Psychiatric Nursing | NCLEX Quiz 189 - Quiz, Flashcards & Trivia

1. The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety?

“I guess you’re worried about something. aren’t you?

“Can I get you some medication to help calm you?”

“Have you been pacing for a long time?”

“I notice that you’re pacing. How are you feeling?”

By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety.In option A. the nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a “yes” or “no” response. which is not therapeutic.In option B. the nurse is intervening before accurately assessing the problem.Option C. which also encourages a “yes” or “no” response. avoids focusing on the client’s anxiety. which is the reason for his pacing.

Explanation

By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety.In option A. the nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a “yes” or “no” response. which is not therapeutic.In option B. the nurse is intervening before accurately assessing the problem.Option C. which also encourages a “yes” or “no” response. avoids focusing on the client’s anxiety. which is the reason for his pacing.

2. A client with obsessive-compulsive disorder is hospitalized on an inpatient unit. Which nursing response is most therapeutic?

Accepting the client’s obsessive-compulsive behaviors

Challenging the client’s obsessive-compulsive behaviors

Preventing the client’s obsessive-compulsive behaviors

Rejecting the client’s obsessive-compulsive behaviors

A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as the client’s attempt to feel secure is therapeutic. When a specific treatment plan is developed. other nursing responses may also be acceptable.Options B. C. and D: The remaining answer choices will increase the client’s anxiety and therefore are inappropriate.

Explanation

A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as the client’s attempt to feel secure is therapeutic. When a specific treatment plan is developed. other nursing responses may also be acceptable.Options B. C. and D: The remaining answer choices will increase the client’s anxiety and therefore are inappropriate.

3. Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreign language?

Rely on nonverbal communication.

Select symbolic pictures as aids.

Speak in universal phrases.

Use the services of an interpreter.

An interpreter will enable the nurse to better assess the client’s problems and concerns.Option A: Nonverbal communication is important; however for the nurse to fully determine the client’s problems and concerns. the assistance of an interpreter is essential.Options B and C: The use of symbolic pictures and universal phrases may assist the nurse in understanding the basic needs of the client; however these are insufficient to assess the client with a psychiatric problem.

Explanation

An interpreter will enable the nurse to better assess the client’s problems and concerns.Option A: Nonverbal communication is important; however for the nurse to fully determine the client’s problems and concerns. the assistance of an interpreter is essential.Options B and C: The use of symbolic pictures and universal phrases may assist the nurse in understanding the basic needs of the client; however these are insufficient to assess the client with a psychiatric problem.

4. The nurse is working with a client with a somatoform disorder. Which client outcome goal would the nurse most likely establish in this situation?

The client will recognize signs and symptoms of physical illness.

The client will cope with physical illness.

The client will take prescribed medications.

The client will express anxiety verbally rather than through physical symptoms.

The client with a somatoform disorder displaces anxiety into physical symptoms. The ability to express anxiety verbally indicates a positive change toward improved health.Options A. B. and C: The remaining responses do not indicate any positive change toward increased coping with anxiety.

Explanation

The client with a somatoform disorder displaces anxiety into physical symptoms. The ability to express anxiety verbally indicates a positive change toward improved health.Options A. B. and C: The remaining responses do not indicate any positive change toward increased coping with anxiety.

5. The nurse explains to a mental health care technician that a client's obsessive-compulsive behaviors are related to an unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement?

Behavioral theory

Cognitive theory

Interpersonal theory

Psychoanalytic theory

Psychoanalytic is based on Freud’s beliefs regarding the importance of unconscious motivation for behavior and the role of the id and superego in opposition to each other.Options A and B: Behavioral cognitive and interpersonal theories do not emphasize unconscious conflicts as the basis for symptomatic behavior.

Explanation

Psychoanalytic is based on Freud’s beliefs regarding the importance of unconscious motivation for behavior and the role of the id and superego in opposition to each other.Options A and B: Behavioral cognitive and interpersonal theories do not emphasize unconscious conflicts as the basis for symptomatic behavior.

6. A 45-year-old woman with a history of depression tells a nurse in her doctor's office that she has difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the following factors would the nurse identify as least significant in contributing to the client's sexual difficulty?

Education and work history

Medication used

Physical health status

Quality of spousal relationship

Education and work history would have the least significance in relation to the client’s sexual problem.Options B. C. and D: Age. health status. physical attributes and relationship issues have great influence on sexual expression.

Explanation

Education and work history would have the least significance in relation to the client’s sexual problem.Options B. C. and D: Age. health status. physical attributes and relationship issues have great influence on sexual expression.

7. A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought processes related to difficulty concentrating. secondary to flight of ideas. Which of the following outcome criteria would indicate improvement in the client?

The client verbalizes feelings directly during treatment.

The client verbalizes positive “self” statement.

The client speaks in coherent sentences.

The client reports feelings calmer.

A client exhibiting flight of ideas typically has a continuous speech flow and jumps from one topic to another. Speaking in coherent sentences is an indicator that the client’s concentration has improved and his thoughts are no longer racing.Options A. B. and D: The remaining options do not relate directly to the stated nursing diagnosis.

Explanation

A client exhibiting flight of ideas typically has a continuous speech flow and jumps from one topic to another. Speaking in coherent sentences is an indicator that the client’s concentration has improved and his thoughts are no longer racing.Options A. B. and D: The remaining options do not relate directly to the stated nursing diagnosis.

8. Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization on a behavioral therapy unit?

Emphasize the importance of good nutrition to establish normal weight.

Ignore the client’s mealtime behavior and focus instead on issues of dependence and independence.

Help establish a plan using privileges and restrictions based on compliance with refeeding.

Teach the client information about the long-term physical consequence of anorexia.

Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan for refeeding to combat the effects of self-induced starvation. Refeeding is accomplished through behavioral therapy. which uses a system of rewards and reinforcements to assist in establishing weight restoration.Options A and D: Emphasizing nutrition and teaching the client about the long-term physical consequences of anorexia maybe appropriate at a later time in the treatment program.Option B: The nurse needs to assess the client’s mealtime behavior continually to evaluate treatment effectiveness.

Explanation

Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan for refeeding to combat the effects of self-induced starvation. Refeeding is accomplished through behavioral therapy. which uses a system of rewards and reinforcements to assist in establishing weight restoration.Options A and D: Emphasizing nutrition and teaching the client about the long-term physical consequences of anorexia maybe appropriate at a later time in the treatment program.Option B: The nurse needs to assess the client’s mealtime behavior continually to evaluate treatment effectiveness.

9. Which method would a nurse use to determine a client's potential risk for suicide?

Wait for the client to bring up the subject of suicide.

Observe the client’s behavior for cues of suicide ideation.

Question the client directly about suicidal thoughts.

Question the client about future plans.

Directly questioning a client about suicide is important to determine suicide risk.Option A: The client may not bring up this subject for several reasons. including guilt regarding suicide. wishing not to be discovered. and his lack of trust in staff.Option B: Behavioral cues are important. but direct questioning is essential to determine suicide risk.Option D: Indirect questions convey to the client that the nurse is not comfortable with the subject of suicide and. therefore. the client may be reluctant to discuss the topic.

Explanation

Directly questioning a client about suicide is important to determine suicide risk.Option A: The client may not bring up this subject for several reasons. including guilt regarding suicide. wishing not to be discovered. and his lack of trust in staff.Option B: Behavioral cues are important. but direct questioning is essential to determine suicide risk.Option D: Indirect questions convey to the client that the nurse is not comfortable with the subject of suicide and. therefore. the client may be reluctant to discuss the topic.

10. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?

The parents reinforce increased decision making by the client.

The parents clearly verbalize their expectations for the client.

The client verbalizes that family meals are now enjoyable.

The client tells her parents about feelings of low self-esteem.

One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention.Options B. C. and D: Although the remaining options may occur during the process of therapy they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addressed in these responses.

Explanation

One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention.Options B. C. and D: Although the remaining options may occur during the process of therapy they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addressed in these responses.