Deck 3: Clients With Mental Disorders, and Vulnerable Populations

Question 1

The nurse should anticipate the client with anorexia nervosa to exhibit which of the following behaviors?

A) Positive self-image
B) Constant over-eating
C) Obsessive rituals
D) Little anxiety regarding food

Answer 1

C

Question 2

Due to the early onset of eating disorders, community-based nurses should develop and implement eating disorder education programs in the following setting first:

A) Community centers.
B) Schools.
C) Doctors' offices.
D) Churches.

Answer 2

B

Question 3

Which of the following questions would the nurse ask the client when assessing for a common condition thought to relate to the degree of stress that occurs with anorexia nervosa?

A) Has your hair been falling out?
B) Do you exercise after eating?
C) Has your menstrual period stopped?
D) Are you purging after you eat?

Answer 3

C

Question 4

A client with an eating disorder is in the demographic group that represents those at highest risk for developing an eating disorder. The client is a/an:

A) Male
B) Older adult
C) Child
D) Female

Question 5

The most appropriate intervention for the nurse to use when integrating cognitive behavioral approaches into therapy for clients with bulimia nervosa is:

A) Client education.
B) Family groups.
C) Individual interventions.
D) Behavior modification.

Question 6

An adolescent student tells the nurse, "I lost 10 pounds in the last 3 months. I believe I have anorexia." The nurse's response should be based on the following understanding:

A) There is cause for alarm since most adolescent females experience anorexia.
B) The student may be anorexic if the weight loss has lead to maintenance body weight less than 85% of the expected.
C) The student is not anorexic because the student's physical development has not been affected by nutritional status.
D) Since the student is willing to talk about the issue, the student is probably not anorexic.

Question 7

The client with bulimia is experiencing anxiety. What action should the nurse take to assist the client to avoid binge-eating and purging in response to the anxiety?

A) Contract for safety since the client is likely to engage in self-injurious behavior.
B) Project a calm reassuring attitude and provide a quiet non-stimulating environment.
C) Assume a matter-of-fact attitude and positive expectations of the client.
D) Maintain total control of the environment and project an attitude of authority.

Question 8

When assessing the client with anorexia or bulimia, the nurse must be aware that the client is more likely to suffer from which of the following comorbid psychological conditions?

A) Psychotic disorders
B) Avoidant personality disorder
C) Depression
D) Schizophrenia

Question 9

What are suggested outcomes for the nursing diagnosis of "Ineffective Individual Coping" for a client with anorexia nervosa?
Select all possible answers.

A) Ability to acquire, organize, and use information
B) Ability to self-restrain altered perceptions
C) Adequate nutrients taken into the body
D) Ability to self-restrain compulsive or impulsive behaviors
E) Actions to manage stressors that tax an individual's resources

Question 10

When assessing the client with dramatic weight loss or gain, the nurse should consider:

A) There is usually a direct cause and effect.
B) The focus of the assessment must be on the physical findings.
C) Both can be caused by physical or mental conditions.
D) The focus of the assessment must be on the psychological findings.

Question 11

Since purging and excessive exercise are not features of binge-eating disorders, these individuals often become:

A) Obese.
B) Hungry.
C) Emaciated.
D) Anorexic.

Question 12

The nurse is assessing a male client who is suspected of having an eating disorder. What additional information should the nurse include in her assessment of this client?

A) Use of anabolic steroids
B) History of illegal substance use
C) Ethnic origin
D) Relationship with family

Question 13

From a psychoanalytic perspective, eating disorders are related to:

A) Conscious intrapersonal and interpersonal conflict.
B) Disturbance in the body system.
C) Regression to pubertal conflicts and repudiation of developing sexuality.
D) Learned behavior regarding the affect of food.

Question 14

The nurse providing case management to clients with eating disorders will focus on which of the following goals?
Select all possible answers.

A) Return to maximum premorbid state
B) Early detection of symptoms
C) Increase public awareness of the problem
D) Effective symptom reduction
E) Assure a smooth transition to inpatient therapy

Question 15

A client with an eating disorder is trying to develop new coping skills. The process the nurse can use to help family members as they support the client is to:

A) Assist the family to challenge the client's behavior.
B) Encourage the family to avoid discussing their feelings about the client's illness.
C) Teach the family how to manipulate the client's environment to avoid problem situations.
D) Assist the family to explore their own coping strategies.

Question 16

Which of the following groups is more accepting of the way they look which may serve as a protective factor against the development of eating disorders?

A) Asian Americans
B) African American women
C) Latino women
D) Homosexual males

Question 17

Which of the following interventions might facilitate the nurse's understanding of how clients with eating disorders view their bodies?

A) Ask the clients to draw a picture of themselves as they are now and as they desire to be.
B) Assess the client's response to limit setting when eating.
C) Discuss the importance of food and exercise in maintaining body image.
D) Observe the client's interactions with other clients with eating disorders.

Question 18

A common characteristic of individuals with anorexia nervosa and bulimia nervosa is that they are preoccupied with:

A) Eating as much as possible.
B) Family relationships.
C) Telling others about their condition.
D) Body shape and size.

Question 19

Clients with which of the following diagnosis are more likely to recognize that their eating behaviors are abnormal and bizarre?

A) Anorexia nervosa
B) Binge-eating disorder
C) Nutritional eating disorder
D) Bulimia nervosa

Question 20

Which of the following physical findings regarding the client's weight is consistent with binge-eating disorders?

A) Weight tends to fluctuate but is generally low.
B) All of the clients are overweight.
C) The client is generally underweight.
D) The client is usually of normal or slightly above average weight.

Question 21

Despite the fact that the patient is 5'6" and weighs 72 lbs, the patient reported feeling "fat and overweight." What is the most appropriate nursing diagnosis for this patient?

A) Body image disturbance
B) Ineffective coping
C) Chronic low self-esteem
D) Altered nutrition

Question 22

Which of the following physical manifestations would the nurse expect in a client who is emaciated, has sunken eyes, and a skeletal appearance?

A) Tachycardia, hypotension, and edema
B) Bradycardia, hypertension, alopecia
C) Bradycardia, hypotension, arrhythmia
D) Tachycardia, arrhythmia, dry skin

Question 23

Which medication should the nurse expect to administer to the client with bulimia nervosa?

A) Prozac
B) Benadryl
C) Ritalin
D) Prolixin

Question 24

The nurse working with clients that have eating disorders must consider which of the following when deciding appropriate boundaries for the client and their family members?

A) Family members of clients with bulimia are overly affectionate.
B) Family members of individuals with bulimia tend to bond together.
C) Family members of clients with anorexia become enmeshed.
D) Family members of clients with anorexia are usually very autonomous.

Question 25

The client with binge-eating disorder reports a lack of involvement in activities, loss of interest in self-care activities, and oversleeping. The client's speech is filled with despondency. What nursing diagnosis is most appropriate for this client?

A) Social Isolation
B) Anxiety
C) Hopelessness
D) Knowledge Deficit

Question 26

What factor contributes to a poor outcome for clients with anorexia nervosa?

A) Treatment approaches are fragmented and controversial.
B) There is no cure for anorexia nervosa.
C) The client with anorexia nervosa actively resents or refuses treatment.
D) Changes in the client's behavior are irreversible.

Question 27

Which of the following neurotransmitters affect eating disorders? Select all possible answers.

A) Serotonin
B) Neoropeptide Y
C) Acetylcholine
D) Dopamine
E) Norepinephrine

Question 28

A 30-year-old man is accused of sexual assault and is arrested by law enforcement. During the interview with the forensic nurse, the client uses flattery and compliments the nurse's interview skills. He asks the nurse for her phone number so his lawyer can contact her as an expert witness for his case. How should the nurse respond?

A) Tell the client that she is listed in the phone book.
B) In a way that establishes the boundaries of the nurse-client relationship.
C) In a way that nurtures the client's feelings.
D) Tell the client that the nurse is working for the prosecution.

Question 29

A client with borderline personality disorder gives written notice of intention to leave the hospital after a voluntary admission. The client tells the nurse, "I will rescind my notice if you expand my smoking privileges." The nurse should respond in a way that:

A) Consistently reinforces the unit rules.
B) ?Refers the client to the physician.
C) Convinces the client to rescind the notice.
D) Provides exceptions to the unit rules.

Question 30

Impulse control is part of the care plan for a client with borderline personality disorder. Which of the following is particularly important to include?

A) Management of emotions
B) Identification of behavior patterns
C) A no-harm contract
D) Identification of support sources

Question 31

The nurse and a client talk about healthy ways to meet needs. The client states, "When I am looking really good, it is not asking too much for people to acknowledge me." The nurse recognizes that this experience is indicative of:

A) Feelings of emptiness.
B) Affective instability.
C) A sense of entitlement.
D) Splitting.

Question 32

A student nurse is working with a client on the inpatient unit who exhibits manipulative behavior. What action should the student incorporate into interactions with this client?

A) No-harm contract
B) Limit setting
C) Confront negative self-concepts
D) Matter-of-fact approach

Question 33

A client presents with an inability to make decisions and function independently. The nurse knows these symptoms are indicative of which of the following disorders?

A) Schizoid personality disorder
B) Schizotypal personality disorder
C) Dependent personality disorder
D) Paranoid personality disorder

Question 34

A client consistently fails to accept the consequences of his or her own behavior. The nurse identifies this behavior as characteristic of:

A) A lack of structure.
B) A personality disorder.
C) Immaturity.
D) A need for medication.

Question 35

The nurse is preparing to assess a client with a diagnosis of paranoid personality disorder. What client characteristics will the nurse expect to observe?

A) Grandiosity
B) Superficial charm
C) Affective instability
D) Suspicions and rigidity

Question 36

The student nurse comparing the essential characteristics of each cluster of personality disorders correctly identifies the essential characteristics of cluster C disorders as:

A) Impulsivity.
B) Pervasive distrust.
C) Openness.
D) Anxiety.

Question 37

How can the nurse differentiate the client with obsessive-compulsive personality disorder from a client with perfectionist personality traits?

A) Clients with obsessive-compulsive personality disorder will exhibit order in their work lives but are able to relax when away from work.
B) Clients with obsessive-compulsive personality disorder will exhibit the need for perfection in everyone but themselves.
C) Clients with obsessive-compulsive personality disorder will exhibit order in all areas of their lives.
D) Clients with obsessive-compulsive personality disorder will exhibit fear, anxiety, and an excessive need for order.

Question 38

The nurse is caring for a client with schizoid personality disorder. Which nursing diagnosis is most appropriate for this client with a cluster A personality disorder?

A) Social isolation related to inadequate social skills, craving of solitude
B) Ineffective individual coping related to high dependency needs
C) High risk for violence, self-directed, related to poor impulse control
D) Fear related to feelings of abandonment

Question 39

In describing personality disorders to a group of consumers, which statement is accurate?

A) Behavior is sporadic with no particular pattern.
B) People with personality disorders are unable to experience painful feelings.
C) These disorders usually develop during the toddler stage.
D) People with personality disorders view their problems as separate from themselves.

Question 40

A client with a diagnosis of paranoid personality disorder appears hypervigilant and sits alone in an isolated area of the unit. The client does not acknowledge other clients and often uses sarcasm when addressing staff. The nurse invites the client to attend a milieu group, but the client ignores the nurse's efforts. An appropriate nursing diagnosis for this client is which of the following?

A) Activity intolerance
B) Fear
C) Powerlessness
D) Impaired social interaction

Question 41

The nurse is working with a client who has a history of impulsive and self-harming behavior. The nurse will need to address which of the following in the plan of care?

A) Appropriate self-disclosure
B) Confidentiality
C) Safety
D) Boundary setting

Question 42

A grandiose sense of self-importance is a characteristic of which of the following personality disorders?

A) Narcissistic personality disorder
B) Avoidant personality disorder
C) Dependent personality disorder
D) Histrionic personality disorder

Question 43

The nursing staff is discussing boundary setting. Which of the following statements about boundary setting is inaccurate?

A) Boundaries are established by providing consistent expectations.
B) Boundaries provide guidelines for self-control.
C) Boundaries are established to make the nursing staff's job easier.
D) Boundaries define the therapeutic relationship.

Question 44

The nurse is planning care for an individual diagnosed with borderline personality disorder. The nurse realizes that interventions will have to be focused on which of the following behaviors?

A) Desiring order and perfection
B) Withdrawing and becoming isolative
C) Acting out when feeling abandoned or disrespected
D) Not being able to make decisions

Question 45

A client with a diagnosis of borderline personality disorder has had several hospitalizations for suicide attempts and self-mutilation. A priority nursing intervention for this client would include which of the following?

A) Anxiety reduction
B) Concrete communication
C) Social interaction
D) Safety maintenance

Question 46

The nurse admits a client who initially presents as intelligent, articulate, and superficially charming. The client claims his admission to the mental health unit is a big mistake. He states that there was a mix-up in the emergency room and he was incorrectly identified. A probable diagnosis is:

A) Antisocial personality disorder.
B) Avoidant personality disorder.
C) Obsessive-compulsive personality disorder.
D) Dependent personality disorder.

Question 47

Which of the following interventions would the nurse implement to address the client with feelings of abandonment?

A) Assist client to verbalize feelings of abandonment in an appropriate manner.
B) Assist client to suppress feelings of abandonment.
C) Encourage client to never get involved in a relationship again.
D) Assist client to express deep rage at the ending of the relationship.

Question 48

The nurse is learning how to handle feelings of frustration and helplessness when caring for clients with cluster B personality disorders. Which of the following statements by the nurse would reflect that learning has taken place?

A) "I can talk about my feelings with my friends."
B) "As long as my words are therapeutic, the client cannot tell what I am really thinking."
C) "I can just ignore my feelings and focus on the client's needs."
D) "I need to maintain professional distance by using empathy."

Question 49

The client with a diagnosis of borderline personality disorder shows the nurse multiple superficial cuts to the arms that were made during the night. The client states, "I told the night staff that I was feeling alone." The nurse recognizes that the self-mutilation may be a result of:

A) Manipulation.
B) Splitting.
C) Impulsive behavior.
D) Anxiety.

Question 50

According to a recent study about suicidal Asian-American youths and African-American adolescents, a significant factor influencing suicidal behavior is:

A) Logical reasoning.
B) Difficulty communicating and the ability to integrate new and old information.
C) Constriction of thought, a dyadic event, and/or increased communication skills.
D) High parental conflict.

Question 51

An attitude inventory for working with suicidal clients is used to help nurses develop awareness of:

A) Client attitudes toward suicide.
B) Personal attitudes held by individuals who engage in self-destructive behaviors.
C) Current research focus on suicidal clients.
D) Public perceptions about self-destructive people.

Question 52

The nursing student learned of a high school classmate who recently committed suicide. The classmate's death surprised the student, because the classmate had always seemed very confident and popular. The student knows, however, that suicide is usually:

A) An impulsive act without meaning.
B) A random act without meaning or purpose.
C) An act with a message and purpose.
D) A random act of selfishness.

Question 53

The nurse on a psychiatric unit looks through a suicidal client's belongings, removing craft materials and mirrors. This is an example of:

A) Maximum suicide precautions.
B) An invasion of privacy.
C) Common precautions.
D) A crime in progress.

Question 54

The nursing instructor knows to teach that the most common reason for suicide includes:

A) A painful terminal illness and/or an untenable personal situation.
B) Punishment or exposure of socially or personally unacceptable behavior.
C) An untenable personal situation such as going to the prom alone.
D) Being a burden to others and self-destructive behaviors.

Question 55

A client who has been self-mutilating has been admitted to the mental health unit. The nurse knows to assess for:

A) Schizophrenia.
B) Suicidality.
C) Depression.
D) Mania.

Question 56

According to biologic theory, there is considerable evidence that what system, partly under genetic control, may influence the risk for suicidal behavior?

A) Neurotransmitter system
B) Serotonergic system
C) System of PET
D) HPA-axis system

Question 57

A high school nurse is sharing the results of a national survey with school faculty and staff. The nurse states that, if the students in their school are similar to those surveyed, close to 1 out of 5 have seriously considered suicide in the:

A) Springtime.
B) Past year.
C) Winter months.
D) 3 months preceding the survey.

Question 58

When working with suicidal clients, the nurse must be compassionate enough to:

A) Avoid asking the client difficult questions in order to prevent an escalation in symptoms.
B) Be able to form an effective link with suicidal clients without being overwhelmed by the client's pain.
C) Communicate effectively to solve the client's problems.
D) Ask the right questions in order to stop the client from getting angry.

Question 59

When teaching students about suicide, the nursing instructor knows to include facts such as:

A) Suicide is the 11^th leading cause of death among Americans, and self-inflicted injuries account for almost 500,000 clients treated each year in emergency departments.
B) Suicide is the 4^th leading cause of death among African-American teenagers and the 9^th leading cause of Caucasian teen deaths.
C) Suicide is the leading cause of death among mentally ill clients, and over 3 million people kill themselves each year according to the CDC.
D) Over 31,000 people kill themselves each year, and suicide is the primary reason for their deaths.
E) Suicide is the 11^th leading cause of self-inflicted injuries, accounting for over 325,000 people each year going to the emergency department.

Question 60

A 22-year-old suicidal client acknowledges being molested by her stepfather since she was eight years old. The nurse knows this client's self-destructive behavior is best explained by:

A) Self-destructive behavior.
B) Biologic theory.
C) Sociocultural theory.
D) Interpersonal theory.

Question 61

A suicidal client tells his psychiatric nurse practitioner, "My death will benefit my family; I'm 83 years old and have outlived my usefulness." The nurse practitioner knows this is an example of:

A) Interpersonal theory.
B) Suicide theory.
C) Sociocultural theory.
D) Biologic theory.

Question 62

The nurse knows that including family members in the plan of care for a suicidal client is extremely important. Two important strategies that families need to know are:
Select all that apply.

A) How to work with other families.
B) How to help loved ones avoid acting on suicidal thoughts.
C) How to prevent suicide.
D) How to communicate with one another.
E) How to communicate with hospital staff.

Question 63

While taking care of a client at the mental health clinic, the student nurse notices scars and healing lacerations on the client's arms. The client states, "I did all of that." The student nurse knows this type of behavior is:
Select all that apply.

A) A prank.
B) Self-destructive.
C) A waste of time.
D) A maladaptive measure.
E) A coping mechanism.

Question 64

A child or adolescent who experiences a parent's or friend's suicide are at greater risk for suicide and should be:

A) Evaluated for depression.
B) Immediately hospitalized.
C) Observed for suicidal attempts.
D) Screened for possible drug overdose.

Question 65

In an effort to prevent suicide, an important advocacy strategy for all nurses to implement is to:

A) Increase nurses' pay.
B) Increase cultural and spiritual diversity.
C) Reduce barriers to health care.
D) Reduce financial burden for all patients through charities.

Question 66

The student nurse realizes that individuals who self-mutilate may:

A) Never learn how to control their urges.
B) Process feeling verbally if someone listens.
C) Have experienced childhood abuse and have difficulty processing feelings.
D) Cut for attention only.

Question 67

The nurse knows that the characteristics of people who are successful in committing suicide include:

A) Ambivalence, constriction of thought, and/or logical reasoning.
B) Difficulty communicating and the ability to integrate new and old information.
C) Logical reasoning, dichotomous thinking, and/or difficulty communicating.
D) Dichotomous thinking, ambivalence, and/or a dyadic event.

Question 68

A nursing student refuses to take care of clients who have been cutting themselves. What question would help this student realize why he or she may have a problem with this type of client?

A) How do I feel about people who deliberately harm themselves?
B) What bothers me about this person?
C) Is this person really suicidal, or just playing games?
D) How do I deal with people who appear to do illogical things?

Question 69

The nurse is presenting information to a gatekeeper training class about the people in a suicide victim's life, including the most commonly recognized risk factors for suicidal behavior, symptoms of mental illness, and barriers to mental health treatment. The nurse teaches that both parents and friends were equally able to recognize many risk factors, but friends were better than parents at recognizing risk factors for:

A) Mania.
B) Substance abuse.
C) Suicide.
D) Depression.

Question 70

A nursing student taking care of a suicidal client realizes that she is too scared to do an adequate job. What question would help her realize why she may be afraid?

A) Can a person who is mentally ill choose suicide as a reasonable course?
B) Do I believe the client can change?
C) Do I believe the client is really suicidal?
D) Are suicidal clients asking me to take responsibility for their behavior?

Question 71

In a 2007 study of suicide prevention hotlines, 1,085 suicide callers had a significant decrease in suicidality during the course of the telephone session when crisis hotline workers demonstrated:

A) Hope, support, and happiness.
B) Faith, respect, and trepidation.
C) Empathy, support, and hopelessness.
D) Empathy, respect, and support.

Question 72

What is the most therapeutic approach when caring for a client who has been the victim of domestic violence?

A) Acknowledge the client's inability to change the situation.
B) Avoid pressuring the client to leave the abuser.
C) Do not ask direct questions about abuse as this will intimidate the client.
D) Invite the abuser to the assessment session.

Question 73

A client with a poorly regulated corticotropin-releasing factor (CRF) will most likely have difficulties:

A) Relating to others.
B) Coping with stress.
C) Balancing life issues.
D) Interpreting the environment.

Question 74

Nurses working with abused clients most commonly feel:

A) Sympathy for the victim, indifference toward the abuser.
B) Sadness for the victim, tolerance toward the abuser.
C) Sympathy for the victim, anger toward the abuser.
D) Anger toward the victim, dislike for the abuser.

Question 75

As a nurse advocate for the reduction of family elder abuse, a nurse:

A) Educates the public about legal consequences of violent acts.
B) Helps abused victims make it to the hospital for treatment.
C) Locates community resources for families.
D) Encourages abusers to come forward to talk about their issues.

Question 76

In assessing a client who has suffered domestic violence, the nurse observes that the client is regressing back to childhood, is having difficulty trusting the nurse, is expressing rage and grief, and is talking about how unfair God has been and wondering why God has been "so insensitive." Based on these observations, what would be the most appropriate plan of action for the nurse?

A) Explain to the client that God has his own reasons that most of us do not understand.
B) Suggest that the client join a survivor support group.
C) Refer the client to a religious counselor.
D) Encourage the client to attend religious activities at the local church.

Question 77

Who is at greatest risk for becoming the victim of intrafamily violence?

A) The child who has a stepfather
B) The child living in a home in which a parent is being abused
C) The male child
D) The child born out of an unplanned pregnancy

Question 78

In caring for victims of violence it is important for nurses to be aware of their personal feelings and attitudes about the situation because:

A) Intense protective feelings result in appropriate interventions for the victim's care.
B) It allows the nurse to express sympathy for the client.
C) Self-awareness protects the nurse's own mental health.
D) Intense negative feelings interfere with assessment and judgment.

Question 79

Which of the following combinations of clinical presentations constitutes the most compelling indication that a client may have been abused?

A) Acting-out behaviors, disobedience, trouble with the law
B) Poor eye contact, depressed mood, unwillingness to give history data
C) Multiple bruises and scars, low self-esteem
D) Sores around the mouth, brittle hair

Question 80

The nurse understands that the underlying issue of most rapists is:

A) A desire to play out fantasies.
B) A desire to overpower and control.
C) The inability to control intense anxiety.
D) An uncontrollably strong sex drive.