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Chapter 1 Answers and Rationales 1. a. By allowing the client to take medication at times that are best for her supports client- centered mental health care. b. Incorrect because the nurse is looking at the client’s individual responses to the medication. c. This is incorrect because it is not an emergency and since the client has a positive response to the medication at a time she chooses, there is no reason to report this information. d. Health education is an integral part of client-centered care, but, answer a depicts a client- centered response. 2. b. Client-centered health care is the correct answer. Answers a, c, and d are not the best explanation for the nurse’s actions in No.1. 3. a. Partial hospitalization is more likely to be a part of the managed care mental health package than the other answers. Answers b and c are not offered with managed care mental health care. Answer (d) is not necessarily apart of mental health care. 4. a. These approaches were used because mental illness was associated with sin and demonic possessions. Answer b is incorrect because mental illness was seen as incurable rather than curable; answer c is incorrect because mental illness was not associated with special powers; answer d is incorrect because mental illness during this period was not treated humanely. 5. a. Is correct because the theory advocates the importance of the nurse-client relationship as a venue for expression of feelings. Answer b is incorrect because although helping clients develop adaptive behaviors may be a goal, the basis of the theory is the nurse-client relationship. Answer c is incorrect because ambivalence is not a major treatment focus. Answer d is incorrect because health education is not the basis of this theory. 6. b. Answer b is correct because by reducing the client’s symptoms, nurses were able to use psychosocial interventions to enhance treatment. Answer a is incorrect because, normally, electroshock produced calmness rather than agitation. Answer c is incorrect because if the client is more sedated, nursing care is increased. Answer d is incorrect because post lobotomy calmness is likely to require less nursing care. 7. b. Answer b is correct because post WW II, psychiatric nurses were more visible to the public and caring for post war psychological needs. Answer a is incorrect because community-based care did not occur during this period. Answer c is incorrect because nurses did not work alone; they were part of mental health teams that provided post war psychological care. Answer d is incorrect because although their roles and practice were beginning to transform, they were still custodial. 8. d. The correct answer is d because there is no such act as the Deinstitutionalization Act of 1961. Answers a, b, and c are legislation which transformed the practice of psychiatric nursing. 9. d. The correct answer is d because it depicts crisis intervention as a primary prevention approach. Answers a, b, and c depict secondary prevention approaches. 10. d. The correct answer is d because all answers reflect models of care that integrate neurobiology and psychosocial concepts. 11. b. The correct response is b because telemedicine does not afford a face-to-face interaction with the client which may interfere with forming a therapeutic relationship. Answer a is incorrect because although telemedicine is costly, the client’s still has access to care because of insurance coverage. Answer c, this intervention is useful in emergency situations. Answer d is incorrect because it offers a referral and this is another advantage of telemedicine. 12. d. The correct response is d because it takes into account cultural and individual preferences. Answers a and b may be important, but cultural considerations and health practices must be assessed and, when appropriate, integrated into health planning. Answer c may actually interfere with meeting the client’s cultural needs. 13. d. The correct answer is d because all of the factors influenced ANA’s efforts to validate psychiatric mental health nursing contributions to the nursing profession. 14. b. The correct answer is b because advances in neurobiology, genetics, and neuroscience are already playing pivotal roles in psychiatric and mental health delivery systems. Answer a is incorrect because increased enrollment in graduate programs alone does not impact the future of the specialty. Answers c and d are incorrect because mental health care models are more likely to parallel managed care which focuses on brief, focused psychotherapy and community-based care. The correct response is b because mental health care must integrate various models such as neurobiology and psychosocial concepts rather than just the former. Answers a, c, and d are incorrect. Chapter 2 Answers and Rationales 1. b. The correct answer is b, ego, because it refers to the structure of the personality that maintains reality orientation and mediates conflict. Answer a, id, is incorrect because it represents the pleasure principle and is often in conflict with the superego. Answer c, eros, is incorrect because it is not part of Freud’s theory on personality structure. Answer d, superego, is also incorrect because it is involved in the ideal principle and conscious (mores) and is often in conflict with the id. 2. d. The correct response is d, repression, because, according to psychoanalytical theory, it is the personality’s first line of defense to keep unwanted thoughts out of the awareness. Answer a, sublimation, is incorrect and refers to a normal form of dealing with undesirable thoughts by keeping them in an acceptable context. Answer b, anxiety, is incorrect because it is not a defense mechanism. Answer c, suppression, is also incorrect because it refers to unconscious, purposeful forgetting of painful or dangerous thoughts (the most basic defense mechanism). 3. b. Answer b, anal, is correct because, according to psychoanalytical theory, it is the developmental stage responsible for problems with excessive orderliness and neatness. Answer a, oral, is incorrect because this developmental stage is responsible for problems with oral activities such as smoking and object relationships. Answer c, phallic, is also incorrect because this developmental stage is responsible for problems with object love and may affect relations in adult life. Lastly, answer d, genital, is incorrect because problems during this developmental stage often result in sexual identity issues. 4. a. Answer a, persona, is the correct answer because it represents Carl Jung’s term, “public personality” , or the aspects of self that one reveals to others. Answer b, anima, is incorrect because it represents the feminine archetype in men. Answer c, animus, is also incorrect because it represent the masculine archetype in women. Answer d, shadow, is also incorrect because it reflects the prehistoric fear of wild animals and the animal side of human nature. 5. c. The correct answer is c, Sullivan, because the concept of “good me,” “bad me,” and “not me” were explicated by this theorist. Answers a, Freud, b, Horney, d, Adler, are incorrect because they did not coin these concepts. 6. b. The correct answer is b, classic conditioning, because this term refers to the behavioral theory concerning reinforcement that occurs before the response. Answer a, operant conditioning, is incorrect because this term refers to a type of learning in which responses are modified by their consequences. Answer c, modeling, is also incorrect because this term means a form of learning in which a person learns by watching someone else perform a desired response. Answer d, respondent conditioning, is also incorrect because it is not associated with behavioral theories. 7. c. Response c, overgeneralization, is correct because it is the concept from cognitive theory that refers to applying a rule, drawn from one or more isolated incidents, across the board to unrelated situations. Answer a, arbitrary inference, is incorrect because it refers to the process of drawing specific conclusions in the absence of evidence to support the conclusion. The evidence may be contrary to the conclusion. Answer b, selective abstraction, is also incorrect because this term refers to a focus on a detail taken out of context, ignoring more salient features of the situation, and conceptualizing the whole experience on the one detail. Answer d, personalization, is also incorrect because it refers to the proclivity to relate external events to oneself when there is no basis for making such a connection. 8. a. Answer a, magnification, is correct because it refers to distorting the significance of an event so gross as to constitute a distortion. Answer b, dichotomous thinking, is incorrect because this concept places all experiences in one of two opposite categories. Answer c, selective abstraction, is also incorrect because it involves focusing on a detail taken out of context, ignoring more salient features of the situation, and conceptualizing the whole experience on the one detail. Answer d, overgeneralization, is incorrect because this concept involves applying a rule, drawn from one or more isolated incidents, across the board to unrelated situations. 9. d. The correct answer is d, Peplau, because she defined nursing as a significant, therapeutic, interpersonal process. Answer a, Roy, is incorrect because her theory described the goal of nursing as contributing to the client’s health, quality of life, and dying with dignity by promoting adaptation in all four spheres. Answer b, Neuman, is also incorrect because she defined nursing as a unique profession concerned with all the variables affecting the person’s response to stressors. Lastly, c, Orem, is incorrect because she stated that nursing consists of deliberate and purposeful actions to provide assistance to those who are unable to meet health-related self-care needs. 10. d. Answer d, projection, is correct because this term refers to attributing one’s unacknowledged thoughts and feelings to others. Answer a, intellectualization, is incorrect because this refers to the use of excessive reasoning rather than reacting or changing. Answer b, displacement, is also incorrect because it means redirection of negative urges or feelings from an original object to a safer or neutral substitute. Answer c, denial, is also incorrect because this term refers to a refusal to admit to a painful reality which is treated as if it does not exist. 11. a. The correct response is a, sublimation, because it refers to what Valliant called a mature defense mechanism. Answer b, denial, is incorrect because Valliant referred to this concept as a psychotic defense mechanism that involved denial of reality and that it is found in healthy people before age 5. Answer c, repression, is also incorrect because Valliant referred to this defense mechanism as a neurotic defense. Answer d, reaction formation, is also incorrect because Valliant referred to this term as a neurotic defense that are found in healthy people. Chapter 3 Answers and Rationales 1. a. The correct answer is a because her perception of the event, stored memory of fear, and ultimate reaction involved activation of the hypothalamus-pituitary-adrenal axis (HPA) and amygdala. The amygdala acts as a powerful modulator of fear responses. Answer b, kindling, neurotransmitters is incorrect because kindling is associated with repeated or recurrent episodes of mood changes and neurotransmitters have vast purposes they do not explain Mary’s responses. Answer c is also incorrect because genetic predisposition does not explain these neurological processes. Lastly, d is incorrect even though it plays a role in encoding and retrieval of memory, it does not account for the physiological responses associated with the HPA. 2. a. The correct answer is a because these are classic psychotic symptoms that are usually associated with dysregulation of neurotransmitter systems, such as dopamine, and alterations in other systems. The answer b is incorrect because it does not explain alterations in neurobiological processes although stressful situations may worsen or exacerbate symptoms there is no evidence that this exists. The answer c is incorrect because, although dopamine plays a role in psychosis, other neurotransmitters also contribute to these symptoms. Furthermore, based on this question, there is a lack of evidence to support that he has been involved in interpersonal conflicts. 3. a. The correct answer is a because stress or pressures often overtax individual coping skills and result in maladaptive behavioral responses. The answer d is important but is not as critical as her present stressors. The answer c, “How long has she lived with you?” is also incorrect because, although the quality of support systems is important, at this time it is not as important as determining her present stressors. Answer d, “Is there a family history of mental illness?” is also important, but, because of the emergent situation, identifying her stressors is more important. 4. a. The correct answer is a because the child’s behavior is normal and reflects a normal stress reaction. Reassuring the parents is important so they can be more supportive to the child and each other. Reassurance also involves educating the child and parents about normal stress reactions. Answer b is incorrect because it suggests that the child is depressed and that his symptoms are maladaptive. Answer c is also incorrect because of the child’s developmental stage and it suggests that his symptoms are maladaptive. The last answer, d, educating the parents about normal stress reactions, is important, but is not the most immediate response to the child and parents. 5. a. The correct answer is a because health maintenance includes interventions that maintain health and address the needs of high-risk groups. In the case of the man who loses his job and is seen in a crisis center, anticipatory counseling is used before he becomes symptomatic. Answers b, c, and d are important nursing interventions but the situations indicate that the clients are symptomatic. 6. c. The correct answer is c because of cognitive deficits stemming from vast degenerative changes in the brain. Persons with Alzheimer’s disease (AD) are likely to become aggressive and verbally abusive due to their inability to learn new information, their impulsivity, and loss of executive functioning. Answer a is incorrect because, although attempts to reorient the client are important, AD interferes with the client’s ability to learn new information. Answer b is also incorrect because, rather than becoming calm and cooperative, the reverse is more likely to occur. Answer d is also incorrect because not only will persons have impaired recent memory, they are also likely to have remote memory problems. Chapter 4 Answers and Rationales 1. a. The correct response is a because the earliest messages about trust, self-worth, value, and self-esteem stem from early childhood interactions. Positive relationships that validate the child and provide emotional, physical, and social needs provide the foundation of coping patterns. Answer b, quality of child-peer relationships, is important but their origins stem from social interaction with parents. Answers c and d are also based on early interactions with parents or caretakers. 2. a. The correct answer is a because verbalization of feelings helps her express her thoughts and feelings about the loss of her friend. It also helps her parents to understand the nature of her grief. Answer b is helpful but her immediate needs involve talking about her loss. Answer c is incorrect because, although teaching the parents how to talk to her, teaching them how to listen is more important. Response d is also incorrect because encouraging dependency actually promotes maladaptive coping responses. 3. c. The most appropriate response to the social worker is c because it affords privacy to respond to her in an assertive and respectful manner. Answer a is incorrect because it is provocative and unproductive and may result in confrontation. Answer b is also incorrect because the nurse assumes that the social worker is correct and requires some proof of the client’s complaints. Finally, answer d is also incorrect because it is disruptive if the response is an inappropriate expression of anger. 4. d. The correct answer is d because social development stems from interactions based on developmental level, neurobiological factors, and social development. Of these factors, social development is the least likely to influence adaptation and coping. 5. a. The correct answer is a, provide continuous and comprehensive care for persons with mental disorders. Answer b, reduce conflict between disciplines, is not client-centered and is also an inappropriate forum for these issues. Answer c is also incorrect because it refers to the client’s educational needs rather than the role of the team. Lastly, d is also incorrect because, again, this answer is not client-centered and is focuses on the staff’s needs. 6. a. The correct answer is a, primary appraisal-stress-injurious, because Mr. Jones perceives being asked for a divorce as injury to his self-esteem and inability to cope with losing his wife. Answer b, primary appraisal-stress challenging, is incorrect because Mr. Jones does not feel hopeful about his marriage nor does he feel happy or enthusiastic. Answer c, primary appraisal-irrelevant-challenging, is incorrect for the same reasons as answer b except irrelevant appraisal takes place when an external event does not pose a threat to the individual’s livelihood. Chapter 5 Answers and Rationales 1. D. The most appropriate response to Mr. Jones who presents in the emergency room complaining of a tight neck and difficulty turning his head is d, all of the above. Answer a, attempt to develop a therapeutic relationship with the client which is essential in establishing trust; answer b, gather as much information about his medication, is equally important to the nursing assessment to determine if this is an adverse drug reaction; and c, inquire if he has had these before, is extremely important in determining how these symptoms were managed and the client’s perception of his symptoms. 2. A. The correct answer is a because delusions, preoccupations, and obsessions represent thought content. Answer b, orientation, is incorrect and refers to the client’s alertness and awareness of surroundings (e.g., person, place, time). Answer c, thought processes, is incorrect and refers to whether the client’s thoughts are organized, disorganized, or incoherent. Answer d, cognition, is also incorrect because this term refers to higher brain function involving issues such as planning, judgment, and level of awareness and alertness. 3. B. In the case of Mary, the 18 year-old-girl seen in a community mental health clinic complaining of abdominal pain, the most appropriate nursing action is answer b, inquire about the duration and progression of pain. By assessing duration and progression, the nurse can gather important information about the client’s physical condition. Answers a, disregard her pain, and c, offer her medication to manage her thoughts, are incorrect. Unfortunately, in persons with mental disorders, physical complaints are often discounted and construed as part of their psychiatric symptoms. The reality is that the nurse must assess the client’s physical complaints and make appropriate medical referrals to discern a differential diagnosis. The last response, d, document her complaints and ask her to call if it persists, is also incorrect for the reasons discussed in the previous response. 4. D. The correct answer is d. Instructing him to take an over-the-counter sleep medication is inappropriate because the nurse has failed to properly assess his symptoms and risk for suicide. Answers a through c are correct because they reflect the nursing assessment of the client’s sleep disturbances. Present medications helps the nurse determine that the client is experiencing side effects that cause sleep problems. Documenting his complaints is part of the data collection process and assessing for suicide is also important because the sleep disturbances may result from a mood or anxiety disorder. 5. A. The most appropriate nursing action in this case is a, acknowledge the client’s concerns and take time to listen, is crucial to forming a therapeutic relationship. Answer b, take the time to listen but let her know that there are more clients waiting, is inappropriate because it negates the client’s needs and conveys a hurried attitude. Answer c is also inappropriate because the nurse needs to take the time to listen and further assess the client’s concerns and needs. Lastly, answer d, apologize and reschedule her for a less busy time, is also inappropriate. Apologizing is appropriate, however, rescheduling her is not appropriate because the client has taken the time to seek help and there is no guarantee that future visits will not be busy. Chapter 6 Answers and Rationales 1. a. The correct answer is a, therapeutic touch, because clients who are suspicious and experiencing paranoia are extremely sensitive to environmental stimuli. The nurse must avoid touching because it is intrusive and often results in the client taking measures to protect himself due to a perceived threat. Answer b, silence, is less threatening and intrusive. Answer c, direct eye contact, is important when establishing rapport but the nurse must limit this and also avoid glaring or staring eye contact which may be perceived as a threat or challenge. Finally, answer d, encouragement of expression of feelings, enables the nurse to assess the client’s experience. 2. c. In the case of a client pacing and clenching his fist, the most appropriate response is c, explore the meaning of his behavior, helps the nurse further assess the client’s needs and experience. Answer a, leave the room, is incorrect unless the nurse feels her life is in danger. Talking to the client and further assessing his nonverbal behavior helps the nurse determine the client’s needs. Answer b, offer an injection of haloperidol, is also incorrect, especially if the nurse has inadequately assessed the client’s behavior. The final answer, d, call security services, is important but not unless the client escalates and the nurse feels threatened. 3. c. The major purpose of the process recording is answer c, evaluate the nurse-client interaction. This is a learning tool that can strengthen communication skills between the nurse and client. Answers a, evaluate the client’s responses, b, evaluate the nurse’s responses, and d, evaluate the client’s verbal cues, are correct. However, answer c actually captures all of these answers. 4. a. Answer a reflects self-awareness because the nurse is able to express her feelings and understand their meaning. She also takes responsibility for her thoughts and feelings. Answer b, allowing the client to stay up later than other clients, is inappropriate and reflects a lack of self-awareness because of the unfairness, a lack of structure, and consistency among the clients. Answer c, referring to the client in room 10 as an alcoholic, is a demeaning statement because rather than referring to the client as a person, the nurse dehumanizes him by calling him an alcoholic. The nurse is obviously unaware of the impact of this statement on the client. Answer d, “I do not want to be assigned to a certain client,” may reflect countertransference issues related to the client and the nurse’s awareness of her behavior and perception of the client. 5. a. Answer a depicts active listening skills, “Mr. Jones, it sounds like you are depressed because of your recent job loss.” Answers b and c suggest that the client does not have a right to his feelings and that the nurses is not listening to his concerns. In answer d, the nurse assumes that because the client is quiet, he is feeling “pretty low.” 6. b. The most appropriate response for using humor is b, promote trust by reducing tension and frustration. Answers a and d suggest inappropriate use of humor, specifically using it destructively because it negates the seriousness of the client’s problems or situation. Answer c is incorrect because although it is healthy to reduce anxiety in the nurse. This fails to justify its use as a therapeutic communication tool. Chapter 7 Answers and Rationales 1. c. The fact that psychiatric symptoms are perceived, evaluated, and acted on differently by people from different cultures is the result of answer c, cultural patterns, because they influence how symptoms are expressed, perceived, and understood. Answer a, cultural conditioning, is not a correct term and has not been used in this chapter. Answers b and d are also incorrect terms and are unrelated to culture or ethnic influences or psychiatric symptoms. 2. a. Groups of symptoms that indicate a specific illness in non-Western cultures but are not found in Western cultures are answer a, culture-bound disorders. Answer b, psychosomatic disorders, are not unique to non-Western cultures and denote emotional states producing or exacerbating physical problems. Answers c and d are not part of the nomenclature of psychiatric disorders. 3. c. Psychiatric nurses who are unclear about their own values and beliefs tend to be answer c, apathetic, because a lack of self-awareness often time results in missed opportunities to recognize the client’s values and beliefs unique to his culture. Answer a, assertive, is incorrect and generally reflects confidence, self-assuredness, and awareness of one’s values and beliefs which promote a greater understanding of the client’s values and cultural sensitivity. Answers b, inconsistent, and d, reliable, are incorrect because they fail to relate to whether the nurse lacks self-awareness about values and beliefs. 4. c. Second-and third-generation Asian-Americans may experience stress-generated conflict between ethnic ideology and American ideology, answer c. The client has to deal with opposite worldview perspectives or enculturation that often produces stress and strain and predispose certain persons to mental distress. Answer a, yin and yang, refer to mental, physical, and spiritual balance. Answer b, extended family and nuclear family, may influence stress-generated conflict but cultural differences between generations are more likely to generate a higher level of conflict and mental distress. Lastly, d, nuclear family and American ideology, is incorrect because these factors are less likely to cause conflict than the other factors. 5. b. An adaptive response to some clients from non-Western cultures is, answer b, fatalistic perspective, is correct because it refers to a belief that no one has control over one’s health outcome. Answer a, extended future perspective, is incorrect because this concept is not related to adaptation within cultures. Answer c, individualism, is also incorrect because this term refers to individual health practices and beliefs that are not necessarily part of a larger culture. Lastly, egalitarianism is also incorrect because this concept refers to belief in the equality of all people. Chapter 8 Answers and Rationales 1. b. Answer b, changes in the delivery care and technology make ongoing review of mental health laws necessary, is true about the history of mental health laws. This answer reflects the progressive nature of mental health laws governing the care of persons with mental illnesses. Answer c is incorrect because various agencies at the federal and state levels were more instrumental in making importance changes in mental health laws than lawyers. Answer a is incorrect because reforms have occurred beyond the 1960s. Answer d is incorrect because in mental health, not all laws are based on the United States Constitution. In fact, they may vary from state to state. 2. c. Answer c, ethical principles, can be used to help guide nursing actions is a true statement concerning ethical principles. Nursing, like other disciplines, have codes of ethics to guide practice. Answer a is incorrect because ethical principles vary among cultures and individuals. Answer b is incorrect because a nurse basing her practice solely on ethical principles does not guarantee acting within the law. Lastly, answer d, disagreement among healthcare providers concerning ethical principles, does not reflect that one is correct and the other one is incorrect. Ethical codes vary among health care providers and each guides practice. 3. a. The correct answer is a, the student nurse informs the client that she is a nursing student during introductions, is not a violation of professional boundaries. Answer b is incorrect because giving a client a backrub in a community health setting who is stressed is clearly a violation of professional boundaries. Likewise, answers c, giving a client a ride home, and d, a nurse describing to a client having been abused as a child, are incorrect. The latter answer involves inappropriate disclosure and is clearly a violation of professional boundaries. 4. d. Answer d, all of the above, is true because nurses who work with clients of other cultures or races should, a, be aware of their own stereotypes or prejudices about other cultures or races; b, attempt to learn more about the cultures and races of the clients they serve; and c, be aware of how cultural issues may affect the nursing process. All increase cultural competence and sensitivity to the clients needs. 5. d. Answer d, all Americans have the legal right to the same mental health care, is true about mental health laws. Answer a is incorrect; clients who are a danger to themselves and other scan be committed (or hospitalized against their will). Answer b is also incorrect because minors do not have the same legal rights as adults regarding mental health issues. Finally, answer c is also incorrect because clients who are civilly committed to treatment do not have the right to refuse treatment. 6. b. Answer b, the obligation of mental health providers to warn against potential victims of violence by clients, refers to the legal “duty to warn.” Answer a is incorrect because the “duty to warn” does not represent an obligation of nurses to tell fellow staff when a client has a history of violence although this data is important to report and document to fellow staff. Answer c is also incorrect because this term does not refer to the obligation of nurses to report substance abuse to fellow nurses, and like answer a, it is important to include this data in the assessment report. Finally, answer d is also incorrect because the “duty to warn” does not involve client obligations to warn staff about other violent clients. 7. c. Answer c, keep reporting suspected child abuse is one situation in which the nurse may breach confidentiality, is a true statement regarding confidentiality. Answer a is incorrect because all information shared by clients should not be kept private, especially when it involves child or elder abuse and other imminently violent situations. Answer b is incorrect because a nurse may not provide information about clients to other nurses in the same institution unless the client gives written permission. Lastly, answer d, spouses do not have the same right to the record as the client because the client has a right to privacy unless the nurse is given written permission to share information with the spouse. 8. b. Answer b is correct because the best way to avoid malpractice allegations is to keep abreast of professional and clinical standards and follow them. Answer a, carrying malpractice insurance, does not guarantee that the nurse will avoid malpractice allegations. Carrying malpractice insurance is important but it does not protect against malpractice allegations. Answer c, keeping personal documentation of every situation with a negative outcome, is also incorrect because nurses must document every client encounter regardless of treatment outcomes. Answer d, attending ten continuing educational programs, is also incorrect. Although the nurse’s professional responsibilities include attending continuing educational programs, they do not protect the nurse from malpractice allegations. Chapter 9 Answers and Rationales 1. a. The correct answer is a, suicide risk. Suicide risk must be a primary safety concern for clients presenting with a major depressive symptoms. Answer b, weight loss, is incorrect because, although it is important data, it is not a primary concern during the initial assessment. Answer c, financial concerns, is incorrect. Although it may be a major stressor, it is not the nurse’s primary concern. Finally, answer d, low self esteem, is incorrect although it may play a role in this client’s level of dangerousness to self and her present major depressive episode. 2. a. Answer a, “I have not changed the linen on the bed since my father’s death 3 months ago,” depicts an abnormal grief reaction because the client has not resolved her grief in a timely manner. Although grief resolution is individual, this case suggests that the client has not taken appropriate steps to resolve hers over a 3 month period. Answers b, c, and d depict appropriate responses that indicate that the clients have taken steps to resolve their grief and reflect normal stages of grief and typical comments. 3. a. Answer a, dependent relationship with the deceased, is correct because it is a risk factor for pathological grief. Answer b is incorrect because adequate support system is essential to facilitating normal grief resolution as well as c, limited losses, and d, a lack of preoccupation with the deceased. 4. b. Answer b is correct because a client with a history of suicide and self-mutilation is at high risk for present and future attempts. When administering or ordering antidepressants, this information is important and often indicates ordering a smaller number of pills, involving family members to oversee medication administration, and using supportive measures such as crisis intervention or partial hospitalization to monitor acute symptoms. Answer a is incorrect because, although this client has recently lost her job and has other stressors, her risk of suicide is not as great as the client with a history of suicide and self-injurious behaviors. Answer c, the client with a one year history of sobriety and presents for treatment has a lower risk of suicide than the 18-year-old client. Answer d, the client with a history of a positive response to antidepressants, like the others, is a good candidate for treatment. 5. a. Answer a, “Has he expressed thoughts of suicide?”, is correct because clients who present with major depressive disorders are at high risk of suicide and this issue must be assessed initially and throughout treatment. It is the most important nursing assessment data concerning this adolescent. Answer b, “Has he been emotionally abuse?”, is incorrect and inappropriate at this point because the adolescent’s concerns involve the tragic loss of his friend. Answer c, “Does he have close friends?”, is also incorrect although it is important to assess his support systems. Answer d, “What is his appetite like?”, is important but this information is not the most important nursing assessment data. Chapter 10 Answers and Rationales 1. d. Answer d, all of the above, is true concerning causative factors of bipolar disorders. Answers a, biological factors, b, genetic factors, and c, precipitating factors, are well documented as causative factors of bipolar disorder. 2. c. Answer c, hyperthymia and racing thoughts, is correct and depict common symptoms of mania across all types of bipolar disorders. Answer a, labile affect and paranoia, is incorrect and these symptoms are not unique to symptoms of mania across all types of bipolar disorder. Answer b, distractibility and dysthymia, is also incorrect. Although clients presenting with mania may be easily distracted, they are more likely to present with hyperthymia rather than dysthymia which is a separate depressive mood disorder. Answer d, dysphoria and rapid cycling, is also incorrect because during a manic episode, the client’s mood is either elated or irritable and rapid cycling indicates various mood swings. 3. d. Answer d, more depression, is the correct answer. Older adults presenting with bipolar disorders for the first time are more likely to present with histories of depression than other age groups. Answer a, greater degree of circulatory disease, is incorrect. Although the older adult may present with dementia-like symptoms, circulatory disease is not part of the client’s history. Answers b and c, less social support and more stressful life events, respectively, are also incorrect. Less social support and more stressful life events may be precipitators but depression is more likely to be the prevailing symptom linked with somatic complaints. 4. b. The correct answer is b, psychotherapy with the client, because the generalist is not educationally prepared to perform psychotherapy. The other answers, a, psychoeducation about the disorders; c, identification of resources in collaboration with the client; and d, monitoring of medication effects, are incorrect because they are all within the generalist’s scope of practice. 5. d. The correct answer is d, all of the above, because a, self-rating scales; b, symptom tracking; and c, mood charting, are techniques that can be used by the nurse and Mary to assist in ongoing evaluation of the client’s mood. 6. a. The correct answer is a, enrolling Mary and her oldest son into family therapy. Although enrolling the client and her son into family therapy may occur, the other answers are more appropriate. Answer b, identifying the client’s designated family, is an important aspect of family counseling because the client, not the nurse, determines the designated family. Answer c, validating client and family needs, enables the nurse to develop client-centered family counseling. Lastly, answer d, assessing own perceptions about minority family structure, indicate self-awareness and its potential impact on nursing diagnosis and treatment. Self-awareness also enables the nurse to work with the client and family to develop a culturally competent plan of care. Chapter 11 Answers and Rationales 1. c. Answer c, putting her at ease using active listening skills, is correct. A client who is crying and distraught is more likely to immediately feel at ease when the nurse uses active listening skills to convey concern and empathy. Answer a, reassuring her that the man will be prosecuted, is ineffective in calming this client and there is no guarantee that this is a true statement. Answer b, referring her to a rape crisis center, is also incorrect because this client needs immediate emotional support and there is a lack of proof that she will take the referral to or follow-up at a rape crisis center. Lastly, answer d, providing her with a tranquilizer to decrease her anxiety, is also incorrect and inappropriate because her immediate needs require immediate emotional support, an opportunity to express her feelings and thoughts, and to be believed. 2. c. Answer c, remain silent and allow her to express her feelings, is correct because the nurse conveys warmth, support, and empathy. Answer a, “I can see this is very upsetting to you,” is also incorrect because, although the nurse is verbalizing her observations, it may also interfere with the client’s ability to express her feelings and thoughts. Answer b, “Please lower your voice because you are disturbing sick client,” may convey that the client needs to “be quiet.” At some point, the client may be asked to lower her voice but it must be in the context of caring and understanding and some limit setting if the client’s behavior continues to escalate. Finally, answer d, offer her a tranquilizer because she is out of control, is also incorrect because it limits the client’s ability to express normal responses to a traumatic event. 3. d. Answer d, present stressors, is correct because with adolescents it offers the nurse information about the client’s level of distress and coping skills. Answer a, history of substance abuse, is incorrect although this information is important when ruling out medical and psychiatric disorders. Answer b, social relationships, is also incorrect because, similarly to answer a, it is important, it is not the most pertinent information regarding making a definitive diagnosis. Answer c, history of these symptoms in the past, is also important but not the most relevant information to treatment planning. 4. a. The correct answer is a, inquire about his last dose of alprazolam (Xanax). This response indicates that the nurse knows that this client has panic disorder with agoraphobia and that he may be taking a benzodiazepine, such as Xanax, to manage acute anxiety symptoms. Answer b, call an ambulance or emergency backup, is incorrect and suggests that the nurse is unfamiliar with symptoms of panic disorder. Answer c, check his vital signs, is also incorrect and although checking his vital signs is important, helping the client manage his symptoms is more important during an acute anxiety attack. Answer d, encourage him to express his feelings, is incorrect and also suggests that the nurse is unfamiliar with the treatment of acute anxiety. Eventually asking the client to express his feelings about the episode and other stressors is important but it is not the most important intervention during this episode. 5. b. Answer b, crying and following in infancy, is correct because these behaviors are not manifestations of child anxiety disorders. In contrast, answers a, inability to form trusting relationships, may indicate an attachment disorders; c, over-concern for the safety of primary caregivers may indicate separation anxiety; and d, excessive hand washing and counting, may indicate obsessive-compulsive disorder. Chapter 12 Answers and Rationales 1. c. The correct answer is c, she shy and has difficulty describing her symptoms, is correct because it represents a typical picture of a client presenting with somatoform disorder. Answer a, she is doing well in college and optimistic about her future, is incorrect because it depicts an individual who is coping with present stressors effectively. Answer b, she is tearful and stressed and reports having difficulty doing housework, is also incorrect and indicates symptoms of a mood disorder rather than somatoform disorder. Answer d, her medical complaints are confirmed by diagnostic laboratory studies, is also incorrect because diagnostic studies performed to rule out medical conditions related to somatoform disorders are often negative and offer little proof of an underlying medical condition. 2. a. Answer a, “I am so depressed,” is correct. Depressed states are considered universal in clients with fibromyalgia. Answer b, “I believe that the man in the chair next to me can read my mind,” is incorrect because it depicts delusions, a common symptom of psychotic disorders. Answer c, “I need a referral for counseling,” is also incorrect because many clients seek medical treatment because of the nature of their physical distress rather than counseling. Answer d, “I need a refill on my medication,” is also incorrect because asking for a refill is not limited to this disorder. 3. a. Answer a, “Judy, let’s discuss what your provider told you during your last visit,” is correct because it indicates that the nurse understands that these clients are high users of health services and the need for structure and consistency in helping them. Consistency among health care providers often reduces the client’s anxiety and helps providers manage their time more efficiently. Answer b, “Judy, I know that you are hurting and I will do everything for you,” is incorrect because it engenders dependency, reinforces the client maladaptive coping patterns, and increases the use of health care services. Answer c, “Judy, this is the second time I have told you to sit down,” is also incorrect because it conveys anger and lack of empathy or understanding of the client’s condition. Answer d, “Judy, I do not agree with what your provider said during your last visit,” is incorrect because, even if the nurse disagrees with the client’s provider, it is inappropriate to discuss her feelings with the client. 4. b. Answer b, conversion disorder, is correct because this client’s symptoms are unexplained physical manifestations or deficits affecting voluntary motor and sensory function that suggest a neurological or medical condition. Answer a, hypochondriasis, is incorrect because major symptoms of this disorder involve fears of having a serious disease owing to an exaggerated appraisal of the risk to disease. These clients do not present with neurological or sensory symptoms like those with conversion disorder. Answer c, extrapyramidal side effects, is also incorrect because these symptoms are usually related to taking neuroleptics and there is no indication of this client taking these medications. Also, the client’s symptoms do not depict EPS. Lastly, answer d, restless leg syndrome, is incorrect because this is a sleep disorder manifested by motor movement during sleep characterized during the day by akathisia which is the inability to sit still and a “deep uneasy” feeling in the legs which is uncommon in the daytime. This disorder is often associated with renal failure and iron deficiency. 5. d. Answer d, obsessive-compulsive disorder, is correct because body dysmorphic disorder has been hypothesized to be related to other psychiatric disorders, including OCD. Answers a, schizotypal personality disorder; b, bipolar I disorder; and c, borderline personality disorder, are not related to body dysmorphic disorder (BDD). 6. d. The correct answer is d, Clomipramine (Anafranil), is correct because of BDD relationship to OCD. This medication has been shown to be effective in the treatment of OCD. Answers a, Risperidone (Respirdal), and b, Ziprasidone (Geodon), are incorrect because they are neuroleptics and have not been shown to be effective in the treatment of BDD. Likewise, answer c, Diazepam (Valium), is a benzodiazepine and is inappropriate in the treatment of BDD.
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