NUR 2459| NUR2459 MENTAL AND BEHAVIORAL HEALTH NURSING

NUR 2459| NUR2459 Mental And Behavioral Health Nursing (latest

2024/2025)

Mental Health Final Exam

Multiple Choice
A client diagnosed with somatic symptom disorder states, "My doctor thinks I
should see a psychiatrist. I can't imagine why he would make such a suggestion."
What is the most common basis for the client's statement?

a. Lack of trust in the physician.

b. Lack of understanding about the correlation of symptoms and stress.
c. Lack of understanding about the role of a psychiatrist.
d. Lack of financial resources.

What is the ultimate goal of therapy for a client with dissociative identity disorder?

a. Integration of the personalities into one

b. The ability to switch from one personality to another voluntarily
c. The ability to select one personality as the dominant self
d. Recognition that the various personalities exist

The ultimate goal of therapy for a client with dissociative identity disorder is most
likely achieved through:

a. Crisis intervention and directed association.

b. Psychotherapy and hypnosis.
c. Psychoanalysis and free association.

d. Insight psychotherapy and dextroamphetamines.

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Lucille has a diagnosis of illness anxiety disorder. Which of the following symptoms
would be consistent with this diagnosis?

a. Complains of a multitude of incapacitating physical symptoms

b. Manifests with pseudoseizures or pseudocyesis
c. Takes substances to induce vomiting to convince the nurse that she needs
treatment
d. Expresses persistent fears of having life-threatening disease

A client diagnosed with somatic symptom disorder tells the nurse about a pain in
her side. She says she has not experienced it before. Which is the most appropriate
response by the nurse?

a. "I don't want to hear about another physical complaint. You know they are all in
your head. It's time for group therapy now."
b. "Let's sit down here together and you can tell me about this new pain you are
experiencing. You'll just have to miss group therapy today."
c. "I will report this pain to your physician. In the meantime, group therapy starts in
5 minutes."
d. "I will call your physician and see if he will order a new pain medication for your
side. The one you have now doesn't seem to provide relief. Why don't you get some
rest for now?"

A client with a history of childhood physical and sexual abuse was diagnosed with
dissociative identity disorder 6 years ago and has been admitted to the psychiatric
unit following a suicide attempt. What is the priority nursing diagnosis for this
client?

a. Disturbed personal identity related to childhood abuse

b. Disturbed sensory perception related to repressed anxiety

c. Impaired memory related to disturbed thought processes

d. Risk for suicide related to unresolved grief
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In establishing trust with a client diagnosed with dissociative identity disorder, the
nurse should:

a. Respond as if the client did not have multiple personalities.

b. Listen nonjudgmentally and respond empathically when the client transitions to
different personality states.
c. Ignore behaviors that the client attributes to other subpersonalities.
d. Explain to the client that they must remain in their primary identity state while
communicating with the nurse.
e. All of the above

A client with multiple cuts and abrasions arrives at the emergency department with
her three small children. She tells the nurse her husband inflicted the wounds. In
the interview, she tells the nurse, "He's been getting more and more violent lately.
He's been under a lot of stress at work the last few weeks, so he drinks a lot when
he gets home. He always gets mean when he drinks. I was getting scared. So I just
finally told him I was going to take the kids and leave. He got furious when I said
that and began beating me with his fists." With knowledge about the cycle of
battering, what does this situation represent?

a. Phase I. Attempting to stay out of his way and keep everything calm.
b. Phase I. A minor battering incident for which she assumes all the blame.
c. Phase II. The acute battering incident that was provoked by her threat to leave.
d. Phase III. The honeymoon phase where the husband believes that he has

A battered woman presents to the emergency department with multiple cuts and
abrasions. Her right eye is swollen shut. She says that her husband did this to her.
What is the priority nursing intervention?

a. Tending to the immediate care of her wounds

b. Providing her with information about a safe place to stay

c. Administering the prn tranquilizer ordered by the physician
d. Explaining how she may go about bringing charges against her husband
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A child, age 5, is sent to the school nurse's office with an upset stomach. She has
vomited and soiled her blouse. When the nurse removes her blouse, she notices that
the child has numerous bruises on her arms and torso in various stages of healing.
She also notices some small scars, and her abdomen protrudes on her small, thin
frame. From the objective physical assessment, the nurse should screen further for:

a. Physical and sexual abuse.

b. Physical abuse and neglect.
c. Emotional neglect.
d. Sexual and emotional abuse.

A school nurse notices bruises and scars on a child's body, but the child refuses to
say how she received them. Which of the following is an evidence-based approach
for further assessment by the nurse?

a. Have her evaluated by the school psychologist.

b. Tell her she may select a "treat" from the treat box (e.g., sucker, balloon, junk
jewelry) if she answers the nurse's questions.
c. Explain to her that if she answers the questions, she may stay in the nurse's
office and not have to go back to class.
d. Use a "family" of dolls to role-play the child's family with her.

The nurse is providing education to a support group for survivors of rape. Which of
the following items is evidence-based information to include in this teaching?

a. Rapists typically drink alcohol and are not in control of their actions.
b. Rape is usually an event that occurs between two people who are sexually
frustrated.
c. Men who are born into poverty are predisposed to becoming rapists after
puberty.
d. Rape is an expression of power and dominance by means of sexual aggression
and violence.
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A client arrives at the emergency department and tells the nurse her husband
inflicted the cuts to her face that required sutures. She says, "I didn't want to come.
I'm really okay. He only does this when he has too much to drink. I just shouldn't
have yelled at him." The best response by the nurse is:

a. "How often does he drink too much?"

b. "It is not your fault. You did the right thing by coming here."
c. "How many times has he done this to you?"
d. "He is not a good husband. You have to leave him before he kills you."

Some obese individuals take amphetamines to suppress appetite and help them
lose weight. Which of the following is an adverse effect associated with the use of
amphetamines that makes this practice undesirable?

a. Bradycardia
b. Amenorrhea
c. Tolerance
d. Convulsions

The Maudsley approach to the treatment of adolescents with anorexia nervosa

advances which of the following fundamental concepts?

a. The patient's family should be actively involved in each phase of treatment.

b. Parents should be prohibited from involvement in helping their child eat since
there are often control issues.
c. Adolescents need to work on developing healthy self-identities before they can
begin to gain weight.
d. Individual psychotherapy is the most effective treatment for adolescents with
anorexia nervosa.
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A client has sought help for his concern that he is binge eating and feels like it has
"gotten out of control." He asks the nurse what can be done to help him. Which of
the following is the most accurate response?

a. "Nothing can be done."

b. "Some medications and psychological treatments have demonstrated

effectiveness in reducing binge eating behaviors."
c. "The primary problem is obesity. I can help you set up a calorie-restricted diet."
d. "Medications can help with weight loss, but there are no medications effective for
reducing binge eating."

Which of the following physical manifestations would you expect to assess in a

client suffering from anorexia nervosa?

a. Tachycardia, hypertension, hyperthermia

b. Bradycardia, hypertension, hyperthermia
c. Bradycardia, hypotension, hypothermia
d. Tachycardia, hypotension, hypothermia

Which medication has been used with some success in clients with anorexia
nervosa?

a. Lorcaserin (Belviq)
b. Diazepam (Valium)
c. Fluoxetine (Prozac)
d. Carbamazepine (Tegretol)

A client is hospitalized on the psychiatric unit with a history and current diagnosis
of bulimia nervosa. Which of the following symptoms would be congruent with this
client's diagnosis?
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a. Binging, purging, obesity, hyperkalemia

b. Binging, purging, normal weight, hypokalemia

c. Binging, laxative abuse, amenorrhea, severe weight loss

d. Binging, purging, severe weight loss, hyperkalemia

A 14-year-old client has just been admitted to the psychiatric unit for anorexia
nervosa. She is emaciated and refuses to eat. What is the priority nursing diagnosis
for this client?

a. Complicated grieving
b. Imbalanced nutrition: Less than body requirements.
c. Interrupted family processes
d. Anxiety (severe)

The nurse is caring for a client who has been hospitalized with anorexia nervosa
and is severely malnourished. The client continues to refuse to eat. What is the
most appropriate response by the nurse?

a. "You know that if you don't eat, you will die."

b. "If you continue to refuse to take food orally, you will be fed through a
nasogastric tube."
c. "You might as well leave if you are not going to follow your therapy regimen."
d. "You don't have to eat if you don't want to. It is your choice."

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and
tells the nurse she is afraid she is going to gain weight. Which is the most
appropriate response by the nurse?

a. "Don't worry. The dietitian will ensure you don't get too many calories in your
diet."
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b. "Don't worry about your weight. We are going to work on other problems while
you are in the hospital."
c. "I understand that you are concerned about your weight, and we will talk about
the importance of good nutrition, but for now I want you to tell me about your
recent invitation to join the National Honor Society. That's quite an
accomplishment."
d. "You are not fat, and the staff will ensure that you do not gain weight while you
are in the hospital, because we know that is important to you."

A client presents in the emergency department with complaints of suicidal ideation.

The following information is collected by the nurse. Which of these assessment
findings suggests that bulimia nervosa might be a health problem? (Select all that
apply.)

a. Parotid glands appear enlarged.

b. Teeth have a "moth-eaten" pattern of tooth decay.
c. Client reports that she takes laxatives daily.
d. Client's weight is within the expected range. {Correct Ans: - a. Parotid glands
appear enlarged.
b. Teeth have a "moth-eaten" pattern of tooth decay.

c. Client reports that she takes laxatives daily.

d. Client's weight is within the expected range.

A client diagnosed with borderline personality disorder manipulates the staff in an

effort to fulfill her own desires. All of the following may be examples of
manipulative behaviors in the borderline patient except:

a. Refusal to stay in a room alone, stating, "It's so lonely."

b. Asking the nurse for cigarettes after 30 minutes, knowing the assigned nurse has
explained she must wait 1 hour.
c. Stating to the nurse, "I really like having you for my nurse. You're the best one
around here."
d. Cutting arms with razor blade after discussing dismissal plans with physician.
{Correct Ans: - a. Refusal to stay in a room alone, stating, "It's so lonely."
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A client on the psychiatric unit has a diagnosis of antisocial personality disorder.

Which of the following characteristics is consistent with this diagnosis?

a. Lack of guilt for wrongdoing

b. Insight into his own behavior
c. Ability to learn from past experiences
d. Compliance with authority {Correct Ans: - a. Lack of guilt for wrongdoing

A nurse on the psychiatric unit documents that the client was attempting to use
"splitting" behaviors with staff. This should be interpreted to mean that the client
is:

a. Trying to keep staff away from other patients.

b. Characterizing staff members as either all good or all bad.
c. Having brief psychotic episodes.
d. Manifesting two or more distinct subpersonalities when communicating with
staff. {Correct Ans: - b. Characterizing staff members as either all good or all bad.

According to researchers, which of the following is a common theme in the health

history of the client with BPD?

a. Autism
b. Attention deficit-hyperactivity disorder

c. Positive and fulfilling interpersonal relationships

d. Early childhood trauma {Correct Ans: - d. Early childhood trauma

Which of the following behavioral patterns is characteristic of individuals with

narcissistic personality disorder?

a. Overly self-centered and exploitative of others

b. Suspicious and mistrustful of others
c. Rule conscious and disapproving of change

d. Anxious and socially isolated {Correct Ans: - a. Overly self-centered and

exploitative of others
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Which of the following behavioral patterns is characteristic of individuals with

schizotypal personality disorder?

a. Belittling themselves and their abilities

b. A lifelong pattern of social withdrawal
c. Suspicious and mistrustful of others
d. Overreacting inappropriately to minor stimuli {Correct Ans: - b. A lifelong pattern
of social withdrawal

A client with a diagnosis of borderline personality disorder exhibits alternating

clinging and distancing behaviors with the nurse who has been assigned to her care.
The most appropriate nursing intervention for this type of behavior would be to:

a. Encourage the client to establish trust in one staff person, with whom all
therapeutic interaction should take place.
b. Secure a verbal contract from the client that she will discontinue these behaviors.
c. Withdraw attention if these behaviors continue.
d. Rotate staff members who work with the client so that she will learn to relate to
more than one person. {Correct Ans: - d. Rotate staff members who work with the
client so that she will learn to relate to more than one person.

A patient diagnosed with antisocial personality disorder approaches the nurse and
says, "You're so cute, are you married?" Which of these is the most appropriate
response by the nurse?

a. "I'm married, but that's none of your business."

b. "Let's talk about your love life instead."
c. "Thank you so much for the compliment but I'm married."
d. "Our relationship is strictly professional. It is not appropriate for us to have that
kind of discussion." {Correct Ans: - d. "Our relationship is strictly professional. It is
not appropriate for us to have that kind of discussion."

A client with BPD reports to the nurse that she is having abdominal pain and is
requesting pain medication. Which action by the nurse is a priority?
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a. Explore alternative pain management strategies.

b. Confront the client about her manipulation to try to get drugs.
c. Assess her pain in more detail.

d. Set limits on her attempts to cling to the nurse. {Correct Ans: - c. Assess her pain
in more detail.

A male client with antisocial personality disorder was found in a female patient's
room on her bed. When instructed to leave the room, the client states, "I'm sick of
you telling me what I can or can't do. If I want to carry on a relationship with a
female patient, it's my right. I'll do exactly as I please!" Which of these actions by
the nurse is a priority at this point?

a. Reassure the client that he will have plenty of opportunities with women after he
is discharged.
b. Reinforce the rules of the treatment program that all clients are expected to
follow.
c. Escort the client to seclusion.
d. Establish a trusting relationship by telling the client that you will make an
exception just this once. {Correct Ans: - b. Reinforce the rules of the treatment
program that all clients are expected to follow.

Which of the following groups is most commonly used for drug management of the
child with attention deficit-hyperactivity disorder?

a. CNS depressants (e.g., diazepam [Valium])

b. CNS stimulants (e.g., methylphenidate [Ritalin])
c. Anticonvulsants (e.g., phenytoin [Dilantin])
d. Major tranquilizers (e.g., haloperidol [Haldol]) {Correct Ans: - b. CNS stimulants
(e.g., methylphenidate [Ritalin])

The nursing history and assessment of an adolescent with conduct disorder might
reveal all of the following behaviors except:

a. Manipulation of others for fulfillment of own desires.

b. Chronic violation of rules.
c. Feelings of guilt associated with the exploitation of others.
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d. Inability to form close peer relationships. {Correct Ans: - c. Feelings of guilt

associated with the exploitation of others.

Certain family dynamics often predispose adolescents to the development of

conduct disorder. Which of the following patterns is thought to be a contributing
factor?

a. Parents who are overprotective

b. Parents who have high expectations for their children
c. Parents who consistently set limits on their children's behavior
d. Parents who are alcohol dependent {Correct Ans: - d. Parents who are alcohol
dependent

Which of the following is least likely to predispose a child to Tourette's disorder?

a. Absence of parental bonding

b. Family history of the disorder
c. Abnormalities of brain neurotransmitters
d. Structural abnormalities of the brain {Correct Ans: - a. Absence of parental
bonding

Which of the following medications is used to treat Tourette's disorder?

a. Methylphenidate (Ritalin)
b. Haloperidol (Haldol)
c. Imipramine (Tofranil)
d. Phenytoin (Dilantin) {Correct Ans: - b. Haloperidol (Haldol)

The child with attention deficit-hyperactivity disorder has a nursing diagnosis of

impaired social interaction. Which of the following nursing interventions are
appropriate for this child? (Select all that apply.)

a. Socially isolate the child when interactions with others are inappropriate.
b. Set limits with consequences on inappropriate behaviors.
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c. Provide rewards for appropriate behaviors.

d. Provide group situations for the child. {Correct Ans: - b. Set limits with
consequences on inappropriate behaviors.

To help the child with mild to moderate intellectual developmental disorder

develop satisfying relationships with others, which of the following nursing
interventions is most appropriate?

a. Interpret the child's behavior for others.

b. Set limits on behavior that is socially inappropriate.
c. Allow the child to behave spontaneously because he or she has no concept of
right or wrong.
d. This child is not capable of forming social relationships. {Correct Ans: - b. Set
limits on behavior that is socially inappropriate.

The child with autism spectrum disorder has difficulty with trust. With this in
mind, which of the following nursing actions would be most appropriate?

a. Encourage all staff to hold the child as often as possible, conveying trust through
touch.
b. Assign a different staff member each day so the child will learn that everyone can
be trusted.
c. Assign the same staff person as often as possible to promote feelings of security
and trust.
d. Avoid eye contact because it is extremely uncomfortable for the child and may
even discourage trust. {Correct Ans: - c. Assign the same staff person as often as
possible to promote feelings of security and trust.

Which of the following nursing diagnoses would be considered the priority in

planning care for the child with severe autism spectrum disorder?

a. Risk for self-mutilation evidenced by banging head against wall

b. Impaired social interaction evidenced by unresponsiveness to people

c. Impaired verbal communication evidenced by absence of verbal expression
d. Disturbed personal identity evidenced by inability to differentiate self from
others {Correct Ans: - a. Risk for self-mutilation evidenced by banging head against
wall
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A child with ADHD is admitted to a residential treatment program. Which of the

following group activities would be most appropriate for the nurse to recommend?

a. Monopoly
b. Volleyball
c. Pool
d. Checkers {Correct Ans: - b. Volleyball

Ms. T. has been diagnosed with agoraphobia. Which behavior would be most
characteristic of this disorder?

a. Ms. T. experiences panic anxiety when she encounters snakes.

b. Ms. T. refuses to fly in an airplane.
c. Ms. T. will not eat in a public place.
d. Ms. T. stays in her home for fear of being in a place from which she cannot
escape. {Correct Ans: - d. Ms. T. stays in her home for fear of being in a place from
which she cannot escape.

Which of the following is the most appropriate therapy for a client with
agoraphobia?

a. 10 mg Valium qid

b. Group therapy with other people with agoraphobia

c. Facing the fear in gradual step progression
d. Hypnosis {Correct Ans: - c. Facing the fear in gradual step progression

With implosion therapy, a client with phobic anxiety would be:

a. Taught relaxation exercises.

b. Subjected to graded intensities of the fear.
c. Instructed to stop the therapeutic session as soon as anxiety is experienced.
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d. Presented with intense exposure to a variety of stimuli associated with the

phobic object or situation. {Correct Ans: - d. Presented with intense exposure to a
variety of stimuli associated with the phobic object or situation.

A client with OCD spends many hours each day washing her hands. The most likely
reason she washes her hands so much is that it:

a. Relieves her anxiety.

b. Reduces the probability of infection.
c. Gives her a feeling of control over her life.
d. Increases her self-concept. {Correct Ans: - a. Relieves her anxiety.

A client is receiving treatment at the mental health clinic with habit-reversal

therapy. Which of the following elements would be included in this therapy? (Select
all that apply.)

a. Awareness training
b. Competing response training
c. Social support
d. Hypnotherapy
e. Aversive therapy {Correct Ans: - a. Awareness training
b. Competing response training
c. Social support

The initial care plan for a client with OCD who washes her hands obsessively would
include which of the following nursing interventions?

a. Keep the client's bathroom locked so she cannot wash her hands all the time.
b. Structure the client's schedule so that she has plenty of time for washing her
hands.
c. Place the client in isolation until she promises to stop washing her hands so
much.
d. Explain the client's behavior to her, because she is probably unaware that it is
maladaptive. {Correct Ans: - b. Structure the client's schedule so that she has plenty
of time for washing her hands.
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A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling
better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other
patients anymore." In light of this change, which nursing intervention is most
appropriate?

a. Give attention to the ritualistic behaviors each time they occur, and point out
their inappropriateness.
b. Ignore the ritualistic behaviors, and they will be eliminated for lack of
reinforcement.
c. Set limits on the amount of time the client may engage in the ritualistic behavior.
d. Continue to allow the client all the time she wants to carry out the ritualistic
behavior. {Correct Ans: - c. Set limits on the amount of time the client may engage
in the ritualistic behavior.

A new client at the mental health clinic is diagnosed with body dysmorphic
disorder. Which of the following nursing interventions is a priority?

a. Support the client's efforts to seek corrective surgery.

b. Recommend the client see a physician for treatment with antipsychotic
medication.

c. Encourage the client to describe reasons for seeking treatment.

d. Reinforce to the client that their body is perfectly normal. {Correct Ans: - c.
Encourage the client to describe reasons for seeking treatment.

A client who is experiencing a panic attack has just arrived at the emergency
department. Which is the priority nursing intervention for this client?

a. Stay with the client and reassure of safety.

b. Administer a dose of diazepam.
c. Leave the client alone in a quiet room so that she can calm down.
d. Encourage the client to talk about what triggered the attack. {Correct Ans: - a.
Stay with the client and reassure of safety.

A client diagnosed with generalized anxiety disorder has been prescribed buspirone
15 mg daily. He says to the nurse, "Why do I have to take this every day? My friend's
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doctor ordered Xanax for him, and he only takes it when he is feeling anxious."
Which of the following would be an appropriate response by the nurse?

a. "Xanax is not effective for generalized anxiety disorder."

b. "Buspirone must be taken daily in order to be effective."
c. "I will ask the doctor if he will change your dose of buspirone to prn so that you
don't have to take it every day."
d. "Your friend really should be taking the Xanax every day." {Correct Ans: - b.
"Buspirone must be taken daily in order to be effective."

A client, who is a veteran of the war in Iraq, is diagnosed with PTSD. He says to the
nurse, "I can't figure out why God took my buddy instead of me." From this
statement, the nurse assesses which of the following in the client?

a. Repressed anger
b. Survivor's guilt
c. Intrusive thoughts
d. Spiritual distress {Correct Ans: - b. Survivor's guilt

Which of the following treatment regimens would most appropriately be ordered

for a client with PTSD?

a. Paroxetine and group therapy

b. Diazepam and implosion therapy
c. Alprazolam and behavior therapy
d. Carbamazepine and cognitive behavior therapy {Correct Ans: - a. Paroxetine and
group therapy

Which of the following may be influential in the predisposition to PTSD?

a. Unsatisfactory parent-child relationship

b. Excess of the neurotransmitter serotonin
c. Distorted, negative cognitions
d. Severity of the stressor and availability of support systems {Correct Ans: - d.
Severity of the stressor and availability of support systems
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Which of the following is true regarding the diagnosis of adjustment disorder?

a. The client will require long-term psychotherapy to achieve relief.

b. The client likely inherited a genetic tendency for the disorder.
c. Symptoms will likely remit once the client has accepted the changes that
precipitated the difficulties with adjustment.
d. Adjustment disorders are not typically related to an identified stressor. {Correct
Ans: - c. Symptoms will likely remit once the client has accepted the changes that
precipitated the difficulties with adjustment.

The physician orders sertraline (Zoloft) for a client who is hospitalized with
adjustment disorder with depressed mood. This medication is intended to:

a. Increase energy and elevate mood.

b. Increase suicidal ideation.
c. Prevent psychotic symptoms.
d. Help the client adjust to change. {Correct Ans: - a. Increase energy and elevate
mood.

Trauma-informed care is a philosophical approach that includes which of the

following principles? (Select all that apply.)

a. Nurses need to be aware of the potential for trauma in any client and provide
care that minimizes the risk of revictimization or retraumatization.
b. Medications need to be given before any other interventions are considered.
c. Trauma-informed care highlights the importance of providing care that protects
the physical, psychological, and emotional safety of the client.

d. Trauma-informed care is based on the principle that traumas are not correlated
with depression or increased risk for suicide. {Correct Ans: - a. Nurses need to be
aware of the potential for trauma in any client and provide care that minimizes the
risk of revictimization or retraumatization.

c. Trauma-informed care highlights the importance of providing care that protects

the physical, psychological, and emotional safety of the client.
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A client experiences a nightmare during his first night in the hospital. He explains
to the nurse that he was dreaming about gunfire all around and people being killed.
The nurse's most appropriate initial intervention is to:

a. Administer alprazolam as ordered prn for anxiety.

b. Call the physician and report the incident.

c. Stay with the client and reassure him of his safety.
d. Have the client listen to a tape of relaxation exercises. {Correct Ans: - c. Stay with
the client and reassure him of his safety.

A client who recently left her husband of 10 years is admitted to the hospital with a
diagnosis of adjustment disorder with depressed mood. She acknowledges that she
was very dependent on him and is having difficulty adjusting to an independent
lifestyle. What is the priority nursing diagnosis for this client?

a. Risk-prone health behavior related to loss of dependency

b. Complicated grieving related to breakup of marriage
c. Ineffective communication related to problems with dependency
d. Social isolation related to depressed mood {Correct Ans: - b. Complicated
grieving related to breakup of marriage

A client, who is depressed following the breakup of a very stormy marriage, says to
the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!"
Which is the best response by the nurse?

a. "Cheer up. You have a lot to be happy about."

b. "You are grieving the loss of your marriage. It's natural for you to feel bad."
c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better."
d. "You did the right thing. Knowing that should make you feel better." {Correct
Ans: - b. "You are grieving the loss of your marriage. It's natural for you to feel bad."

A client, age 16 years, has recently been diagnosed with diabetes mellitus. She must
watch her diet and take an oral hypoglycemic medication daily. She has become
very depressed, and her mother reports that she refuses to change her diet and
often skips her medication. She has been hospitalized for stabilization of her blood
glucose level. The psychiatric nurse practitioner has been called in as a consultant.
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Which of the following nursing diagnoses by the psychiatric nurse would be a

priority for the client at this time?

a. Anxiety related to hospitalization, evidenced by noncompliance

b. Low self-esteem related to feeling different from her peers, evidenced by social
isolation
c. Risk for suicide related to new diagnosis of diabetes mellitus
d. Risk-prone health behavior related to denial of the seriousness of her illness,
evidenced by refusal to follow diet and take medication {Correct Ans: - d. Risk-
prone health behavior related to denial of the seriousness of her illness, evidenced
by refusal to follow diet and take medication

Which of the following symptom profiles would you expect when assessing a client
with somatic symptom disorder?

a. Multiple somatic symptoms in several body systems

b. Fear of having a serious disease
c. Loss or alteration in sensorimotor functioning
d. Belief that his or her body is deformed or defective in some way {Correct Ans: - a.
Multiple somatic symptoms in several body systems

Which of the following ego defense mechanisms describes the underlying

psychodynamics of somatic symptom disorder?

a. Denial of depression
b. Repression of anxiety
c. Suppression of grief
d. Displacement of anger {Correct Ans: - b. Repression of anxiety

Nursing care for a client with somatic symptom disorder should focus on helping
the client to:

a. Eliminate stressors.
b. Discontinue focusing on numerous physical complaints.
c. Take medication only as prescribed.
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d. Learn more adaptive coping strategies. {Correct Ans: - d. Learn more adaptive
coping strategies.

A woman who has a long history of being battered by her husband is staying at the
woman's shelter. She has received emotional support from staff and peers and has
been made aware of the alternatives open to her. Nevertheless, she decides to
return to her home and marriage. The best response by the nurse to the woman's
decision is:

a. "I just can't believe you have decided to go back to that horrible man."
b. "I'm just afraid he will kill you or the children when you go back."
c. "What makes you think things have changed with him?"
d. "I hope you have made the right decision. Call this number if you need help."
{Correct Ans: - d. "I hope you have made the right decision. Call this number if you
need help."

A school nurse notices bruises and scars on a child's body. The nurse suspects that
the child is being physically abused. Which action by the nurse is a priority at this
point?

a. As a health-care worker, report the suspicion to child protective services.

b. Check the child again in a week and see if there are any new bruises.
c. Meet with the child's parents and ask them how she got the bruises.
d. Initiate paperwork to have the child placed in foster care. {Correct Ans: - a. As a
health-care worker, report the suspicion to child protective services.

A college-age client is brought to the emergency department by her roommate after

she confided that she was raped by her date who invited her to a frat party. The
client says to the nurse, "It's all my fault. I shouldn't have gone to a party where I
knew there was going to be alcohol." Which of these is the best response by the
nurse?

a. "Yes, you're right. You put yourself in a very vulnerable position when you
allowed him to get you drunk."
b. "You are not to blame for his behavior. You obviously made some right decisions,
because you survived the attack."
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c. "There's no sense looking back now. Just look forward, and make sure you don't
put yourself in the same situation again."
d. "You'll just have to see that he is arrested so he won't do this to anyone else."
{Correct Ans: - b. "You are not to blame for his behavior. You obviously made some
right decisions, because you survived the attack."

A young man who has just undergone a sexual assault is brought into the
emergency department by a friend. What is the priority nursing intervention?

a. Help him to bathe and clean himself up.

b. Provide physical and emotional support during evidence collection.
c. Provide him with a written list of community resources for survivors of rape.
d. Discuss the importance of a follow-up visit to evaluate for sexually transmitted
diseases. {Correct Ans: - b. Provide physical and emotional support during evidence
collection.

Which of the following is most likely to initiate a grief response in an individual?

(Select all that apply.)

a. Death of a pet dog

b. Being told by her doctor that she has begun menopause
c. Failing an exam
d. Losing a spouse through divorce {Correct Ans: - a. Death of a pet dog
b. Being told by her doctor that she has begun menopause

c. Failing an exam
d. Losing a spouse through divorce

A recent widow states, "I'm going to have to learn to pay all the bills. Hank always
did that. I don't know if I can handle all of that." This is an example of which of the
tasks described by Worden?

a. Task I: Accepting the reality of the loss

b. Task II: Processing the pain of grief

c. Task III: Adjusting to a world without the lost entity
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d. Task IV: Finding an enduring connection with the lost entity in the midst of
embarking on a new life {Correct Ans: - c. Task III: Adjusting to a world without the
lost entity

A client, who is dying of cancer, says to the nurse, "I just want to see my new
grandbaby. If only God will let me live until she is born, then I'll be ready to go."
This is an example of which of Kübler-Ross's stages of grief?

a. Denial
b. Anger
c. Bargaining
d. Acceptance {Correct Ans: - c. Bargaining

Engel identifies which of the following as successful resolution of the grief process?

a. When the bereaved person can talk about the loss without crying
b. When the bereaved person no longer talks about the lost entity
c. When the bereaved person puts all remembrances of the loss out of sight
d. When the bereaved person can discuss both positive and negative aspects about
the lost entity {Correct Ans: - d. When the bereaved person can discuss both
positive and negative aspects about the lost entity

Which of the following is thought to facilitate the grief process?

a. The ability to grieve in anticipation of the loss

b. The ability to grieve alone without interference from others
c. Having recently grieved for another loss
d. Taking personal responsibility for the loss {Correct Ans: - a. The ability to grieve
in anticipation of the loss

A client who lost his wife after 35 years of marriage presents at his primary care
physician's office 10 months later. He has lost 20 pounds and tells the nurse, "I just
don't want to eat or do anything else for that matter." Which of these actions by the
nurse is a priority?
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a. Assess the client for depression and suicide risk.

b. Ask the physician to order gastrointestinal studies.
c. Encourage the client to talk about his relationship with his deceased wife.

d. Instruct the client that the doctor will be in shortly, but right now the physical
assessment must be completed. {Correct Ans: - a. Assess the client for depression
and suicide risk.

An 80-year-old client arrives at the emergency department accompanied by her

daughter. The daughter tells the nurse that her mom lost her husband 2 months
ago and since then her mom has complained of feeling depressed and anxious.
Earlier today, she began complaining of chest pain. Which of these actions by the
nurse is a priority?

a. Instruct the daughter not to worry; these are common grief responses in the
elderly.
b. Assess vital signs and obtain an ECG.
c. Refer the client to grief support groups in the area.
d. Educate the client in relaxation and deep breathing exercises and evaluate
whether this helps resolve the chest pain. {Correct Ans: - b. Assess vital signs and
obtain an ECG.

A 10-year-old child returns to school after the death of his mother. The school
nurse becomes aware that this child is frequently talking in the classroom about
fears that he will die, too. The classroom teacher is asking for recommendations
about how to handle this situation. Which of these actions by the nurse is most
appropriate?

a. Instruct the teacher to refer the child for psychological evaluation because this is
a warning sign of depression and possible suicide.
b. Encourage the teacher to redirect the child to activities that are focused on
school performance.
c. Educate the teacher that this a common reaction in children of this age and it is
best for the teacher to offer reassurance that he is safe.
d. Instruct the teacher to prohibit discussion of this topic in class because children
in this age-group cannot understand the finality of death. {Correct Ans: - c. Educate
the teacher that this a common reaction in children of this age and it is best for the
teacher to offer reassurance that he is safe.
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A client whose husband died from cancer 1 month ago attends a grief support
group being conducted by the hospice nurse. During the group this client states,
"Sometimes I wish I could go be with my husband. I just want to die." Which action
by the nurse is a priority?

a. Ask the client if she is having thoughts of harming or killing herself.

b. Instruct the client and the other group members that this is a normal part of the
grieving process.
c. Make arrangements for the client to be evaluated by a psychiatrist.
d. Elicit support from other group members by asking them if any of them have had
similar feelings. {Correct Ans: - a. Ask the client if she is having thoughts of
harming or killing herself.

An adolescent who recently lost his brother in a fatal accident is referred to the
school nurse following a physical fight with a peer. After attending to the client's
bleeding lip, the parents ask the nurse for recommendations because their son has
had several physical confrontations after the death of his brother. Which of these
actions by the nurse is most beneficial?

a. Encourage the parents to set more limits because adolescents need more
structure as they work through their grief.
b. Encourage the parents to schedule an appointment with a psychiatrist because
his behavior is a sign of a developing conduct disorder.
c. Provide information about available support groups for adolescents who have
also experienced the loss of a loved one.
d. Instruct the parents that making their son accept legal consequences for his
behavior will likely resolve the problem behavior. {Correct Ans: - c. Provide
information about available support groups for adolescents who have also
experienced the loss of a loved one.