic process
when developing unit rules.
2. Maintain consistency of care by open communication
to avoid staff manipulation.
3. Allow the client spokesman to verbalize concerns
during a unit staff meeting.
4. Maintain unit order by the application of
autocratic leadership.
ANS: 2
Rationale: The nursing staff can best handle this
situation by maintaining consistency of care by open communication to avoid
staff manipulation. Clients with borderline personality disorder can exhibit
negative patterns of interaction, such as clinging and distancing, splitting,
manipulation, and self-destructive behaviors.
451. Which nursing approach should be used to maintain
a therapeutic relationship with a client diagnosed with borderline personality
disorder?
1. Being firm, consistent, and empathic, while
addressing specific client behaviors
2. Promoting client self-expression by implementing
laissez-faire leadership
3. Using authoritative leadership to help clients
learn to conform to society norms
4. Overlooking inappropriate behaviors to avoid
providing secondary gains
ANS: 1
Rationale: The best nursing approach when working with
a client diagnosed with borderline personality disorder is to be firm,
consistent, and empathetic while addressing specific client behaviors.
Individuals with borderline personality disorder always seem to be in a state
of crisis and can often have negative patterns of interaction, such as
manipulation and splitting.
452. Which adult client should a nurse identify as
exhibiting the characteristics of a dependent personality disorder?
1. A physically healthy client who is dependent on
meeting social needs by contact with 15 cat
2. A physically healthy client who has a history of
depending on intense relationships to meet basic needs
3. A physically healthy client who lives with parents
and depends on public transportation
4. A physically healthy client who is serious,
inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide
security
ANS: 3
Rationale: A physically healthy adult client who lives
with parents and depends on public transportation exhibits signs of dependent
personality disorder. Dependent personality disorder is characterized by a
pervasive and excessive need to be taken care of that leads to submissive and
clinging behaviors.
453. A client expresses low self-worth, has much
difficulty making decisions, avoids positions of responsibility, and has a
behavioral pattern of “suffering” in silence. Which statement best explains the
etiology of this client’s personality disorder?
1. Childhood nurturance was provided from many
sources, and independent behaviors were encouraged.
2. Childhood nurturance was provided exclusively from
one source, and independent behaviors were discouraged.
3. Childhood nurturance was provided exclusively from
one source, and independent behaviors were encouraged.
4. Childhood nurturance was provided from many
sources, and independent behaviors were discouraged.
Ans: 2
Rationale: The behaviors presented in the question
represent symptoms of dependent personality disorder. Nurturance provided from
one source and discouragement of independent behaviors can contribute to the development
of this personality disorder. Dependent behaviors may be rewarded by a parent
who is overprotective and discourages autonomy.
454. Family members of a client ask the nurse to
explain the difference between schizoid and avoidant personality disorders.
Which is the appropriate nursing response?
1. Clients diagnosed with avoidant personality
disorder desire intimacy but fear it, and clients diagnosed with schizoid
personality disorder prefer to be alone.
2. Clients diagnosed with schizoid personality
disorder exhibit delusions and hallucinations, while clients diagnosed with
avoidant personality disorder do not.
3. Clients diagnosed with avoidant personality
disorder are eccentric, and clients diagnosed with schizoid personality
disorder are dull and vacant.
4. Clients diagnosed with schizoid personality
disorder have a history of psychosis, while clients diagnosed with avoidant
personality disorder remain based in reality.
Ans: 1
Rationale: The nurse should educate the family that
clients diagnosed with avoidant personality disorder desire intimacy but fear
it, while clients diagnosed with schizoid personality disorder prefer to be
alone. Schizoid personality disorder is characterized by a profound deficit in
the ability to form personal relationships. Clients diagnosed with schizoid
personality disorder may exhibit odd and eccentric behaviors but not to the
extent of psychosis.
455. Which nursing diagnosis should a nurse identify
as appropriate when working with a client diagnosed with schizoid personality
disorder?
1. Altered thought processes R/T increased stress
2. Risk for suicide R/T loneliness
3. Risk for violence: directed toward others R/T
paranoid thinking
4. Social isolation R/T inability to relate to others
ANS: 4
Rationale: An appropriate nursing diagnosis when
working with a client diagnosed with schizoid personality disorder is social
isolation R/T inability to relate to others. Clients diagnosed with schizoid
personality disorder appear cold, aloof, and indifferent to others. They prefer
to work in isolation and are not sociable.
456. Looking at a slightly bleeding paper cut, the
client screams, “Somebody help me quick! I’m bleeding. Call 911!” A nurse
should identify this behavior as characteristic of which personality disorder?
1. Schizoid personality disorder
2. Obsessive-compulsive personality disorder
3. Histrionic personality disorder
4. Paranoid personality disorder
ANS: 3
Rationale: The nurse should identify this behavior as
characteristic of histrionic personality disorder. Individuals with this
disorder tend to be self-dramatizing, attention seeking, over gregarious, and
seductive.
457. When planning care for a client diagnosed with
borderline personality disorder, which self-harm behavior should a nurse expect
the client to exhibit?
1. The use of highly lethal methods to commit suicide
2. The use of suicidal gestures to elicit a rescue
response from others
3. The use of isolation and starvation as suicidal
methods
4. The use of self-mutilation to decrease endorphins
in the body
ANS: 2
Rationale: The nurse should expect that a client
diagnosed with borderline personality disorder may use suicidal gestures to
elicit a rescue response from others. Repetitive, self-mutilating behaviors are
common in borderline personality disorders that result from feelings of
abandonment following separation from significant others.
458. A nurse tells a client that the nursing staff
will start alternating weekend shifts. Which response should a nurse identify
as characteristic of clients diagnosed with obsessive-compulsive personality
disorder?
1. “You really don’t have to go by that schedule. I’d
just stay home sick.”
2. “There has got to be a hidden agenda behind this
schedule change.”
3. “Who do you think you are? I expect to interact
with the same nurse every Saturday.”
4. “You can’t make these kinds of changes! Isn’t there
a rule that governs this decision?”
ANS: 4
Rationale: The nurse should identify that a client
with obsessive-compulsive personality disorder would have a difficult time accepting
changes. This disorder is characterized by inflexibility and lack of
spontaneity. Individuals with this disorder are very serious, formal,
over-disciplined, perfectionistic, and preoccupied with rules.
459. Which reaction to a compliment from another
client should a nurse identify as a typical response from a client diagnosed
with avoidant personality disorder?
1. Interpreting the compliment as a secret code used
to increase personal power
2. Feeling the compliment was well deserved
3. Being grateful for the compliment but fearing later
rejection and humiliation
4. Wondering what deep meaning and purpose is attached
to the compliment
ANS: 3
Rationale: The nurse should identify that a client
diagnosed with avoidant personality disorder would be grateful for the
compliment but would fear later rejection and humiliation. Individuals
diagnosed with avoidant personality disorder are extremely sensitive to
rejection and are often awkward and uncomfortable in social situations.
460. Which factors differentiate a client diagnosed
with social phobia from a client diagnosed with schizoid personality disorder?
1. Clients diagnosed with social phobia are treated
with cognitive behavioral therapy, whereas clients diagnosed with schizoid
personality disorder need medications.
2. Clients diagnosed with schizoid personality
disorder experience anxiety only in social settings, whereas clients diagnosed
with social phobia experience generalized anxiety.
3. Clients diagnosed with social phobia avoid
attending birthday parties, whereas clients diagnosed with schizoid personality
disorder would isolate self on a continual basis.
4. Clients diagnosed with schizoid personality
disorder avoid attending birthday parties, whereas clients diagnosed with
social phobia would isolate self on a continual basis.
ANS: 3
Rationale: A client diagnosed with schizoid
personality disorder exhibits a profound deficit in the ability to form
personal relationships. Clients diagnosed with schizoid personality disorder
prefer being alone to being with others and avoid social situations, social
contacts, and activities.
461. Which client symptoms should lead a nurse to
suspect a diagnosis of obsessive-compulsive personality disorder?
1. The client experiences unwanted, intrusive, and
persistent thoughts.
2. The client experiences unwanted, repetitive
behavior patterns.
3. The client experiences inflexibility and lack of
spontaneity when dealing with others.
4. The client experiences obsessive thoughts that are
externally imposed.
ANS: 3
Rationale: The nurse should suspect a diagnosis of
obsessive-compulsive personality disorder when a client experiences
inflexibility and lack of spontaneity. Individuals with this disorder are very
serious, formal, and have difficulty expressing emotions. They are perfectionistic
and preoccupied with rules.
462. Which client is a nurse most likely to admit to
an inpatient facility for self-destructive behaviors?
1. A client diagnosed with antisocial personality
disorder
2. A client diagnosed with borderline personality disorder
3. A client diagnosed with schizoid personality
disorder
4. A client diagnosed with paranoid personality
disorder
ANS: 2
Rationale: The nurse should expect that a client
diagnosed with borderline personality disorder would be most likely to be admitted
to an inpatient facility for self-destructive behaviors. Clients diagnosed with
this disorder often exhibit repetitive, self-mutilating behaviors. Most
gestures are designed to elicit a rescue response.
463. When planning care for clients diagnosed with
personality disorders, what should be the goal of treatment?
1. To stabilize the client’s pathology by using the
correct combination of psychotropic medications
2. To change the characteristics of the dysfunctional
personality
3. To reduce personality trait inflexibility that
interferes with functioning and relationships
4. To decrease the prevalence of neurotransmitters at
receptor sites
ANS: 3
Rationale: The goal of treatment for clients diagnosed
with personality disorders should be to reduce inflexibility of personality
traits that interfere with functioning and relationships. Personality disorders
are often difficult and, in some cases, seem impossible to treat. There are no
psychotropic medications approved specifically for the treatment of personality
disorders.
464. Which client situation would reflect the
impulsive behavior that is commonly associated with borderline personality
disorder?
1. As the day-shift nurse leaves the unit, the client
suddenly hugs the nurse’s arm and whispers, “The night nurse is evil. You have
to stay.”
2. As the day-shift nurse leaves the unit, the client
suddenly hugs the nurse’s arm and states, “I will be up all night if you don’t
stay with me.”
3. As the day-shift nurse leaves the unit, the client
suddenly hugs the nurse’s arm, yelling, “Please don’t go! I can’t sleep without
you being here.”
4. As the day-shift nurse leaves the unit, the client
suddenly shows the nurse a bloody arm and states, “I cut myself because you are
leaving me.”
Ans: 4
Rationale: The client who states, “I cut myself
because you are leaving me” reflects impulsive behavior that is commonly
associated with borderline personality disorder. Repetitive, self-mutilating
behaviors are common in clients diagnosed with borderline personality disorders
that result from feelings of abandonment following separation from significant
others.
465. Which nursing diagnosis should be prioritized
when providing nursing care to a client diagnosed with paranoid personality
disorder?
1. Risk for violence: directed toward others R/T
paranoid thinking
2. Risk for suicide R/T altered thought
3. Altered sensory perception R/T increased levels of
anxiety
4. Social isolation R/T inability to relate to others
Ans: 1
Rationale: The priority nursing diagnosis for a client
diagnosed with paranoid personality disorder should be risk for violence:
directed toward others R/T paranoid thinking. Clients diagnosed with paranoid
personality disorder have a pervasive distrust and suspiciousness of others
that result in a constant threat readiness. They are often tense and irritable,
which increases the likelihood of violent behavior.
466. From a behavioral perspective, which nursing
intervention is appropriate when caring for a client diagnosed with borderline
personality disorder?
1. Seclude the client when inappropriate behaviors are
exhibited.
2. Contract with the client to reinforce positive
behaviors with unit privileges.
3. Teach the purpose of anti-anxiety medications to
improve medication compliance.
4. Encourage the client to journal feelings to improve
awareness of abandonment issues.
Ans: 2
Rationale: The most appropriate nursing intervention
from a behavioral perspective is to contract with the client to reinforce
positive behaviors with unit privileges. Behavioral strategies offer reinforcement
for positive change.
467. A highly emotional client presents at an
outpatient clinic appointment and states, “My dead husband returned to me
during a séance.” Which personality disorder should a nurse associate with this
behavior?
1. Obsessive-compulsive personality disorder
2. Schizotypal personality disorder
3. Narcissistic personality disorder
4. Borderline personality disorder
ANS: 2
Rationale: The nurse should associate schizotypal
personality disorder with this behavior. The behaviors of people diagnosed with
schizotypal personality disorder are odd and eccentric but do not decompensate
to the level of schizophrenia.
468. A nursing instructor is teaching students about
clients diagnosed with histrionic personality disorder and the quality of their
relationships. Which student statement indicates that learning has occurred?
1. “Their dramatic style tends to make their
interpersonal relationships quite interesting and fulfilling.”
2. “Their interpersonal relationships tend to be
shallow and fleeting, serving their dependency needs.”
3. “They tend to develop few relationships because
they are strongly independent but generally maintain deep affection.”
4. “They pay particular attention to details, which
can interfere with the development of relationships.”
ANS: 2
Rationale: The instructor should evaluate that
learning has occurred when the student describes clients diagnosed with
histrionic personality disorder as having relationships that are shallow and
fleeting. These types of relationships tend to serve their dependency needs.
469. During an interview, which client statement
should indicate to a nurse a potential diagnosis of schizotypal personality
disorder?
1. “I don’t have a problem. My family is inflexible,
and relatives are out to get me.”
2. “I am so excited about working with you. Have you
noticed my new nail polish, ‘Ruby Red Roses’?”
3. “I spend all my time tending my bees. I know a
whole lot of information about bees.”
4. “I am getting a message from the beyond that we
have been involved with each other in a previous life.”
ANS: 4
Rationale: The nurse should assess that a client who
states that he or she is getting a message from beyond indicates a potential
diagnosis of schizotypal personality disorder. Individuals with schizotypal
personality disorder are aloof and isolated and behave in a bland and apathetic
manner. The person experiences magical thinking, ideas of reference, illusions,
and depersonalization as part of daily life.
470. Which nursing diagnosis should be prioritized
when providing nursing care to a client diagnosed with avoidant personality
disorder?
1. Risk for violence: directed toward others R/T
paranoid thinking
2. Risk for suicide R/T altered thought
3. Altered sensory perception R/T increased levels of
anxiety
4. Social isolation R/T inability to relate to others
ANS: 4
Rationale: The priority nursing diagnosis for a client
diagnosed with avoidant personality disorder should be social isolation R/T
inability to relate to others. These clients avoid close or romantic relationships,
interpersonal attachments, and intimate sexual relationships.
471. A nurse is admitting a client with a new
diagnosis of a personality disorder. Which of the following would make the
nurse question this diagnosis? (Select all that apply.)
1. The client has been diagnosed with sickle cell
anemia.
2. The client has an inflated self-appraisal and feels
a sense of entitlement.
3. The client has a history of a substance use
disorder.
4. The client is odd and eccentric but not delusional.
5. The client has an intellectual developmental
disorder.
ANS: 1, 3, 5
Rationale: The DSM-5 states that impairments in
personality functioning and the individual’s personality trait expression are
not better understood as normative for the individual’s developmental stage or
sociocultural environment. The impairments in personality functioning and the
individual’s personality trait expression are not solely due to the direct
physiological effects of a substance (e.g., a drug of abuse, medication) or a
general medical condition (e.g., severe head trauma). The nurse would question
the diagnosis of a personality disorder in a client with sickle cell anemia,
substance use disorder, or an intellectual developmental disorder.
472. Which statements represent positive outcomes for
clients diagnosed with narcissistic personality disorder? (Select all that
apply.)
1. The client will relate one empathetic statement to
another client in group by day two.
2. The client will identify one personal limitation by
day one.
3. The client will acknowledge one strength that
another client possesses by day two.
4. The client will list four personal strengths by day
three.
5. The client will list two lifetime achievements by
discharge.
ANS: 1, 2, 3
Rationale: The nurse should determine that appropriate
outcomes for a client diagnosed with narcissistic personality disorder include
relating empathetic statements to other clients, identifying one personal
limitation, and acknowledging one strength in another client. Narcissistic
personality disorder is characterized by an exaggerated sense of self-worth, a
lack of empathy, and exploitation of others.
473. A nurse is caring for a client diagnosed with
antisocial personality disorder. Which factors should the nurse consider when
planning this client’s care? (Select all that apply.)
1. This client has personality traits that are deeply
ingrained and difficult to modify.
2. This client needs medication to treat the
underlying physiological pathology.
3. This client uses manipulation, making the
implementation of treatment problematic.
4. This client has poor impulse control that hinders
compliance with a plan of care.
5. This client is likely to have secondary diagnoses
of substance abuse and depression.
ANS: 1, 3, 4, 5
Rationale: The nurse should consider that individuals
diagnosed with antisocial personality disorders have deeply ingrained
personality traits, use manipulation, have poor impulse control, and often have
secondary diagnoses of substance abuse or depression.
474. A client is being assessed for antisocial personality
disorder. According to the DSM-5, which of the following symptoms must the
client meet in order to be assigned this diagnosis? (Select all that apply.)
1. Ego-centrism and goal setting based on personal
gratification.
2. Incapacity for mutually intimate relationships.
3. Frequent feelings of being down miserable and/or
hopeless.
4. Disregard for and failure to honor financial and
other obligations.
5, Intense feelings of nervousness, tenseness, or
panic.
ANS: 1, 2, 4
Rationale: The essential features of a personality
disorder are impairments in personality (self and interpersonal) functioning
and the presence of pathological personality traits. Pathological personality
traits of antagonism and disinhibition must occur in order to meet the criteria
for the diagnosis of antisocial personality disorder. Frequent feelings of
being down, miserable, and/or hopeless and intense feelings of nervousness,
tenseness, or panic are characteristics of the pathological personality trait
domain of negative affectivity. This domain is listed by the DSM-5 for the
diagnosis of borderline personality disorder, not antisocial personality
disorder.
475. A kindergarten student is frequently violent
toward other children. A school nurse notices bruises and burns on the child’s
face and arms. What other symptom should indicate to the nurse that the child
may have been physically abused?
1. The child shrinks at the approach of adults.
2. The child begs or steals food or money.
3. The child is frequently absent from school.
4. The child is delayed in physical and emotional
development.
ANS: 1
Rationale: The nurse should determine that a child who
shrinks at the approach of adults in addition to having bruises and burns may
be a victim of abuse. Maltreatment is considered, whether or not the adult
intended to harm the child.
476. A woman presents with a history of physical and
emotional abuse in her intimate relationships. What should this information
lead a nurse to suspect?
1. The woman may be exhibiting a controlled response
pattern.
2. The woman may have a history of childhood neglect.
3. The woman may be exhibiting codependent
characteristics.
4. The woman may be a victim of incest.
ANS: 4
Rationale: The nurse should suspect that this client
may be a victim of incest. Many women who are battered have low self-esteem and
have feelings of guilt, anger, fear, and shame. Women in abusive relationships
often grew up in an abusive home.
477. A nursing instructor is developing a lesson plan
to teach about domestic violence. Which information should be included?
1. Power and control are central to the dynamic of
domestic violence.
2. Poor communication and social isolation are central
to the dynamic of domestic violence.
3. Erratic relationships and vulnerability are central
to the dynamic of domestic violence.
4. Emotional injury and learned helplessness are
central to the dynamic of domestic violence.
ANS: 1
Rationale: The nursing instructor should include the
concept that power and control are central to the dynamic of domestic violence.
Battering is defined as a pattern of coercive control founded on physical
and/or sexual violence or threat of violence. The typical abuser is very
possessive and perceives the victim as a possession.
478. A client is brought to an emergency department
after being violently raped. Which nursing action is appropriate?
1. Discourage the client from discussing the rape,
because this may lead to further emotional trauma.
2. Remain nonjudgmental while actively listening to
the client’s description of the violent rape event.
3. Meet the client’s self-care needs by assisting with
showering and perineal care.
4. Probe for further, detailed description of the rape
event.
ANS: 2
Rationale: The most appropriate nursing action is to
remain nonjudgmental and actively listen to the client’s description of the
event. It is important to also communicate to the victim that he/she is safe
and that it is not his/her fault. Nonjudgmental listening provides an avenue
for catharsis, which contributes to the healing process.
479. A raped client answers a nurse’s questions in a
monotone voice with single words, appears calm, and exhibits a blunt affect.
How should the nurse interpret this client’s responses?
1. The client may be lying about the incident.
2. The client may be experiencing a silent rape
reaction.
3. The client may be demonstrating a controlled
response pattern.
4. The client may be having a compounded rape
reaction.
ANS: 3
Rationale: This client is most likely demonstrating a
controlled response pattern. In the controlled response pattern, the client’s
feelings are masked or hidden, and a calm, composed, or subdued affect is seen.
In the expressed response pattern, feelings of fear, anger, and anxiety are
expressed through crying sobbing, smiling, restlessness, and tension.
480. A client who is in a severely abusive
relationship is admitted to a psychiatric inpatient unit. The client fears for
her life. A staff nurse asks, “Why doesn’t she just leave him?” Which is the
nursing supervisor’s most appropriate response?
1. “These clients don’t know life any other way, and
change is not an option until they have improved insight.”
2. “These clients have limited cognitive skills and
few vocational abilities to be able to make it on their own.”
3. “These clients often have a lack of financial
independence to support themselves and their children, and most have religious
beliefs prohibiting divorce and separation.”
4. “These clients are paralyzed into inaction by a
combination of physical threats and a sense of powerlessness.”
ANS: 4
Rationale: The nursing supervisor is accurate when
stating that clients who are in abuse relationships are paralyzed into inaction
by a combination of physical threats and a sense of powerlessness. Women often
choose to stay with an abusive partner: for the children, for financial
reasons, for fear of retaliation, for lack of a support network, for religious
reasons, or because of hopefulness.
481. A woman comes to an emergency department with a
broken nose and multiple bruises after being beaten by her husband. She states,
“The beatings have been getting worse, and I’m afraid, next time, he will kill
me.” Which is the appropriate nursing response?
1. “Leopards don’t change their spots, and neither
will he.”
2. “There are things you can do to prevent him from
losing control.”
3. “Let’s talk about your options so that you don’t
have to go home.”
4. “Why don’t we call the police so that they can
confront your husband with his behavior?”
ANS: 3
Rationale: The most appropriate response by the nurse
is to talk with the client about options so that the client does not have to
return to the abusive environment. It is essential that clients make decisions
on their own without the nurse being the “rescuer.” Imposing judgments and
giving advice is nontherapeutic.
482. A college student was sexually assaulted when out
on a date. After several weeks of crisis intervention therapy, which client
statement should indicate to a nurse that the student is handling this
situation in a healthy manner?
1. “I know that it was not my fault.”
2. “My boyfriend has trouble controlling his sexual
urges.”
3. “If I don’t put myself in a dating situation, I
won’t be at risk.”
4. “Next time I will think twice about wearing a sexy
dress.”
ANS: 1
Rationale: The client who realizes that sexual assault
was not her fault is handling the situation in a healthy manner. The nurse
should provide nonjudgmental listening and communicate statements that instill
trust and validate self-worth.
483. A client asks, “Why does a rapist use a weapon
during the act of rape?” Which is the most appropriate nursing response?
1. “To decrease the victimizer’s insecurity.”
2. “To inflict physical harm with the weapon.”
3. “To terrorize and subdue the victim.”
4. “To mirror learned family behavior patterns related
to weapons.”
ANS: 3
Rationale: The nurse should explain that a rapist uses
weapons to terrorize and subdue the victim. Rape is the expression of power and
dominance by means of sexual violence. Rape can occur over a broad spectrum of
experience, from violent attack to insistence on sexual intercourse by an
acquaintance or spouse.
484. When questioned about bruises, a woman states,
“It was an accident. My husband just had a bad day at work. He’s being so
gentle now and even brought me flowers. He’s going to get a new job, so it
won’t happen again.” This client is in which phase of the cycle of battering?
1. Phase I: The tension-building phase
2. Phase II: The acute battering incident phase
3. Phase III: The honeymoon phase
4. Phase IV: The resolution and reorganization phase
ANS: 3
Rationale: The client is in the honeymoon phase of the
cycle of battering. In this phase, the batterer becomes extremely loving, kind,
and contrite. Promises are often made that the abuse will not happen again.
485. Which information should the nurse in an employee
assistance program provide to an employee who exhibits symptoms of domestic
physical abuse?
1. Have ready access to a gun and learn how to use it.
2. Research lawyers that can aid in divorce
proceedings.
3. File charges of assault and battery.
4. Have ready access to the number of a safe house for
battered women.
ANS: 4
Rationale: The nurse should provide information about
the accessibility of safe houses for battered women when working with a client
who has symptoms of domestic physical abuse. Many women feel powerless within
the abusive relationship and may be staying in the abusive relationship out of
fear.
486. A survivor of rape presents in an emergency
department crying, pacing, and cursing her attacker. A nurse should recognize
these client actions as which behavioral defense?
1. Controlled response pattern
2. Compounded rape reaction
3. Expressed response pattern
4. Silent rape reaction
ANS: 3
Rationale: The nurse should recognize that this client
is exhibiting an expressed response pattern. In the expressed response pattern,
feelings of fear, anger, and anxiety are expressed through crying, sobbing,
smiling, restlessness, and tension. In the controlled response pattern, the
client’s feelings are masked or hidden, and a calm, composed, or subdued affect
is seen.
487. Which assessment data should a school nurse
recognize as a sign of physical neglect?
1. The child is often absent from school and seems
apathetic and tired.
2. The child is very insecure and has poor
self-esteem.
3. The child has multiple bruises on various body
parts.
4. The child has sophisticated knowledge of sexual
behaviors.
ANS: 1
Rationale: The nurse should recognize that a child who
is often absent from school and seems apathetic and tired may be a victim of
neglect. Other indicators of neglect are stealing food or money, lacking
medical or dental care, being consistently dirty, lacking sufficient clothing,
or stating that there is no one home to provide care.
488. A client diagnosed with an eating disorder
experiences insomnia, nightmares, and panic attacks that occur before bedtime.
She has never married or dated, and she lives alone. She states to a nurse, “My
father has recently moved back to town.” What should the nurse suspect?
1. Possible major depressive disorder
2. Possible history of childhood incest
3. Possible histrionic personality disorder
4. Possible history of childhood physical abuse
ANS: 2
Rationale: The nurse should suspect that this client
may have a history of childhood incest. Adult survivors of incest are at risk
for developing post-traumatic stress disorder, sexual dysfunction, somatization
disorders, compulsive sexual behavior disorders, depression, anxiety, eating
disorders, and substance abuse disorders.
489. In planning care for a woman who presents as a
survivor of domestic abuse, a nurse should be aware of which of the following
data? (Select all that apply.)
1. It often takes several attempts before a woman
leaves an abusive situation.
2. Substance abuse is a common factor in abusive
relationships.
3. Until children reach school age, they are usually
not affected by abuse between their parents.
4. Women in abusive relationships usually feel
isolated and unsupported.
5. Economic factors rarely play a role in the decision
to stay.
ANS: 1, 2, 4
Rationale: When planning care for a woman who is a
survivor of domestic abuse, the nurse should be aware that it often takes
several attempts before a woman leaves an abusive situation, that substance
abuse is a common factor in abusive relationships, and that women in abusive
relationships usually feel isolated and unsupported. Children can be affected
by domestic violence from infancy, and economic factors often play a role in
the victim’s decision to stay.
490. Which of the following nursing diagnoses are
typically appropriate for an adult survivor of incest? (Select all that apply.)
1. Low self-esteem
2. Powerlessness
3. Disturbed personal identity
4. Knowledge deficit
5. Non-adherence
ANS: 1, 2
Rationale: An adult survivor of incest would most
likely have low self-esteem and a sense of powerlessness. Adult survivors of
incest are at risk for developing post-traumatic stress disorder, sexual
dysfunction, somatization disorders, compulsive sexual behavior disorders,
depression, anxiety, eating disorders, and substance abuse disorders.
491. A nursing instructor is teaching about intimate
partner violence. Which of the following student statements indicate that
learning has occurred? (Select all that apply.)
1. “Intimate partner violence is a pattern of abusive
behavior that is used by an intimate partner.”
2. “Intimate partner violence is used to gain power
and control over the other intimate partner.”
3. “Fifty-one percent of victims of intimate violence
are women.”
4. “Women ages 25 to 34 experience the highest per
capita rates of intimate violence.”
5. “Victims are typically young married women who are
dependent housewives.”
ANS: 1, 2, 4
Rationale: Intimate partner violence is a pattern of
abusive behavior that is used by an intimate partner. It is used to gain power
and control over the other intimate partner. Women ages 25 to 34 experience the
highest per capita rates of intimate violence. Eighty-five percent of victims
of intimate violence are women. Battered women represent all age, racial,
religious, cultural, educational, and socioeconomic groups. They may be married
or single, housewives or business executives.
492. A client has recently been placed in a long-term
care facility, because of marked confusion and inability to perform most
activities of daily living (ADLs). Which nursing intervention is most
appropriate to maintain the client’s self-esteem?
1. Leave the client alone in the bathroom to test
ability to perform self-care.
2. Assign a variety of caregivers to increase
potential for socialization.
3. Allow client to choose between two different
outfits when dressing for the day.
4. Modify the daily schedule often to maintain variety
and decrease boredom.
ANS: 3
Rationale: The most appropriate nursing intervention
to maintain this client’s self-esteem is to allow the client to choose between
two different outfits when dressing for the day. The nurse should also provide
appropriate supervision to keep the client safe, maintain consistency of
caregivers, and maintain a structured daily routine to minimize confusion.
493. A son, who recently brought his extremely
confused parent to a nursing home for admission, reports feelings of guilt.
Which is the appropriate nursing response?
1. “Support groups are held here on Mondays for
children of residents in similar situations.”
2. “You did what you had to do. I wouldn’t feel guilty
if I were you.”
3. “Support groups are available to low-income
families.”
4. “Your parent is doing just fine. We’ll take very
good care of him.”
ANS: 1
Rationale: The most appropriate response by the nurse
is to offer support to the son by presenting available support groups.
Caregivers can often experience negative emotions and guilt. Release of these
emotions can serve to prevent caregivers from developing psychopathology such a
depression.
494. A family asks why their father is attending
activity groups at the long-term care facility. The son states, “My father
worked hard all of his life. He just needs some rest at this point.” Which is
the appropriate nursing response?
1. “I’m glad we discussed this. We’ll excuse him from
the activity groups.”
2. “The groups benefit your father by providing social
interaction, sensory stimulation, and reality orientation.”
3. “The groups are optional. Only clients at high
functioning levels would benefit.”
4. “If your father doesn’t go to these activity
groups, he will be at high risk for developing cognitive problems.”
ANS: 2
Rationale: The most appropriate nursing response is to
educate the family that the purpose of activity groups is to provide social
interaction, sensory stimulation, and reality orientation. Groups can also
serve to increase self-esteem and reduce depression.
495. A nursing instructor is teaching about
reminiscence therapy. What student statement indicates that learning has
occurred?
1. “Reminiscence therapy is a group in which
participants create collages representing significant aspects of their lives.”
2. “Reminiscence therapy encourages members to share
both positive and negative significant life memories to promote resolution.”
3. “Reminiscence therapy is a social group where
members chat about past events and future plans.”
4. “Reminiscence therapy encourages members to share
positive memories of significant life transitions.”
ANS: 2
Rationale: Reminiscence therapy encourages members to
share both positive and negative significant life memories to promote
resolution. Stimulation of life memories serve to help older clients work
through their losses and maintain self-esteem. Reminiscence therapy can take
place in one-on-one or group settings.
496. A couple both reside in a long-term care
facility. The husband is admitted to the psychiatric unit after physically
abusing his wife. He states, “My wife is having an affair with a young man, and
I want it investigated.” Which is the appropriate nursing response?
1. “Your wife is not having an affair. What makes you
think that?”
2. “Why do you think that your wife is having an
affair?”
3. “Your wife has told us that these thoughts have no
basis in fact.”
4. “I understand that you are upset. We will talk
about it.”
ANS: 4
Rationale: The most appropriate response by the nurse
is to empathize with the client and encourage the client to talk about the
situation. The nurse should remain nonjudgmental and help maintain client’s
orientation, memory, and recognition.
497. A student nurse asks the instructor, “Which
psychiatric disorder is most likely initially diagnosed in the elderly?” Which
instructor response gives the student accurate information?
1. “Schizophrenia is most likely diagnosed later in
life.”
2. “Major depressive disorder is most likely diagnosed
later in life.”
3. “Phobic disorder is most likely diagnosed later in
life.”
4. “Dependent personality disorder is most likely
diagnosed later in life.”
ANS: 2
Rationale: Major depressive disorder is most likely to
be identified later in life. Depression among older adults can be increased by
physical illness, functional disability, cognitive impairment, and loss of a
spouse.
498. An older client attending an adult day care
program suddenly begins reporting dizziness, weakness, and confusion. What
should be the initial nursing intervention?
1. Implement complete bedrest.
2. Advocate for a complete physical exam.
3. Address self-esteem needs.
4. Advocate for individual psychotherapy.
ANS: 2
Rationale: The initial nursing intervention should be
to advocate for a complete physical exam. Sudden onset of dizziness, weakness,
and confusion could indicate a problem with the client’s cardiovascular or
respiratory symptoms. Physical symptoms should be thoroughly assessed prior to
attributing symptoms to psychological causes.
499. An older client who lives with a caregiver is
admitted to an emergency department with a fractured arm. The client is soaked
in urine and has dried fecal matter on lower extremities. The client is 6 feet
tall and weighs 120 pounds. Which condition should the nurse suspect?
1. Inability for the client to meet self-care needs
2. Alzheimer’s disease
3. Abuse and/or neglect
4. Caregiver role strain
ANS: 3
Rationale: The nurse should expect that this client is
a victim of elder abuse or neglect. Indicators of elder physical abuse include
bruises, fractures, burns, and other physical injury. Neglect may be manifested
as hunger, poor hygiene, unattended physical problems, or abandonment.
500. An older, emaciated client is brought to an
emergency department by the client’s caregiver. The client has bruises and
abrasions on shoulders and back in multiple stages of healing. When directly
asked about these symptoms, which type of client response should a nurse
anticipate?
1. The client will honestly reveal the nature of the
injuries.
2. The client may deny or minimize the injuries.
3. The client may have forgotten what caused the
injuries.
4. The client will ask to be placed in a nursing home.
ANS: 2
Rationale: The nurse should anticipate that the client
may deny or minimize the injuries. The older client may be unwilling to
disclose information, because of fear of retaliation, embarrassment about the
existence of abuse in the family, protectiveness toward a family member, or
unwillingness to bring about legal action.
501. A client in the middle stage of Alzheimer’s
disease has difficulty communicating because of cognitive deterioration. Which
nursing intervention is appropriate to improve communication?
1. Discourage attempts at verbal communication owing
to increased client frustration.
2. Increase the volume of the nurse’s communication
responses.
3. Verbalize the nurse’s perception of the implied
communication.
4. Encourage the client to communicate by writing.
ANS: 3
Rationale: The most appropriate nursing intervention
is to verbalize the nurse’s perception of the implied communication. The nurse
should also keep explanations simple, use face-to-face interaction, and speak
slowly without shouting.
502. An older client is exhibiting symptoms of major
depressive disorder. A physician is considering prescribing an antidepressant.
Which physiological problem should make a nurse question this medication
regime?
1. Altered cortical and intellectual functioning
2. Altered respiratory and gastrointestinal
functioning
3. Altered liver and kidney functioning
4. Altered endocrine and immune system functioning
ANS: 3
Rationale: The nurse should question the use of
antidepressant medication in a client with altered liver and kidney function.
Antidepressant medication should be administered with consideration for
age-related physiological changes in absorption, distribution, elimination, and
brain receptor sensitivity. Because of these changes, medications can reach
high levels despite moderate oral dosage.
503. An older client has met the criteria for a
diagnosis of major depressive disorder. The client does not respond to
antidepressant medications. Which therapeutic intervention should a nurse
anticipate will be ordered for this client?
1. Electroconvulsive therapy (ECT)
2. Neuroleptic therapy
3. An antiparkinsonian agent
4. An anxiolytic agent
ANS: 1
Rationale: The nurse should anticipate that ECT will
be ordered to treat this client’s symptoms of depression. ECT remains one of
the safest and most effective treatments for major depression in older adults.
The response to ECT may be slower in older clients, and the effects may be of
limited duration.
504. A nurse is charting assessment information about
a 70-year-old client. According to the U.S. Census Bureau, what term would the
nurse use to describe this client?
1. The nurse should document using the term older.
2. The nurse should document using the term elderly.
3. The nurse should document using the term aged.
4. The nurse should document using the term very old.
ANS: 2
Rationale: The U.S. Census Bureau classifies a
70-year-old individual as elderly. The U.S. Census Bureau has developed a
system for classification of older Americans: older: 55–64; elderly: 65–74;
aged: 75–84; very old: 85 years and older.
505. Which individual is most likely to be below the
poverty level in the United States?
1. A 70-year-old Hispanic woman living alone
2. A 72-year-old African American man living alone
3. A 68-year-old Asian American woman living with
family
4. A 75-year-old Latino American man living with
family
ANS: 1
Rationale: Approximately 3.5 million persons age 65 or
older were below the poverty level in 2010. Older women had a higher poverty
rate than older men, and older Hispanic women living alone had the highest poverty
rate.
506. According to Reichard, Livson, and Peterson,
which classification of the personalities of older men describe
passive-dependent individuals who are content to lean on others for support, to
disengage, and to let most of life’s activities pass them by?
1. “Mature men” personalities
2. “Armored men” personalities
3. “Self-haters” personalities
4. “Rocking chair” personalities
ANS: 4
Rationale: In a classic study by Reichard, Livson, and
Peterson, the personalities of older men were classified into five major
categories according to their patterns of adjustment to aging. “Rocking chair”
personalities are found in passive-dependent individuals who are content to
lean on others for support, to disengage, and to let most of life’s activities
pass them by.
507. According to Reichard, Livson, and Peterson, a
client is classified as an “armored man.” Which personality description led to
this classification?
1. Rigid and stable, presenting a strong silent front
2. Passive-dependent individuals who lean on others
for support
3. Aggressiveness is common, as is suspicion of others
4. Animosity is turned inward on themselves
ANS: 1
Rationale: In a classic study by Reichard, Livson, and
Peterson, the personalities of older men were classified into five major categories
according to their patterns of adjustment to aging. Armored men have
well-integrated defense mechanisms, which serve as adequate protection. Rigid
and stable, they present a strong silent front and often rely on activity as an
expression of their continuing independence.
508. According to genetic theory, aging is an
involuntarily inherited process that operates over time to alter cellular or
tissue structures. Which of the following findings support this theory?
(Select all that apply.)
1. Decreased amounts of adrenocorticotropic hormone,
resulting in less-efficient stress response
2. The development of collagen
3. The development of lipofuscin
4. The increased frequency in the occurrence of cancer
5. The increased frequency in the occurrence of autoimmune
disorders
ANS: 2, 3, 4, 5
Rationale: According to genetic theory, aging is an
involuntarily inherited process that operates over time to alter cellular or
tissue structures. This theory suggests that life span and longevity changes
are predetermined. The development of free radicals, collagen, and lipofuscin
in the aging body, and an increased frequency in the occurrence of cancer and
autoimmune disorders, provide some evidence for this theory and the proposition
that error or mutation occurs at the molecular and cellular level. Decreased
amounts of adrenocorticotropic hormone, resulting in less-efficient stress
response is part of the normal aging process of the endocrine system.
509. Approximately two million American children have
experienced the deployment of a parent to Iraq or Afghanistan. How many of
these children either lost a parent or have a parent who was wounded in these
conflicts?
1. 48,000
2. 26,000
3. 11,000
4. 8,000
ANS: 1
Rationale: More than 48,000 children have either lost
a parent or have a parent who was wounded in Iraq or Afghanistan.
510. Research has shown that an adolescent (13 to18
years) would typically exhibit which behavior as a reaction to parental
military deployment?
1. May exhibit regressive behaviors and assume blame
for parent’s departure.
2. May become sullen, tearful, throw temper tantrums,
or develop sleep problems.
3. May participate in high-risk behaviors, sexual
acting out, and drug or alcohol abuse.
4. May respond to schedule disruptions with
irritability and/or apathy and weight loss.
ANS: 3
Rationale: Infants (birth to 12 months) may respond to
schedule disruptions with irritability and/or apathy and weight loss. Toddlers
(1 to 3 years) may become sullen, tearful, throw temper tantrums, or develop
sleep problems. Preschoolers (3 to 6 years) may regress in areas such as toilet
training, sleep, separation fears, physical complaints, or thumb sucking and
may assume blame for parent’s departure. School age children (6 to 12 years)
are more aware of potential dangers to parent. May exhibit irritable behavior,
aggression, or whininess. May become more regressed and fearful about parent’s
safety.
Adolescents (13 to 18 years) may be rebellious,
irritable, or more challenging of authority. Parents need to be alert to
high-risk behaviors, such as problems with the law, sexual acting out, and drug
or alcohol abuse.
511. What is the expected feeling and/or behavior
experienced by military families during the “sustainment” cycle of deployment,
as described by Pincus and associates?
1. Feelings alternate between denial and anticipation
of loss.
2. Feelings alternate between excitement and
apprehension associated with homecoming.
3. Feelings focus on the establishment of new support
systems and new family routines.
4. Feelings focus on the struggle to take charge of
the details of the new family structure.
ANS: 3
Rationale: In the pre-deployment cycle, feelings
alternate between denial and anticipation of loss. In the redeployment cycle,
feelings alternate between excitement and apprehension associated with
homecoming. In the sustainment cycle, families establish new support systems
and new family routines. In the deployment cycle, the spouse struggles to take
charge of the details of living without his or her partner.
512. A nursing instructor is teaching about suicide
among active duty military. Which fact should the instructor include in the
lesson plan?
1. On average, two suicides a day occur in the U.S.
military.
2. From 2005 to 2009, relationship distress factored
in more than 25% of Army suicides.
3. Statistically, in 2012, suicide rates of service
members surpassed the number killed in combat.
4. Military suicides are associated with a
narcissistic personality disorder diagnosis.
ANS: 3
Rationale: On average, one not two suicides a day occur
in the U.S. military. From 2005 to 2009, relationship distress factored in more
than 50% not 25% of Army suicides. Military suicides are associated with the
diagnoses of substance use disorder, major depressive disorder, PTSD, and TBI,
not narcissistic personality disorder. Statistically, in 2012, suicide rates of
service members surpassed the number killed in combat.
513. A nursing instructor is preparing a lesson plan
related to the history of the diagnosis of post-traumatic stress disorder
(PTSD). Which of the following facts would be appropriate to include? (Select
all that apply.)
1. Between 1950 and 1970, little was written about
PTSD.
2. During the 1970s and 1980s, there was a major
increase in research on PTSD.
3. During the 1970s and 1980s, much research was
related to World War II veterans.
4. PTSD did not appear until the third edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
5. PTSD did not appear until the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
ANS: 1, 2, 4
Rationale: Very little was written about PTSD during
the years between 1950 and 1970. This absence was followed in the 1970s and
1980s with an explosion in the amount of research and writing on the subject.
During this time, much research was related to Vietnam not World War II
veterans. PTSD did not appear until the third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-III).
514. Which of the following should a nurse identify as
stressors in the lives of military spouses and children? (Select all that
apply.)
1. Frequent moves
2. School credit transfer issues
3. Complications of spousal employment
4. Spousal loneliness
5. Loss of military privileges during spousal
deployment
ANS: 1, 2, 3, 4
Rationale: The lives of military spouses and children
are clearly affected when the service-member’s active duty assignments require
frequent family moves. These include, among others, school credit transfer
issues, complications of spousal employment, and spousal loneliness. Military
privileges are not lost during spousal deployment.
515. Owing to the unique challenges experienced by
children of active duty military, which of the following fears would a nurse
most likely identify? (Select all that apply.)
1. Fear of not being accepted in new schools
2. Fear of being behind academically
3. Fear of not making friends in new schools
4. Fear of losing athletic standing
5. Fear of discrimination from new school faculty
ANS: 1, 2, 3, 4
Rationale: Military children face unique challenges.
They fear not being accepted, being behind academically, not making friends,
and losing athletic standing as they move from one school to another. Fear of
discrimination from new school faculty has not been shown as a realistic fear
in this population.
516. After reporting a sexual assault, a female
soldier is diagnosed with a personality disorder. Which of the following
consequences may result? (Select all that apply.)
1. Court-martial proceedings
2. Loss of health-care benefits
3. Loss of service-related disability compensation
4. Stigma of a psychiatric diagnosis
5. Service discharge
ANS: 2, 3, 4, 5
Rationale: Some military women who report their sexual
assaults are discharged with a psychiatric diagnosis of personality disorder or
adjustment disorder. Some of the consequences of this diagnosis are loss of
health-care benefits, loss of service-related disability compensation, and the
stigma of a psychiatric diagnosis. The report of a sexual assault would not
lead to courtmartial proceedings for the victim.
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